(2 years, 3 months ago)
Public Bill CommitteesI welcome that intervention, but we cannot ignore the trebling of the number of 11 to 17-year-olds who are starting to vape. However much the Minister says that people who are not smoking should not vape, and that no children should be vaping, that is not the reality in the communities that we serve. It is certainly not the reality in my Copeland community. I think the hon. Lady is saying that vaping helps us to fix the problem, but I am equally keen to prevent the problem. The rate at which young people are taking up vaping needs serious consideration, but we also need serious evidence-gathering to understand not only the harms that could be caused by those who are vaping in the vicinity of others, but nicotine addiction.
My hon. Friend is making a very passionate speech on behalf of herself and my hon. Friend the Member for Sleaford and North Hykeham, who I am sure will be very pleased with the contribution. However, I have to say that I agree with the hon. Member for North Tyneside because the evidence that we heard strongly suggested that smoking and vaping are not commensurate. My hon. Friend the Member for Copeland is entirely right that we need further evidence, but perhaps we should be looking at evidence-based policy making so that we make the policy when we have the evidence. The best way forward would be to seek such evidence.
My hon. Friend makes an excellent point. That is really what I am calling for, although it does not detract from the need to prevent the normalisation of vaping. However, I repeat the request for more in-depth research into the impacts of vaping and nicotine addiction on children.
(2 years, 3 months ago)
Public Bill CommitteesI share the views expressed here today that we have got to stop the marketing aimed at children in the brutal and cynical way that is happening right now. Hon. Members will appreciate that the limiting of flavours is a tricky thing to achieve. Is it the name of the flavour? Is it the ingredients in the flavour? Is it a combination of the ingredients and the flavours?
The Minister is making a considered point. The Committee has received research data from ASH that highlights how complex the issue is. Although 50% of child vapers preferred fruit flavours, 47% of adult vapers also preferred fruit flavours. We therefore have to consult on and take these issues forward in a very considered way, because we do not want to undermine the harm reduction from helping adults who are trying to stop smoking.
(2 years, 3 months ago)
Public Bill CommitteesAs I say, I accept the hon. Lady’s point and will reflect on it.
The broader point is that there is obviously a balance here. We want to exclude vapes from children, but we do not want to exclude vapes from adults who want to quit smoking, because that is the real prize that we are seeking to hang on to. The more difficult we make it for adults to access vapes as a quit aid, the more we are discouraging adults who, we have all agreed—violently—we want to stop smoking. That is the killer.
The Minister is making an extremely important point: we have to do everything in a proportionate manner. Although we need to protect children, and do not want children—I have children of my own—to take up vaping in childhood or have access to vapes, vaping can be a harm-reduction approach for adults. Putting vapes behind the counter, like tobacco, might go against some of the evidence we heard about the harm of vaping being much less than that of smoking itself. It could perhaps give the wrong impression to the public: that vaping is not a harm-reduction tool, that it is not going to be useful to them, and that it is in the same category as smoking itself.
My hon. Friend highlights exactly the challenge, which is the balance between helping adults to stop smoking, where turning to vapes can be the most successful tool in the toolkit, and preventing children from ever taking up and becoming addicted to nicotine.
(2 years, 3 months ago)
Public Bill CommitteesThe hon. Lady is making a very informed speech, but I want to pick up on one thing. She said that the sole purpose of the vaping industry is to get people addicted to vaping, but does she acknowledge that many people across the UK, and particularly adults, as we heard in evidence, have reduced their addiction through vaping? They are tapering down the amount of nicotine they are using, as opposed to when they were smoking. We also heard that there were some health benefits from people moving from smoking to vaping.
I am grateful to the hon. Lady for the point she made. Certainly, I did highlight that transitional benefit of moving from smoking to vaping to, hopefully, stopping altogether. However, we must also highlight that vaping is not without risk, and we need to give that serious consideration. I am just concerned that the Government are slightly light, shall I say, in terms of their concern about vaping, in order to drive down the smoking. I absolutely understand that, because smoking kills, but I just think that we could be on the “too light” side. I know that it is about balance, but I hope that we can reflect on that during the course of the Bill.
