COP10: WHO Framework Convention on Tobacco Control

Martyn Day Excerpts

Thursday 18th January 2024 Westminster Hall

[Martyn Day (Linlithgow and East Falkirk) (SNP)]

It is a pleasure to serve under your chairmanship, Mr Vickers. I am grateful to my cross-party colleagues, the hon. Members for Northampton South (Andrew Lewer) and for Ealing, Southall (Mr Sharma), for securing this debate. I should put it on the record that although I was an initial sponsor of the debate, I removed my name in order to sum up for the SNP. I agree with a lot of the points that my colleagues made; I take a different view on some of them, but one thing we are united in is our desire to know what the Government’s position will be at COP10.

Health is a devolved matter to the Scottish Parliament. Smoking is a significant public health issue in Scotland and a leading cause of preventable ill health, premature death and disability. However, international treaties, including those with World Health Organisation involvement, are reserved issues determined by this Parliament. Personally, I wish that it were otherwise and that Scotland could determine all matters for itself, but until then we need Ministers here to tell us what they are doing on our behalf.

Today’s debate is very timely, because the 10th session of the conference of the parties to the World Health Organisation framework convention on tobacco control, COP10, will take place from 5 to 10 February in Panama, having been postponed from November. I look forward to hearing the view that UK Ministers will be taking on our behalf when those decisions take place.

The framework convention on tobacco control is the first treaty negotiated under the auspices of the World Health Organisation. It came into force on 27 February 2005 and was one of the quickest-ratified treaties in UN history. It was developed in response to the globalisation of the tobacco epidemic. It is a supranational agreement that seeks to protect present and future generations from the devastating health, social, environmental and economic consequences of tobacco consumption and exposure to tobacco smoke by enacting a set of universal standards stating the dangers of tobacco and limiting its use in all forms worldwide. I support those aims. The treaty’s provisions include rules that govern the production, sale, distribution, advertisement and taxation of tobacco. Importantly, FCTC standards are minimum requirements; signatories are encouraged to be even more stringent in their regulation of tobacco than the treaty requires.

Evidence suggests that the FCTC has been very effective where it has been implemented. It is significantly associated with lower smoking prevalence and consequently with an anticipated future reduction in tobacco-related mortality. Smoking declined much faster among children and adults after the UK became a party to the FCTC in 2005. It is worth pointing out that that was some time before e-cigarettes, which are the subject of a major debate in this country, took off. We should therefore endeavour to build on those standards and go further in tackling tobacco and smoking abuse.

Different countries take different approaches. Under the Australian model, e-cigarettes are available only on prescription. We need to take appropriate action to address our own smoking cessation objectives. The Scottish Government have ambitious targets to reduce smoking rates to less than 5% of the adult population by 2034, with the aim of creating a generation of young people who do not want to smoke, with all the health and economic benefits that follow. I cannot pretend to be a young person, and I have never smoked and never understood the desire to do so, but I have many friends who did so and went through great difficulties in stopping. Some have managed to stop, some have relapsed and some have used e-cigarettes to assist them.

Scotland was the first UK nation to commit to consulting on a proposed ban on single-use vapes and other measures. I am pleased to see the consensus that has formed on the need for prompt action, and I welcome the publication of the four nations consultation on smoking and vaping, which aligns with the Scottish National party-led Scottish Government’s goals for smoking cessation and tackling the environmental impact of single-use vapes. Scotland was littered last year by at least 2.7 million single-use vapes. We know that about half a million of our population were using vapes, some of them correctly. Worryingly, though, 22% of our under-18s had tried vaping, so there is a real danger of it being a gateway drug. I am concerned about that. Vaping remains one possible smoking cessation method, but it must not be a lifestyle accessory, and vapes should not be used by children, our young people or non-smokers.

I would be grateful for confirmation from the Minister that the UK delegation to COP10 will not agree to any measures that would restrict Scotland’s options to deliver its tobacco action plan or the recently published tobacco and vaping framework. I end with a question to the Minister: what discussions have taken place with colleagues in the devolved nations in advance of COP10?

Oral Answers to Questions

Martyn Day Excerpts

Tuesday 11th July 2023 Commons Chamber

[Mr Speaker]

I call the SNP spokesperson.

[Martyn Day (Linlithgow and East Falkirk) (SNP)]

Youngsters who try e-cigarettes are at much greater risk of both nicotine addiction and later going on to use tobacco itself, so what consideration have this Government given to banning disposable vapes completely as a way of protecting our young people?

--- Later in debate ---

[Mr Speaker]

I call the SNP spokesperson.

[Martyn Day (Linlithgow and East Falkirk) (SNP)]

Millions of people with disabilities or serious medical conditions rely on specialist equipment, such as ventilators or home dialysis, which personally costs them more money to run, while giving considerable savings to NHS hospitals. Will the Minister urge Cabinet colleagues in the Department for Work and Pensions to help to tackle health inequalities by ensuring that those people receive a fair and timely reimbursement for those additional costs, which are essential to run the equipment to help keep them alive?

