Smoking

Lord Rennard Excerpts

Thursday 25th January 2024 Lords Chamber

Asked by

[Lord Rennard]

To ask His Majesty’s Government what progress they have made towards the ambition of creating a “smokefree” generation by 2030.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)]

Smoking is responsible for around 80,000 deaths a year in the UK, costs our country £17 billion a year and puts a huge burden on the National Health Service. That is why we will shortly introduce the tobacco and vapes Bill to Parliament in the coming weeks, to create the first smoke-free generation and further crack down on youth vaping. The Bill will be informed by our recent consultation, which we will publish soon.

--- Later in debate ---

[Lord Rennard (LD)]

My Lords, all parties have agreed on the need to reduce the prevalence of smoking in this country to below 5% by 2030, so the Bill to prevent young people ever becoming smokers is vital. Does the Minister accept that we need to do more to help the over 6 million people in this country who are addicted smokers, most of whom are struggling to give up smoking and want to? They are damaging their health and that of others affected by smoking. Does he agree that allowing integrated care boards to make further cuts to tobacco dependence treatment budgets will not help us to achieve this target?

[Lord Markham (Con)]

I thank the noble Lord. Actually, Khan recommended four major things to achieve that in his report Smokefree 2030. The first was to increase the anti-smoking spend that the noble Lord refers to. As part of this, we propose to increase that spend from £70 million to £140 million—so we are doing absolutely what the noble Lord suggests. The second was to increase the age of sale, which of course this legislation is all about. The third was to promote vaping to help quit smoking. Again, the legislation will do that. The fourth was to increase NHS prevention methods which, again, we will do from here. So it is very much a range of measures to stop people ever smoking but also to stop many who are currently smoking by helping them to quit.

King’s Speech

Lord Rennard Excerpts

Thursday 9th November 2023 Lords Chamber

[Lord Rennard (LD)]

My Lords, in the seven minutes in which we are asked to speak today, seven people will have hospital appointments because of their smoking habit. The Department of Health and Social Care estimates that this amounts to around 450,000 hospital appointments in England every year. In the seven hours we expect to debate today, around 700 GP appointments will be made because of smoking. Cancer Research UK estimates that around 900,000 GP appointments are made every year because of smoking. In England alone, nearly 200 people will die every day because of smoking.

The tobacco manufacturers try to suggest that the frequent ill health and the 50% death rate of those who smoke are a simply a matter of their personal choice, but smoking tobacco has consequences for many other people beyond those trapped by nicotine addiction.

Aged 16, I was woken by my younger brother, as our mum had overslept and we were late for school. I got up, but I could not wake her. She was just 53, and she never woke up. She was a heavy smoker and severely disabled. She died of hypertensive heart disease, and smoking was a significant contributory factor in her death. She did not choose to die that way; she was addicted. She did not choose for her children to become orphans and for us to lose our home—and becoming homeless at that time was not a “lifestyle choice”. So, yes, the issue is a personal one about the consequences of smoking: it is not a choice but an addiction, and one which the vast majority of smokers, having started in their youth, come to regret.

There was little in the gracious Speech to inspire anyone, including those on the Government Benches. Change is not change when little more is promised than bland slogans about a brighter future but with the same people and the same policies. But praise must be given where praise is due; and the latest in a lengthy line of successful measures to help reduce the prevalence of tobacco smoking is to be heartily welcomed. Lives will be saved; people will be healthier and wealthier, and the whole country will benefit.

This year, the cost to the public purse of early deaths due to smoking will be £31 billion. This year, the cost of lost productivity due to smoking will be £38 billion. This year, the cost due to smoking in terms of lost tax receipts, increased social security spending and extra costs to public services such as the NHS will be more than £9 billion, and that is after the tax receipts from tobacco are taken into account.

Meanwhile, the tobacco companies continue to make enormous profits. This year, the four biggest tobacco companies in the UK will make around £900 million in profits. It is no wonder that they spend so much money on desperate tactics to deceive people about every single measure that we have ever introduced to reduce the prevalence of tobacco smoking. We should listen instead to medical advice. Sir Chris Whitty, the Chief Medical Officer for England, spoke recently about the plan to gradually raise the age at which you can be legally sold tobacco. He said:

“The overwhelming majority of the medical profession, the nursing profession and all the health charities support this”.