I want to draw out one question that I have about clause 9 and giving away vapes. I certainly understand why the measures would be applied to industry, but I want to ask about public health measures that could be deployed. I recognise that the clause is about under-18s, but unfortunately, despite the current legislation, we know that many people under 18 smoke, and we obviously need to ensure that they stop and move into a safer space. The Government have been very much pressing the idea that vaping is a route out of smoking. Does the Public Health Minister see vaping as a means to help people under the age of 18 to stop smoking, or will they have no access to vapes? I would just like some clarity around that. Clearly, there are other smoking-cessation programmes and products available, but it would be useful to know the answer to that question. If vaping is to be used in that way, and clinicians are to be able in future to prescribe or indeed provide vapes for young people to stop smoking—if that was the only tool—we need to understand whether we are to have a blanket ban in the Bill. It would be very useful to understand that.
(2 years, 3 months ago)
Public Bill CommitteesQ
Mark Rowland: I really support the Bill’s efforts to regulate and protect young people from ever engaging in vaping. As you say, it is about the unintended consequences. We are not quite clear on the mental health consequences of vaping for young people. We know that young people who have lower levels of mental wellbeing are more likely to vape. We know that the targeting of young people drives them into addictive behaviour, so we need to protect young people from that. We need a regulatory environment that does not allow young people to be exposed to advertising that is particularly targeted at them. I would support such a measure.
I think the unintended consequence of children missing out on education due to vaping cannot be underestimated. We also have an issue around the mental health of young people who are not attending school—the school rejectors. We need to bring them into an education environment in which we can see what that young person needs and what the consequences for their mental health have been from not being in school. I would rather kids were in school and that that educational setting was protected for them.
Q
Mark Rowland: The evidence around cannabis use and the increased risk around psychosis is really clear and strong. I have personal experience of the absolutely devastating experience of friends who have experimented casually with cannabis and the consequences for their mental health.
It is a fair supposition to make for you as legislators that a Bill that makes such a symbolic and strong stand against young people getting addicted to smoking, reducing the rates and preventing young people from getting addicted to vaping will set a fantastic context for preventing addiction to other substances. Would it not be great if we also saw some delay in the first experience of young people drinking? We could be on the cusp of doing something really fantastic for young people if we look at the range of addictive or self-soothing products, and cannabis would be one of them. If you break the chain and teach people how to manage their mental health and distress in a positive way, you will reduce the risk of people choosing addictive and damaging products to do that for them.
The Chair
If there are no further questions, can I thank the witness? We will move on to the next panel.
Examination of Witness
Dr Laura Squire gave evidence.
Q
Professor McNeill: Very. Keeping vapes accessible, both in terms of price and where they can be purchased, is really important for smokers to stop.
Professor West: I was going to reinforce the point about young people, smoking and disposables. It is about the unit cost, or having a low start-up cost. With disposables, if you look at it over the long run they are more expensive than having a tank device and refilling it with the liquid, but the upfront cost is greater. We do not know for sure, but certain bits of evidence point in particular directions. If you put the unit cost, or the start-up cost, together with the potential ease of use, the appeal and all the rest of the things in the package, you reach a point at which arguably you cross a threshold and then it begins to take off. Then it becomes a self-fulfilling thing, because it becomes fashionable and faddy. It is possible, if the plateau we are seeing now carries on or if it starts to go down in the absence of what we might do, that will also be testament to the social norm side of it. Running against that is the fact that nicotine is addictive, so that will drive it up. However, I think you make a good point.
Q
Professor McNeill: I certainly think the cartoon packaging and names are inappropriate and clearly targeted, at young people, as I think the previous speaker said, and they are unnecessary. As she said, they are probably not having the effect we want with adult smokers in making them feel that these products are for them, so I do think about reducing that branding. The promotions on social media seem to be important and influential, so if something can be done about that, that would be good. I also think the easy accessibility in shops is a factor.
Q
Professor West: I think that is right. What was interesting is that I talked about having your cake and eating it, and we were doing pretty well until recently. A key factor there, if you look at the sentiment among young people and what they thought of vaping, was that it was an old person’s thing to do to help them stop smoking. That is what we want; we want people to think of vapes as a thing you use to help you stop smoking. Unfashionable, but useful.
(2 years, 3 months ago)
Public Bill CommitteesI am an NHS consultant paediatrician, and a member of the Royal College of Paediatrics and Child Health.