[Neil O’Brien]

Absolutely. We are conscious of the additional needs of people who have equipment like that. By the end of June, the Government had covered nearly half of a typical household’s energy bill through the support schemes we put in place, but we are always looking at what more we can do to help vulnerable households.

Defibrillators: Public Access

Martyn Day Excerpts

Tuesday 4th July 2023 Westminster Hall

[Martyn Day (Linlithgow and East Falkirk) (SNP)]

I am grateful to the hon. Member for Erith and Thamesmead (Abena Oppong-Asare) for securing today’s important debate on public access to defibrillators, and I congratulate her on the thorough way in which she opened it. It is always a pleasure to take part in debates that are so consensual, and I suspect we are all on the same page, which is nice for a change.

Cardiac arrests strike without warning, and usually outside the confines of a hospital, leaving people in immediate need of medical attention. We have heard from a number of speakers that fewer than one in 10 people survive, which is truly frightening. According to medical professionals, every passing minute without defibrillation reduces a cardiac arrest victim’s chances of survival by a staggering 10%. In such critical moments, defibrillators emerge as vital instruments that are capable of restoring the rhythm of a failing heart, so accessibility and knowledge of where they are located are vital. Incredibly, there is no official centralised database that records the number of defibrillators and their locations.

Thankfully, as we have heard, some organisations have launched their own maps, such as the British Heart Foundation’s Circuit, to improve access to defibrillators. The Circuit is a comprehensive national network of defibrillators, which aims to improve survival rates by mapping the locations of defibrillators across the UK, enabling prompt access during emergencies. There are currently 60,000 defibrillators registered on The Circuit, but it is estimated that tens of thousands remain unknown to the emergency services. Raising awareness about The Circuit and encouraging registration of these devices will enhance their effectiveness in critical situations.

[Luke Pollard]

Having the data on one database is really important. Does the hon. Gentleman agree that the data has to be accessible and pulled through to other devices? I just googled “defibrillators near me” on Google Maps, and there really are not any, so we need to make sure not only that the data is stored, but that it is publicly available for people, especially on their handheld devices.

[Martyn Day]

That is a very good point. None of us, myself included, goes anywhere without a mobile device nowadays, so that is the obvious tool of choice.

Timely defibrillation is a cornerstone of improving survival, and Scotland’s out-of-hospital cardiac arrest strategy aims to increase to 20% the rate of incidents where a PAD is applied to the patient before the arrival of the Scottish ambulance service. I encourage groups and organisations with a defibrillator to ensure that it is registered.

Early defibrillation can massively increase someone’s chances of surviving out-of-hospital cardiac arrest, but many defibrillators are never used because the emergency services simply do not know about them. “Scotland’s Out-of-Hospital Cardiac Arrest Report 2019-22” highlights:

“The number of Public Access Defibrillators (PAD) in communities across Scotland that are registered on the national defibrillator network (The Circuit) has more than doubled since 2019”.

That is good, but we need to do better. Currently around 5,000 are registered. Registration on The Circuit makes a PAD device visible to the Scottish Ambulance Service and alerts emergency call handlers that there is a pad near an out-of-hospital cardiac arrest. That makes registration a vital component in that chain of survival.

I am reminded of the Gandhi quote: “You cannot help everyone, but everyone can help someone.” Each of us as an individual can play a crucial role in bridging the gap between cardiac emergencies and lifesaving interventions. The British Heart Foundation’s map of The Circuit offers a valuable resource that allows individuals to check the availability of nearby defibrillators. By using the tool, anyone can quickly identify the nearest defibrillator, which improves response times and potentially saves lives.

Of course, 80% of cardiac arrests occur at home, so it is vital that Governments continue to consider ways to increase engagement at community level. For example, the Scottish Government want bystanders who witness an out-of-hospital cardiac arrest to feel able to take action. To achieve that, Scotland’s out-of-hospital cardiac arrest strategy aims to familiarise a total of 1 million people in Scotland with CPR skills; it works through increased engagement with community organisations such as sports hubs, local businesses and other community groups to raise awareness of and offer opportunities to learn CPR. I had CPR training in the past, but I think I could do with a refresher, as I suspect could many of us who have had the training. It is not done often enough; if an emergency occurred, I am not sure that I would feel as confident as I would have done a month or a couple of months after the training.

As I repeatedly point out in health debates, we cannot escape the fact that health inequality and poverty go hand in hand, and that is the case with out-of-hospital cardiac arrests. Those in the most deprived areas are twice as likely to have an out-of-hospital cardiac arrest and 60% less likely to survive than those in less deprived areas. Deprivation also has a significant effect on the likelihood of receiving bystander CPR. Then there are geographic and demographic issues: around 11% of the population of Scotland live in rural areas; they are 32% less likely to survive or to leave hospital after an out-of-hospital cardiac arrest than those living in urban areas. Over the last seven years, we have started to understand more clearly the association between measures of socioeconomic position and decreased survival rates after such incidents.

