Tobacco Control Plan

Kevin Barron Excerpts

Thursday 19th July 2018 Commons Chamber

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

I beg to move,

That this House considered the Tobacco Control Plan.

Last year—how time flies!—in response to a question from my shadow on the Opposition Front Bench, the hon. Member for Washington and Sunderland West (Mrs Hodgson), I confirmed my intention to publish a tobacco control plan for England. I published it and then we debated its lofty ambitions in this House. Today, on its first birthday, I hope that we can reaffirm the importance of the plan and welcome the progress that has been made, while recognising—as I always do at the Dispatch Box—there is much more to do.

Last year we announced an ambition to reduce the prevalence of adult smokers from 15.5% to 12%, of pregnant smokers from 10.7% to 6%, and of 15-year-old smokers from 8% to 3%. We also pledged to reduce the inequality gap in smoking prevalence between those in routine and manual occupations and the general population. Furthermore, we set out a long-term goal of a smoke-free generation, reducing adult prevalence to below 5%. We were very clear, however, that now—then or now—is not the time for more legislation. I am still of that view because there is quite enough for us to do in this House.

The UK has some of the toughest tobacco control laws in the world, and we are consistently considered by independent experts to have the best tobacco control measures in the whole of Europe. The plan recognised that smoking in certain groups is stubbornly high, although masked by the overall declines in prevalence. To achieve our ambitions, we need to recognise that smoking is increasingly focused on particular groups in society, and in particular areas. We need to shift the emphasis from action at the national level—hence no need for more legislation—to focused local action in support of smokers.

Pregnant smokers are one critical group. People with mental illness are also much more likely to smoke: a little more than 40% of people with serious mental health conditions smoke, which is more than twice the national average. I repeat: smoking among those with mental health conditions is more than twice the national average. We need to work across the system, as we are, to ensure that everyone is making their full contribution to deliver for those groups.

Earlier this year I was fortunate enough to visit the Maudsley Hospital, which has done an awful lot of very good and fruitful work in this area. I place on record my thanks to the team at the Maudsley for their dedication and hard work. It was good to meet them—staff and patients—and to thank them in person.

When I talk about working across the system to ensure that everyone is making their full contribution, that is what we are doing. Last month we published the tobacco control delivery plan, which sets out detailed commitments made by various organisations in central Government and the arm’s length bodies to help deliver on our 66 recommendations. We will be tracking delivery of those commitments, and adding to them, as we move through the lifetime of the plan.

Let me touch on the work that is under way. The Prison Service is making the whole prison estate in England smoke free—no ifs, and definitely no butts. Do you see what I did there, Madam Deputy Speaker? This is a huge achievement, and I would like to pay tribute to the hard work that has made it possible. Her Majesty’s Revenue and Customs has supported the UK Government’s ratification of the protocol on illicit tobacco under the World Health Organisation’s framework convention on tobacco control. This new treaty aims to eliminate all forms of illicit trade in tobacco products throughout the supply chain. The protocol has now been ratified by the necessary 40 countries and is in force.

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

When the Health Committee looked at the issue of smoking in public places and took evidence from different institutions, the Prison Service felt at the time that it would be impossible for it ever to get to a situation in which it was smoke free. We should all look back and thank it for what it has done, which it told us years ago was impossible.

[Steve Brine]

I agree with the right hon. Gentleman. Those of us who have secure estates in our constituencies and go in and visit them regularly will be aware of just how much of a challenge this is, given how ingrained smoking is within the cohort. That relates to the point I made about specific groups. I think that the Prison Service deserves great credit. Suffice it to say that it has a lot of pressures on it, and in some ways it probably felt that this was the least of its worries and the last thing it could deal with, but it is actually very important. That is why I say we are working well across the Government, and the Prison Service is really pulling out the stops in its area. I thank him for that intervention.

To finish on the protocol, HMRC will continue to lead on it on behalf of the Government, working with my officials at the Department of Health and Social Care. Through the protocol, we are sharing our expertise as a leading tobacco control nation; this is not just about what we are doing domestically. We are funding the FCTC secretariat with £15 million over the spending review period to support tobacco control in 15 low and middle-income countries. I am very proud of that work, and I am pleased to say that we are already having an impact. Georgia introduced smoke-free legislation and a ban on advertising on 1 May. It seems strange to talk about banning advertising as a new measure, given how long a ban has been in place in our country, but it shows that other parts of the world have a long way to go to catch up. I am very proud that we are using our experience and our evidence-based experience to help countries such as Georgia to do so. I want to place on the record my congratulations to Georgia.