I am a practising psychologist, and I also chair the all-party parliamentary health group.
Sir George, do we have to declare our memberships of any groups? I am a member of the all-party parliamentary group for responsible vaping.
The Chair
We will now hear oral evidence from Michelle Mitchell, the chief executive of Cancer Research UK, Deborah Arnott, the chief executive of Action on Smoking and Health, and Sheila Duffy, the chief executive of ASH Scotland. To begin with, I will call on Michelle Mitchell.
Michelle Mitchell: First, thank you for your openness and transparency, Sir George. It is also important to declare whether anybody giving evidence has associations with the tobacco industry; I have none. The principle of accountability and transparency is also important for the people who are giving evidence.
Smoking is the biggest cause of death, ill health and disability. It is the biggest cause of cancer in the UK. It has a huge impact on preventable deaths, the economy, productivity and of course families and loved ones. Cancer Research UK supports the legislation to create the first ever smoke-free generation and to stop young people developing addictions, risk, ill health and, of course, cancer. We believe that the rights and entitlements of current smokers are reasonably unaffected. We urge you through your considerations in Parliament to pass the legislation, as does the public, 73% of whom support the legislation.
Q
Dr Griffiths: I would observe that there is so much variation between products and how people are consuming them. I think it is quite difficult to give advice in a standard way, and that it is part of it being an emergent product and market. As we have discussed, there is no doubt that, with nicotine being so deeply addictive, it is an incredible worry that a child has a single puff on a vape, given the potency of nicotine and where we know it leads people, having seen that over generations with smoking.
I should perhaps take a moment to emphasise that we also really support the £70 million investment being allocated to public health campaigning and cessation services, as well as enforcement. You are right that we need to be really clear with the messaging of the Bill to encourage support from parents and others around children in particular. We really applaud the decision to put resourcing behind this as well. We know that effective public campaigning can be an incredibly powerful tool. We were really proud to run the “Give Up Before You Clog Up” fatty cigarette campaign way back 20 years ago, and we know even that campaign led to 14,000 smokers seeking to quit. We know public campaigning works, and it was a great thought to allocate that resource as part of this work—it will be needed.
Sarah Sleet: The variation in nicotine levels and the method of delivery, which affects the uptake of the nicotine, is undoubtedly very concerning in vapes. I am a mother of three adult children who all vape, and I am very concerned about how often they are doing that and what impact that is having. We must also remember that, from what we know at the moment, it would appear that smoking is far and away the most damaging activity, compared with vaping. There is a little bit of concern that we overemphasise the harms of vaping to the extent that people say, “Well, I might as well smoke then. I’ll do that instead.” We need to be very careful about how we have this conversation.
Q
Dr Griffiths: That is an interesting question, and I can see the clear linkage you have described, but I am not able to provide any evidence. I am very happy to go back and provide that as a follow-up.
Sarah Sleet: I am not aware of any evidence around that either.
Dr Griffiths: It is a great question.
Q
Matthew Shanks: I completely agree. The way in which vapes are marketed—the colours, flavours and so on—and the places where they are marketed suggest to people that they are safe. The fact that they are put forward as a “safe” alternative to cigarettes, the fact that parents use them and the fact that there are lots of colourful vape shops open in high streets: all those aspects promote the idea that vaping is okay.
At the same time, getting into a child’s mindset—we have all been there, as children—we like to break the rules and feel like we are pushing at boundaries. We know that it is not okay, but it is made okay. I would suggest that more children engage in vaping than in cigarette smoking, because they are not sure what the harmful effects are. That is the danger in it. I do think it leads on, because the younger children vape, but by the time they are 16 or 17, vaping might not be cool any more, so they go on to cigarettes or other things.
Anecdotally, we have heard of schools down in the south-west where people are putting cannabis into the vapes, so the addiction grows from that point of view as well. It leads to children coming out of lessons agitated. If I did not have three coffees in the morning, my agitation would be quite high. If children are not getting nicotine, as well as going through all the other things they are going through, they really do present as confrontational to staff, which makes it difficult to deal with them in classrooms and engage them in their learning. At the same time, to repeat a point I made earlier, you have parents at home who are saying, “Well, it’s okay to do.” I absolutely concur about the way it is marketed and so on.