Ethnicity can also be a factor in how likely a person is to experience an out-of-hospital cardiac arrest. For example, people from south Asian backgrounds are at up to 50% higher risk of developing coronary heart disease than white Europeans, and coronary heart disease can lead to heart attack or cardiac arrest. In addition, international studies show that women are less likely to have CPR performed on them—a pattern that we also see in the Scottish data. The misconception that breasts make CPR more challenging, fear of doing harm, fear of inappropriate touching and fear of being accused of sexual assault have been given by the public as reasons for that gender discrepancy. It is important that we work to combat those fears and embed the knowledge that CPR is a gender-neutral lifesaving technique. Those health inequalities confirm beyond doubt the importance of prioritising pads in areas of the highest risk first, as a number of other speakers have mentioned.

Availability and accessibility of defibrillators are critical factors in reducing the devastating impact of cardiac arrests. One way of making defibrillators more accessible would be to make them more affordable. Currently, charities and local authorities can claim a VAT exemption when purchasing a defibrillator, but that should be extended to anyone buying the equipment. Quite simply, the UK should follow Ireland’s example and remove the tax. However, raising awareness of initiatives such as The Circuit, encouraging greater community involvement and tackling poverty all remain essential. By embracing those measures and working together, we can create a society in which every individual has a fighting chance against cardiac emergencies, and ultimately save more lives.

Ultra-processed Food

Martyn Day Excerpts

Wednesday 21st June 2023 Westminster Hall

[Martyn Day (Linlithgow and East Falkirk) (SNP)]

It is a pleasure to serve under your chairmanship today, Dr Huq. As many Members know, the subject of food and nutrition is close to my heart, and not just because I enjoy eating good food. I chair the all-party parliamentary food and health forum, which is discussing holding a joint meeting with the all-party parliamentary group on obesity on this very subject. I am therefore really grateful to the hon. Member for Stourbridge (Suzanne Webb) for securing the debate. I know that the Minister’s closing remarks will be of interest to the Members here, to people throughout the nations, and to both all-party groups.

There can be no doubt that ultra-processed foods have created a looming health crisis that has cost implications for the future of our public services, particularly our NHS. With more than half the calories consumed by the average person in the UK coming from ultra-processed foods, and with research from The BMJ linking these foods to early death and poor health, we really cannot afford to be complacent.

As we have heard, ultra-processed foods usually contain ingredients that people would not add when cooking food themselves. Many would not recognise the names of these ingredients, many of which are chemicals, colourings, sweeteners and preservatives. Research suggests that these additives could be responsible for other negative health effects, with several studies showing links between larger amounts of ultra-processed foods and cardiovascular disease and death, and the more of them a person eats, the greater the risk. The words of Professor Tim Spector, professor of epidemiology at King’s College London, are alarming. He said:

“In the last decade, the evidence has been slowly growing that ultra-processed food is harmful for us in ways we hadn’t thought. We’re talking about a whole variety of cancers, heart disease, strokes, dementia”.

Let that sink in. Quite frightening.

Buying processed foods can lead to people eating excess amounts of sugar, salt and fat, often unaware of how much has been added to the foods they are buying and eating. Scotland, as I mentioned a couple of weeks ago, has the highest obesity levels in the OECD countries, so we have a bit of work to do. Public Health Scotland found that children from the most deprived backgrounds were almost three times as likely to be at risk of obesity as those from the least deprived. According to the Scottish health survey, in 2021 two thirds of adults were overweight, similar to or marginally higher than the rates recorded every year since 2008. We are not making much progress in tackling the issue. Men have consistently shown higher prevalence of being overweight than women each year since 2008. One third of children are overweight, and I have no doubt that diet, and overprocessed foods in particular, is a major factor.

I want the UK Government to implement a sustainable food strategy that targets products that are high in sugar and ultra-processed foods. Our colleagues in Holyrood published the Good Food Nation Bill and passed it unanimously, enshrining in law the Scottish Government’s commitment to Scotland being a good food nation, where people in every walk of life take pride and pleasure in and benefit from the food they produce, buy, cook, serve and eat each day.

Education and consumer knowledge are important tools in the fight against ultra-processed foods, but accessibility and price are also key. A few weeks ago, in another debate, I pointed out that for many living in poverty, eating healthy food is a secondary consideration to eating at all. Access to healthy food should be a right, not a privilege.

[Carol Monaghan]

We have talked a lot about children, and there are a few issues there. Children who are obese are less able to exercise, which continues the cycle, and of course this is made more difficult in areas of deprivation. Some Members know that I coach gymnastics locally. We see children, some of them very young, who struggle to exercise because they are overweight. We need serious action.

[Martyn Day]

I thank my hon. Friend for making that point. I agree entirely; the only thing I would add is that not only is it important for children to exercise, but when they do they develop habits that stay with them for their lifetime. We have to crack the children issue at an early age.

On a positive footnote—I will get hell for this when I get home—I am pleased to say that our household contains a 19-year-old who has much healthier eating habits than I had as a 19-year-old male, all those decades ago. If I ask him before going to the shops what he would like, I am invariably told, “Raspberries, strawberries and grapes,” whereas I would have asked for chocolate bars and cans of fizzy juice.

