Smokefree England: Covid-19 and PHE Abolition

Mary Kelly Foy Excerpts

Thursday 12th November 2020 Commons Chamber

[Mary Kelly Foy (City of Durham) (Lab)]

I beg to move,

That this House welcomes the Government’s ambition for England to be smokefree by 2030; notes the increasing disparities in smoking rates between the richest and poorest in society; further notes the effect of the covid-19 outbreak and the opportunities and risks provided by the reorganisation of public health on the UK’s ability to achieve this ambition; and calls on the Government to set out the further steps it plans to take to deliver a smokefree England by 2030.

I thank the Backbench Business Committee for granting this debate. I am also grateful to every Member who has given up their time to speak, especially the hon. Member for Strangford (Jim Shannon), who I believe has already had two questions and a speech today—and I suspect that he still has an Adjournment debate ahead of him.

This debate is on an issue that is close to my heart. I must declare an interest as a former chair of the Gateshead tobacco control alliance. As the prevention Green Paper acknowledged, achieving the smokefree 2030 ambition will be challenging, especially in deprived communities where smoking rates are higher. On current progress, Cancer Research UK estimates that these communities will not reach the 5% ambition until the mid-2040s. This is simply not acceptable. Indeed, in County Durham, adult smoking prevalence is 17% compared with 13.9% nationally. This rises to 27% among people in routine and manual occupations. On top of that, 16.8% of mothers smoked during pregnancy compared with 10.4% in England.

Smokers in the north-east lose around £600 million because of unemployment and reduced income due to smoking. For working smokers, weekly earnings are on average 6.8% lower than for non-smokers, equivalent to £1,424 less per smoker annually—and this, of course, was prior to covid-19, which is disproportionately harming the health of local economies of already disadvantaged areas. Helping smokers to quit will benefit not just their health and wellbeing but their incomes, helping to level up disadvantaged communities. Smoking is also responsible for half the difference in life expectancy between the rich and the poor. For every person who dies from smoking, another 30 are suffering from serious smoking-related diseases. Disturbingly, every week in England, almost 2,000 children take up smoking, two thirds of whom will go on to become regular smokers.

With 1,500 people dying from smoking-related diseases every week, there is no time to waste. The tobacco control plan published in 2017 was for five years, which comes to an end in 2022. It has already been overtaken by events and is no longer fit for purpose in the light of the ambition for England to be smokefree by 2030, the decision to abolish Public Health England, and the Government’s manifesto commitments to increase healthy life expectancy by five years by 2035 while narrowing inequalities. If a new tobacco control plan is to be put in place in a timely manner, it needs to be in development now. The Minister may remember that the last plan was published two years after its predecessor ran out of time. We need bold announcements from the Government on tough new measures, along the lines set out in the “Roadmap to a smokefree 2030”, which has been endorsed by the all-party group on smoking and health, if we are to achieve a smokefree 2030. Will the Minister confirm whether the Government are developing a new tobacco control plan, and if not consider doing so urgently? Will he further commit to publishing a new tobacco control plan in 2021, setting out concrete measures for delivering on the smokefree 2030 ambition?

Britain is a world leader in tobacco control, having driven down smoking rates by 60% since the start of this century. However, the Government’s decision to abolish Public Health England without a clear plan for the future risks undermining this hard-won progress. The success in tobacco control has been driven by combining national population level interventions with comprehensive actions at regional and local levels.

The national function is currently provided by a combination of the Department of Health and Social Care and Public Health England; what is crucial is not where the function sits, but that it has protected funding and continues to exist. Furthermore, while inequalities in smoking rates remain, where regional tobacco control programmes have been in place there has been a significantly higher rate of decline. Regional programmes, such as those led by Fresh in the north-east, provide an effective bridge between national and local activity and between local authorities and the NHS. The Government must publish a clear plan setting out the future of Public Health England’s health improvement and wider functions; that is crucial if we are to achieve the Government’s interlocking pledges not just to achieve a smokefree 2030, but to increase disability-free life years, reduce inequalities, improve mental health and reduce obesity and alcohol harm.

The covid-19 pandemic makes action to reduce smoking prevalence all the more urgent. Chronic diseases such as cardiovascular disease, respiratory diseases and diabetes account for about 89% of all deaths in the UK and are also linked to higher rates of mortality from covid-19. A robust and sustainable approach to health improvement is vital if we are to tackle the leading causes of chronic diseases, namely smoking, obesity and alcohol and drug abuse.