Domestically, Her Majesty’s Treasury continues to maintain high duty rates for tobacco products to make tobacco less affordable, which is absolutely right. Public Health England, for which I am responsible, and NHS England are working on a joint action plan to reduce smoking in pregnancy. A key part of this is helping midwives to identify women who smoke and help them to quit and to support the implementation of National Institute for Health and Care Excellence guidance on reducing smoking during pregnancy and immediately following childbirth.

PHE has been encouraging the use of e-cigarettes to help people quit. As part of this, the most recent Stoptober campaign for the first time highlighted the role of e-cigarettes in quitting. The best evidence suggests that e-cigarettes are helping thousands of people to quit and that they are particularly effective in the context of a smoking cessation clinic. PHE’s data website, “Local tobacco control profiles for England”—another snappy title I dreamed up—is helping local commissioners and service planners to identify where they are succeeding, where they face the greatest challenges and how they compare with their neighbours and the rest of England.

--- Later in debate ---

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

I speak as an honorary fellow of the Royal College of Physicians and as a vice-chair of the all-party parliamentary group on smoking and health, to which, as everybody knows, the secretariat is Action on Smoking and Health, which I have been involved in for over two and a half decades now.

Smoking continues to be one of the most pressing health issues in my constituency, despite decades of progress in this country. Most importantly, it remains an enduring cause of unequal life expectancy for my constituents—something that it is extremely welcome to see the Government acknowledge in the tobacco control plan. Different Governments over the years have not always acknowledged these stark issues, which have been around for decades.

In Rotherham, which is partly in my constituency, 16.2% of the population smoke, which is above the English average of 14.9%. In 2016-17, 17.1% of women were smokers at the time of delivery, compared with the regional value of 14.4% and the national value of 10.7%, so we have higher rates of smoking in pregnancy than elsewhere. In 2014-16, of the estimated deaths attributed to smoking per 1,000 of the population aged 35-plus, 1,487 were in Rotherham. If anything else was killing that number of the population in our constituencies, we would rightly be taking action, and more action than we currently do.

In 2016, there were 3,620 smoking-attributable hospital admissions in Rotherham. In 2017, 22.8% of routine workers smoked compared with 13.1% of those in managerial professions. Among people who have never worked, the smoking rate rises further, up to 24.8%. Each year, smoking in Rotherham costs society approximately £64.2 million. This cost is accrued in a range of social domains, including healthcare, productivity, social care and house fires. It used to be chip pans that caused more house fires in constituencies such as mine, but cigarettes have now taken over.

The total annual cost of smoking to the NHS across Rotherham is estimated at about £12.7 million, with £3.7 million of this due to 3,244 hospital admissions for smoking-related conditions and £9 million due to treating smoking-related illness via primary and ambulatory care services. In 2015, there were 24,924 households in Rotherham with at least one smoker. When net income and smoking expenditure is taken into account, 34% of households with a smoker fell below the poverty line. If those smokers were to quit, 2,173 households in Rotherham would be elevated above the poverty line. These are the stakes for people with this addiction in constituencies such as mine.

I have long supported a strong approach to tobacco harm reduction as an important plank in the strategy to reduce health inequalities. Smokers who are disadvantaged face many more barriers to quitting, including high levels of addiction. A properly implemented tobacco harm reduction strategy can address this, and obviously has been doing so in the recent past. The commitment in the tobacco control plan to support innovation is welcome. Since the plan was published, Public Health England has published an updated evidence review of e-cigarettes showing the growing evidence that vaping is less harmful than smoking and has the potential to support thousands more people to become smoke free.

As I said in the debate on this subject in Westminster Hall, this is the first tobacco control plan that has ever mentioned e-cigarettes. The recent report by the Royal College of Physicians on smoking and the NHS reiterated the RCP’s support for the use of e-cigarettes and encouraged wider use of these products within the NHS. However, smokers’ appetite for trying e-cigarettes seems to have slowed somewhat. Since 2013, there has been a tailing off in the rapid growth in the market. This coincides with a deterioration of public understanding about the relative safety of e-cigarettes compared with smoking.