[Carol Monaghan]

They are expensive.

--- Later in debate ---

[Martyn Day]

They are, I know. That leads in nicely to my next point, which is that the situation is not helped by food inflation: 70% of households are now worried about food and drink costs. This is frightening and does not help us to tackle the food crisis. The impact of deprivation on nutrition, diet and obesity rates is deeply concerning. With unhealthy food often cheaper and more accessible than healthier alternatives, it is little wonder that the UK is one of the biggest consumers of ultra-processed foods in Europe.

We must act now, before it is too late. While many of the policy levers are devolved, several key factors, such as advertising, are determined here. I call on the Government to prioritise children’s health and to protect youngsters from junk food advertising on TV and online. Health inequalities cannot be separated from poverty, so we must also tackle the underlying causes of that, which includes ending poverty, supporting fair wages, and improving physical and social environments, as well as public education.

Smokefree 2030 Target

Martyn Day Excerpts

Tuesday 20th June 2023 Westminster Hall

[Martyn Day (Linlithgow and East Falkirk) (SNP)]

It is a pleasure to serve under your chairmanship today, Mr Sharma, and I thank the hon. Members for Harrow East (Bob Blackman) and for City of Durham (Mary Kelly Foy) for securing today’s debate. This is absolutely vital issue that needs to get far more attention than it has had.

It is good to hear the broad cross-party consensus in the debate. Of course, as has already been mentioned by a number of speakers, health is a devolved matter. However, smoking is a significant public health issue in Scotland and a leading cause of preventable ill health, premature death and disability.

In 2013, the Scottish Government set a target that children born that year would reach adulthood in a smoke-free Scotland; our target for that is 2034, a few years after the English target date. A recent YouGov poll for ASH found that that 2034 target is supported by three quarters of adults in Scotland, with even more support coming from the supporters of my party—it was supported by eight out of 10 of them at the last election. It is perhaps worth remembering that the ban on smoking in public places came into force in Scotland in the spring of 2006, with the rest of the UK following soon afterwards.

As a footnote, the ban in Scotland came in on my birthday, which, as a non-smoker, I thought was a wonderful thing. I thoroughly enjoyed nights out a lot more afterwards. However, a much more profound effect was felt by my friends who smoked. Almost all of them have either stopped smoking completely or very significantly reduced their consumption.

Research shows that the number of heart attacks in Scotland fell by 74% between 1990 and 2014. Reduction in the number of people smoking and the increased uptake of cholesterol testing and statin drugs were cited as major contributory factors for that fall. That is very positive and it backs up the evidence I have seen with my own eyes among my friends and family connections. Since 2013, smoking prevalence has fallen significantly, from 22% to 14% now, but much remains to be done.

Smoking remains the leading cause of death in Scotland. Indeed, in 2021 the Scottish health survey set out that smoking was the cause of about one in five deaths and it is estimated that it also causes around 100,000 hospital admissions a year. The Scottish Government estimate that smoking costs NHS Scotland at least £300 million and the true figure could be upwards of £500 million, with additional costs, such as lost productivity, environmental and fire costs, calculated by Landman Economics at another £500 million. That is money literally going up in smoke for public services, as well as for smokers, at a time when the cost of living crisis is hitting hard everywhere.

We should not forget that the average smoker in Scotland—I do not know what the equivalent figures are for England, Wales or Northern Ireland—consumes around 12 cigarettes a day, which means they spend £1,875 a year on smoking. It remains pretty big business. Of course, smoking prevalence is highest in the areas that are most deprived, which further compounds health inequalities and poverty issues.

As Scotland’s five-year tobacco control plan is set to be renewed later this year, I hope for an ambitious set of policies that can help us to achieve our goal of a smoke-free 2034. A range of policies that aim to make smoking less visible, such as prohibiting smoking in public playgrounds, are being considered. However, there is only so much that can be done by Holyrood.

The Government’s Green Paper on prevention commits to considering options for raising revenue to fund evidence-based tobacco control, including a “polluter pays” approach, using mechanisms set out in the Health Act 2006. That would be a public health fund rather than a tax, modelled on the pharmaceutical pricing scheme that is organised and collected by the Department of Health and Social Care on behalf of England and the devolved nations.

Three quarters of adults in Great Britain support making the tobacco industry pay a levy or licence fee to Government for measures to help smokers quit and to prevent young people from taking up smoking. Tobacco must be the only product that kills when it is used as intended. I had a smile moment when the hon. Member for Arfon (Hywel Williams) mentioned why he stopped. I always think of the Bob Newhart comedy sketch, for those of a certain generation, about introducing tobacco to the western world. If it had been found nowadays, no one would use it. That makes me wonder why we continue.

The tobacco industry continues to make vast profits: on average, 50% of operating profits, compared with only 10% on average for UK manufacturing. Big tobacco can—and should be made to—pay. A “polluter pays” levy would be not a tax but a public health fund, raising a fixed sum to pay for recurring costs of tobacco control. Capping profits at 10% would prevent tobacco manufacturers from passing on the cost to smokers and ensure that tobacco taxes were not undermined.

