Tobacco and Vapes Bill (Tenth sitting)

Mary Kelly Foy Excerpts

Committee stage
Tuesday 21st January 2025 Public Bill Committees

Features of Products

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

I beg to move amendment 5, in clause 91, page 51, line 26, at the end insert—

“and markings containing health warnings”.

This amendment enables regulations to be made requiring health warnings to be marked on individual cigarettes and cigarette papers.

[The Chair]

With this it will be convenient to discuss the following:

New clause 1—Mandatory health warnings on cigarettes and cigarette rolling papers: consultation—

“(1) The Secretary of State must consult on draft regulations (see section 91 (features of products)) which would, if made, include a requirement on producers of tobacco products and cigarette papers to print health warnings on individual cigarettes and individual cigarette papers.

(2) In this section, ‘cigarette paper’ and ‘tobacco product’ have the same meaning as in section 112.”

This new clause commits the government to consult on regulations under clause 91 requiring the placing of specified health warnings on cigarettes and rolling papers by tobacco manufacturers and importers.

Clause stand part.

[Mary Kelly Foy]

I will not press these provisions to a vote but they are worth raising now, and perhaps for consideration at a later stage of the Bill, further down the line.

The amendment and new clause would require tobacco manufacturers and importers to put health warnings on individual cigarettes and cigarette papers. The Government are consulting on pack inserts which, of course, is welcome. However, those warnings do not catch those who buy individual cigarettes or those who are offered one out of someone else’s pack. Warnings on individual cigarettes—dissuasive cigarettes—were recommended by the all-party parliamentary group on smoking and health in 2021, and by the Khan review in 2022. These warnings already exist in Canada, introduced in August 2023, and will be implemented in Australia from July this year. Research commissioned by Health Canada into the appeal and attractiveness of cigarettes showed that cigarettes with health warnings were seen as less appealing than those without. That is true the other way too; cigarettes without health warnings were perceived as less harmful. We all know about the harms of smoking, and we have heard it again and again in these sessions, but the more that we can convey that message to consumers, and particularly young people, the better.

Overall, participants in the research felt that labelling individual cigarettes made packages complete and impactful. That was particularly true among youths who do not smoke, smoked occasionally or wished to quit. We know how addictive cigarettes are. It is often said in these debates that the only choice is the first cigarette. For many, even that may not be true; children are four times more likely to take up smoking if their parents smoke. If we truly want to stop the start, we need to make sure that people know how harmful these products are, even if they are offered just one of them.

It is great that the Department is currently consulting on pack inserts, but that does not quite capture those who may purchase or are offered single cigarettes.

[Jack Rankin]

Earlier in the debate, we voted on a clause about splitting up cigarettes—I was just trying to find which clause it was—so I think we are already proposing to make it illegal to sell single cigarettes. Does the hon. Lady not think that, given that we voted for that clause to stand part, these amendments are unnecessary?

[Mary Kelly Foy]

No, I do not. As I said, the Department is consulting on pack inserts, but that may not capture the people who have or are offered one cigarette. We all know that it takes only one cigarette to become addicted. Does the Minister have a timeframe that the Department is working to for the introduction of pack inserts? Will the Department monitor the effectiveness of that and continue to look at evidence from other countries, such as Canada, where dissuasive cigarettes do have an impact, and potentially use the powers in the Bill to introduce dissuasive individual cigarettes at a later stage?

[Dr Caroline Johnson]

I thank the hon. Member for City of Durham for tabling this amendment, supported by my hon. Friend the Member for Harrow East (Bob Blackman). I suspect that it is a reversal of the process from the last Committee, when my hon. Friend was on that Committee and moved a similar amendment, which was supported by the hon. Lady.

This is not a new suggestion. In fact, looking back at the debate from the last iteration of this Bill—I think it was about new clause 5 at the time—I discovered that it was the noble Lord Young of Cookham who first proposed warnings on cigarettes in 1979. He said:

“The solution to many of today’s medical problems will not be found in the research laboratories of our hospitals, but in our Parliaments. For the prospective patient, the answer may not be cure by incision at the operating table, but prevention by decision at the Cabinet table…Historically, a nation would look to its doctors for better health. Now they should look to their Members of Parliament.”

That is one of the reasons why I am here, standing with you today, and why I see a number of other medical professionals on the Opposition Benches. Parliament offers the opportunity not to look after one’s patients one at a time, but to look after the health of many patients all at the same time. I hope that we will seize that opportunity in relation to the public health measures in much of this Bill. My noble friend in the other House, Lord Young, has now been in Parliament for over 50 years—I hope we will get round to bringing forward some of the things he has proposed before another 50 years go by. The proposal was supported not only by the noble Lord Young, but by Sir Stephen Powis, then director of NHS England, and by the Khan review.

However, I have a couple of questions. I understand the point that my hon. Friend the Member for Windsor is making, which is that if people sell cigarettes only in packages and the packages are, as we have discussed, very thoroughly controlled in terms of what they look like and what they say, is it then necessary to mark the cigarettes that are inside them? I also understand that in clause 4, we as a Committee have chosen to introduce a measure that bans the sale of single cigarettes, but despite that being something people should already not do, it does happen, as we heard from the Royal College of Physicians in its evidence at the beginning of the Committee proceedings on 7 January.

There is some benefit to marking the cigarettes. It is also the case that it does not look terribly cool to have a stick sticking out of one’s mouth that says “Smoking kills”, and I get that. One question I would ask, though—perhaps the hon. Member for City of Durham will know the answer to this—is what they use to dye the papers chemically and what the effect of breathing in the smoke from the dyes is.

We talked about cigarette papers and why they are being banned at the beginning of the Bill; we talked about the chemicals put into cigarette papers to colour the paper, to ensure that the ash is white, to control how fast it burns and so on. If cigarette papers are to be marked with a message, that will require inks of some description, which will then be burned and the smoke from them inhaled. I do not know whether the hon. Lady has information on whether that can be done without adding additional harm to an already harmful product. On the one hand, what is the benefit of adding the message to reduce people’s uptake of cigarettes, and on the other, what harm is added to the cigarette by adding the message?

Cigarette papers already have a lot of pictures on them. I do not know whether the Minister will change that under clause 90, but health warnings on cigarette papers, as opposed to the cigarettes that come pre-rolled, would have the same effect: if one is printing a message on them, what harm is one adding and what risks is one taking away? I suppose he would have to look at both the risks and the benefits.

Clause 91 relates to the features of the products. Subsection (1) authorises the Secretary of State to make regulations on the features of various products, including

“(i) tobacco products,

(ii) tobacco related devices,

(iii) herbal smoking products,

(iv) cigarette papers,

(v) vaping products, or

(vi) nicotine products,”,

covering such aspects as the marking on the products, including branding, trademarks and logos, and the information provided with them. It also includes regulations on the appearance, size and shape of products and any distinguishing features that could differentiate brands.

Subsection (2) states that the regulations may include

“prohibitions, requirements or limitations in relation to the production, importation or supply of such products in the course of business.”

Subsection (3) clarifies that regulations made under this section are also subject to the affirmative resolution procedure, so the Minister is correct that at some point there will be a short delegated legislation meeting to debate them, but there will not be as much time to scrutinise them as there is in this Bill Committee.

The shape and size of packaging and of products have changed over time. Tobacco always used to be sold in bulk or in pouches by weight and wrapped in simple paper packaging. Cigarettes were not very common, and most tobacco products at that stage were loose-leaf cigars or pipe tobacco. The size and shape of the packages was straightforward, and the design at that time was more for preservation than marketing. As the industry grew, they became more standardised and recognisable. The first iconic package designs were rectangular boxes, usually made from cardboard, with a flip-top opening containing 10, 20 or 25 cigarettes.