He described claims from the tobacco industry that the policy would not work as “bogus”. He told the BBC:

“As a doctor I’ve seen many people in hospital desperate to stop smoking because it’s killing them and yet they cannot—their choice has been removed”.


The Bill has support from the British Heart Foundation, Cancer Research UK, the Royal Society of Public Health, the UK Faculty of Public Health, Asthma + Lung UK, and Alzheimer’s Research UK, among all the many organisations putting public health above the vast private profits of the tobacco companies. However, using their well-funded front organisations, the tobacco companies are orchestrating their usual deceptive and devious techniques to try to protect those profits. They have a few champions, such as Liz Truss and the Institute of Economic Affairs, which helped her to crash our economy—and Boris Johnson, whose judgment and integrity are well known, who says that the plan is a ban.

The plan is not a ban on smoking, because no smoker will be banned from their habit. What will be made illegal is underage sale, in the same way that a few years ago we extended the minimum age for someone who can be sold cigarettes from 16 to 18. The plan will extend this further year by year. The measure offers great hope to everyone below the age of 14, for whom it will never be legal to be sold cigarettes. The evidence is that such measures will not increase the illicit market. When the age of sale increased from 16 to 18 in 2007, it had no negative impact on this market, which continues to fall.

The issue of moving to a more smoke-free Britain, and seeking to be smoke-free by 2030, does not involve a choice between restricting sales of tobacco and more public health activity to help smokers quit. We need both. Two-thirds of those people trying just one cigarette, usually as children, go on to become daily smokers, and daily smokers are addicted smokers. The plan to limit cigarette sales further has strong public support; it does not divide the Government and the Opposition Front Benches—and I hope that pressure from the tobacco lobbyists will be firmly resisted across both Houses, as it clearly has been in this House today.

Osteoporosis: Early Detection

Lord Rennard Excerpts

Thursday 19th January 2023 Lords Chamber

[Lord Markham (Con)]

I agree with my noble friend that prevention is always better than cure. The beauty of these processes is that I get to swot up, and I learned that the second largest bed-intake cause is actually a fractured femur from osteoporosis, so he is correct. We have a target that 95% of patients will get a check within six weeks by March 2025. It is good that musculoskeletal services are now part of the national improvement programme, but we clearly need to make sure we are on top of that.

[Lord Rennard (LD)]

My Lords, a year ago the Minister’s predecessor said to the House that he hoped NHS England would ensure that effective fracture services were universal. However, unlike in Scotland and Wales, that is not the case in England. Is not part of the problem with healthcare in this country that the Government struggle to resource treatment and pay for those who provide it while failing to invest in prevention and public health initiatives? What action are they taking to ensure that osteoporosis is given sufficient priority by recognising that it needs to be considered in parity with other long-term conditions?

[Lord Markham (Con)]

The noble Lord refers to the fracture liaison services. It is the responsibility of all ICBs to roll out those services or their equivalent. Regarding the numbers that he cited, I should say that 51% of ICBs have a fracture liaison service in that shape or form and the others have different versions of it, and they are all responsible for rolling those out. At the same time, they are also responsible for musculoskeletal services, to make sure that we have nationwide provision for it.

Tobacco Control Plan

Lord Rennard Excerpts

Wednesday 23rd November 2022 Lords Chamber

[Lord Markham (Con)]

I agree with my noble friend. The key age group to attack, so to speak, is 16 to 18-year-olds, which is often when the smoking habit begins. We must look seriously at every step we can take to reduce smoking in that age group. I am also aware that 18 is the age of consent, of being able to do lots of things, and changing that for smoking would obviously be quite a radical step, but everything is on the table as we review the best way forward.

[Lord Rennard (LD)]

My Lords, the Health Foundation recently published figures showing that the budgets for tobacco control and smoking cessation have been cut in real terms by 41%. Is not part of the answer to funding treatment for addiction to tobacco, alcohol and gambling the extension of the “polluter pays” principle? What is the argument against a levy on the very large profits of the tobacco companies, in order to pay towards helping their customers who want to quit?

