Draft Tobacco and Related Products (Amendment) (Northern Ireland) Regulations 2023

Neil O'Brien Excerpts

Tuesday 11th July 2023 General Committees

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

I beg to move,

That the Committee has considered the draft Tobacco and Related Products (Amendment) (Northern Ireland) Regulations 2023.

It is a pleasure to serve under your chairmanship, Ms Harris. The purpose of this statutory instrument is to implement the EU Commission delegated directive (EU) 2022/2100 of 29 June 2022, which amends directive 2014/40/EU —the tobacco products directive—to withdraw certain exemptions in respect of heated tobacco products placed on the Northern Ireland market. The regulations amend the Tobacco and Related Products Regulations 2016 in relation to Northern Ireland. Subject to their approval by Parliament, they are due to come into force on 23 October this year.

The regulations apply to Northern Ireland only and are made for the purposes of dealing with matters arising out of, or related to, the Windsor framework. Regulation 3(3) amends TRPR—the 2016 regulations—to prohibit the production or supply of Northern Ireland heated tobacco products that contain a characterising flavour. Unlike cigarettes, heated tobacco can currently contain characterising flavours such as menthol, vanilla and so on. Under the changes the SI implements, that will no longer be the case for heated tobacco products sold in Northern Ireland from 23 October 2023.

We do not need to make changes in the light of the Commission delegated directive that requires heated tobacco products to contain health warnings and information messages if they combust. If heated tobacco products that involved a combustion process were placed on the UK market, they would be regulated as tobacco products for smoking and would be subject to existing regulations in TRPR that require such products to contain a combined health warning and information message. However, there are currently no heated tobacco products on the Great Britain or Northern Ireland markets that involve a combustion process and, as such, products are subject to the labelling requirements applicable to smokeless tobacco products.

A full assessment of the impact on Northern Ireland business has not been prepared for this instrument because the amounts involved on business fall below the threshold for producing one. The regulations will apply to producers, suppliers, retailers and wholesalers that produce or supply heated tobacco products for consumption in Northern Ireland. The Department of Health and Social Care communicated with the tobacco industry, NI retail representatives and enforcement agencies regarding the proposed changes in February and again when the draft SI was laid in June.

Heated tobacco products on the UK market are produced and manufactured by the tobacco industry outside the UK. The characterising flavour ban will limit the products the industry can produce and supply to the Northern Ireland market and may impact on its profits in what is a relatively small market for the industry in Northern Ireland. There is no significant impact on the public sector, and each district council in Northern Ireland will, when required, enforce the new requirements, which are not expected to be a significant burden on councils given the very low use of heated tobacco products in Northern Ireland.

I am content to introduce the regulations, which allow us to honour our current commitments under the Windsor framework and will have limited impact on Northern Ireland business. I commend the regulations to the Committee.

[The Chair]

Before I call the Opposition spokesperson, I should say that I have no problem if people wish to remove their jackets, given how warm the room is.

--- Later in debate ---

[Neil O'Brien]

We have driven down smoking rates in England to a record low—from about 40% in the 1970s to about 20% in 2010 and down to a record low of 13% today. We have done that partly by doubling excise duties and partly by introducing a minimum excise on the cheapest cigarettes.

We continue to move forward in our efforts to cut smoking. I recently set out plans to give all women who smoke during pregnancy new incentives to quit smoking, and plans to give 1 million smokers help to “swap to stop” with free vaping kits. The Government are taking determined action to drive down rates of smoking, and we will keep all measures about comparability between Northern Ireland and the rest of the UK under review.

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

The Minister has not responded to the point made by my hon. Friend the Member for York Central.

[Neil O'Brien]

Which point?

[Debbie Abrahams]

The point about the inequalities that there will be between Northern Ireland and the rest of the UK, and whether there has been an assessment of them. I gently remind the Minister that it was a Labour Government that introduced smoke-free zones and ensured that people were protected from second-hand smoking. The Government need to recognise that.

[Neil O'Brien]

We keep all those things under review. Flavourings in heated tobacco are a relatively niche issue, but of course we will look at the regulation of those things. The mainstay of our policy is raising tax on cigarettes, which has driven down smoking rates, and using vapes, but not heated tobacco, as a potential substitute to get people off smoking.

I commend the draft regulations to the Committee.

Question put and agreed to.

Electronic Cigarettes

Neil O'Brien Excerpts

Thursday 29th June 2023 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mrs Latham.

