Oral Answers to Questions

Debate between Liz Twist and Baroness Laing of Elderslie

Wednesday 29th March 2023 Commons Chamber

[Madam Deputy Speaker (Dame Eleanor Laing)]

I call the shadow Minister.

[Liz Twist (Blaydon) (Lab)]

Across Scotland, just like in my constituency, the cost of living crisis continues to make life difficult for so many families. Inflation is now at 10.4%, with the British Retail Consortium reporting that food inflation is above 15%, and interest rates have been increased for the 11th consecutive time. The Chancellor’s Budget was yet another missed opportunity for the Government to take the action needed to tackle the cost of living. Does the Minister agree with me that the Government should have implemented a proper windfall tax and used the money raised to help struggling families?

Smokefree England: Covid-19 and PHE Abolition

Debate between Liz Twist and Baroness Laing of Elderslie

Thursday 12th November 2020 Commons Chamber

[Liz Twist]

Sorry, Madam Deputy Speaker. I am getting carried away.

I will be asking the Minister what he will be doing to ensure that vital maternity safety programmes, such as the saving babies’ lives care bundle, can get back on track. I will be asking him what he will do to develop a national strategy for reducing rates of smoking in pregnancy among women from disadvantaged communities, learning the lessons from the areas where the greatest declines have been seen in smoking in pregnancy. I will be asking him how he will ensure that mental health trusts are required to implement National Institute for Health and Care Excellence guidance and that the Care Quality Commission is directed to assess that when it carries out its inspections. Finally, I will be asking him what steps he will take to ensure that smokers with mental health conditions receive evidence-based advice about switching from smoking to vaping.

I want to elaborate a little further on those issues. As a result of comprehensive action at national, regional and local levels, significant progress has been made over the years on bringing down smoking rates in England. The 2019 prevention Green Paper’s commitment to make England smokefree by 2030 was an appropriately ambitious and welcome commitment to continuing this important mission. However, a year on from the end of the Green Paper consultation, we have yet to see the Government’s response or their promised and much-needed further proposals, which would enable us to meet the 2030 ambition.

Despite our national progress, smoking remains the leading cause of preventable illness and death in England. Each year, smoking kills more people than obesity, alcohol, drug misuse, HIV and traffic accidents combined. Smoking is a particular challenge in my constituency of Blaydon, where 17.4% of adults smoke, compared with 15.3% across the north-east and 13.9% nationally. Smoking costs Blaydon £1.8 million every year, largely as a result of NHS treatment costs, lost productivity due to ill health and premature death caused by smoking. For communities such as Blaydon, achieving the smokefree 2030 ambition will be tough, but it remains essential for the health and wellbeing of our community. However, analysis by Cancer Research UK finds that on current trends, disadvantaged communities such as my own will not become smokefree until the mid-2040s. This rate of progress is not acceptable and not affordable for our most deprived communities.

The last tobacco control plan was two years late, as we have heard. It should have been published in 2015, and it was delivered in the summer of 2017 only because of the commitment of the then Health Minister, the hon. Member for Winchester (Steve Brine), who I am pleased to say has just joined us. The tobacco control plan that he introduced included the ambition for a smokefree generation, and now that the Government have committed to deliver this by 2030, the pressure is on. Our current tobacco control plan is set to run out in 2022, leaving an eight-year gap in which, according to Cancer Research UK, the rate of smoking prevalence decline must be 40% faster than our current trajectory if our nation is to meet the 2030 tobacco control plan commensurate with the scale of the ambition to be smokefree by 2030.

I shall turn now to the NHS long-term plan. The successful delivery of the plan is essential to the achievement of the smokefree 2030 ambition. The plan published in January last year sets out welcome commitments to tackle smoking in the NHS. By 2023-24, NHS-funded tobacco dependence treatment will be offered to all hospital in-patients who smoke; all pregnant smokers and their partners, too, if they smoke; and all long-term users of specialist mental health and learning disability services who smoke.

The evidence is clear of the benefits this will bring, both to smokers and to the NHS. Smokers are 36% more likely to be admitted to hospital and smoking is responsible for almost 500,000 admissions each year in England. One hospital patient in four is estimated to smoke. The increased demand that smoking places on NHS treatment capacity translates into an enormous financial burden. Each year, smoking costs the NHS around £2.6 billion, including avoidable secondary care costs estimated at £890 million a year. The cost in the north-east to the NHS is around £132.3 million a year, with smoking in Blaydon alone responsible for around £300,000 of that. Across the north-east, it is estimated that implementing the long-term plan commitments at just 40% coverage, as is aimed for by the end of 2021-22, would deliver net savings of nearly £12 million to the NHS in the north-east.