Patrick Roach: To add to that, because those are important points: vape producers and manufacturers, and indeed those supplying vapes, are advertising freely in ways that make their products increasingly attractive to children and young people, with the way vapes are advertised and the marketing descriptors used for them. All the evidence we have, and certainly what our members tell us—our survey was of 4,000 teachers, so this is not anecdotal; it has an impact right across the system— suggests that the way those products are marketed and described deliberately seeks to entice young people to make use of them.
We believe that this is a strong Bill that very clearly sets out the societal expectations in this space, but as with any legislation, there is always scope for loopholes. If there are areas in the Bill where there is potential to further strengthen the legislation, I think the enticing way products are described, before an individual understands what they are getting themselves into, is something that needs to be considered and addressed.
From our point of view, it is about advertising, but it is also about access to these products. With the best will in the world, and no matter how they are advertised, if the products are easily available at the point of sale it makes things incredibly difficult. I remember that when I was bringing up my own children I worried about going to the supermarket with them, because they would be surrounded by candy and sweet products at the checkouts. You could not navigate your way through the checkouts. Thankfully, things have moved on: that has changed, and many parents are benefiting from those changes.
Young people are very much interacting with many of these products at the point of sale. They are in the shops that are in the vicinity of or on the route to and from school. They are being marketed in places that young people will frequent, whether that be a local café, the hairdressers or the barbers. They are in places where young people will be. They are also immediately available. The more we can do to stop the immediacy of marketing of these products and that easy availability, no matter how they are described, the better.
Q
Matthew Shanks: Absolutely: children will find any which way they can to do what they want to do. At the moment, while this is not illegal, they will gather more people to follow the crowd and go out. In my experience, the majority of children want to do as they are instructed—probably about 85%, anecdotally, over the years—but they will follow the herd. At the moment, there is a greater herd growing because of all the things we have talked about, with the marketing and colour of vapes. I can absolutely see children going out at lunchtime and spending their money on that, instead of on food. There is peer pressure to do that as well—it is taking more people with them. As Patrick said, you can see these products in the barbers, in the shops and so on.
Patrick Roach: To add to that, there are also bullying behaviours that manifest themselves. Whether a pupil is making the choice to go out at lunchtime to acquire vapes or is feeling coerced to do so, there is an issue either way. The availability of those products in the proximity of schools needs to be considered. That is a point that we would make.
Increasingly, schools have introduced systems to seek to ensure that children are being fed at lunch times, for example. We should not lose sight of that, but in some instances these products—particularly disposable vapes —are cheap as chips. I know that that is an issue of concern to the Government, and it is of concern to us and our members.
It is really important that we look at how we can ban the sale of disposable vapes entirely, because frankly no one knows what is in them, and they are incredibly cheap to acquire. Even if your parent can see what you had on Tuesday lunchtime because it comes up on their phone, how will they know if you have spent 10 minutes popping out to the local shop to acquire some vapes, particularly if they are of the disposable variety? More can be done not only to limit appeal, but to reduce the availability and accessibility of those products to young people. The more that can be done on that, the better.
The Chair
Four more people want to get in—actually, it has just gone up to five—and we have about 12 or 13 minutes left. It is unlikely that I will be able to get everybody in, but if Members put their questions as briefly as possible and witnesses respond as concisely as possible, I will try.
The Chair
I will attempt one final question from Dr Lisa Cameron. I simply make the point that the briefer the question, the more possibility there is that she will get an answer.
Q
Paul Farmer: I think a lot of people made a choice without having the information in front of them. I suppose my parting thought to this Committee is that the consequences of failing to intervene in previous generations are now seen by the older people of today. If this legislation is implemented, the first generation of people will not reach 65 until 2074, but I can tell you that that generation of 65-year-olds will look back and recognise the contribution that the Government have made to changing and impacting on their long-term health in the same way that this generation looks back on the contribution of other Governments in other health initiatives.
The Chair
I thank the witness for his answers to the questions from Members, which were really helpful. They gave us not only the perspective of those who his organisation represents, but the intergenerational nature of their role in the world. That brings us to the end of this morning’s sitting. The Committee will meet again at 2 pm here in the Boothroyd room to continue taking oral evidence.