I start by thanking my hon. Friend the Member for Sleaford and North Hykeham (Dr Johnson), who is a former colleague in the Department for Health and Social Care. I thank her not only for this debate and her brilliant speech, which was full of interesting observations and ideas, striking and concerning anecdotes, and great wit, but for her work in really driving the debate on vaping in recent months and years. She has been a leading voice in this area. Likewise, I thank my right hon. Friend the Member for Calder Valley (Craig Whittaker) for his interesting insights.

Before I get into the main body of my speech, I will address some of the specific issues raised. My hon. Friend the Member for Sleaford and North Hykeham asked about the availability of prescription products. The reason they are not available is that the producers have not come forward with them at this stage. We remain hopeful that that will happen, but we are reliant on commercial companies wanting to do it. That is not about concerns that it is less safe than smoking; it is just about commercial partners bringing that forward for approval.

The SNP spokesperson, the hon. Member for Paisley and Renfrewshire North (Gavin Newlands), pointed out that, interestingly, vaping products are not available in China, even though it exports them to the rest of the world. I do not think that that has as much to do with the Chinese Communist party’s position on public health as it does with the fact that it gets huge revenues from its ownership of the tobacco industry, which is still extremely big in China. I think it has more to do with that than with an enlightened view on the relative safety of vaping and smoking.

The Opposition spokesman, the hon. Member for Ilford North (Wes Streeting), asked specifically what we are doing on smoking. Smoking rates came down from some 40% in the 1970s to 21% in 2010, and they are now at a record low of 13%. That is partly because we have doubled excise duties and brought in a minimum excise tax on the cheapest cigarettes, but it is also because we continue to take further measures, including the measures I announced recently, such as the help for a million smokers to “swap to stop”, which is an innovative, world-first policy, and our provision of health incentives to help those smoking during pregnancy to stop. We know from partners in local areas that evidence-based policy works. Much has been done and there is yet more to do in the future.

I absolutely understand the concerns, and I am just as motivated as my hon. Friend the Member for Sleaford and North Hykeham by the challenge of youth vaping. Until recently, our regulations, such as the minimum age of sale, advertising restrictions and the cap on nicotine levels, had been holding down vaping rates. However, over the last two years we have started to see a surge in the use and promotion of cheap, colourful products that do not always comply with our regulations. As hon. Members have mentioned, there has been a sharp increase in children vaping and the awareness of vaping. That is of great concern to me, for exactly the same reason that it concerns my hon. Friend.

Despite its high effectiveness as a tool to help adults quit smoking, we are absolutely aware of the risks that vapes pose to children. Vapes are not risk-free. Nicotine is highly addictive, it can be harmful and there are unanswered questions on long-term use, as raised by my hon. Friend. As Professor Chris Whitty, the chief medical officer, said:

“If you smoke, vaping is much safer; if you don’t smoke, don’t vape”.

Last month, the Prime Minister announced several new measures to tackle youth vaping, including taking steps to close the loophole in our laws that allows the vaping industry to give out free samples of vapes to under-18s. Recent data suggests that 2% of 11 to 15-year-old ever vapers—approximately 20,000 of them—said that they were given it by a vape company, so we will stop that.

Secondly, the Prime Minister announced that we will update the health education curriculum to teach kids about the risks of vaping, as called for by my hon. Friend, just as schools do for the risks of smoking and excessive drinking. To support that, the Office for Health Improvement and Disparities is producing a new resource pack for schools on vaping for the start of the new academic year. The resources have been informed by research with teachers and young people. The activities will feature films made with young people in which they will talk in their own words about the issues around vaping, as well as a clear presentation of the latest evidence. Those resources build on other content we have already produced for young people, including on the Frank and Better Health websites, and input into educational resources produced by partners including the Personal, Social, Health and Economic Education Association.

The Prime Minister also announced that we will review the rules on selling nicotine-free vapes to under-18s, to ensure that our rules keep pace with what is happening in the industry, and review the rules on issuing fines to shops selling vapes to under-18s, to allow local trading standards to issue on-the-spot fines and fixed penalty notices more easily. That will complement existing fine and penalty procedures and cover both illegal and underage sales for vapes and tobacco. Those steps build on measures we are already undertaking.

Earlier this year, in April, I announced new measures to step up our efforts to stop kids getting hooked on vaping. First, we launched a call for evidence on youth vaping to identify opportunities to reduce the number of children accessing and using vape products, and to explore where Government can go further. That explored a range of issues, several of which were touched on by my hon. Friend, including the appearance and characteristics of vapes, the marketing and promotion of vapes, and the role of social media, as touched on by the hon. Member for Paisley and Renfrewshire North. It sought to better understand the vape market, looking at issues such as the price of low-cost products, mentioned by my hon. Friend, and the environmental impact of vapes. The call for evidence closed on 6 June, and Department of Health and Social Care officials have begun to carefully examine the responses. We will be publishing our response in early autumn, identifying and outlining areas where we can go further.