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[Gregory Stafford]

Given that the hon. Member for City of Durham has decided not to press new clause 1 to a vote, I will not elaborate on it much, but she did mention that she might bring it back so I will just make a few comments. New clause 1 emphasises putting specific health warnings on individual cigarette papers and cigarettes. The hon. Member mentioned that Canada has introduced this and that Australia is thinking of doing so in coming months, specifically on the butts of the cigarettes. I believe there are warnings such as “toxic addiction” and “poison in every puff”—obviously, the phraseology has to be relatively succinct, given the size of a cigarette.

I understand that the point in trying to make it clear to those using the product that it is unsafe, unhealthy and will have negative implications on their health, but I am not aware that there is any substantive evidence to suggest that placing such wording on individual papers or products has a noticeable impact on smoking cessation. If the hon. Member for City of Durham is planning to bring the new clause back later, or if the Minister is minded to pick it up in some way, we—as the Minister said during the debate on clause 90—must be data-driven along these lines. We should not put extra burdens on the producer and customer if there is no evidence that having individualised health warnings on individual cigarette papers and cigarettes has any noticeable effect on smoking cessation.

[Mary Kelly Foy]

In my speech, I referenced evidence from Canada—the Health Canada survey. If the hon. Gentleman would like some more information on that, he could get in touch with ASH, which has the results. There was evidence to suggest that having health warnings had an impact, particularly on young people.

[Gregory Stafford]

That is very helpful. If I have not already seen it in the evidence packs that have been sent to us, then I will look that up.

I move on to clause 91—the features of the product. Implementing the regulations could require significant adjustments from manufacturers. To quote the Minister back to himself, he wants to move “like the clappers” on this. Although I welcome that, there needs to be a period where manufacturers have the opportunity to adapt to the rules.

[Gregory Stafford]

My hon. Friend makes a key point, and she has been making it throughout our discussions, as have others. Clearly, we want to move as rapidly as possible to ensure that as few children as possible are addicted to cigarettes or ever pick one up. I completely agree that we should move as fast as possible, but we need to do it in a sensible way to ensure that manufacturers can implement what we want them to implement, and that we do not end up in a situation where they are caught out by that.

[Mary Kelly Foy]

I am not pressing the new clause to a vote, although I suggested that the Minister or Department could look into the issue once the Bill has received Royal Assent. But just for information, Canada is the first country in the world to require mandatory health warnings on cigarettes. That legislation came into force in 2023. To address the hon. Gentleman’s point, there was a minimum lead-in time for king-size cigarettes of nine months for manufacturers and 12 months for retailers, and longer lead-in times for other products. Australia followed suit by passing legislation in December 2023; its regulations will come into force by July this year.

[Gregory Stafford]

Those sound like fairly reasonable timeframes; if the Minister were minded to follow those, I would support him, notwithstanding what I have already said.

On clause 91, which I support, we need to ensure that there is a comprehensive stakeholder consultation for whatever the Minister plans to do in this area. There needs to be some kind of phased implementation—by which I mean an eight or nine-month period, or whatever—to ensure that manufacturers can catch up with whatever is being implemented. As I have said previously on other clauses, there must be robust enforcement mechanisms to ensure that manufacturers and retailers comply. Once again, this is all about educating the public about what the legislation means and what they should be expecting. Public education campaigns on this matter are essential.

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[Andrew Gwynne]

Of course, trading standards enforces the sale of these things, so if the hon. Lady has concerns about particular products being sold in the online sphere, the first port of call is trading standards, which can investigate and take the appropriate action.

Regarding enforcement of online sales, the Bill enables Ministers in England, Wales and Northern Ireland to introduce the licensing scheme that we have already debated for retail sale, including online retail sale, of tobacco, vapes and nicotine products. Penalties will be capable of being brought against retailers who do not adhere to sales regulations. Obviously, as we have discussed —I do not want to tread on old ground—we will consult on the details of the licensing scheme before regulations are laid. Moreover, in the financial year 2025-26, this Government will invest a total of £30 million of new funding for the enforcement agencies, including trading standards, His Majesty’s Revenue and Customs and Border Force, to tackle illicit and under-age sales of tobacco and vapes, supporting the implementation of measures in the Bill.

The hon. Member for Farnham and Bordon rightly raised some concerns about how long manufacturers and retailers will have to implement the changes. There will be a transition period for businesses before any of the new regulations come into force. The length of the transition will be considered as part of the consultation exercise. There is clearly a balance to be struck between acting quickly to curb youth vaping and carefully considering the unintended consequences that we are all worried about. That is why these measures are a proportionate step. However, let me be clear that we will not stand idly by while industry knowingly and deliberately encourages children to use a product that will addict them to nicotine. Industry has failed to self-regulate. The fact that a quarter—25%—of all children aged between 11 and 15 have vaped shows that self-regulation has failed. We must now intervene to ensure that this can no longer happen—or get worse.

We are not banning the sale or manufacture of vapes; rather, we are ensuring that all the measures that we are talking about happen in a proportionate way that seeks to remove the harm and risk to our children and future generations. However, let me be clear that industry self-regulation has failed. That is why I call on hon. Members to support clause 91.

[Mary Kelly Foy]

I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Clause 91 ordered to stand part of the Bill.

Clause 92

Contents and flavour

Question proposed, That the clause stand part of the Bill.

[Andrew Gwynne]

This clause provides the Secretary of State with powers to regulate substances, and the amount of a substance, used in vaping products, tobacco products, tobacco-related devices, nicotine products, cigarette papers and herbal smoking products.

We know that the use of tobacco products and herbal smoking products can increase when they are flavoured or are used alongside flavour accessories. For instance, menthol cigarettes appeal to young people because, compared with non-menthol cigarettes, they make it easier and less harsh to inhale smoke. That is why the sale of menthol-flavoured cigarettes was rightly banned in May 2020 by the previous Government, and I give credit to them for moving on that issue.

It is therefore very concerning that industry has used the same tactics for vaping and nicotine products. Research shows that children are attracted to the fruit and sweet flavours of vapes, both in their taste and smell, as well as how they are described. We have heard a lot over the past few weeks, particularly from the shadow Minister, as well as from others, about flavours such as gummy bear and rainbow burst. Unicorn milkshake was another favourite of the shadow Minister—not that I am suggesting that she vapes, just that it is one of her favourites to refer to.

Tobacco and Vapes Bill (Fourth sitting)

Mary Kelly Foy Excerpts

Committee stage
Thursday 9th January 2025 Public Bill Committees

[Dr Johnson]

If one is expected to have a policy, guidance on what that policy should contain is certainly important. If one is going to be held accountable for not having such a policy in law, it is clearly not sufficient to say, “You must have a policy but we are not going to tell you what it must say or do.” It comes back to the point that I have been making throughout the day. Who will face this fine? How will it be decided who the fine applies to? Will it be applied to the retailer as well as to shop workers, shop supervisors, shift supervisors or CEOs, and under what circumstances? I think there needs to be guidance on that so we have a clear pathway.

Clause 1 states that it is a defence if someone has taken “all reasonable steps”. If having a policy is not to be a reasonable step—there are arguments for why we might not want it to be, because it is an extra regulatory burden on business, and some very small businesses could struggle with that—and neither is looking at someone and making one’s own mind up, it is important to understand what is. I do not think we have got to the bottom of that yet.

My final question for the hon. Member for City of Durham, who tabled new clause 3, is: why not Northern Ireland? I think one reason why she has chosen to introduce this is because there is such a policy for Scotland, but not for England and Wales. I do not believe there is such a policy for Northern Ireland either, and I wonder why she did not seek to correct that in her new clause. It may be something that she wants to consider in refining such a new clause before Report.