Action on Smoking and Health has recently provided evidence to the Science and Technology Committee inquiry on e-cigarettes. ASH reported a moderate improvement in accurate understanding of the harms from e-cigarettes between 2017 and 2018, but 22% of current smokers still think that e-cigarettes are as harmful or more harmful than smoking. Yet Public Health England has said that they are now at least 95% safer than cigarettes. Clearly, more needs to be done to promote better health understanding of the relative safety of e-cigarettes. This should include addressing the lack of understanding also among health professionals, in addition to engaging smokers more in this.

I want to give a couple of brief examples of how e-cigarettes interact with smoking rates. The Minister has heard me say before that meeting the targets in the last plan and reducing adult smoking to its current levels was probably very much helped by smokers voluntarily taking up e-cigarettes. Some 2.9 million adults in the UK use e-cigarettes, more than half of whom have stopped smoking completely, so about 1.5 million people have stopped smoking because of e-cigarettes. ASH produced those figures for 2017. Likewise, 18% of smokers used e-cigarettes in 2017, and 23% of ex-smokers reported that they use or used to use an e-cigarette. One person in the UK switches to e-cigarettes every three minutes, allegedly.

I want to give a comparator and to refer back to my intervention on the Minister. I chaired the Health Committee in 2005, after we had fought an election on a manifesto commitment by the Labour party to introduce a ban on smoking in public places. I stood on that manifesto, but the ban proposed was not a comprehensive one. The Health Committee, of which I became the Chair, investigated smoking in public places. We went to Ireland to take evidence, because it had had such a ban for about two years.

I will now demonstrate the effectiveness of e-cigarettes by comparing smoking rates in the UK versus those in Ireland, where every other approach to tobacco control is identical to those in the UK, such as plain packaging, retail display bans and marketing promotions all stopped. In recent years in the UK, smoking rates have dropped by almost a quarter—according to the Office for National Statistics, 24.4% of UK adults smoked in 2012 and 15.8% in 2016—and the UK now has the second lowest smoking rate in Europe. In Ireland, which has exactly the same tobacco control as we put through this place over many years, smoking rates have stagnated: 23% of adults smoked in 2015 and 2016, dropping to 22% in 2017, according to Healthy Ireland stats. That shows how the use of e-cigarettes has been good in reducing smoking in this country.

According to Public Health England, e-cigarette use is associated with improved quitting success rates over the past year and an accelerated drop in smoking rates across the country. It said that e-cigarettes contribute to at least 20,000 successful new quits per year and possibly many more—we are not measuring them in those terms, although that is something that clearly needs to be done.

I will finish soon, but as much as I support the tobacco plan in all its targets and everything else, we still need to look at what is happening on the ground, as several other Members have said. I think that we would all accept that the availability of smoking cessation programmes is patchy to say the least.

ONS stats on smoking prevalence identify for us the five local authorities with the highest rates: Redditch, Thanet—so this is not necessarily a north-south thing as a result of deprivation, or there is clearly deprivation in Thanet as well, down on the south coast—the City of Kingston upon Hull, which I think was mentioned earlier in this debate, Glasgow City and Sunderland. The five local authorities with the lowest smoking prevalence rates are Christchurch, West Devon, Maldon, North Warwickshire and the Orkney Islands. In my view, we need to recognise those differences to get to the meat of the targets. We need to look beyond saying that this is a matter for local authorities.

“Feeling the Heat: The Decline of Stop Smoking Services in England” was a Cancer Research UK survey and report done in 2017. Its conclusions were that budgets for local authority cessation services ranged from nil to £1.7 million, or an average of £436,000 per local authority, and that 61% of local authorities offered specialist cessation services, with advisers offering one-to-one or group support and access to medication. Some have been replaced with a more general lifestyle service. Tobacco control was said to be a high priority by 57% of the local authorities—they say that, but have they the ability to do anything?—while 75% of local authority cessation services supported use of e-cigarettes, but only 50% of primary care providers did so. We need a consistent approach in line with public health and NICE recommendations. The last figure I will give from the report was that a third of local authorities had no budget for wider tobacco control activity, dealing with issues such as illicit and under-age trade.

I will finish with this point for the Minister. Given that we know the areas where there is evidence of high levels of smoking and therefore a high number of premature deaths from smoking, we need something more—in the current situation of austerity and everything else—than just saying that we want local authorities to get on with this. Having identified where such needs have to be met—this should definitely be ring-fenced—perhaps the national Government, or the Department of Health and Social Care, will find a way to look at this and make sure that we get the services where the need is greatest. I will leave that with the Minister. I thank him again for all he has done since he has been in office, and I hope that the success we want from this tobacco plan will take place.