[Lord Markham (Con)]

There are a number of ways we can tackle this, price, obviously, being one of the main ways, along with taxation. The noble Lord will be aware that we increase the tax by 2% every year, and cigarettes prices here are now the highest in Europe. We are still providing funding of £73 million per year to help 100,000 people stop smoking. But it is not always money that counts. Anti-smoking campaigns, branding restrictions and taxation are all other elements which are proving successful.

Ambulance Delays

Lord Rennard Excerpts

Wednesday 9th November 2022 Lords Chamber

[Lord Markham (Con)]

I agree with the noble Baroness that social care is a key solution to all this. As I said, that is what is behind the 13% of beds that are currently blocked and the £500 million spend in this area. However, we can be more innovative. That is what the virtual ward initiative, which I saw working so well in Watford, is about; it has reduced reattendance rates after 90 days from 46% to around 8% for COPD patients. This is an area where we need focus and innovation, and which is very much top of my agenda.

[Lord Rennard (LD)]

My Lords, as the Minister has already suggested, part of the problem is unnecessary call-outs to ambulance services for people who do not need admission to hospital. Care homes regularly call on ambulance services to lift their fallen residents, even though more than 45% are uninjured and do not require transportation to hospital. If care homes had the right equipment to lift people safely, an ambulance may not be needed after a fall. Some ambulance services are providing this kind of equipment to care homes, from their own resources, to reduce the number of unnecessary call-outs. Should we not ensure that all such homes and blocks of sheltered accommodation have access to this kind of equipment, which would get people up more quickly, reduce the number of call- outs and save money?

[Lord Markham (Con)]

Many noble Lords have talked today about what is a whole-system problem, which the noble Lord has mentioned in terms of care homes. It is all about treating people in the right place, with the right equipment, so I absolutely agree with this approach. It is the approach that we are taking to make sure that people are treated in the right place, so I will take the noble Lord’s suggestion back to the department.

Bereavement Support

Lord Rennard Excerpts

Wednesday 9th November 2022 Lords Chamber

[Lord Rennard (LD)]

My Lords, I lost my father at the age of three and lost my mother just before I was 17. At that point, my schoolfriends did not know what to say, my teachers’ concern was confined to my academic progress, and when I was suffering from the consequences of bereavement while at university, I found no sympathy or support from staff. Recently, half of the respondents to a Childhood Bereavement Network survey said that they had little or no support from their educational setting after bereavement. What can be done to improve access to bereavement services, to improve the training of education professionals in helping young people manage their lives after bereavement, and to help children better understand the process of dying and managing their emotional feelings in those difficult circumstances?

[Lord Markham (Con)]

I thank the noble Lord, and I agree. I have to admit that when I was a child, I failed a friend, because I did not know what to say. As I mentioned, the DfE is part of this working group and we are training 10,000 early years practitioners in this space to try to ensure that they can provide the training that is needed in schools. The number of schools supported in this way is increasing, but today it is still only 35%, so clearly there is more work to be done. The noble Lord can rest assured that we take this very seriously.

Childhood Obesity

Lord Rennard Excerpts

Monday 17th October 2022 Lords Chamber

[Lord Markham (Con)]

I thank the noble Lord. The figures to which he refers are a mixture of the pricing of these so-called “buy one, get one free”-type promotions and their positioning in a supermarket. In fact, the data shows that as much as a 50% increase in sales can be driven by where these promotions are placed in a supermarket. That is why the focus now is on what changes will be made on 1 October to reduce the purchase of a lot of the types of food groups we are talking about by moving them away from prominent areas. Once we see the results of those changes, we will be in a position to review some of the pricing and promotions to which the noble Lord refers.

[Lord Rennard (LD)]

My Lords, this morning, this month’s Chancellor reversed nearly all last month’s Chancellor’s tax changes. Meanwhile, increasing levels of childhood obesity are adding considerably to the cost to the NHS of treating conditions such as diabetes. Can the Minister confirm the commitment to the soft drinks industry levy, which has been successful in reducing the level of sugar in soft drinks and provides funds for sporting activities in schools and school breakfast clubs?

