E-cigarettes

Kevin Barron Excerpts

Thursday 31st October 2019 Westminster Hall

[Norman Lamb]

I totally agree. The statistics that I am citing make the point about raising awareness, even among clinicians. We thought that it was just the general public who needed to understand better the relative risks, but clearly clinicians also need to understand the relative risks so that they can advise their patients more effectively.

Two in five clinicians feel uncomfortable recommending e-cigarettes to their patients who smoke. Again, that is an extraordinary finding. Fewer than three in 10 agree that their current knowledge is enough for advising patients about e-cigarettes. That extraordinary data reveals a clear need for the awareness raising to which the hon. Member for Dartford (Gareth Johnson) has just referred.

What assessment has the Minister made of the number of smoking cessation services in the NHS that are actively promoting e-cigarettes as alternatives to conventional cigarettes? It ought to be every single one throughout the country, but are they actually doing it? Do we know? Can the Minister tell us what work the Government are doing with NHS England on increasing knowledge among clinicians of the uses, benefits and risks of e-cigarettes for current smokers?

Our report recommended that NHS England should create a post for someone who is responsible for implementing the Government’s tobacco control plan. The response said:

“The Government broadly accepts this recommendation.”

However, no specific steps to implement our recommendation were set out. We pursued that with NHS England, which in January told me:

“It is our intention to appoint an individual with lead responsibility for this role. This will be an important part of our delivery programme for the NHS Long Term Plan.”

We would all assume that that person was appointed long ago and that active work is now underway to pursue this vital agenda, which will save lives, but can the Minister confirm that NHS England has created that post and, if so, is someone actually in post and doing the job?

The Government say that, in their long-term plan, provision is made for

“all smokers who are admitted to hospital being offered support to stop smoking”.

That is not due to be fully implemented until 2023-24. Again, given the extraordinary health benefits of stopping people smoking, I would have hoped for a tighter timescale than ’23-24 to implement that. Will the Minister tell us how implementation of that proposal is going and whether consideration is being given to implementing it fully before 2023-24?

Our report recommended that the NHS should have a clear policy on e-cigarettes in mental health facilities that establishes a default of allowing e-cigarette use by patients. This comes back to my point that approximately 40% of those with severe and enduring mental ill health still smoke. The attitude and culture within mental health trusts is critical if we are to enable and help people with severe and enduring mental ill health to give up smoking. We said that it should be the default that e-cigarettes should be made available in mental health facilities unless there are clear evidence-based reasons for not doing so.

The Government response said:

“NHS England will provide guidance to mental health trusts that sets out that existing vapers should be permitted to use e-cigarettes as part of smoking cessation programmes, and…tobacco smokers should be supported to stop smoking through smoking cessation programmes”.

Can the Minister tell us whether that guidance has been issued? I very much hope that it has. If not, when will it be issued and what is the reason for the delay in issuing such important guidance? If it has been issued, what assessment has been made of how it is working?

The UK is making good progress in getting people to stop smoking and use e-cigarettes to achieve that, but that is at risk from recent concerns about e-cigarette use. Those concerns have been expressed particularly in other countries. We have put the concerns to Public Health England. The first is the claim that deaths in the US have been linked to the use of e-cigarettes and vaping products. The reality is that the US operates in a totally different regulatory context and “illicit products” were

“implicated in this outbreak…including vaping cannabis derivatives.”

That is from Public Health England. It has also explained that

“the suddenness of the outbreak across many USA states in just a few months, suggests that this is not a gradual effect of long-term use, but because of a specific agent coming into use in the affected population.”

Next are the concerns that flavoured e-cigarettes are “luring” children into vaping. Public Health England’s response explained that the data it had seen so far was reassuring that e-cigarettes were not re-normalising smoking. Furthermore, the UK and the US have different rules on advertising, nicotine concentration and education on vaping, which explains why flavours of e-cigarettes are less impactful in the UK compared with the United States.

The next issue is the introduction of a ban in India on the production, import and sale of e-cigarettes because of concerns about the risks that they pose to health and to the young. Again, an assertion has been made that is at risk of infecting the debate that we have in this country. However, Public Health England has explained:

“India is one of several countries that appears to be responding to the outbreak of lung disease among cannabis”

vapers

“by proposing a ban on nicotine inhalers.”

It has also explained that smoking is far more prevalent in India and causes 7 million deaths a year there.

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

Is it not true that India has a massive vested public interest in the tobacco industry?

[Norman Lamb]

I suspect that the right hon. Gentleman knows better than I do, but I note the point that he makes. My view, based on the evidence that the Committee heard, is that the action taken by India is not based on evidence and is likely to result in more people dying of lung cancer. I think that is shameful.

I encourage all right hon. and hon. Members to read the helpful and comprehensive reply that we received from Public Health England on these issues and others, and which we have published so that anyone can delve into the detail. I am reassured that Public Health England is in “close dialogue” with a range of international partners, and I agree with Public Health England when it says:

“It is no exaggeration to say that inflating fears about e-cigarettes could cost lives.”

Incidentally, I have concerns about the attitude at the World Health Organisation, which does not take the same evidence-based approach, as far as I can see, as this country has done. Again, that has implications through the potential loss of life for millions of people across the globe.

It seems to me that people often conflate the fact that we do not have all the long-term evidence on vaping impact with an assertion that that should lead us to conclude that we should not be recommending vaping as an alternative to smoking. Frankly, that is stupid as a public policy approach, because we know that smoking is killing—I think—more than 70,000 people in England every year, and all the evidence so far shows that nothing like that is happening from vaping. According to Public Health England, it is 95% less dangerous than smoking. Therefore, the clear public health advice has to be that vaping is an appropriate way to help people give up smoking. Of course, the best thing of all is not to vape and not to smoke, but if that is not possible for someone, the clear public health advice needs to be that vaping is better than smoking.

Will the Minister set out what contact the Government —she or other Ministers—have had with other countries on international approaches to e-cigarettes? In particular, what are they doing at the World Health Organisation to encourage a more enlightened approach? What assessment have the Government made of the effects of those international approaches on public perception of e-cigarettes in the UK? What steps will the Minister take to ensure that this misinformation on e-cigarettes is challenged?