I also announced in April that we are going further to enforce the existing rules on vaping. I announced a specialised illicit vaping enforcement squad, which is a dedicated team to tackle underage vape sales and the illicit products that young people have access to. That will hold companies to account and enforce our current rules. We are providing an extra £3 million to trading standards, which will help share knowledge and intelligence across the country. It will undertake test purchasing, disrupt illicit supply, including from organised crime gangs, and remove illegal products from shelves at our borders, which will tackle the horrifying issue raised by my hon. Friend about the content of some illicit vapes. There will be more testing to ensure compliance with our rules, and we will be bolstering the training capacity of trading standards too.

Companies failing to comply with the law will absolutely be held to account. In some cases, we have already got companies to withdraw products from their shelves if they have not met our rules. I am pleased to announce that National Trading Standards has begun setting up the operation, gathering intelligence, training staff and bolstering capacity to begin field work later this summer.

I absolutely appreciate the calls for single-use vapes to be banned due to their environmental impact, and also because of their appeal to young people. In 2022, about 52% of young people who vaped used disposable products, compared with just 8% in 2021. We are concerned by the increasing use of these products and their improper disposal, for the reasons my hon. Friend mentioned. We are exploring a whole range of options to address this through the youth vaping call for evidence.

This is absolutely not a reason for not doing anything, but one of the issues we will have to deal with is the nature of the industry, which is based in Shenzhen, is highly nimble and manufactures lots of different things. It will be a challenge to address issues specific to disposable vapes, because the industry will try to get around them by saying, “This is potentially refillable.” In theory, my biro is refillable, but in practice, and if it was cheap, it can simply be thrown away. Careful consideration needs to be given to the question of what is and is not disposable, if we are going to put some weight on it. I am not in any way arguing that nothing can be done, but extremely careful thought is required to ensure that the actions we take are highly effective.

All vapes, including single-use vapes, fall within the scope of the UK’s Waste Electrical and Electronic Equipment Regulations 2013, which require importers and manufacturers of vapes to finance the cost of collection and proper treatment of all equipment that is disposed of via local authority household waste sites and returned to retailers and internet sellers. From an environmental perspective, the starting point must be to assist businesses to understand their obligations and bring them into compliance. If we can achieve that, the environmental impacts can be reduced. The Department for Environment, Food and Rural Affairs will shortly be consulting on reforming the WEEE Regulations to ensure that more of this material is properly recycled.

We are committed to doing all we can to prevent children from starting vaping, and we are already taking robust action in a range of areas. We are also looking closely at how we can go further. As I mentioned, early this autumn we will publish the response to the youth vaping call for evidence and outline our next steps, and we want to move fast.

[Craig Whittaker]

Before the Minister concludes, does he have any thoughts on the World Health Organisation forum in Panama this November and whether the UK will be subscribing to the WHO requests or pursuing our own policies as a sovereign nation?

[Neil O’Brien]

My right hon. Friend asks an important question. We will set out our position for that conference of the parties in due course. On the question of heat-not-vape products, they are, as far as one can see from the evidence, more dangerous and contain more toxic chemicals than vapes, so there is a concern about the use of those products. When I was on the Science and Technology Committee, I remember looking at all these different products and the new things on the market. There is a substantial gap in terms of safety. It may be that they are safer than smoking, but there are serious concerns about the health effects of heat-not-burn products—even more significant than those about vapes, which have been raised in this debate.

I end as I began by paying tribute to my hon. Friend the Member for Sleaford and North Hykeham for all the work she has done to drive this important debate. As constituency MPs, we all see this important and growing issue in our schools and through talking to young people. We are moving at pace and will continue to do so to address these challenges. It is important that we calibrate our approach correctly so that it is effective. We have already done a number of things, and we stand ready to do more to tackle this extremely important issue.

Ultra-processed Food

Neil O'Brien Excerpts

Wednesday 21st June 2023 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Dr Huq. I am particularly grateful to my hon. Friend the Member for Stourbridge (Suzanne Webb) for securing this debate, which is timely and deals with an incredibly important issue, which I am very interested in. I recently met Dr Van Tulleken and the Scientific Advisory Committee on Nutrition, and we are working on this at pace, so I welcome the debate.

