Tobacco Control Plan

Michelle Donelan Excerpts

Thursday 19th October 2017 Commons Chamber

[Michelle Donelan (Chippenham) (Con)]

I am delighted to have the opportunity to speak in today’s debate on the Government’s tobacco control plan, which was unveiled in July 2017 and is supported by the British Heart Foundation. It is a co-ordinated effort to bring together the NHS, the Department of Health and local government to tackle smoking.

Although smoking in the UK is declining, the problem should not be underestimated. There are still 7.3 million adult smokers in the UK, and more than 200 smoking-related deaths a day in England, which costs the NHS millions every year. I welcome the plan and the £16 billion that has been ring-fenced by the Government for local public health services until 2021.

Those who use a local stop-smoking service are four times more likely to quit. The figures are astonishing. As the daughter of a smoker of more than 20 years, I have seen at first hand the journey that needs to be replicated to achieve the goal of a “smoke-free generation”.

The success of the 2011 to 2015 tobacco control plan reduced adult smoking rates from just over 20% to just over 15%. The aim now is to reduce rates to 12% and lower by 2022. That is not only right, but essential. We must work to save the 79,000 preventable deaths in England per year and the £11 billion that smoking is costing the economy.

Smoking is not a necessity. A cigarette is not a fashion accessory; it is the way towards lung and mouth cancer, strokes and heart disease and a host of other ailments and illnesses that kill. Let me be clear: I believe in choice and individual freedom, but I also believe that the Government have a role not only to guide, but to signpost and to promote the choices that will lead to healthier lifestyles. That is why I am so proud that the Government are prioritising the issue of smoking.

Some people have said to me: “Michelle if people want to smoke, let them.” I respond by saying that we must arm those people with all the information—the warnings and the facts. We must work together to deglamorise smoking. As has been pointed out, the smoking industry also has a responsibility to play its part. We must guide people and steer them to make informed choices. We must also discourage them, otherwise we will have to pay their NHS bills—money that could be spent in other sectors of the NHS. I often ask people, “If smoking were invented today and we knew all the risks and effects, would it be so freely available and popular?” Armed with the facts, we often make different choices in life.

My mother started smoking in an era when the health consequences were not known. I saw her struggle, desperately trying to give up. My Dad describes that time as a caricature, with my mother wearing anti-smoking patches and smoking cigarettes, while chewing anti-smoking gum and seeing a hypnotist, all at the same time. She simply tried everything. All the hypnotist did was to get her on to menthol cigarettes and give her a fear of hypnotists, so that did not go quite to plan. That taught me that, to break the cycle, it needs to be killed at the root, and people need to be prevented from smoking in the first place. I must add that my Mum has now not smoked a cigarette for seven years. [Hon. Members: “Hear, hear.”] Instead, she has e-cigarettes. Although that cannot be seen as the answer, it is very much part of the solution.

As part of the tobacco control plan, I want to touch on the support provided for pregnant workers, which aims significantly to reduce the likelihood of a person smoking while having a child. Currently, more than 10% of pregnant women smoke, and the plan is to get it down to 6%. Smoking during pregnancy increases the risk of stillbirth. Babies born to mothers who smoke are more likely to be born underdeveloped and in poor health. It is important that we give those mothers all the support and information available. For example, within the plan, NHS England will work to reduce smoking in pregnancy through carbon monoxide testing at antenatal care facilities and referrals to stop smoking services through the Saving Babies’ Lives care bundle.

Support, advice and information are crucial. We must make sure that all mothers are aware of the dangers of smoking. I urge us to be bold—bold with our information and bold with our warnings.

[Alex Cunningham]

Information is key to this matter as well. ASH has told me that the Government no longer have the measure of the number of people with mental health conditions who smoke. Does the hon. Lady agree that the Government need to re-establish a national measure for smoking rates among people with mental health conditions, as that will aid planning and the provision of services?