The current pharmaceutical scheme, set out in the Health Act 2006, is administered by the DHSC, with the devolved Administrations opting in. A tobacco control fund could easily be operated on the same basis. Funding for evidence-based tobacco control policies, such as public education campaigns, smoking cessation services and enforcement, has declined since 2010. The levy could restore funding for those vital activities, and provide additional resource for the further activity needed to reach a smoke-free generation throughout the UK’s nations. Will the Minister listen to the public and commit to consulting on a “polluter pays” levy to provide the funding needed to deliver Smokefree 2030 through the rest of the UK, and to assist Scotland with its 2034 target?

No debate on smoking could be complete without consideration of vaping, which has come up several times today. For many, vapes are a helpful route out of smoking and towards less harm. They are potentially a useful aid for many adult smokers, which has been proven by evidence from Cancer Research UK. However, as we have heard today, understandable concerns about youth vaping are growing, particularly about the cheap, disposable vapes most widely used by children. There have been many calls throughout Scotland to ban disposable vapes, and that movement is gaining traction, with 21 of the 32 councils in Scotland now backing a national ban on those products. It is true that single-use e-cigarettes are often discarded irresponsibly and, because of their composition, do not break down in the environment. Even if users attempt to recycle them, as is theoretically possible, they will find that the infrastructure required to do so does not exist in many places.

I am particularly troubled by the rise in youth vaping, about which several hon. Members have already expressed concern. Those products should never have been intended for children or for non-smokers, yet recent surveys have found an increase in experimental use among 11- to 17-year-olds. The cynic in me thinks that big tobacco may have designed those products to have child appeal, and ensure a future generation of consumers. Disposable vapes are brightly coloured, available in flavours attractive to children, and are in a price range that is accessible to those with limited funds. They should probably be banned but, at the very least, an excise tax on disposables should be introduced. That would put the price up and make them far less affordable to children, thereby driving down the use of these environmentally damaging products.

In conclusion, while the rate of smoking continues to fall in Scotland, it remains too high to be confident about meeting our targets of reducing it by 2034. We must all come together to eliminate smoking and stop the spread of nicotine addiction. I thank all hon. Members for their contributions and continued dedication to trying to eliminate the UK’s leading cause of preventable death. I urge Ministers to commit to implementing a “polluter pays” levy to help fund much-needed tobacco control action not just in England but throughout the devolved nations.

Obesity and Fatty Liver Disease

Martyn Day Excerpts

Thursday 8th June 2023 Westminster Hall

[Martyn Day (Linlithgow and East Falkirk) (SNP)]

I am grateful to the hon. Member for Caerphilly (Wayne David) for securing today’s important debate, and for the comprehensive manner in which he introduced the issue and highlighted the scale of the problem. We have had a very informed debate. Obesity is a problem on an escalating global scale, with Scotland’s obesity levels among the highest of OECD countries. Indeed, I was until recently classed as obese myself, and despite reducing a bit I am still in the overweight category. I am going the right way, but I have a long way to go to catch up with the hon. Member for Strangford (Jim Shannon), who has made much greater headway than I have.

Obesity vastly increases the chances of a person developing a range of lifetime diseases, including heart disease, type 2 diabetes and several other forms of cancer, as well as non-alcoholic fatty liver disease, which is what we are focusing on. Obesity reduces quality of life and ultimately contributes to premature death. As we have heard, the UK is very much the sick man of Europe in terms of obesity, and sadly rates of obesity are even higher in Scotland than in England, Wales and Northern Ireland. Two thirds of adults aged 16 and over in Scotland are overweight, and nearly one in three people are obese, placing them at higher risk of premature death, chronic disease and a multitude of cancers. Obesity doubles the risk of developing liver cancer.

The causes of obesity are complicated and vary from person to person. They include the genetic make-up of a person and biological and social factors. It is also heavily influenced by health inequalities. A report by Public Health Scotland found that for children from the most deprived backgrounds, the risk of obesity was almost three times higher than for those from the least deprived—21% versus 8%. There can be no denying that poverty is a significant factor, as are housing, education, access to open spaces, exposure to advertising and the availability and sale of unhealthy foods, all of which affect whether we can be active or eat healthily and consequently have an impact on the risks of developing obesity. The predominant driver in all those factors is what we eat, which is in turn shaped by our environment. For example, for many living in poverty, eating healthy food is a secondary consideration to just eating at all —or even heating their homes. Access to healthy food should be a right, not a privilege.

I am therefore delighted that the Scottish Government have committed to restricting less healthy food promotions and to improving the availability of healthier options when people are eating out in their Out of Home action plan. Their support has also meant investment of more than £400,000 in the last five years to help smaller businesses reformulate common products to make them healthier. That plays an important role in improving dietary health by removing hundreds of millions of calories from Scottish food and drink products. We could, and need to, do a lot more on that if we are going to improve people’s diet, and local companies that are rising to the reformulation challenge should be commended for their efforts.