[Lord Markham (Con)]

My Lords, as the House will be aware, the tax on sugar in drinks has reduced consumption of sugar by 44%, so I totally agree with the sentiment. We have been successful in this. We are looking to improve in the area of sugary food, where we have managed to reduce some of that content by as much as 13%.

Health and Care Bill

Lord Rennard Excerpts

Consideration of Commons amendments
Tuesday 5th April 2022 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, I, too, support the noble Lord, Lord Crisp, in his amendment. My noble friend Lord Faulkner would of course have been in his place to speak in favour, but he is unable to be here, so perhaps I may make a few remarks which I think he might have made.

Going back to Report, the Minister suggested that the tobacco industry is already required to make a significant contribution to public finances through tobacco duty, VAT and corporation tax. But I do not think that states the case as accurately as possible, because we know that tobacco manufacturers are skilled at minimising the amount they pay. For example, between 2009 and 2016, Imperial Brands, the British company that is market leader in the UK, received £35 million more in corporation tax refund credits than it paid in tax. The largest amount of tax collected by the Government comes from excise tax and VAT. This, of course, is not paid by the manufacturer; it is passed on to the consumer. That was a point HM Treasury made in 2015, when the Government consulted but, alas, decided not to put an additional tax on tobacco products to pay for tobacco control.

My understanding is that, in total, smokers spend nearly £11 billion on tax-paid tobacco products, more than three-quarters of which goes to the Government in taxes. We know that the majority of smokers are not well off; they often suffer multiple disadvantages. We must compare that huge tax take with the pitiful amount that is actually spent by the Government encouraging people to stop smoking. It is certainly not enough to make England smoke-free by 2030.

I listened carefully to the Minister’s introductory remarks. The noble Lord, Lord Kamall, objected to the terms of the amendment of the noble Lord, Lord Crisp, because, he said, the independent review had not yet reported and therefore we were seeking to pre-empt what the review will say. I thought the noble Lord, Lord Crisp, responded to that incredibly well. I do not think he is seeking to pre-empt the review; his amendment asks the Government to consult on recommendations in the review if the Secretary of State thinks that it is required. It is left entirely in the Secretary of State’s hands to act according to whether he or she considers that the recommendations should be consulted on.

This is a sensible amendment, it points us in the right direction, and I hope that, even at this late stage, Ministers may be sympathetic.

[Lord Rennard (LD)]

My Lords, if I understood the Minister correctly in his introductory remarks, he was saying that the Government’s case against the amendment is that they do not want to consult on something to which they are not already committed. So what is the point of consultations if they are only on things to which the Government are already committed? Should the Government not consult on what they might do, and take into account the opinions of experts and others?

Amendment 85B, in the name of the noble Lord, Lord Crisp, has the support of these Benches. It is in accordance with my party’s policy but, more importantly, it is essential to the Government’s stated objective of reducing the prevalence of smoking to below 5% by 2030. The amendment does not require the Government to do anything that they do not want to do; it just asks them to consult on something which they have said that they would consider—namely, to make tobacco companies pay more towards helping save and prolong the lives of their customers.

Last year, I found myself outside the HQ of British American Tobacco. It is an enormous headquarters: it looked like a palace of which any Russian oligarch would be proud. This company makes huge profits that could be diverted towards ameliorating the damage done by its products. The amendment would mean taking action to help people live longer and more healthily, with fewer families living in poverty because of smoking.

I expect we will have more warm words from the Minister and from the Department of Health and Social Care, but I believe that Parliament wants to adopt the polluter pays principle in relation to tobacco. So I end with a quote from a great parliamentarian, John Pym, who, in 1628—I am sorry that I do not have the Hansard reference—said: “Actions are more precious than words”.

Health and Care Bill

Lord Rennard Excerpts

Lords Hansard - Part 1 & Committee stage
Monday 24th January 2022 Lords Chamber

We need Amendment 72 in order to provide greater certainty for patients to be able to choose elective care providers, to reduce the enormous backlog of treatment and to send a message to NHS staff about the rights of patients. I hope that the Minister will accept these arguments and will be able to answer my questions. I beg to move.