In the north-east, progress towards implementation of the long-term plan’s commitments on smoking is well under way. Treating tobacco dependency is one of two key priorities for the north-east and north Cumbria integrated care system population health and prevention work stream. To focus efforts across the region, a dedicated north-east Smokefree NHS/Treating Tobacco Dependency Task Force was established in 2017. The taskforce has provided strategic direction, developing regional resources and facilitating partnership working with all stakeholders, including NHS trusts, local authority tobacco commissioners, Public Health England and primary care.

As of April 2020, all NHS trusts in the north-east had achieved smokefree NHS status by implementing updated smokefree NHS policies and pathways to identify and treat smokers from admission, in line with national guidance. Across the north-east, trusts have established good links between hospitals and community stop-smoking services funded by local authorities to ensure treatment started in hospital is continued after patients leave hospital. Trusts are training staff to build capacity. They have also signed the NHS smokefree pledge as a clear and visible way to show commitment to helping smokers to quit and to providing smokefree environments.

Elsewhere, progress has not been so heartening, and it is clear that the funding and focus promised by the long-term plan are much needed. An audit of smoking cessation advice and services in NHS acute hospitals, published earlier this year by the British Thoracic Society, concluded that there is poor adherence to national standards and slow progress in identifying and treating smokers. In fact, in many cases the situation is worse than at the time of the last audit in 2016. One smoker in two is not asked whether they would like help to quit. Only one hospital in three has a hospital-funded smoking cessation practitioner, compared to one in two in 2016. Referral to hospital smoking cessation services is available in only four out of 10 hospitals. In 2016, the figure was more than half.

Progress on the long-term plan’s commitments has also not been immune from the impact of the covid-19 pandemic. Early implementation sites chosen to stress test the new tobacco dependency treatment pathways set out in the long-term plan were due to start in April, but this had to be delayed until last month. With winter approaching, and the risk of co-circulation of covid-19 and seasonal flu looming, there is a real risk that work to deliver the long-term plan’s commitments on smoking could be derailed. If we are to achieve the smokefree 2030 ambition, addressing smoking where contact with smokers is greatest is an opportunity that must not be missed

Let me turn to smoking in pregnancy. The Minister is as concerned as I am about this issue, on which there is too little progress. This needs to be a major focus of the next tobacco control plan. Ensuring that more pregnancies are smokefree not only protects the baby as it grows and reduces the risks of complications such as stillbirth and miscarriage; it also gives children the best start in life. NHS England has included addressing smoking as a key part of the initiative to reduce stillbirth and neonatal deaths through its saving babies’ lives care bundle, which is designed to encourage trusts to implement evidence-based measures to improve the safety of pregnancies. However, as with other aspects of NHS activity, this work has been undermined by the impact of covid-19, with a key aspect—carbon monoxide breath tests for all women—currently suspended. I understand that there are also reports from local authorities’ stop-smoking services that fewer pregnant women are being referred for them for support by maternity services. What will the Minister do to ensure that those vital maternity services get back on track as a matter of urgency?

Despite work in the NHS, progress has not been made anywhere near swiftly enough. There are big variations in the performance of different parts of the country. In a soon-to-be published analysis, Action on Smoking and Health finds that rates of smoking in pregnancy have increased in the past five years in a third of clinical commissioning groups, while declines have been seen in less than half, or 44%. It is therefore hardly surprising that the Government seem so unlikely to achieve their ambition of reducing rates to 6% by 2022. In the north-east, we continue to have some of the highest rates of smoking in pregnancy in the country. These are driven by high levels of disadvantage in the region, but, unlike in some regions where rates have even increased, rates in the north-east have fallen in the past five years, from 17% in 2016 to 15% in 2020. Progress has been driven by the regional tobacco programme in the north-east and by the work of NHS England, Public Health England and local government.

The Minister might be interested to hear that a recent analysis by The Times found that areas of the country that were likely to have seen big drops in rates of smoking in pregnancy were also more likely to have implemented financial incentive schemes to support pregnant women to quit. Evidence on the effectiveness of these schemes has been accumulating for many years; they have been shown to increase quit rates when implemented alongside evidence-based quit support. Such incentive schemes are in place in Greater Manchester and South Tyneside. Madam Deputy Speaker, I can see you looking at the clock, so I shall press on.

[Madam Deputy Speaker (Dame Eleanor Laing)]

For the sake of clarification, there are very few people present and the hon. Lady is making important points, so, just for once, I am not putting her under any time pressure.

[Liz Twist]

As you say, Madam Deputy Speaker, this is an important issue.

I return to my point about developing a national strategy for reducing rates of smoking in pregnancy among women and the disadvantaged communities they come from. What does the Minister plan to do to ensure that those reductions are seen and that there is a continued decline in smoking in pregnancy?