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

I wish to speak to new clause 3, which is in my name. I do not intend to press it to a vote, and I will be very brief because there has been a lot of discussion—about three and a half hours—on this part of the Bill already, and I hope it will answer some of those points. I am introducing it because I think it would enhance the Bill’s consistency with the Government’s four-nations approach. New clause 3 would apply to all the nations of the United Kingdom mandatory age verification for purchasing tobacco, vapes and non-medicinal nicotine products, in line with the provisions set out for Scotland in the Bill.

Scotland has had mandatory age verification for anyone who looks under 20 as a legal requirement for purchasing tobacco and vapes since 2017. In lay terms, there is a legal underpinning for Challenge 25, which is voluntary in the rest of the UK. The Bill amends the Scottish system so that from 2033, it will be a legal requirement to verify the age of anyone trying to purchase tobacco who looks like they were born on or after 1 January 2009. My new clause would simply extend that beyond Scotland to ensure consistency for retailers, customers and enforcement agencies.

[Gregory Stafford]

Just for clarification, is the hon. Lady doing this simply to make it equitable across the United Kingdom, or is there something specific in the policy that she thinks will strengthen the Bill or add to it parts that are not covered currently?

[Mary Kelly Foy]

The new clause will make the policy consistent across the nations and simplify the process. If I can carry on, I will expand on those points. The new clause will extend the policy further than Scotland and simplify the process for retailers, customers and enforcement agencies. There has already been a lot of discussion about the implementation of a smoke-free generation, and about trying to make it simple and easy to understand. We heard in oral evidence concerns about the difficulty, when the policy has been in place for some decades, in telling the difference between two individuals in their forties who fall on either side of the policy. While that is likely to be a marginal issue in practice, the new clause will further help to resolve it.

Mandatory age verification currently exists in Scotland and is supported by retailers here. In response to the Minister’s point about it possibly being a burden on businesses, a survey of independent UK tobacco retailers by Action on Smoking and Health in 2024 found that more than seven out of 10 retailers—71%—in England and Wales supported this.

[Dr Johnson]

We have heard dreadful stories of retailers who have experienced nasty abuse and, in some cases, violence when they have asked for someone’s age. If somebody knew for certain that they would have their ID checked, it would no longer be an evaluation by the shopkeeper of their age, but merely a simple, expected transaction.

[Mary Kelly Foy]

I agree. We heard concerns on Tuesday in evidence about the aggression towards retailers, and the impact that the Bill might have on that. I would argue that providing consistency about identification is a potential mitigation of those risks. It takes away the guesswork.

[Dr Johnson]

May I ask the hon. Lady if there is any evidence that in Scotland, it has reduced aggression towards retailers?

[Mary Kelly Foy]

I cannot point to any evidence in statistics, but retailers welcome it. I think 90% of retailers in Scotland are in favour of it. In England, 83% of small retailers agree with it, and I am sure that is because it takes away those cloudy grey areas. It means that once someone shows their ID, that is the end of it.

On the point about this being a slippery slope towards mandatory ID cards, young people now are used to carrying ID. In fact, the Bill provides a list of different forms of ID that people can provide, including passports and driving licences. I believe the Government are talking about introducing digital ID checks for the purchase of alcohol. If this were applied to tobacco, individuals would not need to carry a physical ID with them. The measure is supported by retailers and by seven out of 10 members of the public, as well as by the Local Government Association and trading standards, which both believe it would help with enforcing the legislation and aid prosecution.

I have tabled the new clause to simplify things. This has already happened in Scotland, and it would make the Bill consistent with the Government's four-nation approach. Given the issues that we have been discussing today, having mandatory ID would make things so much easier and simpler. Just to be clear, I will not be pushing it to a vote.

[Sarah Bool]

I want to take a step back and look again at clause 1 itself. Enforceability has to be considered as an important element of achieving the smoke-free generation. As I keep stating, as a former lawyer, I want to be absolutely sure before I can give further support.

I seek assurances from the Minister on the implementation of the policy with regard to Northern Ireland, if it is truly to be a smoke-free nation. One of the provisions of EU law in the Windsor framework is the EU’s second tobacco products directive—TPD2—which applies to Northern Ireland. It lays down various requirements that must be satisfied for tobacco products and vapes to be marketed in the EU—for example, on ingredients, emission levels and packaging. Most crucially, it also states that member states, which include Northern Ireland for these purposes,

“may not...prohibit or restrict the placing on the market of tobacco or related products which comply with this Directive.”

So a generational smoking ban may be incompatible with TPD2.

Similar plans for generational bans in Denmark and the Republic of Ireland were ditched in 2022 and 2024, respectively, because of TPD2. I ask the Minister whether the Department of Health and Social Care has any plans for this issue, and whether the Attorney General has formed a view that can be shared with us. I think we have learned over the years that it is imperative that we do not jeopardise our Northern Irish friends.

--- Later in debate ---

I turn briefly to new clause 3 tabled by the hon. Member for City of Durham. I understand her point about simplification, but I say to her and to Scottish Members—SNP Members or whoever—that I think it is a regulatory burden too far. Far be it from me to tell any Scotsman or woman what to do, but I do not think we need to introduce such a measure in England, Wales or Northern Ireland.

[Mary Kelly Foy]

As I pointed out, surveys of retailers in Scotland show that 83% of them do not think it is a burden. As things are, there are fewer tobacco sales year on year, and as we progress, the sale of tobacco will phase out anyway; it will not be a thing of the future for businesses. In the meantime, they have pointed out that this measure aids them.

[Gregory Stafford]

I am interested to hear those facts. I know the hon. Lady will not press her new clause to a vote, and given that the Government do not support it, as far as I can tell, it is probably not going to be part of the law, but perhaps we can have a further discussion on Report.

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[Jack Rankin]

I thank the Minister for his passionate remarks, which I am obviously not going to take lying down. I agree wholeheartedly that the United Kingdom of Great Britain and Northern Ireland is the greatest country in the world, but before I try to make some progress, I might humbly suggest to him that a lot of that greatness may be based on the primacy of the individual and our rights to get on with our lives.

[Mary Kelly Foy]

The hon. Gentleman talks about civil liberties, agency and this great country. One purpose of the Bill is to tackle inequalities in our country—stark inequalities between the rich and the poor. We know that tobacco is mainly prevalent in deprived areas, and that it kills one out of two of its users. What agency does a young person have, in terms of their health and life expectancy, once the tobacco industry has them hooked? That is not agency. Tobacco is a product that kills people, and the tobacco industry will continue to find loopholes to replace the people who have died because of its product. If the hon. Gentleman believes in this great country, he should believe that tackling inequalities and making a smoke-free future for our young people are paramount.

[Jack Rankin]

I recognise the hon. Lady’s passionate belief in equality, but I find that somewhat paternalistic and somewhat—I do not mean this dismissively—condescending. Poorer people have the same agency as anybody else. That is the point.

Tobacco and Vapes Bill (Second sitting)

Mary Kelly Foy Excerpts

Committee stage
Tuesday 7th January 2025 Public Bill Committees

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

Q Can I ask a question to all of you? We know that the Bill will go a long way towards reducing health inequalities. In more deprived areas, which have the highest prevalence of smoking, will the Bill also have an impact on the economics of local communities?

Professor Tracy Daszkiewicz: That is exactly the focus: reducing health inequalities and ensuring we get good health equity across all of our populations. When we look at preventable premature mortality, we know that smoking is a huge driver around that. We need to think about this across the life course. If we can stop the harms that second hand smoke causes to children, we can then think about deprivation across the life course and people who are dying early from preventable harms, with smoking being one of the risk factors.