[Lord Rennard (LD)]

My Lords, I support Amendments 109 and 226 in this group, both of which are in my name and that of the noble Lord, Lord Hunt of Kings Heath. I will address them from the perspective of people with diabetes and with the support of the Juvenile Diabetes Research Foundation and Diabetes UK.

It is just over 100 years since insulin was discovered. Before 1921, a type 1 diabetic would live for no more than a year or two from when the condition became discernible. In the 1920s, my father, a World War I veteran, developed diabetes, and he was very fortunate that this was the decade in which insulin was discovered. It was so successful that it enabled him to have a long and happy life—indeed, I was born when he was 71, and my younger brother was born when he was 73.

Much progress has been made in the treatment of diabetes over the last 100 years, but we are not making the most of technological developments relating to insulin use and diabetes management. I have struggled with these issues myself, and I have learned much about them since I became dependent on insulin in 1994. I personally have enormous reason to be grateful to the diabetic team at St Thomas’ Hospital, just over the river from us, but not everyone with diabetes gets that standard of care, and progress with the adoption of the most recent technology is simply too slow.

There have been great developments in wearable medical technology, such as insulin pumps, flash glucose monitoring and continuous glucose monitoring. We are making progress with such innovations and in NICE’s obtaining approval for them, but they are often not widely accessible. Access to technology, including linking a person’s insulin pump and a continuous glucose monitor, may help a person to self-manage their condition in the absence of routine NHS support. The long-term cost savings are demonstrated by the wider use of such technology in insurance-based systems, where the outlay must be justified by reducing the costs of later complications, which can be very considerable.

Diabetes probably now takes up 10% of the NHS budget, and 80% of the cost of diabetes relates to complications, with the largest costs arising from excess in-patient days, cardiovascular disease and damaged kidneys and nerves. The latest technology may enable parents of young people with type 1 diabetes to obtain a full night’s sleeping soundly, knowing that their child’s glucose monitor will issue an alarm and wake them up if they experience a severe high or low-glucose episode. New technology has been shown to support blood glucose stability and to lower average blood sugar levels, reducing potential health complications and hypos or hypers, which can lead to coma or even death if not treated. There are great benefits to physical and mental health from better long-term control of blood sugar levels.

Research by JDRF shows that barriers to the uptake of this technology include the fact that many clinicians are not trained in it and that the pressure on appointments means that there is often not time to discuss treatment options. Amendment 109 would require NHS England’s oversight framework for integrated care systems to include a metric on the percentage of diabetes patients in their area accessing diabetes technology. An embedded requirement that would better support the prescription of technology would incentivise better training for clinicians and encourage more time to be provided in appointments to discuss technological treatment options and any potential fears or concerns of the patient.

Amendment 226 concerns the promotion of self-management using the latest technologies. We need it in order to reduce the number of people with diabetes suffering from complications, which may include sight loss and problems with their feet, presently resulting in around 6,000 amputations per year. When in hospital, people with type 1 diabetes require five times more secondary care support than people without diabetes, so it is essential that the NHS invests in technology that can significantly reduce the instances of hospitalisation and adverse health outcomes for people with type 1 diabetes.

[Lord Lansley (Con)]

My Lords, I thought those were very interesting and helpful remarks from the noble Lord, Lord Rennard. They serve to remind us of the importance of self-management in securing the best possible outcomes for patients. I just add the thought that, when the Government promulgate regulations relating to patient choice, one of the things we want to include is shared decision-making between clinicians and patients. In my observed experience, that too can deliver better outcomes. I think we have made significant progress in recent years in encouraging shared decision-making, and I hope we will see that come forward.

In moving Amendment 72, the noble Lord, Lord Warner, touched on a range of issues. I will not go down one or two paths, but I highlight that we will need to think hard about the interconnections between the question of patient choice and how far patients continue to be given choice. We need to ensure that it is not just talked about in the constitution or in regulations that say it is generally a good thing. For choice to happen in practice, subsequent clauses in the Bill relating to procurement, such as Clause 70, need to enable a choice of providers. The noble Lord made that perfectly clear.