Let me turn to smoking and mental health. The last tobacco control plan for England was widely welcomed for including a specific focus on smoking and mental health. With such high rates of smoking in the community and such little progress in reducing rates, this focus was long overdue. Progress has been made since the plan was published, with mental health trusts being set a target: to implement smokefree settings, in line with NICE guidance on smoking, by 2018.

However, despite that, an ASH survey commissioned by Public Health England to look at trust implementation found the following:

“Staff behaviour often enables smoking, with staff accompanying patients on smoking breaks every day in 57% of trusts.

In 55% of trusts, patients were not always asked if they smoked on admission.

Only 47% of trusts offered the choice”

of stop smoking medications

“in line with NICE best practice”.

The impact of covid-19 is likely to have further hindered the implementation of NICE guidance. The Mental Health and Smoking Partnership, a coalition of leading mental health and physical health charities, has raised concerns that some trusts have been rolling back what smokefree policies they had put in place. There are concerns that the Care Quality Commission is not assessing the implementation of NICE guidance on smoking in a consistent way, with trusts receiving conflicting messages on implementation from different parts of the system. Another question I ask the Minister is whether he will ensure that mental health trusts are required to implement NICE guidance PH48 and that the CQC is directed to address this when it carries out inspections.

Action in mental health in-patient settings is only the tip of the iceberg; most smokers with a mental health condition will never have an in-patient stay. The NHS long-term plan has committed to implement a universal smoking cessation service in mental health settings. A promising area for support in the community, and via primary care, is improving access to psychological therapies services, which were established in 2008 with the ambition of scaling up access to talking therapies. About 1 million people with depression and anxiety access IAPT services each year. It is estimated that about 28% of people with depression and anxiety smoke. Quitting smoking has also been found to improve depression, with the same effect as taking antidepressants, so there is a major opportunity to improve both mental and physical health by integrating smoking cessation support into IAPT services. Research by the University of Bristol is under way to explore the integration of support for smokers with these talking therapies, and the early findings are positive. Individual local services, such as Talkworks in Devon, have also started to explore the potential of integration. However, smaller-scale pilots, although important, miss the big opportunity to reach many thousands each year with additional support.

E-cigarettes are a major opportunity to help more smokers to quit, particularly those with high levels of dependency, common among smokers with a mental health condition. E-cigarettes have been shown to help smokers successfully quit at greater rates than traditional nicotine replacement therapies and to be popular quitting aids. Despite the need among smokers with mental health conditions and the potential for e-cigarettes to save many lives, the attitude towards e-cigarettes within mental health services remains varied. Two excellent examples of good practice in mental health trusts can be found in my region, where the Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust and the Tees, Esk and Wear Valleys NHS Foundation Trust both offer e-cigarettes to their patients as a treatment option, alongside the provision of nicotine replacement therapies. Those trusts have shown not only leadership in treating tobacco dependency and implementing national guidance, but real pragmatism on vaping, which could save the lives of many smokers with mental health problems who may not otherwise be able to quit smoking.

Unfortunately, that pragmatism is not found nationwide, and in many trusts the restrictions placed on vaping are not dissimilar to those placed on smoking. Such inconsistency is also seen in staff attitudes towards e-cigarettes. New unpublished data gathered by ASH found that 46% of mental health nurses and 66% of psychiatrists had received no training on e-cigarettes. As a result, many are uncertain about the role of e-cigarettes in supporting smokers in their care. So I reiterate the last of my questions: what steps will the Minister take to ensure that smokers with mental health conditions receive evidence-based advice about switching to vaping? This is an important issue that requires persistence and detailed attention. I look forward to the Minister’s positive responses to these proposals.

De La Rue: Gateshead

Debate between Liz Twist and Baroness Laing of Elderslie

Thursday 25th June 2020 Commons Chamber

[Liz Twist (Blaydon) (Lab)]

I am glad to have secured this debate on the Government response to job losses at the De La Rue site in Gateshead. I know that you, Madam Deputy Speaker, take a particular interest in this debate, as you have a De La Rue site in your constituency of Epping Forest. I thank you for the concern you have expressed for the staff in Gateshead.

On 25 March 2018, I stood in this Chamber as a fairly new MP to ask an urgent question of the Home Office about the awarding of the contract to produce UK passports to Franco-Dutch company Gemalto rather than to De La Rue, which produced the passports at Team Valley in my constituency.

The De La Rue site, which quite literally prints money as well as producing passports, is one of the industrial jewels in the Gateshead crown. It produces high-quality, nationally important projects with great skill and in highly secure conditions. The staff are highly skilled and trained and well paid. These are quality jobs and staff are proud of the work they do. They do not just come from my constituency; they travel from a wide area around. Hon. Members from across the north-east will also have constituents who work at the site.