However, the impact of smoking is not limited to the UK. It is estimated that at least 8 million deaths around the world every year are linked to tobacco, more than for AIDS, tuberculosis and malaria combined. Over 80% of the more than 1 billion smokers in the world live in low and middle-income countries. In addition to the human cost, the impact on already overstretched health care systems puts a heavy economic burden on those countries, adding to the difficulties LMICs face in recovering from the global pandemic.

That is why we can all be proud that the UK, as a global leader in tobacco control, is providing funding via Official Development Assistance to support implementation of the framework convention on tobacco control in low and middle-income countries. The funding was £15 million over five years for the World Health Organisation’s FCTC 2030 project to support low and middle-income countries to implement tobacco control measures. The FCTC 2030 project has been very well regarded; however, funding is due to come to an end. Extending this funding will accelerate progress in ending the global tobacco epidemic, support FCTC 2030 beneficiary countries to recover from covid-19 domestically, and as the UK leaves the EU maintain our position and as a global leader on tobacco control.

This is a matter of development funding so it requires broader support than just from the Department of Health and Social Care, but the Minister’s support for the proposal would greatly facilitate the likelihood of success. Will the Minister therefore commit to supporting extending the UK’s funding for the FCTC 2030 project beyond 2021?

Aside from our international commitments, it is important that there is a focus within the UK at regional and local authority level. Smokers from deprived communities with higher smoking rates tend to be more heavily addicted than those from more affluent communities. Deprived smokers are just as motivated to quit as other smokers, but it is harder to succeed when people are more addicted, when smoking is more commonplace and when cheap, illicit tobacco is widely available.

Regional tobacco control programmes have been effective in tackling these disparities, as shown most clearly by the example of Fresh in the north-east, which is the longest-running and only surviving regional office for tobacco control. When Fresh was founded in 2005, smoking prevalence in the north-east was much higher than the average for England, at 29% compared with 24%, and the disparity was growing. Since then, the north-east has seen the greatest decline in smoking prevalence of any region, and smoking prevalence is now only a little higher than the England average. Smoking rates have also fallen faster among routine and manual workers in the north-east compared with in England as a whole. As a result, although the differential between routine and manual and professional workers declined in the north-east between 2012 and 2017, it has increased in England as a whole. The success and value of Fresh’s work is clear, and I commend it for its vital work in the region.

After the public health grant to local authorities was cut in 2015-16, the funding provided by local authorities for regional offices in the north-west and south-west was cut completely. Even in the north-east, funding has been significantly reduced. New funding streams are therefore needed. In addition, there are stop smoking services that act as a highly effective and cost-effective way of supporting smokers to quit. However, there is a stark inequity in the local authority offer to smokers across England. In some areas, stop smoking services have been scaled down or decommissioned altogether, whereas elsewhere local authorities have sustained or developed their services.

An Action on Smoking and Health and Cancer Research UK report published in January looked at the state of local stop smoking support and found that among the local authorities that still had a budget for stop smoking services, 35% had cut that budget between 2018-19 and 2019-20. That was the fifth successive year in which more than a third of local authorities had cut their stop smoking service budgets. Financial pressures caused by the cuts to public health funding and the wider pressures on local government finances are the major reason for that. The public health grant, which funds local authority tobacco control, has been cut by around a fifth in real terms since 2015-16, falling from £4 billion in ’15-16 to £3.2 billion now.

Analysis by the King’s Fund in 2018 found that wider tobacco control and stop smoking services were among the biggest losers in planned budget cuts and that these cuts have been accompanied by a 38% decline in the number of smokers setting quit dates at stop smoking services since 2015. Among pregnant women, the number setting quit dates has fallen by a fifth. This is one of the many failures of austerity, so will the Minister confirm that the Government will reverse the cuts made to local public health budgets to ensure that local authorities can play their part in delivering a smokefree 2030?

We must also recognise the value of social marketing campaigns, which have immediate impact, can be targeted with precision at disadvantaged smokers and can be highly cost-effective if carried out at a regional and national level. Such campaigns play a particularly important role in motivating smokers to try to quit. In 2016, Fresh worked with Smoke Free Yorkshire and the Humber to implement a hard-hitting quit smoking campaign aimed at raising smokers’ awareness of the links between smoking and 16 types of cancer and to trigger quit attempts, reaching millions of people. It is now thought to have been among the most successful quit campaigns to have ever been run in England in terms of awareness, attitudes and actions taken, with around 10% of people who saw it making a quit attempt—that is around 72,000 smokers. However, this regional activity is threatened by local authority budget cuts, which led to the decommissioning of the regional offices in the north-west and south-west. A smokefree 2030 fund imposed on the tobacco industry, as proposed in the Green Paper consultation, would provide vital funding for national and regional anti-smoking mass media campaigns.