We need to focus really narrowly on that, because it is not just about life expectancy, but about the number of years we live in good health. In my patch across Gwent in Wales there is huge variance, with up to 14 years’ difference in healthy life years between the richest and the poorest parts of the population. It is about not only the health outcomes around that, but the economic part of it, in terms of work productivity and work days lost. When we think about the cost of the NHS, which we often do, that is the cost of healthcare, but if we look at the economic picture of employability, productivity and those kinds of things, it increases that sum tenfold. We need to think about this so that when we look at the inequalities associated with smoking, we do so through a social, cultural, economic and environmental lens, to ensure that we get the full cost impact. It is something that we need to be mindful of.

Alison Challenger: I wanted to make a point about household income. We know that cigarette smoking is incredibly expensive. If one or both parents smoke in a household with a low income, that will have a considerable impact on the family’s spending capability for other things. It is not a matter of choice, either; smoking is an addiction. Seven out of 10 smokers really do not want to smoke, but it is incredibly difficult because of the level of addiction. If one or both parents smoke in a family household, that has huge repercussions for the funding of all the other household commitments.

[Sadik Al-Hassan]

Q We have touched on local variations. How do you think local variations should take into account the small variations in health inequalities that exist in different areas? You gave an example of a shop being the only shop in a village, but if that village was also an area of high deprivation, how should that affect the outcome?

David Fothergill: That is where local knowledge comes in. Taking that shop in the village, we would not say that it should not sell tobacco, but we would say that it should not be selling tobacco during these periods—for example, 8.30 am to 9.30 am, or 3.30 pm to 4.30 pm. Knowing the local communities and being able to put in local restrictions would help us to really have an impact. Clearly, in urban areas it would be very different.

When the Minister asked questions about England, Wales and Northern Ireland, I should have said that what we would really like to see—it is in the Scottish legislation—is verification, where people are required to verify their age. Challenge 25 seems to work really well with alcohol, and we would like to see that brought in. We understand that that is in the Scottish legislation, and we would like to see it brought in in England as well.

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[Euan Stainbank]

Q Thank you. My second question digs into the illicit online vape market that you referred to. Is the issue more the structure of enforcement that you were discussing, or do you have any concern about online retailers’ age gating policies?

Lord Michael Bichard: No, the point I was making was about enforcement.

Wendy Martin: To add to that, as part of the programme that DHSC has been funding for the last 18 months, we tested out a number of issues, and one was online under-age sales. I think we tested 312 purchases, and there was a 10% failure rate. That was significantly lower than premises-based sales. There was a lot in the platform’s corporate website design to try to ask the right questions and kick purchasers out. It is very much about who does it and who takes responsibility, rather than a major problem in itself.

We also work quite closely with the Advertising Standards Authority, and it does a lot around broadcast and published media, and website compliance and claims. That is quite a well-established mechanism for enforcement. It is about the structure of enforcement, as you have rightly identified.

Lord Michael Bichard: It is probably worth pointing out—it does not relate to the online point—that I said earlier that last year we carried out 4,000 test purchases, and 26% of those were failures. Compared to the 10% online, it is significantly higher. This is a very practical point, but some of the other changes that are going to happen will make it easier for us to do test purchasing. At the present moment, we can only use children or young people, so we have issues of safeguarding and we can only do it at certain times of the day. It should become easier, in that sense, for us to enforce the legislation.

[Mary Kelly Foy]

Q We heard from a previous witness that young people say that most of the advertising for vapes is in the shops. The Bill will bring in powers to regulate vapes, and that includes advertising. How do you envisage that the ban on advertising will be enforced on the high street, locally and in small shops?

Lord Michael Bichard: It will be enforced in the same way we enforce it for tobacco and other things. This is not new. Trading standards officers employed by local authorities are constantly visiting premises, and they will therefore deal with any offences that are being committed. They also have their own local intelligence networks. We cannot afford, because we do not have enough staff, to just have a random system where we pop in every now and then. We depend on people giving us intelligence. Some of those people are members of the public, and some are from other agencies. We try to target what we do. When you visit a shop—there are something like 60,000 outlets—you can see whether the current legislation, or future legislation, is being implemented. We can take action against the retailer if it is not.

[Mary Kelly Foy]

Q I was basing that on what you said at the beginning—that trading standards had been cut by 50%—so I know that local authorities will struggle. I also know that although a penalty has been put in place, six months later that same shop will be doing exactly the same thing again. I guess the question is about the resourcing of trading standards—

Lord Michael Bichard: Absolutely. I was going to say that if you are making a case for trading standards to have more resources, I am absolutely with you. I think that trading standards does an amazing job with limited resources. One borough in London now has no trading standards officers, and that is a great worry. We are there to protect consumers in all sorts of ways, but we are also there to try to establish a fair marketplace, so we are working on behalf of legitimate businesses. A lot of retailers want to support us in dealing with bad practice among their competitors. Yes, we need more resources.

Wendy Martin: Clearly, the responsibility is on businesses to comply with the law, first and foremost, and the hope would be that the vast majority of those outlets do so, because they are either part of bigger businesses with corporate structures to ensure compliance, or part of trading associations where that training and information is available. Generally, most people want to do the right thing. What that means is that the additional resources are necessary and can be focused on those sectors where there is intelligence from consumers, enforcers and other businesses—businesses will complain, and rightly so, about competitors who are flouting the law. That enables targeting, rather than feeling the need to try to inspect 60,000 or 70,000 premises. That would not work, and it does not need to work like that.

Lord Michael Bichard: Local trading standards officers know the problem retailers, where the problems are. I started my career doing prosecutions for trading standards, so I know a bit about how they work on the ground. They know where to target their efforts. I should also point out that there is a committed workforce here. Recently, we did a survey of the workforce, and 80% of them supported the legislation. It always helps.

[The Chair]

One final quick question from Jim Dickson, before we have to go on to the next panel.

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[Sadik Al-Hassan]

Q From what I remember, vapes really started in the UK around 2010. Do you think that the Bill is sufficiently future-proof for the next evolution of nicotine or oral tobacco products? Whatever is coming next, do you think the Bill has enough to protect us from it?

Professor Sanjay Agrawal: I have not yet had the chance to say this, but first, I think the Bill is really well balanced. It is bold and world leading; all nicotine products and non-nicotine containing vapes are part of it. The people who put this together should be congratulated, but we also have to be aware that industry never sleeps. It will try to adapt to regulation and legislation, and we need to be wary of that and make sure that we use the powers in the Bill in the future, depending on how industry responds.

For example, with disposable vapes, which are due to be banned later this year, I am sure that there will be a lot of companies right now changing their products to make them look as though they are not disposable vapes when, to all intents and purposes, they are. There will be lots of adaptation by industry that we must be wary about. The Bill provides those future powers for us to adapt to industry.

[Mary Kelly Foy]

Q As we know, we have very high levels of child poverty in this country. Much of that poverty is in the areas where there is high smoking prevalence, as well as many other health issues. How important do you think the Bill is for the health of children as they grow into adulthood, for the impact that it will have on the communities they live in, and for addressing inequality?

Professor Steve Turner: Touching on what I have said before, there are communities, invariably the poorer communities, in something called the tobacco map. If you look at the areas where tobacco use is greatest, it maps totally on top of deprivation. We have an opportunity to break that generational social norm of, “It’s okay to smoke.” The people who come to the greatest harm from cigarette smoking and nicotine addiction are invariably the poorest. What is proposed here will be a good step towards narrowing the divide we see in this country in health outcomes, which is totally determined by poverty.