The clause relating to payment systems—Clause 68, if my memory serves me correctly—still needs to have a “money follows the patient” approach. It is not me saying that these are all good things; they were put in place by the Blair Government, not the coalition Government, who did not do away with them but entrenched them.

I am worried. I will just make this point about Clause 70, the effect of which is to repeal Section 75 of the 2012 legislation. Included within that was that one of the requirements of the procurement regulations would be to support the right to patient choice, and the Government are proposing to repeal that.

The Minister may well, perfectly correctly, say, “That may be so, but we have the power in this Bill to set regulations relating to patient choice”, but this is separate, and, in the event, we may find that the link is broken between procurement and payment and patient choice. The net effect would be that patient choice is vitiated. I am worried, for exactly the reasons that I think the noble Lord, Lord Warner, is worried, that what has been around for some 18 years in one form or another—the expectations on the part of patients that they can exercise choice—may not be able to be exercised in practice because the preference of the NHS in many of these localities is to operate as a monopoly and not to give any opportunities for that choice actually to function.

Our debate on this group would be far better and easier to have—and might not even be needed—if the Government published the regulations under Clause 68 in draft so that we can see what they are proposing to do. They have not done it; between now and Report they could do it. When we get to Report, we are going to have a very difficult—certainly from my own personal point of view—set of conversations about how patient choice is to be exercised, how the NHS is to get best value from its procurement, and how trusts and providers are to be paid appropriately, rather than simply go back to block budgets. How do we get out of that debate? The answer is: let us see what the regulations the Government are proposing—in this case relating to patient choice—actually look like, and let us see it before Report.

Health and Care Bill

Lord Rennard Excerpts

Committee stage
Thursday 20th January 2022 Lords Chamber

[Lord Rennard (LD)]

My Lords, I draw the Committee’s attention to my registered interests in healthcare equipment. I have added my name to Amendment 50, moved by the noble Lord, Lord Black of Brentwood. The noble Lord, Lord Hunt of Kings Heath, demonstrated clearly, as have others, that it simply cannot be said that the amendment is unnecessary.

The recent report on fracture liaison services from the APPG on Osteoporosis and Bone Health makes important reading. It shows clearly that the health and independence of tens of thousands of older people who suffer from osteoporosis are threatened by great inconsistencies in accessing vital services and treatment. Far too many people are suffering multiple fractures before their condition is properly diagnosed. Much unnecessary pain is caused and more permanent disability results from failures to diagnose osteoporosis in thousands of cases. Those failures add significantly to the future costs of the NHS and care system than would have been the case with early diagnosis.

The Committee has already heard from the noble Lord, Lord Black, of the significant cost savings to the NHS where a fracture liaison service is in place. The Royal Osteoporosis Society estimates that extending fracture liaison service provision to cover the whole population would require a modest initial investment of about £27 million in England and £2 million in Wales. There should be much more long-term cost-benefit analysis of provision such as this, and it would more than justify those sums of expenditure.

There are many examples in preventive healthcare where focused interventions dramatically improve outcomes for patients and cut long-term costs. We need to raise awareness of conditions such as osteoporosis, provide more education and training for healthcare providers about diagnosing it and increase support for people who suffer from it. Osteoporosis is a long-term condition. It is more prevalent than many people realise and we should all recognise that a spinal or hip fracture is equivalent to a heart attack or stroke in terms of its clinical implications. Fractures are often preventable through use of pharmacological treatments supported by lifestyle modifications, which include appropriate exercise and smoking cessation as well as nutritional supplements such as calcium and vitamin D.

There needs to be much greater public awareness of how to maintain or improve bone health, particularly for the most at-risk populations. The introduction of integrated care boards will provide an opportunity to better co-ordinate and integrate fracture prevention and osteoporosis care. It is currently too dispersed across different parts of the system, as so often our short debate on this group of amendments has shown is the case. For fracture liaison services we need universal access. We need a clear mandate from government that the new boards have a specific responsibility to provide fracture liaison services for the whole population.