Ordered, That further consideration be now adjourned. —(Aaron Bell.)
(2 years, 3 months ago)
Public Bill CommitteesQ
Ailsa Rutter: We have a really good track record over the last two decades of collaboration and cross-party working, with fantastic support from civil society, the NHS and local authorities. The previous legislation has gone through really well, overall, because we have worked together to build up public awareness and support. It is really important that we have adequate resourcing for our important professional groups, such as trading standards.
For me, it is about the communication, the vision and the narrative that we can set. Undoubtedly, if we can get this through, it will not just stop a whole new generation starting; we also know that it will trigger many people to think, “You know what? I am going to give it another go. I am going to try to quit.” We know that it can take people many attempts to quit for good. That is why it is really good that this is being backed up by additional investment in the important stop-smoking support systems and in our NHS trusts.
Q
Ailsa Rutter: I note the aspects of the Bill that deal with flavours. We absolutely think that more should be done on the descriptors. We wholeheartedly agree that some of the description is completely inappropriate. However, flavours play a really important role. For example, in our mental health trust, it is the fruit flavours that have got addicted smokers to stop. I genuinely have not heard that come up in the north-east—parents thinking that it is somehow healthy for a young person if it has a fruit flavour. What is wrong, though, is when it is in a packet called “Unicorn bubbly shake” or whatever, with a cartoon image on it. Those are things that we should look at addressing.
On vaping by young people in the north east, I want to make the point that we need to be careful about the data. Sometimes people say that all young people are vaping, but the evidence does not stack up. All of our local authorities do health behaviour questionnaires and, across the board, around 10% occasionally vape. I am not at all saying that we should be happy with that, but the risk of a public narrative that all young people are vaping is that we inadvertently promote it as a norm. Schools North East—
The Chair
Order. I am sorry, but we have hit 2.50 pm. Caroline, I am sorry to you, too. We are not allowed to go over the time limit. Ailsa, thank you so much for your evidence; it has been absolutely first-class. We wish you well with all the important work.
Examination of Witness
Adrian Simpson gave evidence.
Q
Adrian Simpson: Exactly. Our membership is predominantly the household-name retailers—the large retailers; the ones that certainly would not be selling illicit vapes. We have comprehensive supply chains, and our members put a lot of effort into making sure that their supply chains are operating with integrity, so that illicit products cannot enter them. I have not seen that report, but my feeling would be that the sellers mentioned in it are highly unlikely to be members of a reputable trade organisation. They might be ones that would not be looking for the same standards that our members would operate to.
Q
Adrian Simpson: A lot of the training done by our members has been put together with the help of trading standards’ services, so there is a lot in there about the law, but also about what perhaps is termed the soft skills—how to deal with the aggression, and with violence as well. Of course, this is a high-profile issue, and it is one of the top priorities at the British Retail Consortium as well.
We know that, with new rules, new regulations and new opportunities to challenge consumers, there will always be some resistance from consumers. We will certainly make sure that all our colleagues working in our members’ stores are given all the support they need to deal with any potential aggression or any bother, and our members will comply with whatever the law says. They will not let someone who should not buy a product buy it just because they are worried, or something like that. They will follow whatever the in-store procedures are and the training from the work with trading standards.
Q
Adrian Simpson: I agree—that is difficult. It takes me back to discussions around Challenge 25, which we have mentioned. It started out as Challenge 21, and the age was raised because it was very difficult to tell the difference between a 21-year-old and an 18-year-old. Technology is evolving in this area. There are new things. We know that members are using new forms of technology to help with that. They rely on things like Government-issued ID. There are various ways of challenging someone. It comes down to things like the training and how the consumer is around the till. Are they acting nervous or like they are up to something? It is then down to the retailer to use the training that they have been given to check the ID and use their own in-store procedures, as well to try to operate responsibly.
Q
Adrian Simpson: Yes, we do work closely with trading standards, who are very good at doing the education side. It is not just about educating our members, but educating the public and bringing about a cultural change where it is almost expected that you will be asked for ID. If you have been in any large retailer recently, you have probably seen the badges they wear that say, “It’s our job to ask for your age”, for example. Certainly, among our member businesses, it very much is the culture to go for the Challenge 25. Although these regulations with the rolling age will have challenges, I am sure our members are well placed to overcome them.