--- Later in debate ---

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

I am really happy to be here this afternoon, also giving my last speech in Westminster Hall, which is something that I have been looking forward to for a considerable time—since 2016, when something that I do not want to mention happened.

I have been active in smoking cessation over many years in Parliament. This is a good, well sourced and evidenced report about where we should move in the future to protect our fellow citizens. Let me admit two things—this is a bit of a confession. First, it has been more than 40 years since I stopped, but I, too, used to smoke cigarettes; I was quite addicted. Secondly, I ought to mention that although there is no money in it, I am an honorary fellow of the Royal College of Physicians.

The report makes it clear that e-cigarettes have proven to be a unique opportunity to steepen the decline of smoking rates in this country. They lack the dangerous tar and carbon monoxide components of conventional tobacco cigarettes and are consequently 95% safer, as Public Health England says. It should also be noted that second-hand vapour from e-cigarettes is substantially less dangerous than from tobacco cigarettes. As we all know, e-cigarettes can and do operate as a pathway from conventional smoking to quitting altogether. At present, something like 2.9 million Britons use them as a pathway towards quitting, with tens of thousands successfully stopping each year.

We were all surprised that under the previous tobacco control plan we got well below the target adult smoking rate: it is below 16% now, which is extraordinary. Sadly, that was not because e-cigarettes were used in smoking cessation programmes, although in my view that should be the future; it was because millions of our fellow citizens were buying those products themselves. Getting adult smoking below 16% is no mean feat, but more than 80,000 of our fellow citizens are still dying prematurely from tobacco use each year. We should never forget those statistics. If anything else were taking lives in this country every year at that level, we would be up in arms and this House would have done more to stop it.

Cancer Research UK’s briefing recommends that e-cigarettes be used as a tool to aid smokers who wish to quit in achieving their goal. However, it rightly points out —as the Chair of the Science and Technology Committee, the right hon. Member for North Norfolk (Norman Lamb) did—that unfortunately surveys have shown that 40% of clinicians are uncomfortable recommending e-cigarettes to their patients, and a further third are unsure whether they are safe to recommend, notwithstanding what Public Health England says about them. Moreover, just 30% feel that their knowledge is sufficient to advise patients on vaping.

Healthcare professionals must be made aware of the benefits of e-cigarettes in aiding people to quit. Although vaping is not completely risk-free, the reality is that it is significantly safer than smoking conventional cigarettes. Healthcare professionals must be made fully aware of that, so that they can ensure that their patients have the strongest chance of quitting smoking. It is difficult, and it may not necessarily be something that new doctors or doctors in training will be looking at. However, any health professionals attending or reading this debate, especially general practitioners, could do worse than go round to the vaping shop on their local high street to talk to the people who sell the products, because those are the people who trace their patients. They will know people who have gone from 50 cigarettes a day to none, or who used to need higher hits of nicotine but are now on lower and lower doses. I know people who still vape but use no nicotine at all; they are satisfying not an addiction, but a habit of using their hands. That is what ought to happen. It is quite true that there is no long-term evidence, just as there was not when the first heart transplant happened in South Africa, but it is pretty clear that there is evidence out there in our communities. We need our health professionals to go and talk to the people who have probably been dealing with their patients for some time.

Naturally, many people have raised deep concerns about whether vaping can operate as a gateway to smoking conventional tobacco cigarettes, but there is no evidence to suggest that such a phenomenon has materialised in any meaningful or demonstrated way. ASH, which I have been active with in this country for decades, has been monitoring what is happening annually, particularly around young children, and there is no evidence that it is causing nicotine addiction and leading people on to cigarettes.

I have to say that some of the evidence that we have seen about vaping in America is shocking. Some of the stuff that they put in is class A drugs—that is why we are having deaths. I know from going to America from time to time, where I have two step-grandchildren, that one company, which shall remain nameless in this debate, has been promoting vaping to young children with different flavours, although not necessarily with nicotine. When we talk to schools about it, they are up in arms about the nuisance and the litter. There is something to think about there, but we should not be too scared of it.

Although there are advertising restrictions and regulations on vaping, they are less stringent than those that apply to tobacco products. In June, the Library published a briefing paper that is well worth reading, “Advertising: vaping and e-cigarettes”. I first campaigned against tobacco in the 1993-94 Session when I introduced the Tobacco Advertising Bill, a private Member’s Bill to ban tobacco advertising and promotion. We are a long way down the road now, but there are still lessons to be learned from the Library’s paper about how these products are advertised.

The Science and Technology Committee has recommended that cigarette pack inserts could be used to refer smokers to e-cigarettes as a healthier alternative, but unfortunately that is currently banned under the Standardised Packaging of Tobacco Products Regulations 2015. We need to think quickly, because the people addicted to cigarettes are the ones who are going into shops and buying e-cigarettes. They are the people we should be targeting; I do not think that we can do it with things like websites. We could change those regulations in super-quick time—I can’t, because I’m off, but Parliament could, which would put us in a position to get to the people who are still addicted.

E-cigarettes need to be endorsed as mainstream in cessation programmes. About three years ago I visited the Leicester smoking cessation programme, which has been at the forefront of using such products. It has a wonderful scheme—led by a nurse at the time—in which pregnant women vaped at least throughout their pregnancy, which greatly enhanced the health and the life chances of their child. There is no reason why we should not make that mainstream. I know that people who smoke will now be referred to community pharmacies; that is good, but we should be looking at specific interventions with these products for people who are vulnerable, including unborn children.

Smoking cessations ought to be funded directly by the tobacco industry. I know that that would be an issue for the Treasury, but the Minister will need to talk to it. We often talk about making the polluter pay; tobacco companies should be paying for our smoking cessation programmes. Sadly, as we have said in previous debates, some of those programmes are now fading away. There are parts of this country that still have heavy and intense levels of adult smoking but have no smoking cessation programmes at all. That is wrong and, with more than 80,000 deaths a year, it should be stopped.

[Gareth Johnson (Dartford) (Con)]

Unlike the three previous speakers, I rather hope that this will not be my last speech in Westminster Hall—but that is up to the people of Dartford, not me.