Professor Sanjay Agrawal: We estimate that around 350 children a day start to smoke. A lot of those will be from the most deprived communities. In addition, smoking in the UK brings around a quarter of a million families into poverty, and those families have children. The Bill will go a long way to not only reducing the health harms to individuals, but reducing poverty and hopefully smoking-related deprivation.

To answer one of the questions earlier about the cost of smoking to the NHS, it is estimated that it costs secondary care about £1 billion a year. With primary care in addition, that is a total cost of £2.6 billion to the NHS, around £20 billion a year to social care, and about £50 billion a year in lost productivity. That is the overall cost of smoking to our society, whether at the level of the individual, poverty, deprivation, social care or workforce productivity, and that is why the Bill is so important.

[Jim Dickson]

Q Some other countries, notably Australia and Canada, have introduced mandatory health warnings for manufacturers to place on individual cigarettes and filters, because quite often, young people in particular are accepting cigarettes away from the packaging. Do you see that as a useful way of increasing the saliency of health warnings?

Professor Sanjay Agrawal: These additional measures warn people away from smoking—those who might be looking at the packaging or the individual cigarette. Remember, an individual cigarette—every time someone takes out a cigarette—is an advertisement for cigarettes. Lots of times, children are sold cigarettes on a per-cigarette basis, and they have never actually seen the packet; they have only seen the cigarettes. Therefore, having on-cigarette warnings is another measure that we can introduce to warn people off the harms of smoking. It would be great to see that.

--- Later in debate ---

[Mr Barros-Curtis]

Q Minister, could you say a bit more about why you are taking the four-nation approach? I am a Welsh MP, and we have talked about some of the positive and progressive examples that have been illustrated in Wales, which we can learn from. Is the four-nation approach one of the strengths of this Bill? Will it help to ensure that you get that world you talked about, which I suspect—although I do not want to speak for everyone—we all support? Can you say a bit more about that four-nation approach, and if that is one of the key strengths underpinning this Bill?

Andrew Gwynne: It is. The four nations that make up our United Kingdom have gone at different speeds and to different depths in terms of tobacco control over recent years. Zubir was absolutely right to point out that it was the Scottish Labour Government that first introduced the indoor smoking ban, and we followed suit soon after, but it is really important that the four nations stand together on this, not least because some of this does require a four-nation approach in legislative terms. It also means that we can meet this ambition together, and that we are all in this together, because, for me, a health inequality in parts of Greater Manchester is just as important as a health inequality in Glasgow, Cardiff or Belfast.

We need to tackle these inequalities, because they are a scourge on our society. That is why a four-nation approach, alongside the permissive nature of this Bill, means that the four nations can go forward together, but also diverge on the basis of extending consultations and so on. That is why we have the support of the devolved nations and the Ministers, who come from different political persuasions across Northern Ireland, Wales and Scotland; we are all in one, as far as this Bill is concerned, and we have shaped it together.

[Mary Kelly Foy]

Q We have heard overwhelmingly from the witnesses how important the Bill will be for tackling inequalities and bringing about a smoke-free future. I am confident that the Bill will pass. In terms of supporting the 6 million current smokers that we have in the UK, do the Government still have plans to make good on their pledge to produce a road map and strategy for reaching targets, especially in places such as the north-east and other deprived area? That way, we can keep an eye on those smokers who do want to quit and what the smoking prevalence ranges are in those areas. A few of the witnesses and submissions have called for that, saying how it would help them.

Andrew Gwynne: That is really important, and I want all Members to understand that a key aspect of reaching our smoke-free ambition is to drive down the prevalence of current smokers. That means a real investment in smoking cessation, a close eye on what is happening on the ground, and using the flexibilities in the Bill, should they be needed, to ensure that we reach that smoke-free ambition.

We announced £70 million of stop smoking funding this week, which has been weighted towards the areas with highest deprivation and smoking prevalence, so that we can try to drive down those inequalities. Obviously, future years funding is subject to the usual processes of the spending review, but let me make it clear that it is a priority of this Government to invest in stop-smoking services. We will ensure that local authorities and the public health functions of the country have the resources needed to reach a point where we are smoke free.

[The Chair]

Last, but certainly not least, I call Taiwo Owatemi.

Tobacco and Vapes Bill (First sitting)

Mary Kelly Foy Excerpts

Committee stage
Tuesday 7th January 2025 Public Bill Committees

[Sadik Al-Hassan (North Somerset) (Lab)]

I declare an interest as a practising pharmacist. [Interruption.]

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

I cannot hear everything because of that noise, but I am co-chair of the all-party parliamentary group on smoking and health.

[Jim Dickson (Dartford) (Lab)]

I declare an interest as vice chair of the APPG on smoking and health.

Examination of Witnesses

Professor Sir Chris Whitty, Sir Francis Atherton, Professor Sir Michael McBride and Professor Sir Gregor Ian Smith gave evidence.

--- Later in debate ---

[The Chair]

I have about three minutes left, so I will ask Mary Kelly Foy to ask a very brief question with a very short answer, because we will be finishing spot on 10.25 am.

[Mary Kelly Foy]

Q Do you have any view on how restricting vapes in public places, which is obviously a very welcome power, should be implemented so that it does not deter smokers from switching to vapes and they do not relapse back into smoking cigarettes?

Professor Sir Chris Whitty: I will suggest that Sir Frank takes this question, because it is his very last answer to a parliamentary question; he is about to stop as chief medical officer, so he is going out on a high.

Sir Francis Atherton: What the Bill does is to simplify matters, making it as simple as possible: a smoke-free place is a vape-free place as well. That does not take away people’s ability to go into a place where smoking and vaping are allowed, but it helps to disentangle the confusion that currently exists about where people can legitimately use those products. It is a simplification that can only help to lead, in the long term, to that reduction that we need. In Wales, 13% of people continue to smoke. Our ambition is to get to 5% by 2030; we will struggle to get there, but this Bill will help us to get there.

[The Chair]

I am afraid that that draws this particular session to a close. I thank our witnesses, Sir Chris Whitty, Sir Francis Atherton, Sir Gregor Smith and Sir Michael McBride, for their attendance and for their helpful contributions, and I thank Members for their helpful questions. Thank you very much.

Examination of Witnesses

Hazel Cheeseman, Sheila Duffy, Suzanne Cass and Naomi Thompson gave evidence.

--- Later in debate ---

[Sarah Bool]

Q I want to follow up on that point, because clause 12 of the Bill will actually include a ban on vending machines for vaping, but I know that there have been mental health trusts that have said that, actually, they would call for those to be exempted. Is that one of the exemptions that you would perhaps go for, and actually allow those vending machines in hospitals?

Suzanne Cass: Absolutely. I think we need to consider the vulnerable smoker at the heart of this and how they are managing to abstain from that addiction. It comes back to that addiction all the time. With smoking, nicotine is such an addictive substance that it is very difficult just to tell somebody that they cannot do it. You need to give them the right support, as well as the support that they want. When it comes to choice, that is where we need to be looking at what their choices are and how they choose to move away from that deadly tobacco use.

Hazel Cheeseman: On the mental health settings, we have done a lot of work in England with mental health trusts, and vending machines have been one way in which they have been facilitating access to vapes in quite a large number of mental health trusts. It is certainly something that we would be interested in looking at, because it will make it a bit more challenging for them to implement smoke-free policies in mental health settings if the vending machine rule applies across the NHS estate.

Also, going back to Dr Cooper’s question, in mental health settings and those places with vulnerable smokers, vapes have been really important in England in facilitating. We do not have legislation in relation to smoke-free grounds in England, but obviously it is the policy across the NHS estate that they are smoke free. Allowing vaping, particularly in those mental health settings, has been very facilitative of creating smoke-free grounds and supporting those people to maintain their smoke- free status as they move out of mental health settings as well.