More needs to be done, however. Minister Jenni Minto announced in Holyrood last month that the Scottish Government will undertake a consultation on regulations to restrict promotions of food high in fat, sugar and salt. That is a vital next step in fixing the broken food system, which is driving the obesity and fatty liver disease crisis in Scotland. So I echo other hon. Members’ points and ask the Minister to commit to delivering prior policy commitments that are still to be implemented. Those include implementing the 9 pm watershed to protect children from junk food advertising on TV and online, and banning multi-buy junk food deals. Those measures enjoy huge public popularity, and I believe they would be effective tools.

The Scottish Government are at the forefront of efforts to strengthen obesity prevention and improve earlier detection of liver disease, including through pioneering use of intelligent liver function tests in primary care, which are now being piloted in sites across England as well. The British Liver Trust categorised my local health board, NHS Lothian, as green in autumn 2022, as it now has a fully effective patient care pathway for the early detection of liver disease. That is important because the mortality rate for chronic liver disease in my local health board is lower than the national average in Scotland, at 15.3 versus 17.9 per 100,000, reflecting the growing momentum for action to help improve liver disease outcomes and save lives.

Scotland is also at the forefront of harnessing new diagnostic tools to improve earlier detection of liver disease. The hon. Member for Strangford and others have spoken about how detection is important. We must prevent people from becoming ill in the first place if we really are to tackle the problem. However, by the time people are diagnosed, we often find they are too far down the pathway to make significant improvement.

The intelligent liver function testing pathway developed by the University of Dundee uses an automated algorithm-based system to further investigate abnormal liver function test results on initial blood samples from primary care. Intelligent liver function tests represent a nearly threefold increase in the diagnosis of liver disease and are estimated to be saving the NHS more than £3,000 per patient with an abnormal liver blood test. Indeed, iLFTs are now being piloted in Birmingham, Wolverhampton, Coventry, Liverpool and north London, and the roll-out of such technology is welcome. I urge Ministers to look at other examples of good practice from the devolved nations to help improve patients’ pathways for early detection and management of liver disease. Will he commit to delivering a new nationally endorsed pathology pathway for early diagnosis of liver disease that incorporates intelligent liver function testing in primary care?

In conclusion, we know that obesity doubles the risk of developing liver cancer, which is now the fastest rising cause of cancer death in the UK. Non-alcoholic fatty liver disease is now the fastest rising cause of hepatocellular carcinoma globally. In Scotland, liver cancer has seen the largest increase in mortality rates—38%—of all cancer types over the past decade, and liver cancer is now the fastest rising cause of cancer death in the UK. Unfortunately, Scotland has the highest incidence of liver cancer among our four nations.

The liver disease public health crisis disproportionately impacts our most disadvantaged and vulnerable communities. In 2021, chronic liver disease mortality rates in Scotland were 5.8 times higher in the most deprived areas than in the most affluent. Individuals in deprived areas are more likely to develop liver disease, be hospitalised with it and die from it than those in affluent areas. We must improve early diagnosis and prevention if we are to tackle this issue. That also means tackling poverty and health inequalities.

Oral Answers to Questions

Martyn Day Excerpts

Tuesday 6th June 2023 Commons Chamber

[Mr Speaker]

I call the Scottish National party spokesperson.

[Martyn Day (Linlithgow and East Falkirk) (SNP)]

The last time I asked Ministers whether they would support that Bill I was told that the issue of VAT and skin cancer was a matter for the Treasury, and we have just heard a similar answer. Surely this is a matter for joined-up government. What are Ministers doing—instead of imposing more pressure and costs on the NHS—to persuade their Treasury colleagues to consider more cost-effective cost preventive measures such as making skin protection products more affordable?

[Neil O’Brien]

The hon. Gentleman is campaigning for a reduction in the VAT on suncream, but let me put this into perspective. As I have said, our cost of living support is worth, on average, £3,300 per household. That is help on a huge scale. On cancer we are taking more action across the piece, and more people are being given life-saving checks, referrals and treatment than before.

--- Later in debate ---

[Mr Speaker]

I call the SNP spokesperson.

[Martyn Day (Linlithgow and East Falkirk) (SNP)]

Kidney Research UK has published a report on the health economics of kidney disease, predicting a terrifying rise over the next 10 years. As we know, uncontrolled diabetes is the biggest cause, with Diabetes UK noting that those disproportionately most at risk are those from poverty and from south Asian and black ethnic backgrounds. Reducing health inequalities is therefore key, and it is a key ambition for the Scottish Government. It means tackling poverty in our society. What steps is the Minister’s Department—

[Mr Speaker]

Order. This is topicals.

[Martyn Day]

It is topical because the research was just published yesterday.