I am pleased to contribute to the debate, because I feel strongly that vaping is something that we should embrace as a country. It has been mentioned that Public Health England says that vaping is 95% risk-free; that is really significant, and it is not just Public Health England making such statements. Cancer Research UK says that there are significant benefits from vaping in comparison with tobacco consumption. ASH, the British Heart Foundation and the British Lung Foundation—organisations that understandably have traditionally frowned on anything associated with smoking—recognise that vaping saves lives. That is what we are talking about, and the sooner the country recognises that we have an invention that could save thousands of lives in the UK, let alone the rest of the world, the sooner we can start saving the maximum possible number of lives.

It was with great regret that we heard the stories coming out of the United States. It was only when we starting drilling down and saw that the deaths were potentially linked to acetates, cannabis oil and so on—those are the irritants actually causing the deaths—that we recognised that we should not allow those tragic circumstances to cloud people’s image of vaping. It is not only clinicians who are unsure about vaping, and whether they can recommend it to patients; the general public are also unsure whether vaping is as safe as some experts have said. We need to educate people, and say that it is a well-known fact that tobacco seriously damages health and therefore is highly risky, but that with vaping the risks are substantially smaller.

Nobody in this debate, or anywhere in the House of Commons that I am aware of, is suggesting that people who do not smoke should take up vaping. The suggestion is that it is people who smoke, and who are addicted to tobacco and nicotine, who will benefit from vaping. There are risks associated with pretty much anything, and vaping is no exception. The message should go out loud and clear that people who do not smoke should not start vaping, but people who smoke may wish to try that alternative as an effective way of reducing their tobacco consumption, or helping them to come off tobacco completely.

I welcome the fact that some tobacco companies have embraced vaping; they realise its potential. Japanese Tobacco International has highlighted to me some of the dangers associated with products that do not contain nicotine, and so do not come under the Tobacco and Related Products Regulations 2016 and can be targeted at children. They can be marketed to look like food, or something trendy that people will want to get involved with, and as they do not have to comply with the tobacco regulations, their ingredients are not known. We need to look at that.

The Science and Technology Committee, chaired by the right hon. Member for North Norfolk (Norman Lamb), has looked at the 2016 regulations, which have serious flaws. For a start, they should not lump together tobacco and vaping products; they should be covered by separate regulations. That would bring an end to the ridiculous situation whereby a vaping product that has no nicotine in it must have a warning on its front saying, “This product contains nicotine”. If the vaping company does not put that warning on its product, it will fall foul of the regulations, but if it does, it might fall foul of other regulations. It is a crazy situation that has developed.

We need to consider whether it is right to allow more advertising of vaping products. I believe that it is, but regulations seem to prevent that. I think it is right that we should enable people to be educated, and aware of the products available and their potential benefits.

I do not want to turn this into a debate on Brexit, but there is no getting away from the fact that once we leave the European Union, we as a country can look at the regulations ourselves, and see what best suits our needs and what would be a sensible approach to vaping. We can ensure that people are aware of vaping and can benefit from it, so we should do so.

I have met a number of organisations that are trying to push forward a change in vaping regulations. Imperial Brands—formerly Imperial Tobacco—is doing a lot, and there is also a company called Blu, whose products are pioneering. That is a key part of the process. Companies are investing a lot in developing products that will be attractive to smokers, in that they will satisfy their cravings, so that they feel less necessity to smoke cigarettes.

I do not want to demonise smokers. If an adult chooses to smoke, knowing the risks, that is their decision. However, it is incumbent on the Government to ensure that people are aware of the alternatives to smoking, of the risks, and that there is comparatively less risk associated with vaping.

The Government are rightly pursuing a target of reducing the number of people who smoke and eventually eliminating smoking in this country. That is very ambitious, and if we are to achieve that, it will be necessary to introduce people to vaping through their GP.

[Sir Kevin Barron]

On this idea that smoking is an adult thing, very few people start smoking after the age of 21. The hard reality is that for most people, the starting point comes when they are quite young. I think I was about 11 or 12 when I started getting addicted to nicotine. I think we have to be very careful about this. It is not really an adult choice; it is just something that adults have done from a very early age.

[Gareth Johnson]

I totally agree. I take the view that if adults want to smoke, knowing the risks, that is up to them. However, there is a duty of care on the Government to ensure that tobacco products are not consumed by children. That is absolutely clear, and it is right that we keep the age at which people can start vaping at 18; we do not want vaping products targeted at children. In my experience, no responsible vaping company would do that or has done that.

The Government approach is sensible. I believe that they can embrace the potential of vaping to save lives. There are so many measures that could be taken—through the taxation system, through advertising, through education, and by making people aware of these products and making them more accessible to smokers.

We must recognise that for the first time in my life, there is something that genuinely can help people to get off tobacco—something effective that works. If we look at a graph of the number of people smoking and a graph of the number of vapers in this country, we can see a direct correlation: the more people vape, the fewer people smoke. We need to highlight that and celebrate it, and the Government should take that forward.

Community Pharmacies

Kevin Barron Excerpts

Wednesday 2nd October 2019 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Sir David. I thank my hon. Friend the Member for Halifax (Holly Lynch) for securing the debate. I have a non-financial interest to declare: I chair the all-party group on pharmacy.

Community pharmacies play a major role in supporting the prevention agenda, which is a key development in the NHS long-term plan. As an integral part of the NHS, they are also a valued community facility with a positive track record of improving access to healthcare services. Compared with GP surgeries, there are more than 11,600 community pharmacies across England, and 89% of the population are estimated to have access to one within a 20-minute walk. That percentage rises to 99% in the most deprived areas of our country. We should recognise that community pharmacies are crucial.

There is still much more that could be done to unlock the huge potential of pharmacies and to further integrate them with emerging local healthcare networks. For example, service commissioning is patchy across the country, meaning that not all patients can access the same services from their local community pharmacies. More than 95% of community pharmacies now have a private consultation room from which they can offer advice to patients and a range of nationally commissioned services, such as the flu vaccination service. In 2018-19, 1.4 million flu vaccinations took place in community pharmacies. Two years ago, when the service was first introduced, other parts of the medical profession did not like the idea of pharmacies moving into that area, but the figures show that it was a good idea.