Another important regional issue is the impact of illicit tobacco, which is concentrated in poorer communities. Cheap and illicit tobacco provides easier access to tobacco for children and reduces the incentive for adults to quit. In 2009, Fresh, along with colleagues in the north-west and Yorkshire and the Humber, established the North of England Tackling Illicit Tobacco for Better Health programme, originally with pump priming from a Department of Health grant. The aim was to increase the health of the population by reducing smoking prevalence; reducing the availability of illicit tobacco, therefore keeping real tobacco prices high; developing infrastructure to aid information sharing, identification of illicit markets and enforcement action; reducing the demand for illicit tobacco through campaigns raising awareness of the issue; engaging with relevant health and community workers; and finally, regularly monitoring smokers’ attitudes and behaviour to measure the effectiveness of the programme.

Between 2009 and 2019, the illicit market share declined by a third in the north-east from 15% to 10%, and enforcement was enhanced. That compares with the national market share of illicit tobacco in 2018-19 and of manufactured cigarettes, with a share of 34% for hand-rolled tobacco. Elements of the original north of England programme have been sustained by Fresh in the north-east, including insight-led demand reduction programmes. Fresh now leads the national Illicit Tobacco Partnership, supported by ASH and other partners. However, the 2013 National Audit Office recommendation that this approach be rolled out nationally has not yet been adopted, while essential regional activity to tackle illicit tobacco and reduce smoking among children and young people has been put at risk by cuts to public health grants since 2015-16. Does the Minister agree that regional activity to get illicit tobacco off our streets should be sustainably funded?

Finally, I would like to raise the regulation review. While we await the Government’s response to the prevention Green Paper consultation, I hope the Minister can tell us what has happened to the Government’s response to the consultation on the Nicotine Inhaling Products (Age of Sale and Proxy Purchasing) Regulations 2015, which closed in September last year. A response to that consultation was due last December, and almost a year on, there has been no word from the Government about when it will be published. The Government are also required to review the Tobacco and Related Products Regulations 2016 and the Standardised Packaging of Tobacco Products Regulations 2015 by May 2021. They should set out the timetable for the consultation process for both sets of regulations as soon as possible. We are therefore awaiting the Government’s response to two consultations and the launch of two more, which need to be reported by the end of the financial year. Can the Minister confirm when the Government will deliver on all four of those?

I recognise that I have posed a lot of questions, and I thank the Minister and the House for their time. However, those are questions that need to be asked and answered if we are to achieve the smokefree 2030 ambition that is shared right across the House.

--- Later in debate ---

[Mary Kelly Foy]

I thank every Member for their contribution to this important debate: my hon. Friend the Member for Blaydon (Liz Twist), the hon. Members for Winchester (Steve Brine) and for Strangford (Jim Shannon), my hon. Friend the Member for Nottingham North (Alex Norris) and the Minister. I am glad that there is consensus across the House on the need to reach the target of a smokefree England by 2030. If I may, Madam Deputy Speaker, I would like to thank Deborah Arnott from ASH and Ailsa Rutter from Fresh who have been a continued source of support and knowledge in all things smoking-harm related.

I am aware that, at the minute, a significant amount of public health focus is directed at tackling the coronavirus pandemic, and rightly so. However, I hope that this debate serves as a reminder that there remain significant health inequalities in society. In our most deprived communities, these inequalities pose a grave risk to the health of countless people. While this has been exacerbated by the pandemic, without action the threat to our most vulnerable communities will only become more grave. It is vital, therefore, that the issues raised today are addressed. As the hon. Member for Strangford (Jim Shannon) highlighted, tackling and addressing health inequalities is a matter of urgency.

Question put and agreed to.

Resolved,

That this House welcomes the Government’s ambition for England to be smokefree by 2030; notes the increasing disparities in smoking rates between the richest and poorest in society; further notes the effect of the covid-19 outbreak and the opportunities and risks provided by the reorganisation of public health on the UK’s ability to achieve this ambition; and calls on the Government to set out the further steps it plans to take to deliver a smokefree England by 2030.