Allergy Awareness Week

Martyn Day Excerpts

Thursday 11th May 2023 Westminster Hall

[Martyn Day (Linlithgow and East Falkirk) (SNP)]

May I express my gratitude to the hon. Member for Dagenham and Rainham (Jon Cruddas) for securing today’s debate and for the comprehensive manner in which he opened it? He said much that I can agree with. Indeed, there is not that much left to say, because it was a very comprehensive introduction.

I am grateful to the patient charity Allergy UK for its very informative briefing ahead of the debate and for its sterling work over more than three decades in raising awareness and supporting people living with allergies, who represent a significant proportion of the population across these islands. Allergy Awareness Week was held from 24 to 28 April and was initiated by Allergy UK, which is urging every NHS integrated care board in the UK to appoint at least one allergy nurse and dietician. Allergy UK believes that this measure would enhance the standard and the promptness of the care, advice and support available to allergy sufferers. It is hard to disagree with that. We really must ensure that all people living with allergies can access the best possible care and support, and we must recognise that rising food prices are having a disproportionate impact on many of those with allergies. We must also acknowledge that climate change, which is extending the length of the pollen season, is having an adverse effect on many people.

Across the UK, 21 million people have an allergy. That is one of the highest rates in the world. We have seen an increase of 650% in hospital admissions for allergic conditions over the past 20 years, which is truly staggering. An allergy is the immune system’s reaction to normally harmless substances such as pollen, food or house dust mites, which can trigger an adverse response in allergic individuals, ranging from localised itching to potentially fatal anaphylaxis. According to Allergy UK, the most common causes of allergic reactions are pollen from trees and grasses; proteins secreted from house dust mites; mould; food such as peanuts, tree nuts, milk and eggs; pets such as cats and dogs, and other furry or hairy animals; insects such as wasps and bees; and even medicines. It is quite a lengthy list.

I have been fortunate not to have any allergies. Looking back on my life, I do not recall allergies being on the same scale as they are now. When I was a young man, I was sent to school with peanuts as a treat on occasion. I thought that was great, but we would never dream of doing it now.

The world has changed quite dramatically, and not for the best. Allergies are very common in children; some go away as a child gets older, but not all do. We know that fewer pensioners have allergies and that incidence is significantly higher among under-35s. It has also been suggested that we may be paying the price for being too hygienic and insufficiently exposed to bacteria that would help to train the immune system. Sometimes in life it seems that you can never win.

In Scotland, most allergic conditions are treated through primary care. The Scottish Government are committed to ensuring that people living with an allergic condition receive the care they need when they need it. GPs in primary care are at the heart of the healthcare system. The Scottish Government are investing in multidisciplinary teams to increase the capacity in primary care, which will allow patients to be seen at the right time by the right person.

Asthma continues to be the most common allergic condition, accounting for 69% of the approximately 5,100 allergy-related hospital admissions each year in Scotland. The Scottish Government are providing guidance to education authorities, health boards and schools to fulfil their obligations to students and their healthcare requirements. In December 2017 they published guidance for supporting students’ healthcare needs, including a section on allergic reactions and anaphylaxis. I think we would probably all benefit from knowing a bit more about what to do if someone is exposed to that situation. I would be lost if it happened in front of me in my office, so I think there is a lesson there for all of us. We need to know more and to be able to help when something goes wrong.

Food is a large factor. I welcome the new legislation, which has been referred to as Natasha’s law, requiring food businesses in Scotland and throughout the rest of the UK to label all pre-packed food for direct sale with a complete ingredient list. The law, which came into effect in October 2021, was implemented after the sad death of 15-year-old Natasha Ednan-Laperouse, who suffered a fatal allergic reaction to a pre-packed sandwich containing undeclared sesame seeds. It applies to products such as pre-wrapped sandwiches, fast food and daily items such as cheese and meat that are already wrapped for service. The Food Standards Scotland chief executive, Geoff Ogle, said:

“This is a huge step in helping improve the quality of life for around two million people living with food allergies in the UK—with 200,000 of those living here in Scotland.”

I echo his comments. I also echo the calls from other Members to see more progress with Owen’s law so that anyone can eat out safely.

Grocery prices are continuing to climb, and those with allergies or special dietary requirements are being disproportionately hit. I urge the UK Government to better support people with allergies during the cost of living crisis. Statistics from January this year show that households with specific dietary requirements can be paying up to 73% more for their food than those who do not need to buy “free from” products, according to analysis by the allergy team. Pea milk is £2 per litre, roughly 50% more expensive than cows’ milk. Gluten-free penne pasta at Morrisons jumped by 125% in 12 months, from 60p in January 2022 to £1.35 this January. The cost of Sainsbury’s Nurishh vegan cheddar-style cheese slices alternative increased by 67% from £1.50 to £2.50, while the cost of Alpro soya growing-up milk at Asda increased by 27% from £1.50 to £1.90. For a lot of people who have no alternative, that is simply not affordable.

In Scotland, people who have been clinically diagnosed with coeliac disease or dermatitis herpetiformis—I probably pronounced that as badly as I typed it last night—can receive a range of gluten-free food on prescription at no charge. Perhaps the UK should look at that. There is more that each of our nations need to do for the increasing numbers of people who are living with allergies. That does not just go for health treatments; we must also tackle the cost of living and climate change.