The new medicine service allows pharmacies to provide support for people with long-term conditions who have been newly prescribed a medicine to help improve medicine adherence. My hon. Friend mentioned it in relation to the elderly. I am sure we all know that more than 70% of NHS expenditure in the UK is on people with long-term conditions in the acute or primary sector. It is important to recognise that. Many pharmacies are commissioned to offer public health services by local authorities and the NHS.

On the new national services in 2019-20, my hon. Friend mentioned the community pharmacist consultation service, which is something we should look forward to, with the community pharmacists as the first port of call for minor illness or for the urgent supply of medicines. Pharmacies will offer patients a consultation to help manage their minor illnesses or provide an emergency supply of medicine. The service will take referrals from NHS 111, but in years to come such referrals could come from other settings such as GP practices and the NHS online. That is a progressive move so that we can access services far better than we can at the moment. We will see how it goes.

The other national service is hepatitis C testing. Pharmacies will offer testing for people using pharmacy needle and syringe programmes to support the national hepatitis C elimination programme. There will, however, be an extension of the reach of the six mandated public health campaigns that community pharmacies have to take part in, and many community pharmacies will also choose to take part in the pharmacy quality scheme. This year, that might involve preparing for engagement with primary care networks, which is crucial. When I first talked to my local primary care network about where the pharmacy fits in with this, they were not at all sure. We also have: carrying out audits on prescribing safety for lithium, on pregnancy prevention for women taking valproate, and on the use of non-steroidal anti-inflammatory drugs; checking with patients with diabetes whether they have had annual foot and eye checks; reducing the volume of sugar-sweetened beverages; complete training and assessment on look-alike, sound-alike errors, which is crucial for us all; updating risk reviews; completing sepsis online training and assessment, along with risk mitigation; and completing the dementia-friendly environment standards.

From April 2020, all pharmacies will be required to be able to process electronic prescriptions and to have attained healthy living pharmacy level 1 status. Accreditation will mean the pharmacies are local hubs for promoting health, wellbeing and self-care, and providing services to prevent ill health. That is the real move we should be seeing in community pharmacy now, to promote population health and reduce health inequalities. Pharmacies have a major role to play in that.

With regard to other future pharmacy service developments, as part of the five-year deal community pharmacies may also be able to support the appropriate use of medicines through the expansion of the new medicine service to other conditions. In addition, the NHS will use the national pharmacy integration fund to pilot services for potential roll-out. These include a model for detecting undiagnosed cardiovascular diseases and smoking cessation referrals from secondary care. That is crucial—this is a matter for another day—when we see the reduction in smoking cessation services here in the UK, yet still more than 85,000 of our fellow citizens are dying prematurely each year from smoking-related disease.

Further services include: the use of point-of-care testing around minor illnesses to support efforts to tackle antimicrobial resistance; routine monitoring of patients, such as those taking oral contraception, under an electronic repeat dispensing arrangement; activity to support primary care network priorities, such as early cancer diagnosis and tackling health inequalities; and a service to improve access to palliative care. These are the ideas that the community pharmacy has got and where it is going to move in the next five years. That is crucial.

Once again, I thank my hon. Friend the Member for Halifax for securing the debate and providing this opportunity. The issue of expenditure has been mentioned, although I will not go into the history of it now. The Minister will be acutely aware that when we had the pharmacy integration fund, it was set aside after the cut. In fact, it was not used very well and lots of money was left in there. We are now moving into areas where that money should have been used. It is crucial that we get the money now on the table into frontline pharmacy services.

Heated Tobacco

Kevin Barron Excerpts

Wednesday 26th June 2019 Westminster Hall

[Seema Kennedy]

I hear what my hon. Friend is saying. For a lot of people, nicotine substitutes are a good transition to giving up smoking or other things completely. We have seen a dramatic rise in the use of e-cigarettes from 1.6 million users in 2014 to about 2.5 million in 2017. Encouragingly, about half of them in England have quit smoking completely. E-cigarettes are not risk-free, however. The evidence is increasingly clear that they are significantly less harmful to health than smoking tobacco. They can help smokers to quit, particularly when combined with stop smoking services. Recent studies have shown they can be twice as effective as nicotine replacement therapy in helping people quit smoking. As my right hon. Friend the Member for Clwyd West pointed out, the sales of e-cigarettes are plateauing, and we are coming to the stubborn 5% of people who are still smoking.

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

The Minister will know that expenditure on smoking cessation programmes has fallen rapidly in the past few years. I promoted a ten-minute rule Bill to put a levy on tobacco companies to fund smoking cessation programmes and research into less harmful products. The greatest problem we have had for many years—this is anecdotal at the moment—is that products such as patches and gums cannot get heavy smokers to quit. There is some evidence, although it is not firm, that heated products are a way of getting to people who have a real problem with addiction.

[Seema Kennedy]

The right hon. Gentleman makes an important point. Those of us who represent seats in the north and the devolved nations know that in some communities a very high proportion of people—particularly older men—are still smoking. Smoking cessation services are obviously part of the conversation about public health that the Department will be taking forward to the spending review.

My right hon. Friend the Member for Clwyd West has argued that it would be timely for the Government to commission independent research into heated tobacco products’ potential for harm reduction. Obviously, if the tobacco companies were paying for it, it would not be independent. The right hon. Member for Rother Valley (Sir Kevin Barron) has set me an interesting challenge on tobacco levies. The new levy is being introduced in a few days, and I will definitely keep that under review.

The primary focus of our research at the moment is e-cigarettes, because heated tobacco is still very new on the market in this country. We will keep it under review and we will monitor the evidence through Public Heath England’s reviews. I agree entirely that it is important to look carefully at the evidence of harm reduction. I assure the House that we are, and will continue to be, led by that evidence.

Heated tobacco products are regulated under the Tobacco and Related Products Regulations 2016 as novel tobacco, in accordance with the EU’s tobacco products directive. We know far more about e-cigarettes than we do about heated tobacco products. The research and evidence base is still in its infancy, and is mainly conducted by the tobacco industry. We asked the Committee on Toxicity to research the toxicological risks of heated tobacco products and compare them with those attributed to conventional cigarettes. It reported in December 2017, and the evidence suggests that heated tobacco products still pose a risk to users. There is likely to be a reduction in risk for cigarette smokers who switch to heated tobacco products, but quitting tobacco entirely is the most beneficial thing that anybody can do.