Sheila Duffy: Scotland already has a ban on e-cigarettes in vending machines and has had for some years.

[Mary Kelly Foy]

Q I notice in your submission that you have a recommendation:

“The government should make good on their pledge to publish a ‘roadmap to a smokefree country’…with a strong focus on tackling inequalities.”

I am from the north-east region, where we have high deprivation and high smoking prevalence. It is the only region that has a clear vision—if you like—and declaration from Fresh and the directors of public health for how to achieve a smoke-free country. Could you explain a bit more why we need that vision and that strategy going forward?

Hazel Cheeseman: The legislation is fantastic; it is world-leading and brilliant, and it will really set us on that path toward being a smoke-free country. However, it will not be the last word in how that is achieved. We have 6 million smokers across this country, and we need to ensure that all of our agencies are lined up to do the job that they need to do to help those people stop smoking—the NHS, local government and integrated care boards across the system need to have the right approach. We also need to ensure that the funding is there to do that too. The Government have committed to the funding in stop-smoking services in local government, but we also need to see funding in mass media campaigns. The chief medical officer was talking earlier about people’s waning understanding of the harms of second-hand smoke. One way to address that would be to go back on TV and radio and explain to people what the harms of second-hand smoke are. That package of measures alongside this legislation would really help us to accelerate progress.

The Bill will massively raise the saliency of the harms of smoking with the public—there is no doubt about that. There has been, and there will continue to be, a strong public debate on the measures in this Bill. By really riding the wave of that public understanding through that coherent strategy and that investment, we could really see smoking rates start to drop, particularly in those disadvantaged populations where we continue to have persistently high levels of smoking.

[Euan Stainbank]

Q By restricting vaping products in this Bill in the same ways that tobacco products are currently restricted—be that packaging, display or potentially flavourings, as we discussed with the CMOs earlier—do you think that this will lead to greater misconceptions by the public and, quite crucially, current smokers about the relative harm between the two products?

Suzanne Cass: We obviously have an issue when it comes to the understanding of and the misconceptions around the harms of vaping. In particular, the most worrying stats are among smokers considering them as harmful as or more harmful than tobacco. That is that a significant issue. This legislation allows us to reset the clock and promote these products as smoking cessation products, using health professionals to promote them and getting the right language around them. Rather than their being seen as a recreational toy, they can be seen as a product that is going to help people to quit smoking. When it comes to the positioning of these products, it is essential to readdress those misconceptions and re-place this product.

On standardised packaging, what we did with tobacco was put it in the ugliest packaging you could ever imagine. We are not talking about that when it comes to vaping products; we are talking about plain packaging—something that is informative but not necessarily attractive to young people. There is a big difference between something that is repulsive and something that is not attractive. That is where we see the difference, and that is where we see this legislation coming into its own and allowing us to reset and to have that different conversation.

Hazel Cheeseman: I am sure we will tease more of it out through the consultation process that will follow this legislation, but some of the early research that has been done has indicated that you can, to some extent, have your cake and eat it on this. If we remove some of the attractive branding elements on packaging, which we know appeal to children, that does reduce the products’ appeal to children, but it does not damage their appeal to adult smokers and it does not damage harm misperceptions. We can progress with this legislation, via the consultation and looking properly at the evidence, to make sure that we get the balance right.

There are also provisions in the Bill to allow public health bodies to do marketing and public health messages around vapes as a smoking cessation tool. It will be important that the Department of Health and Social Care and the Advertising Standards Authority work with public health bodies to make sure that they have the right guidance to be able to do that and to give smokers directly the right information about how vapes can be used as a cessation tool.

Lobular Breast Cancer

Mary Kelly Foy Excerpts

Tuesday 10th December 2024 Westminster Hall

[Helen Hayes]

I thank the hon. Lady very much for that intervention and for sharing her personal story.

I pay tribute to Dr Michaelis for her research and campaigning on lobular cancer. I hope that all Members have received their Dr Susan Michaelis rose this week, named in her honour, and will plant it as a reminder of the urgency of her work.

There are so many other stories. Katie Swinburne was 47 when she was diagnosed with invasive lobular cancer in her left breast, leading to a double mastectomy, radiotherapy and 10 years of targeted chemotherapy. She writes:

“It is very hard to accept that none of my treatment is specific to lobular breast cancer and no one can tell me if it is working or has been effective…I find myself living in fear of recurrence. I deserved to have an early diagnosis. I did not get this. I deserve a specific treatment; I do not have this. I have three young children; they deserve to have a mum. I deserve effective follow up; I do not get this. I need you to change this for me, my husband, my family, all the women with a lobular diagnosis and all the women who will be diagnosed in the future.”

Emma Hunwick writes:

“I was a happy, healthy and relatively fit 49-year-old professional woman when I noticed a tiny pull in my right nipple. No lump, no other obvious external changes. An annual medical and referral just 12 days later resulted in a clear mammogram and a clear second 3D mammogram. An ultrasound then reported an area of 2 cm of concern. I rapidly went from ‘caught early’ to borderline stage 2 breast cancer. After my mastectomy I was informed that I was in fact stage 3c invasive lobular breast cancer…I am now at high risk with predicted survival outcomes at 10 and 15 years of approximately 45% and 30% respectively...I need to know that the vital scientific research into lobular breast cancer is being done now. Not next year or in 10 years but starting now, so that I might survive longer and continue to work with less worry about whether the standard monitoring tests that missed my first cancer, will miss a recurrence.”

Kirstin Spencer’s story is also typical. Diagnosed in 2018, she and had a double mastectomy, but was warned that, especially in the first two years afterwards, the disease could recur in areas such as the scar tissue, chest wall and surrounding skin. She was told that vigilance and well-managed medical follow-up were everything. Within a year of her diagnosis, she developed red-flag symptoms that were repeatedly dismissed by her breast specialist. She was refused follow-up treatment and sent for psychological counselling. By the time that a new GP listened to her concerns, substantial recurrence was confirmed, with extensive metastatic disease.

My mother-in-law Cressida’s story is very different from Heather’s, and we are all so grateful to the doctors who treated her and for the subsequent 22 years of health that she has had and continues to enjoy. Cressida did not have any grandchildren when she was diagnosed, but a prompt diagnosis meant that she has been able to be closely involved in the lives of eight subsequent grandchildren, as a much-loved granny. But Cressida’s outcome was about luck rather than design, so much so that it was only very recently, when reviewing her medical notes, that she found out that the type of cancer she had was lobular.

Breast cancer survival rates are directly impacted by the stage of diagnosis. Late diagnosis, which is all too common for lobular breast cancer, leads to far worse outcomes. To improve this situation, we need much better awareness of the full range of breast cancer symptoms, including the very small skin changes that are typical of lobular cancer. Not all cancers cause lumps. A clear mammogram does not provide absolute reassurance, because lobular cancer typically does not show on a mammogram. We need lobular-specific research and treatments.

Staff at Manchester Breast Centre have stated that they are able to do the research to understand the complete pathology of lobular breast cancer—research that has never been done—to pave the way for bespoke treatments to be developed. This will take five years and cost £20 million—moonshot funding that will be recouped many times over in the tax revenue paid by women like Heather, who would be able to continue working, and in the NHS costs that will be saved.

Hundreds of MPs in the last Parliament and this one have listened to the stories of constituents affected by lobular breast cancer and pledged their support for the Lobular Moon Shot Project. Lobular cancer is the sixth most common cancer in women. It is more common than ovarian, brain, central nervous system, non-Hodgkin lymphoma, pancreatic and kidney cancers. I know that the Minister cares deeply about women’s health equality and I put it to her that lobular cancer is a women’s health equality issue.