--- Later in debate ---

[Michelle Donelan]

Indeed, we have problems among many categories in the country. By 2018, the target is to ensure that all mental health facilities are smoke free. We need to identify why people with mental health problems are turning to smoking and then target those issues.

I urge us to be bold with our information and warnings. We should not be afraid to shock in our marketing material, because we in this House have a duty to those who have yet to have a voice and the ability to choose for themselves.



As I mentioned before, perhaps the section of the plan that will prove the most successful is the backing of evidence-based research into e-cigarettes. As the right hon. Member for Rother Valley (Sir Kevin Barron) said, it is the first plan to reference e-cigarettes. In 2016, it was estimated that 2 million people had used e-cigarettes and completely stopped smoking, while a further 470,000 were using them as an aid to quit.

There has been a great deal of discussion on e-cigarettes—the pros and the cons—so what is needed now is more evidence to support them and enable their use positively. They are not risk free and they are addictive—it would be wrong not to mention that—but I agree with Public Health England, which recommends that e-cigarettes are used in areas not covered by the smoke-free legislation and that organisations do not include them in their smoking policies. It is true that we do not know the full extent of the medical effects, but we do know that, for the majority of people, they are the only way to stop smoking and they are by far a better alternative.

In addition, statistics show that people rarely start on e-cigarettes. They use them as a way of breaking their cigarette addictions. It is important to remember that, to tackle smoking effectively, we need a prevention strategy as well as a strategy to help people quit smoking. Dr Andy McEwen, executive director of the National Centre for Smoking Cessation and Training, stated that switching from tobacco to e-cigarettes substantially reduces the major health risk. I urge the Minister to push the case for a review by the National Institute for Health and Care Excellence, which currently is at odds with Public Health England on this topic.

As I said, we have seen many worried headlines about e-cigarettes, particularly for young people. However, the latest and largest study, based on five separate surveys, gathered data from 2015 to 2017 and was from a collaboration including experts from Public Health England. It showed that a tenth to a fifth of 11 to 16-year-olds had tried an e-cigarette. However, only 3% or fewer used them regularly, and they were already smoking tobacco-based products. Among young people who have never smoked, the use of e-cigarettes was completely negligible, despite the media headlines. It is also important to remember that they are restricted in terms of the minimum age sale and the tight restriction on marketing. Let us be clear: the best thing that a smoker can do is to quit smoking. However, the evidence is increasingly clear that e-cigarettes are significantly less harmful to health than smoking tobacco.

Another area that I want to mention is inequality in smoking. By 2022, the Government expect to reduce the inequality gap in smoking prevalence between those in lower paid or manual occupations and those in higher paid or professional occupations. For example, the plan includes promoting links to “stop smoking” services across health and care systems in the UK. However, it is important that we look at the causes, not just the symptoms, when we examine why those in lower economic circumstances smoke more, and why they struggle more to quit. That is why support to councils is so vital, so that they can identify local trends and solutions. I would be interested to hear more about the Government’s plans to invest in research into the causes. We do need to pay more attention to the challenges that are faced by the disadvantaged and those from lower socio-economic groups.

As someone who believes in low tax in general, it would be remiss of me not to point out that on this subject I passionately argue that we should maintain a high duty rate for tobacco products. It is a disincentive for people to start smoking, especially the young, and I urge the Government to go further in the upcoming Budget. Of course, enforcement is nothing without encouragement to give up. So, to conclude, I echo the sentiments that tackling smoking requires a plan—a plan that seeks to prevent smoking, but also assists those who currently want to give up smoking. This plan does that. Treating smoking-related illnesses is estimated to cost the NHS £2.5 billion a year, while the wider cost to society is a staggering £12.7 billion. But the real cost is the human lives—those that are cut short, and the families that suffer: families in Wiltshire, in my constituency, and up and down the country. I am delighted that in Wiltshire there are now 25% fewer hospital deaths from smoking-related illnesses, but that is still too many, and that is why creating a smoke-free generation is essential.