We have asked Public Health England to update the evidence base on e-cigarettes and other novel nicotine delivery systems annually. The PHE 2018 evidence review also had a comprehensive chapter on heated tobacco. It concluded the same as the Committee on Toxicity. As my right hon. Friend the Member for Clwyd West said, it stated that e-cigarettes are less harmful than heated tobacco. The latest PHE evidence review in February 2019 did not cover heated tobacco products, essentially because there was insufficient new evidence since the previous review in 2018.

My right hon. Friend pointed to the experience of other countries. I agree that we must look beyond our shores and learn lessons, but we must also acknowledge that there are different contexts in which heated tobacco products are used. For example, Japan has banned e-cigarettes, but it has introduced heated tobacco products, which have made an impact there. The Food and Drug Administration in the United States has permitted the sale of heated tobacco products, but is yet to pronounce on whether Philip Morris International may make claims of reduced risk for its IQOS product. I believe, therefore, that we need to be cautious about assuming that heated tobacco products are likely to find a large market in the UK.

I recognise that more independent research on heated tobacco products would be helpful for understanding their relative risks. The Department and its arms’ length bodies will consider research proposals in this field, but at present none has been forthcoming. I need to be clear that such proposals would need to demonstrate good use of public money. We will continue to monitor the international evidence and develop our policy as such evidence develops.

Health Inequalities

Kevin Barron Excerpts

Wednesday 20th March 2019 Westminster Hall

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

Thank you for calling me, Mr Hollobone. I am pleased to be here this afternoon and that the hon. Member for Telford (Lucy Allan) has brought up this matter of health inequalities. She mentioned the Health Committee of the previous Session. I chaired the Health Committee under the last Labour Government, which looked into health inequalities and found that there are great difficulties in moving on from that.

In 2010, the Marmot review on health inequalities was published. Since then, we have had legislation. I was on the Committee for the Health and Social Care Act 2012. I was really pleased that health inequalities and population health was a big issue, and it was put in statute that those things needed addressing. I am sad to say that I have not heard a murmur from Ministers since then in relation to reducing health inequalities.

As my hon. Friend the Member for Oldham East and Saddleworth (Debbie Abrahams) said, Sir Michael Marmot was a leader on this matter. He is now involved in the Institute of Health Equity, which, in September last year, released a fascinating publication. In conjunction with that publication, Sir Michael Marmot wrote on his blog about the complexity of health equalities, a point recognised by the hon. Member for Telford and my hon. Friend the Member for Oldham East and Saddleworth. Sir Michael Marmot wrote:

“There has been a contradiction at the heart of recommendations for action on health inequalities. No one is more concerned with health than those of us in the health sector. But the key determinants of health inequalities lie outside the health care system. It is not so much what doctors do, or don’t do, for patients that cause health inequalities, but the conditions in which people are born, grow, live, work and age.”

That is absolutely true. To be fair, the coalition Government tried to bring in legislation that would help people to recognise that, not only in the health service, but in the wider world.

The report published last September, “Reducing Health Inequalities Through New Models of Care: A Resource for New Care Models”, is really worth reading. Sometimes I despair when I hear Members of Parliament saying that we do not want new models or changes in the health service, because this is what happens and that is how it should be. In fact, the Institute of Health Equity provides some great guidance that we could all learn from, in terms of what should or should not be done.

One issue highlighted in that report is that the Public Services (Social Value) Act 2012 came into force in 2013, across the public sector. The report says:

“The Act states that for public bodies procuring service contracts over a certain threshold”—

both examples given are below £200,000—

“the authority must consider: ‘a) how what is being proposed to be procured might improve the economic, social and environmental wellbeing of the relevant area, and b) how, in conducting the process of procurement, it might act with a view to securing that improvement.’”

That is exciting, at one level. However, on the next page, regarding take-up of those considerations, the report states:

“Social value contracting is still relatively underdeveloped within the NHS, even though it is a legal requirement. Only 13 per cent of CCGs were able in recent research to evidence active use of the Act.”

Under those circumstances, it seems to me—it is not just the NHS, but the rest of the public sector—that we need to concentrate our minds, as a nation, on how we get through this issue. It is an issue not only of health, but of many other things.

The report talks about using

“social prescribing to create action on social determinants”.

The Minister—in her life before being elected—comes from close to the borough of Rotherham. Rotherham Social Prescribing service has won national awards for how it works with different communities. Voluntary Action Rotherham also works with different voluntary groups—not groups that deliver health services as such—to ensure that people get the help that they need now. Social prescribing, in my view, is a way to get away from the health service and into the wider communities, and it is an avenue that this House should encourage. I hope the Minister agrees with that.

Oral Answers to Questions

Kevin Barron Excerpts

Tuesday 23rd October 2018 Commons Chamber

[Mr Speaker]

Nevertheless, the hon. Gentleman has had his say, and I feel sure that he will say it again as often as is necessary.

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

Will the Minister tell me whether the withdrawal of funding for the Healthy Futures programme in the north-west and Public Health Action in the south-west is likely to help or hinder us meeting the smoking cessation targets in the tobacco control programme?

[Steve Brine]

This comes back to the matter of public health budgets—£16 billion during the current spending review period, with local authorities best placed to make local decisions on what is needed in their local area. That is the same in the right hon. Gentleman’s area as it is in mine.

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.

Tobacco Control Plan

Kevin Barron Excerpts

Thursday 19th October 2017 Commons Chamber

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

I beg to move,

That this House has considered the Government’s publication of the new Tobacco control plan.

I begin by thanking the Backbench Business Committee for allocating time for this very important debate. I also welcome the Minister to his new post in the Department of Health, and I am sure he will hear much more about this issue in the months to come.

I have no financial interest, but I should mention that I am an honorary fellow of the Royal College of Physicians, as it is heavily involved in the debate on tobacco.

I have repeatedly called in this House for the publication of a comprehensive tobacco control plan to replace the Government’s previous plan, “Smoking Still Kills,” which expired in 2015. I welcome the Government’s publication of this new five-year strategy this summer, which seeks to achieve what they term a “smokefree generation”.