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

I thank my hon. Friend for raising this very important issue. I was diagnosed with, treated for and cured of breast cancer this year, in a very timely way. I was very grateful to be told that it was one of the best cancers to have, because there is so much research into it and treatment for it. It is unimaginable that someone could be treated for a different type of breast cancer for which the research and treatment are not available. I am sure my hon. Friend will agree that this situation needs to be addressed immediately, because we cannot have these inequalities. Lobular cancer should be on a par with other breast cancers in terms of treatment.

[Helen Hayes]

I thank my hon. Friend for that intervention. She makes the point extremely well. How can it be that there are so few targeted programmes to improve the diagnosis and treatment of a cancer that affects 15% of breast cancer patients? How can it be that such poor information is provided to women that does not empower them to seek help when the symptoms of lobular cancer recur? How can it be that women are lured into a false sense of security when they receive a clear mammogram, or are fobbed off when they raise concerns?

We need to do better for women affected by lobular breast cancer, in memory of Heather and many more women like her who will not live to see their children grow up. We need to do better for women like Dr Susan Michaelis, who are living today with their lobular cancer being held just about at bay by generic breast cancer treatments, but who live with the constant anxiety that one day the treatment will stop working. We need to do better for the 22 women today and the 22 women tomorrow—the 22 women every single day—who are diagnosed with lobular cancer.

I have a number of asks to make of the Minister. Will she commit to investigate why there are so few targeted programmes to improve diagnosis, research and treatment of a cancer that affects 15% of breast cancer patients? Will she confirm that lobular cancer will remain a priority in the Government’s women’s health strategy? Will she take steps to address the lack of information given to women about mammograms, so that every woman is reminded to remain vigilant for non-lump changes in their breasts, including very small changes? Will she take steps to improve the education of primary care doctors on the symptoms of lobular breast cancer, so that women are not provided with false reassurance, but promptly referred for diagnostic tests?

For patients treated for ductal breast cancer, the first five years are critical, but for lobular breast cancer the risk will remain for 10 years and sometimes beyond, yet lobular patients are typically released from surveillance care after only five years. Will the Minister take steps to ensure that there is a specific follow-up pathway for lobular breast cancer? Will she support Manchester Breast Centre’s call for Lobular Moon Shot funding—£20 million over five years—to enable the basic pathology of lobular cancer to be fully understood as the foundation for developing bespoke treatments? Will she look at the fairness of the distribution of research funding to ensure that this funding can be identified without further delay?

I know the heartbreak that Heather's death has caused for all who knew and loved her, and most especially for her family. We can act to ensure that, in future, women like Heather who are diagnosed with lobular cancer can live to see their children grow up, and it is imperative that we do so.

Tobacco and Vapes Bill

Mary Kelly Foy Excerpts

2nd reading
Tuesday 26th November 2024 Commons Chamber

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

I declare an interest as the co-chair of the all-party parliamentary group on smoking and health. Just over a year ago, I welcomed the previous Government’s Tobacco and Vapes Bill. As the House may know, I have called for a smokefree generation for many years. I was not best pleased when the Conservatives voted down my amendments to the Health and Social Care Bill in 2021. Those amendments called for a ban on flavours and packaging targeted at children, which the shadow Secretary of State has just brought to the House’s attention. If they had not been voted down, we would already have regulations to protect children from smoking and vaping.

I join the Secretary of State in congratulating the former Prime Minister, the right hon. Member for Richmond and Northallerton (Rishi Sunak) on bringing the Smoking and Vapes Bill forward, but it was regrettable that the previous Government did not fast-track it in the wash-up before the general election. Nevertheless, I am grateful to the Labour Government for bringing this Bill forward. It is stronger than the previous legislation, and it responds to many of the issues that I and others raised in Committee with the previous Bill.

The comprehensive regulation of all vaping and nicotine products is important for addressing the concerns that vaping has become too widespread among young people. I strongly support regulations to reduce the appeal of such products, but we must ensure that the regulations are enforceable, robust and fit for purpose. My first of many questions to the Minister is this: will he confirm that a detailed policy paper will be forthcoming, setting out the policy objectives on vaping and how the new regulations will deliver against the objectives?

The Labour manifesto made a bold commitment on halving the gap in healthy life expectancy between the richest and poorest regions in England. Tobacco control is the best way to close the gap. We cannot say it enough: the range of diseases that smoking causes is extraordinary, from stillbirths and asthma in children to heart disease, stroke, dementia in old age, poor mental health and many cancers.

It will never cease to amaze me that there are people in this place who are happy to be lobbied by the tobacco companies—including, I am guessing, the shadow Secretary of State—some of whom we have heard from already, knowing full well the damage caused to individuals, families and communities, as well as to our health services. That includes communities such as mine in the north-east of England, where smoking is still the key driver of health inequalities and has been the cause of 26% of all deaths in the last 50 years and the cause of 125,000 deaths since 2020.

In my constituency of City of Durham, smoking costs us over £95 million a year, and more than £3 million is spent on healthcare. In County Durham, smoking costs us over £500 million a year, and over £21 million is spent on healthcare. In the north-east, the cost is over £2 billion, with healthcare costs at over £93 million. Nationally, smoking is still the greatest cause of preventable death, still the leading cause of premature death and disability, and still responsible for half the difference in healthy life expectancy between the rich and poor. That is why I have asked time and again in this Chamber for action.

It is a tragedy when we consider the further health implications. According to Cancer Research UK, the most deprived communities will not be smokefree until 2050. I urge the Government to restate their intention to publish a road map to a smokefree country and outline how support will be targeted at those who most need to quit. Smoking is also directly and indirectly linked to poor mental health. Nearly 40% of those who have a severe mental health problem smoke, and smoking accounts for two thirds of the reduction in life expectancy among that group.

I want to touch on the “polluter pays” levy. The Darzi review found that our health service is in real trouble. The Secretary of State is right that to rebalance supply and demand in our healthcare system, we need a major shift from sickness to prevention. The Khan review and the all-party parliamentary group on smoking and health have advocated for a “polluter pays” levy, which could raise £700 million a year to create a smokefree fund. That would ensure that the tobacco companies—not the public—pay for the harm that they inflict. Will the Minister consider that approach to fund the work needed to reduce smoking across society and to protect the NHS?

I should add that public health initiatives to tackle smoking are remarkably good value for money and that failing to fund efforts to tackle smoking is a false economy. Initiatives such as Fresh—the north-east’s tobacco control programme—have led the way in tackling smoking in our region. Fresh and others could provide best practice for the Department.

The Minister will know that the UK Government are party to the World Health Organisation framework convention on tobacco control. Article 5.3 seeks to protect policymaking from industry influence, but we have already seen that influence even at this stage of the Bill. Will the Minister confirm that the Government will live up to their obligations under the FCTC and commit to protecting the Bill from industry influence throughout its parliamentary process and the following regulations?

I am proud to vote for a Bill that will improve people’s lives and extinguish the injustice that smoking causes to individuals and society. Smoking is never about choice, and it is pathetic that some Members have argued that this is an issue of freedom; it is absolutely nothing of the sort. Tobacco companies target children and young people. Smoking is an addiction, and the only free choice is that first cigarette. When someone is in hospital, struggling to breathe because of smoking-induced lung cancer, where is their freedom? Today, we have the opportunity to give people the freedom to live healthy lives, free from disease and the inequalities that smoking causes.

[Madam Deputy Speaker (Judith Cummins)]

I call the Liberal Democrat spokesperson.

Woman and Equality: North of England

Mary Kelly Foy Excerpts

Tuesday 5th November 2024 Westminster Hall

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

I beg to move,

That this House has considered inequalities faced by women in the north of England.