Branded Medicines Voluntary Scheme and the Life Sciences Vision

Martyn Day Excerpts

Wednesday 3rd May 2023 Westminster Hall

[Martyn Day (Linlithgow and East Falkirk) (SNP)]

It is a pleasure to serve under your chairmanship, Mr Sharma. I am grateful to the hon. Member for Newton Abbot (Anne Marie Morris) for securing today’s debate on the voluntary scheme for branded medicines and the life sciences vision.

The UK Government’s current voluntary scheme for pharmaceutical companies has come under criticism for its unsustainable payment rates, which are well above both historical and international norms. As we have heard, companies are required to pay a revenue tax of 26.5% to the UK Government, in addition to all other taxes, which is significantly higher than that in other countries. That has led to two large US-based drug companies, AbbVie and Eli Lilly, exiting the VPAS, citing the punitive system of revenue clawbacks. Other companies, such as Bayer and Bristol-Myers Squibb, have also threatened to reduce their UK footprint in response to the increasing clawbacks.

The pharmaceutical trade body has called for the UK Government to scrap their plans to raise the repayment rates for drug makers, so as to avoid possible setbacks for the sector. The high payment rates are seen as a global outlier and are undermining the UK’s ability to attract investment and become a global leader post Brexit. I sincerely hope that the UK Government are successful in their efforts to address these concerns. Sir Hugh Taylor has been appointed as chief adviser for VPAS negotiations. He will oversee the negotiations for the Government and the NHS on a successor to the 2019 VPAS, which will expire at the end of 2023.

Medicines are crucial for healthcare and are the second largest expense for NHS Scotland. They prevent, control, palliate or cure many diseases. The Scottish Government are committed to improving patient access to safe and effective new medicines. The regulation of medicine pricing is the responsibility of the UK Government, but the Scottish Government are involved in the UK-wide voluntary VPAS agreement between the four UK nations and the pharmaceutical industry that caps NHS spending on branded medicines. Companies exceeding the VPAS revenue cap pay rebates to the Scottish Government and the three other UK Administrations. The cap grows by 2% annually and the sales above it are paid back to the Department of Health and Social Care via the levy. As we know, the scheme has been active since 2019 and will end later this year.

Scotland uses the VPAS receipts to fund the new medicines fund, which supports health boards with the cost of introducing new medicines, including orphan, ultra-orphan and end-of-life medicines. The fund covers medicines approved by the Scottish Medicines Consortium, and affordability should not prevent access to new medicines. Since 2014, £456.5 million has been made available to health boards. However, it is unclear if the new medicines fund will be sustained beyond December, as VPAS funding is not certain. Going forward, certainty is essential both for the NHS and for our life sciences sector.

Scotland’s life sciences community has distinctive capabilities, a strong business base and excellent research institutions that continue to create high-value jobs. We aim to make Scotland the preferred location for the life sciences community. Scotland’s life sciences sector provides economic benefits and improves healthcare. With over 700 businesses and institutions, it employs 41,700 people. It is identified as a growth sector and is part of Scotland’s national strategy for economic transformation. Scotland is known for drug discovery and advanced manufacturing, contributing to international exports and research and development investment. In 2018, £164 million was invested in pharmaceutical research and development. It is estimated that that will generate £1.5 billion in economic benefits over the next three decades. That puts its importance in scale.

In conclusion, there can be no doubt as to how important the sector is to Scotland’s economy, both now and in the future, nor is there any doubt as to the significance of the funding that VPAS provides to our NHS. Certainty of funding beyond the current scheme is now needed. We need to get the balance right, however, both to sustain the life sciences sector and to support our NHS.

Oral Answers

Martyn Day Excerpts

Tuesday 25th April 2023 Commons Chamber

[Mr Speaker]

I call the SNP spokesperson.

[Martyn Day (Linlithgow and East Falkirk) (SNP)]

Welcome as the UK Government’s recent announcement is to help more people in England to quit smoking, the Khan review’s key recommendation to increase investment in smokefree policies, making the polluter pay by raising tobacco duty, was not mentioned. Product duty, as we all know, is a wholly reserved matter, so what representations have been made with Cabinet colleagues about implementing that recommendation to improve public health outcomes across all four of our nations?

--- Later in debate ---

[Mr Speaker]

I call the SNP spokesperson.

[Martyn Day (Linlithgow and East Falkirk) (SNP)]

The British Medical Journal has warned that the comprehensive and progressive agreement for trans-Pacific partnership trade deal will make it harder for the UK to regulate tobacco and alcohol or banned products such as those containing harmful pesticides. Given that no health impact assessment has been carried out, The BMJ recommends that one should be performed now. Will the Secretary of State commit to assessing the deal’s threat to public health?

[The Parliamentary Under-Secretary of State for Health and Social Care (Neil O’Brien)]

We do not plan to debate any of our existing standards. We have some of the strongest standards for control anywhere in the world. We have no plans to get rid of any of those things.