Despite a long-term reduction in smoking rates, tobacco use remains the leading cause of preventable premature deaths and ill health, accounting for about 100,000 deaths each year in the UK. In addition, 23% of all hospital admissions for respiratory problems in 2014-15 were directly attributable to smoking. I thoroughly welcome the falling adult smoking rates in England—down from 46% in 1974 to 15.5% in 2016—but I have to say to the Minister and to the House that we cannot take this work for granted. That is why we need the tough but achievable targets that the new current control plan contains.

Smoking and the harm it causes are not evenly distributed, as hon. Members will know. People in more deprived areas are more likely to smoke and less likely to quit. Smoking is increasingly concentrated in more disadvantaged groups and is the main contributor to health inequalities in England. Men and women from the most deprived groups have more than double the death rate from lung cancer of those from the least deprived areas of the UK. I am not saying there is exactly a north-south divide, but where money is divided in such a way that is likely to happen. Rates do vary between north and south on occasion, as we see if we examine smoking during pregnancy rates, which vary from 2% in the Central London clinical commissioning group area to 27% in the Blackpool CCG area.

[Alex Cunningham (Stockton North) (Lab)]

Data produced by Public Health England show that in my local authority area 18.1% of women smoke at the time of delivery compared with the national average of 10.6%. The plan says that it will reduce the prevalence of smoking during pregnancy. Does my right hon. Friend agree that every CCG and local authority will have to have sufficient funds to carry this work forward?

[Sir Kevin Barron]

Clearly that is the case. I agree with this publication and its intention, but there will be issues to address on different forms of funding. I will discuss that a little later in my speech. We can see from the two figures from central London and Blackpool that there is a challenge out there; this difference alone can have a dramatic impact on health inequalities, as maternal smoking causes up to 5,000 miscarriages, 300 perinatal deaths and 2,200 premature births in the UK each year.

In my area of Rotherham alone, the smoking rate among people in managerial and professional occupations is about 10.2%, but that leaps to 29.4% among those who have never worked or are long-term unemployed. Such facts clearly show that we are still struggling to get through to certain groups within society, and the Government must do more to identify ways of getting through to these difficult-to-reach groups.

[Mark Pawsey (Rugby) (Con)]

The right hon. Gentleman is setting out the harm caused by tobacco. As a recent convert to the benefit of e-cigarettes in assisting people to stop smoking, I wonder whether he will be talking about the valuable role they play. Does he agree that it is a bit of a shame that the tobacco control plan does not go further in recognising the role that e-cigarettes can play?

[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.

[Alex Cunningham]

Some 4,000 people in my Stockton North constituency use e-cigarettes and 14,000 people still smoke. Can my right hon. Friend envisage a day when e-cigarettes are available on prescription, like other products?

[Sir Kevin Barron]

I actually had this conversation in Leicester, although I was not going to mention it in my speech. There is an issue—I think it was in a column in one of the national newspapers many months ago and I have tried to avoid it. If somebody avoids spending £20 or £25 a week on cigarettes, should they get free NHS prescriptions, if they are eligible, to help them to quit? There is a debate there, but I shall say no more than that at this stage.

I asked the team in Leicester what they thought about e-cigarettes on prescription for people who are eligible for free prescriptions, and they said that there might be a case for doing it for a month to break the person away from the cigarette-smoking habit and get them on to e-cigarettes. For the purposes of this debate, I shall leave that where it sits, but there might be a case for it. We clearly need more evidence on the use of e-cigarettes for smoking cessation so that we can make a better estimate.

[Mark Pawsey]

I accept that the right hon. Gentleman wishes to park the issue of whether e-cigarettes should be available on prescription, but does he think that e-cigarette manufacturers should have a little more freedom—the tobacco products directive places restrictions on the advertising of e-cigarettes—to tell people about the nature of their products and how they can help people to switch from tobacco?

[Sir Kevin Barron]

I shall address that briefly, because I know that other Members wish to get involved in the debate. The simple answer is that that is one of several issues that need to be addressed.

The best thing smokers can do for their health is of course to quit smoking altogether, but it is clear that e-cigarettes are significantly less harmful to health than smoking tobacco. Public Health England found that e-cigarettes are around 95% less harmful than smoking cigarettes. My instinct is that the remaining 5% is down to the fact that they have not yet been tested for long enough for it to be said that there is little or no danger at all. There is no evidence that e-cigarettes act as a smoking gateway for children or non-smokers, but research is still needed on their long-term use, and it should be carried out. Quitting smoking is always best, but there is clearly a hard core of smokers who have so far struggled to quit; they must be the people we focus on. It is worrying that an ASH survey found over a three-year period that the number of people who thought that e-cigs were “as or more dangerous” than cigarettes rose from 7% to 26%. That is why we need Government-funded research. I find it incredible that statistic is moving in that direction, rather than the opposite, although I must say that the debate on e-cigarettes, both in the Chamber and elsewhere, has not always been particularly clear.

Other innovations are continuing the “nicotine revolution”. Manufacturers are developing additional smoke-free products to persuade heavy smokers who would not otherwise quit smoking to switch to smoke-free alternatives, among which are the heated-tobacco products that have come on to the scene in the past year or so. Referred to in the “novel tobacco products” category of the tobacco control plan, such products could be the next step to reaching those hard-core smokers who, although they did not get on with e-cigarettes, are looking for another way out of smoking. I was pleased to see in the plan that Public Health England will continue to lead the investigation into the use of novel products as stop-smoking tools, with the evidence updated annually, and that PHE acknowledges that novel products are currently the most popular aid to stopping smoking in England.

Many people are wary of so-called novel products and the fact that many are produced or funded by tobacco companies. We must recognise that tobacco companies have in the past been extremely dishonest about the harms of smoking and the products they have sold, so we urgently need more research on these devices, and I hope the Government’s annual review will help to provide more information. I have been anti-tobacco for more than two decades in this House, but we should not ignore the potential benefits for people who have not been able to stop with more traditional smoking-cessation products just because some of these products have tobacco connections. It is vital that we all focus our minds on the reality of getting people off this habit that is still killing people and shortening the lives of more than 100,000 of our fellow citizens every year.