In 2018, despite huge public support for keeping passport production in the north-east and in the UK, despite newspaper campaigns and despite meetings with Government Ministers, the contract was eventually awarded to Gemalto. UK passport production was to be offshored, with blank books—a highly valuable commodity—being produced overseas and the personalisation being done in the UK.

Decisions were based primarily on cost in the procurement process that started in 2017. In my view, the Government should have taken a more strategic view from the start, as some other EU countries have done, believing that passport production is essentially a part of the integrity of our security system.

I do not absolve De La Rue’s senior management at the time for getting the price wrong, but my concern is for the staff who worked so hard and with such great pride to produce a secure quality passport for Great Britain. We must learn those lessons for the future when we reconsider the passport contract, but meanwhile, De La Rue employees are bearing the after-effects of that decision.

The loss of the passport contract meant the loss of 200 jobs as the contract came to an end, with a start date for the new contract of July 2019, but more job losses were to follow. In June 2019, a further 170 jobs were lost at Gateshead, from the currency production side. One of the two currency production lines printing banknotes was closed down as the company looked to reduce costs in the aftermath of the loss of their passport contract. Work was again transferred from Gateshead to the company’s other sites, including those in Gibraltar and Kenya.

To add insult to injury, chief executive Martin Sutherland stood down with a bonus worth more than 30% of his executive pay of £197,000, as staff pay was frozen, 48% of shareholders voted against De La Rue’s remuneration report in June 2019 and the future of the company looked very uncertain. Staff at the Gateshead site were facing redundancy. The Guardian wrote in November 2019:

“The farewell bonus for Sutherland, who finally departed last month, now looks like a wretched joke about a licence to print money.”

Sadly, it is not a joke for the staff who actually printed the money for De La Rue.

Each time I visited the site, I talked to staff, who are incredibly proud of the work they do and the responsibility that they carry. I talked to the union Unite about trying to save those jobs. Each time, top management told them that they would be looking to bring more work to Gateshead to replace the passport contract. None materialised.

Last week, as the company financial reports were released, news came of the proposal to end production of currency at Gateshead, with the loss of 255 jobs, leaving only 90 jobs in highly specialised functions at a site that just a few years ago had more than 600 jobs. For many staff not on shift when the stock markets opened, the news first reached them via the Chronicle website, social media, a text from friends or local TV and radio news. The staff deserve better than that.

Once again, work previously done in Gateshead will be moved to De La Rue’s other sites in the UK or overseas. There is a direct link between the decision to award the passport contract to Gemalto and the job losses across the Gateshead site. Because of the number of redundancies, there is now a consultation period of 45 days, so I will be working with Unite and echoing its call for this decision to be reversed and for work to be kept at the Gateshead site. Last week, I spoke to the current chief executive and chairman to let them know my anger at the decision and to support Unite’s call for it to be reversed. I will keep on pushing hard for that throughout the consultation period.

However, the Government have a responsibility in this too, and I am asking the Minister to help me and my colleagues to retain these skilled, high-quality jobs in the north-east. I want to know what the Government are going to do to ensure that jobs such as these are retained in the north-east. We simply cannot afford to lose them. These highly-skilled, well-paid jobs will help to stimulate our regional economy. We need sustainable jobs in the north-east. The Government say that they want to level up the north of England, so they must take practical and decisive action to keep those jobs and to secure more of them for our workers.

Behind those numbers are individuals, families and livelihoods. With the loss of those jobs comes a loss of security, of safety, of hope and of aspiration. Many will be shaken and shattered by this news, and those affected will emerge from the current pandemic even more uncertain about their futures. I join with Unite, the staff trade union, in calling for the company to reverse its plans and maintain production at its Gateshead site.

As I have already said, in 2018 and 2019 the previous management of De La Rue told staff at Gateshead that they would work to bring new work to the site and that the site was important to the company. Those promises were not delivered. Empty words mean nothing to people in my constituency, so I urge the Government to act now. They can start by ensuring that De La Rue’s site is maintained and that the contract to produce passports is returned to the UK as a matter of urgency. They can also help by taking action now to help me to keep those jobs in Gateshead. We must act with immediacy not only to protect local quality jobs, but to safeguard our local economy and strengthen our place in a rapidly changing world. The staff of De La Rue Gateshead deserve no less.

I will finish with one final irony. Today, almost one full year after the new contractor was due to take on the passport contract, some passports are still being produced by De La Rue staff on the Gateshead site in Team Valley in my constituency. That work is due to end at the end of June, just a few days from now. The remaining 80 passport staff will lose their jobs and passport production will cease on the site. I thank those staff and all the staff at the Gateshead site, and end with the hope that we will see a resurgence of the high-skilled, high-quality jobs we so need in the north-east.

[Madam Deputy Speaker (Dame Eleanor Laing)]

I thank the hon. Lady for graciously mentioning that I share her concerns, as De La Rue is a major employer in my Epping Forest constituency.