It is a pleasure to serve under your chairmanship, Sirusb Christopher. This debate is about the “Woman of the North” report, published in September 2024 by Health Equity North. I thank Health Equity North for the report and for their support for today’s debate, as well as all those who contributed to that vital research.

Women in the north of England face unequal challenges and inequalities in their lives and their health, compared with the rest of the country. They are more likely to work more hours for less pay and be in worse health. They are also more likely to be an unpaid carer, live in poverty and have fewer qualifications. In fact, the inequality between women living in the north of England and those in the rest of the country has grown over the past decade. It has harmed women’s quality of life and work and harmed their communities and families.

Today, I am going to debate the key findings of the research and highlight the report’s recommendations. The report does not make for easy reading. Even though the Minister, like me, will be all too aware of the impact of austerity on our communities, many of the findings will, I am sure, come as a shock, as they did for me.

I will not be able to cover everything, but I hope the debate will begin a dialogue between the Department and the contributors to this important research.

[Jim Shannon (Strangford) (DUP)]

I commend the hon. Lady for bringing this issue forward. First, there is an anomaly—there are two and a half times more self-employed men than women, with jobs and opportunities. Women have the skills and the talent, but one of the things that holds them back is childcare. It does not matter where someone is in this great United Kingdom of Great Britain and Northern Ireland: if they do not have childcare, they have nothing—they cannot get the opportunities. Last week on the TV it said that the cost of childcare for some families is as much as the mortgage. That is a massive issue.

[Mary Kelly Foy]

I could not agree more. That is why I am pleased that the Labour Government will be bringing in thousands of new nursery places and breakfast clubs, which will hopefully alleviate some of the problems of childcare. I know that childcare is an issue not just in the north of England but also in the north of Ireland.

I shall begin with employment. Employment rates for women in the north are lower than the national average of 72.2%. In my region, the north-east, the rate is just under 70%; in Yorkshire and the Humber, it is just over 70%; and in the Minister’s region, the north-west, it is just over 71%.

Disability and long-term sickness is a major issue in the north. All northern regions have levels of disability and long-term sickness higher than the national average, and considerably higher than the south-east. The report states that the resulting estimated economic cost is around £0.4 billion per annum. Compounding that is the fact that the median weekly wage for women in the north is below the national average for both full-time and part-time employment. For instance, the average weekly wage for a full-time working woman in the north-east is £569. That is much lower than the national average of £625 and considerably lower than the average weekly wage for women in London, £757. Overall, women in the north could be losing out on around £132 million a week.

In terms of education, the number of women without qualifications is higher in the north than it is in the south and the south-east. That leads to the next point about women and poverty—an issue that is worth its own debate. A higher percentage of families in the north are on universal credit than in regions in the south. In fact, the average number of families on universal credit across the north is 3% higher than in the south. The figure is even higher if London is excluded.

All 12 local authorities in the north-east have rates of absolute child poverty above the English average. By contrast, all 30 local authorities in the south-west have rates of absolute child poverty below the English average.

The north is also the region of unpaid care, with 12% of women in the north-east providing it—just under 2% higher than the national average. Health Equity North estimates that women in the north are providing around £10 billion a year in unpaid care. Harrowingly, it also estimates that, in the last decade, the life expectancy of girls born in the north of England has begun to stall and in some cases decrease. In addition, girls born in the north will not live as long in good health compared with the national average. For older women, menopause is often cited as a potential driver of change in women’s health, which makes it all the more concerning that there are regional differences in levels of hormone replacement therapy, with lower levels of HRT being prescribed in the north of England.

The picture is even more bleak when we consider pregnancy and reproductive health. We have seen the biggest increase in abortion rates between 2012 and 2021, and there has been a demonstrable relationship between austerity, the implementation of the Tory two-child limit and the increased rate of abortions. I should also add that the two-child limit itself affects over a million children in the country, and it impacts over 60,000 babies, children and young people in the north-east alone. Right now, over 25% of pregnant women in the north of England are living in the most deprived 10% of areas, with 40% of pregnant women living in the top 20% most destitute areas. Tragically, stillbirths are the highest in the most deprived communities, and highest among black African and Caribbean women living in the areas of greatest deprivation. Also, women living in poverty are at increased risk of death and depression. Subsequently, babies are at a higher risk of stillbirth, neonatal death, pre-term delivery and low birth weight.

The report also refers to smoking and pregnancy; I am glad to see that the Tobacco and Vapes Bill will receive its First Reading today. It would be good to hear from the Minister whether the Government will continue to fund the financial incentives scheme for pregnant smokers.

Women in the north of England have the highest rates of domestic violence abuse in the country, which is something that many children are exposed to. That also deserves its own debate. When we consider mental health, the report highlights that, in a cohort of over a million women aged between 16 and 65, from 2005 to 2018, the prevalence of mental illness was higher in three northern regions compared with the south of England. With severe mental illnesses, such as bipolar disorder and schizophrenia, the north-west and the north have higher prevalence rates. Lastly, the report covers the reality of marginalised women in the north, which includes a range of areas, from criminal justice to education and health, as well as issues related to homelessness and substance abuse. I do not have time to go into each point, but I encourage the Minister to read that section if he has not already, and I will either write to him about those issues or table parliamentary questions.

The report’s recommendations are spread across multiple departmental areas, so the Minister may want to follow up in writing if he prefers. One key recommendation of the “Woman of the North” report is that central Government should deliver a national health inequalities strategy—one that convenes Government Departments from across Whitehall to put health at the heart of all policies to address the wider determinants of health. Many of the policies announced in the Budget, as well as the Employment Rights Bill, will be welcome, such as uprating universal credit in line with inflation and tackling zero-hours contracts. Of course, we wait in anticipation for the child poverty taskforce strategy next year, and I sincerely hope that we will see an end to the Tory two-child limit. In addition, the report recommends that the Treasury should consider targeted support for pregnant women, as well as improving childcare. When it comes to local and regional government, which I know the Minister has experience in, the report suggests targeted support delivered to 11 to 18-year-olds through careers hubs in the areas of greatest deprivation and a higher level of the adult education budget for the north. Greater support is also required for women navigating the social security system and for social security uptake, and for women to transition back to their families and integrate into their communities after involvement in the criminal justice system.

Finally, with health and social care, NHS England could provide additional support and investment for women’s health hubs, and health services should be supported to collect routine data on ethnicity and other key demographic data. That would help deliver better information for service development and improve our understanding of different health needs. It would also explore the ways in which the services’ work can be adapted to address health inequalities across different population groups, with examples including providing cultural sensitivity training, adopting a trauma-informed approach to care and promoting person-centred approaches.

I have been an MP since 2019 and have spoken about health inequalities ever since I was elected. Today’s debate is not pleasant, but I am genuinely hopeful that we can turn a page under a Labour Government. We have already seen positive measures, such as those in the Employment Rights Bill and the Budget. I look forward to the Minister’s reply and hope to work with him alongside Health Equity North to deliver happiness and dignity for women in the north, which is long overdue.

Oral Answers to Questions

Mary Kelly Foy Excerpts

Tuesday 15th October 2024 Commons Chamber

[Wes Streeting]

The right hon. Alan Milburn is alive, he is safe and we are treating him well.

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

October is Breast Cancer Awareness Month, and I stand here today as someone who was diagnosed, treated and cured of breast cancer this year by the amazing staff in the north-east, but not enough women are taking up their breast screening appointments. Will the Minister do more to raise awareness of, and access to, breast screening appointments, and may I urge all women to check themselves regularly?

[Andrew Gwynne]

I pay tribute to my hon. Friend for her work in this area and for setting out eloquently her own personal experiences. Of course this Government will do more to raise awareness and enable more women to access breast screening services.