Many of the products I am talking about are covered by the EU tobacco product directive, which has resulted in many good things, including the establishment of reporting and notification requirements for tobacco products. Nevertheless, stakeholders have raised issues with some of the other requirements, and we may be able to use Brexit as a chance to look at the directive. I understand that we have been thrown into the TPD at the last minute. We have had the debate and I do not want to bore anyone with it further. We need to move on, because that is what happens in politics sometimes. We need to talk about what should be happening now and in future for the sake of our fellow citizens. Brexit is coming, so we should not be tied into a timetable for any changes to the TPD—although I do not even know the potential timetable for any further debate on Brexit. Nevertheless, if there is any discussion about changes to the TPD, we need to ensure that all stakeholders are involved in working groups to design a directive that works for the good of the United Kingdom, taking into account the issues I have mentioned.

For all its positives, there is a glaring problem with the tobacco control plan, and we all know what it is: money. Although not short on lofty ambitions, local authorities face huge strain and will not be able to deliver the kind of joined-up smoking-cessation services that the tobacco control plan deserves. Luckily, there are people who can help. Tobacco companies have made a fortune selling cigarettes. We might well argue that they got us into the mess we are now in, so it is only right they get should us out of it. They have the resources and customer base to help smoking cessation tools to get straight to the people who need them most. If the industry is willing to commit to a future based on e-cigarettes and other reduced-harm products, we should take them up on the offer and allow the Government and local authorities to partner with them to ensure we have the financial and technical assistance needed to help smokers to quit. I would not have said that five years ago, but five years ago we did not have these products that can clearly help a lot of our fellow citizens to get off cigarettes.

[Alex Cunningham]

It was remiss of me earlier not to pay tribute to my right hon. Friend for all his work on this issue in recent years. Will he talk a little about people with mental health conditions and the fact that the tobacco control plan emphasises the need for parity of esteem in their treatment, in a similar way as there should be parity of esteem between the treatment of mental health conditions and the treatment of the general population? For that parity of esteem, the professionals who work with people with mental health conditions would need the necessary expertise and education. Will my right hon. Friend join me in encouraging the Minister to step up education for mental health professionals so that they, too, can be part of the campaign to help people to quit smoking?

[Sir Kevin Barron]

I will indeed. The use of e-cigarettes in mental health institutions or in prisons could go a long way towards alleviating some of the problems in such institutions. When I was Chair of the Health Committee, we looked into smoking in public places in 2005-06, and we saw tobacco in effect being used as a form of control in some institutions, and everyone knew the damage it was doing to the people in those institutions. A lot of institutions have moved on now, though. It is a matter for the Prisons Minister, not the Minister who is present, but we need to consider the availability of e-cigarettes in such institutions so that we can get people away from this life-threatening habit.

In conclusion, the tobacco control plan offers the groundwork for a comprehensive strategy that is much broader than just cessation and that must include measures that reduce uptake as well as those that increase quitting. They should include reducing the affordability of tobacco by increasing taxation, which has been happening in this country for many years now. I will certainly have a close eye on the Budget in a few weeks’ time, as we need a renewed commitment from the Government to the tobacco tax escalator. Any money that is raised should be ring-fenced for use in smoking cessation and mass media campaigns to motivate quitting and enforcement of age of sale, which is also an issue. When the mass media campaigns ended after the 2010 general election—people were no longer seeing them on television or in other parts of their life—the demand for smoking cessation services reduced.

We all want a smoke-free society as soon as possible. We on the Labour Benches, and even some tobacco companies, are now saying that as well, so the Government could not ask for a better opportunity to take this further, to do it more comprehensively and with more success. The challenge now is to make sure that reality lives up to these ambitions. The tobacco control plan needs to be properly implemented and built on if we are to achieve those goals.

[Several hon. Members rose—]

--- Later in debate ---

[Sir Kevin Barron]

I just have a few reflections. Several people mentioned my involvement in anti-tobacco measures in this Chamber over many years, but it was never just me. Whether sat on the Opposition or Government Benches, I had allies on the other side who forced different Governments to take different positions all the time. Listening to the debate, we have now reached a consensus. We started off by banning tobacco advertising and promotion, then smoking in public places, then point of sale advertising and now we have standardised packaging. It has been just wonderful to sit here and recognise the fact that we now know what is in our midst, shortening the lives of many tens of thousands of our fellow citizens, and we are now seriously doing something about it. I say to the Minister—if I was on the Government Benches, I would say the same—that I do not see any need for further legislation. We need to implement what we have already done on smoking cessation to help people break this habit. I am thankful for what was said about me, but it is was not just me; there have been teams of people at different times.

It has been really good today that we have recognised the new products on the market, such as e-cigarettes and other novel products—I think “novel” is a European term that has come in from the tobacco product directive. No matter who owns them and no matter who is promoting them, people now recognise that such products can potentially be very useful in getting citizens off this killer—tobacco shortens the life of 50% of those who use it. We need the research, and we need to be determined.

I enjoyed all the Front-Bench speeches, and I say to my hon. Friend the Member for Washington and Sunderland West (Mrs Hodgson) that I loved the parliamentary Labour party brief I received last night—I cannot always say that when I talk about tobacco products or tobacco policy in this House. We now need to make sure that we improve things for our fellow citizens as soon as possible.

Question put and agreed to.

Resolved,

That this House has considered the Government's publication of the new Tobacco control plan.

Baby Loss (Public Health Guidelines)

Kevin Barron Excerpts

Tuesday 21st March 2017 Commons Chamber

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

May I congratulate the hon. Member for Colchester (Will Quince) on securing the debate? As an officer of the all-party group on smoking and health, I must congratulate him on the length of time that he has for this debate. Never in my wildest dreams did I ever think that we would get more than a one-and-a-half hour debate in Westminster Hall for such a matter.

The hon. Gentleman rightly pointed out the dangers of smoking in pregnancy. I do not plan to fill up these three and a half hours—I can see some smiles of relief—but I will pick up one or two issues that he raised. The Minister knows that I and many other Members have been calling for the new tobacco control plan for quite a while, since the last one finished at the end of 2015. The word I would add to that, because things do move on, is “comprehensive”; it ought to be a comprehensive tobacco smoking control plan. There are areas where that could help very much indeed.