Q
John Herriman: I will let Kate answer on this one as well. There was a really good, comprehensive answer earlier from one of the people giving evidence: if this is the right thing to do, the right idea, it is something we will have to get used to doing. I think that is probably the principle that we would apply within the world of trading standards as well. We just have to get used to the new legislation and what it asks us to do, and then make sure that sellers are following that legislation. Probably the problem will be more at the business end rather than at our end, and this is where there is a really important role for business education and the likes of the British Retail Consortium, the Association of Convenience Stores and other organisations.
We must get the balance right: this is about the enforcement activity and the right level of legislation, but we also have to make sure there is an onus of responsibility and accountability on businesses themselves to solve part of the problem. I do not think it is right to put all of the problem on enforcement, for example. Therefore I would definitely be looking towards businesses to make sure that they are embracing this and making sure that they are doing the right business education and training along the way. Have you anything else to say on that, Kate?
Kate Pike: Absolutely. The other point, obviously, is about resources, which John has already highlighted. We are in discussions, but we do need to make it clear that trading standards needs more resources to enable it to deliver the enforcement in this Bill.
The Chair
I think we have received that message very loud and very clear.
Kate Pike: Good.
John Herriman: Did I mention that? [Laughter.]
(2 years, 3 months ago)
Commons ChamberThese reforms are being brought forward because of a simply unsustainable rise in the number of people being given fit notes so that they cannot re-enter the world of work. We want to support people into work, not only because we believe that it is the best way to help them to recover, but because it helps us to fund the NHS. It is funded by people who work and pay their taxes. Again, I draw the hon. Lady’s attention to matters a little closer to home; sadly, Scotland’s record on health is very difficult to read and it includes the worst level of drug deaths in Europe. I encourage her to concentrate on how the SNP is running health services in its local area.
That is an important point. We know how vital it is to support everyone who is working so hard in our NHS to support patients. NHS England is reviewing mental health services for all staff who need them, to ensure that they can access the support they need. It is working collaboratively with regions and integrated care systems to agree the best approach to doing that.
(2 years, 6 months ago)
Commons ChamberI have news for the hon. Gentleman, because we have a plan and it is working. Our investment of £143 million into crisis support is showing early evidence of reducing admissions—admissions are 8% lower. With the crisis telephone services, which are available 24/7, we have admissions down 12%. More importantly, detentions under the Mental Health Act are 15% lower. We have a plan, and it is working.
We have made progress against our target to reduce learning disability and autism in-patient numbers in England by 50% since 2015. For people with a learning disability without an autism diagnosis, there has been a 58% net reduction; for people with a learning disability who are autistic, the net reduction is 35%.
I thank the Secretary of State for that comprehensive answer. As chair of the all-party parliamentary group for disability, I have been hearing from organisations such as Mencap that remain concerned that people with learning difficulties are disproportionately detained for five to 10 years and for over 10 years. Will she reassure those organisations that the “Building the right support” action plan will continue to progress the great work that is being done?
I thank my hon. Friend for her interest and, of course, her many years working as a clinical psychologist. She brings that experience to the Chamber. National commissioning guidance to integrated care boards was published in November. It sets out that a mental health in-patient stay for a person with a learning disability
“should be for the minimum time possible, for assessment and/or treatment which can only be provided in hospital”.
In overseeing implementation of the action plan going forwards, the “Building the right support” delivery board will maintain focus on quality of care and on reducing long stays.
(3 years, 2 months ago)
Commons ChamberClearly, an increase in population in a specific area will have an impact on the health needs there. I recognise the concern that my right hon. Friend raises, and I will ask the Minister for Primary Care and Public Health to follow up with him on this important point. While the NHS is well equipped to deal with short-term pressures, this issue highlights the importance of the Prime Minister’s commitment to stop the boats and the Government’s overall strategy on illegal migration.
I very much welcome it. I am delighted to hear that constructive approach to AI from the hon. Lady. The importance of AI is why we have been funding more than 80 AI lab schemes with more than £130 million. AI has huge potential to help patients. We are seeing that, for example, in stroke patients getting care much quicker. She is right that there are also some regulatory and other issues that we need to address, but we should not miss the opportunities of AI, and she is right to highlight them.