Smoking in pregnancy is a massive issue that is obviously caused by nicotine addiction. For many years, the only way that people could meet that addiction, other than with chewing gum and patches, was by using cigarettes. Hon. Members will know that Public Health England published a report on e-cigarettes in August 2015, saying that they were 95% safer than the tobacco in cigarettes as a means of taking in nicotine. It is pretty obvious to me that consumers are moving to e-cigarettes on a vast scale, and the Government are also moving towards e-cigarettes to look into how they can help in certain situations.

I recently tabled the following written question:

“To ask the Secretary of State for Health, what steps are being taken by (a) his Department, (b) the Medicines and Healthcare Products Regulatory Agency and (c) Public Health England to encourage research into the use of e-cigarettes.”

Although the Minister may not have direct responsibility for this, I would like to tell him that I am very pleased with the answer, which I received today and which says that his Department is “working closely” with all the organisations

“to encourage research into the use of electronic cigarettes…and monitor the emerging evidence. PHE’s next updated evidence report on e-cigarettes is expected to be published before the end of the 2017. In addition to the publication…PHE have partnered with Cancer Research UK and the UK Centre for Tobacco and Alcohol Studies to develop a forum that brings together policy makers, researchers, practitioners and the non-governmental organisation representatives to discuss the emerging evidence, identify research priorities and generate ideas for new research projects, thereby enhancing collaboration between forum participants.”

I am sorry for going on about that, but it is a comprehensive answer that talks about identifying research priorities. We could not have a better advocate for such a priority than the statistics on the effects of smoking tobacco in pregnancy read out by the hon. Member for Colchester. The people involved, including PHE, which is doing a magnificent job, ought to be looking at whether smoking in pregnancy could be one area for comprehensive research. Perhaps we could replace the cigarette—a mechanism for satisfying nicotine addiction that we all know is very bad for us—and use something like e-cigarettes to satisfy the addiction in pregnant women without the risk to the individual woman and her child.

I congratulate the hon. Gentleman on bringing this up, and I congratulate the Under-Secretary of State for Health, the hon. Member for Oxford West and Abingdon (Nicola Blackwood), on the answer I received today. We should be ensuring that we look into these areas in some detail to ensure that we can avoid the awful statistics that the hon. Gentleman read out.

O’Neill Review

Kevin Barron Excerpts

Tuesday 7th March 2017 Westminster Hall

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

I congratulate the hon. Member for Thirsk and Malton (Kevin Hollinrake) on securing this very important debate. We will all be aware that the World Health Organisation says that antibiotic resistance is one of the most significant threats to safety in Europe. Resistance is driven by overusing and inappropriately prescribing antibiotics, and it leads to higher medical costs, prolonged hospital stays and increased mortality. The aim of appropriate use is to ensure that patients receive the treatment that is most likely to treat their condition without increasing antimicrobial resistance. That includes ensuring that courses of antibiotics are completed and are not prescribed unnecessarily, and reducing the spread of infection through vaccines and other early interventions.

One area that is often overlooked is dentistry, which accounts for up to 10% of all antibiotics prescribed in the UK. It is essential that dentists play their part in reducing antibiotic prescribing, and I believe that they are willing to do that. The British Dental Association tells me that many patients are not aware that antibiotics cannot cure decay or dental abscesses and that surgical intervention and painkillers are more often the appropriate treatment for tooth-related pain. The briefing sheet that the BDA sent me gives this good example:

“Hundreds of thousands of patients show up at GP surgeries and A&E departments every year with dental pain, but these places are not equipped to help them, and they are sent home with antibiotics to tide them over until they can arrange to see a dentist.”

There should be awareness of that throughout the medical profession.

I agree with Lord O’Neill’s statement that diagnostic technology needs to be improved to ensure that antimicrobials are used appropriately. I am no expert in this area, but the chair of the review board called on the Governments of rich countries to ensure that, by 2020, all prescriptions for antibiotics will be on the basis of surveillance information and a rapid diagnostic test where one is available. The review recommended a diagnostic market stimulus to support the diagnostic technology market. The Minister is not in the Chamber at present, but I hope that the Government will look at diagnostics.

The Government must also look at the factors that have hampered investment in antibiotic development, particularly the low commercial returns on investment. With high costs and long lead times for developing new medicines, there is a need to create an attractive environment for companies to invest in antibiotic development, in order to increase research and development. The current system of antibiotic reimbursement does not provide companies with a fair return on investment. That is driving companies out of the anti-infection market.

Pharmaceutical companies and Government are developing a delinked domestic reimbursement model. That will remove the incentive for companies to promote antibiotic sales, which can accelerate the development of resistance. The proposed model will deliver a return on investment for antibiotics that is delinked from the volume of sales. It will also encourage the appropriate use of new antibiotics by ensuring that they are prescribed based on clinical need and in line with stewardship goals.

I see the time, Mr Streeter, and I am about to conclude. A delinkage model is proposed in the O’Neill report, and we must put our minds to it, but it is very much for the future. What we have to examine now is how we manage patients’ expectations on when antibiotics are and are not appropriate. We should be doing that daily in all parts of the health service.

Oral Answers to Questions

Kevin Barron Excerpts

Tuesday 20th December 2016 Commons Chamber

[David Mowat]

My right hon. Friend is right; CCGs are variable in the extent to which they commission pharmacy services. However, we have set out the minor ailments scheme, it will be rolled out nationally by April 2018 and we expect every CCG to take a part in it.

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

As chair of the all-party group on pharmacy, I have seen many examples of drugs that have been prescribed and not used, as I am sure we all have. Should we not renegotiate the national contract, which currently pays community pharmacies more than 90% of their income through prescribing? Surely we can do things differently.

[David Mowat]

The right hon. Gentleman rightly says that we must change the contract to move away from 90% of the income coming from dispensing. Far more must come from services, which are separately commissioned by CCGs and others. The Murray review, which he will be aware of from his work on the all-party group, sets out a road map for that, and NHS England is determined to implement it.