One of the great challenges with ultra-processed food is defining what it is. The most commonly used definition, as we have heard, is the NOVA definition, which includes foods that are clearly less healthy, such as sugary drinks, confectionery, salty snacks, cakes and other products that are high in calories, saturated fat, salt and sugar. A diet high in those things increases the risk of excess weight gain and obesity. We are committed to tackling obesity, and have a programme of measures to do that. We have introduced calorie labelling in cafés and restaurants, and since last October we have introduced location restrictions on less healthy foods to reduce pester power. An advertising watershed will be introduced in 2025. That requires numerous steps, and we are taking them.

For children and young people, we are spending £150 million a year on healthy food schemes, such as school fruit and veg and nursery milk, through our Healthy Start scheme. We are also putting in £330 million a year for school sport and the PE premium. In addition, there is a £300-million youth investment fund in facilities to encourage an active lifestyle, and we are spending about £20 million a year on the national child measurement programme, which aims to nip problems in the bud. Only a few weeks ago, the Prime Minister made an announcement on funding a £40-million start in the use of new weight loss drugs for those living with obesity.

[Maggie Throup]

Are the Government still committed to halving child obesity by 2030?

[Neil O'Brien]

Yes. We are working with food businesses and we have set out direct measures to further progress reformulation, which is crucial to helping people to make healthy choices. The soft drinks industry levy decreased the amount of sugar in soft drinks by 46% between 2015 and 2020, and the voluntary sugar reduction programme has delivered a nearly 15% reduction in average sugar levels in breakfast cereals and a 13.5% reduction in yoghurts and fromage frais. Together, these policies are expected to accrue health benefits of about £60 billion, producing savings for the NHS.

Although a significant amount of work has been published, there is no universally agreed definition of ultra-processed food; nor is there an evidenced position. We do have definitions of products that are high in fat, salt and sugar, and that is the basis on which we regulate and control those foods. The Scientific Advisory Committee on Nutrition provides the Government with robust, independent advice on the science and the underpinning evidence base. SACN is clear that there is evidence that a diet high in calories, fat, salt and sugar is bad for people’s health. The question then is what ultra-processing adds to that impact. Is it something about the ease of eating these foods, or what it does to someone’s physiology? Are the products in some way addictive, or is it something else entirely?

Some people say, “Why don’t you just adopt the NOVA definition?” but the breadth of the NOVA definition is such that it includes foods that our current dietary guidelines encourage as part of a healthier diet. Shop-bought wholemeal bread, baked beans, or wholegrain breakfast cereals such as bran flakes and Weetabix would be captured by it, so clearly there is work to do to reach the right definition. Some of the foods that I have mentioned can make a positive contribution to nutrient intakes: for example, fortified breakfast cereals or bread and pasta made from fortified wheat flours are the largest source of dietary iron in all age and sex groups and provide, on average, between a third to a half of our calcium intake.

Defining the problem is not completely straightforward. To make progress so that we can start to regulate or do anything else, we need to have a clear definition. However, even though how to define these things is not totally obvious, that does not mean that there is not a problem, that we will not take action, or that we cannot find a solution. We all know it when we see it—I particularly admired the definition of my hon. Friend the Member for Erewash (Maggie Throup) that having an unpronounce-able ingredient is a pretty good sign—but we need to be precise and follow the scientific evidence.

That is why SACN is carrying out the scoping review of the evidence on processed foods and health, which includes reviewing existing processed food classifications and the ability to apply NOVA to UK diets and our national diet and nutrition survey. SACN aims to publish its initial assessment this summer, so we are moving quickly. We are also in touch with other countries in the same position, and I know that France and Canada are doing similar work. As part of the review, SACN will consider whether there is sufficient evidence to undertake a full risk assessment. Only after an in-depth risk assessment and the identification of robust supporting evidence would we consider updates to Government dietary advice.

The Eatwell Guide, which most Members present will know about, summarises dietary recommendations and shows how much of what we eat overall should come from different food groups to achieve a healthy, balanced diet. It recommends that we consume less often, and in smaller amounts, food and drinks that are high in saturated fat, salt or free sugars. Foods such as crisps, biscuits, cakes, ice cream and sugary drinks are all shown outside the main Eatwell Guide image to highlight that they are not necessary. Those foods also meet the NOVA definition of ultra-processed foods.

The Eatwell Guide and associated messaging is promoted through a range of channels, including the NHS and gov.uk websites, and the Government’s national social marketing campaigns, such as Better Health. We know from our national diet and nutrition survey that most people in the UK are not meeting the dietary recommendations depicted in the Eatwell Guide. Aligning diets more closely with existing dietary recommendations will deliver considerable population health benefits and healthcare savings.

Obviously, one of the things that we are doing to achieve those benefits is supporting people with the cost of living so that they can afford to do it. Support for the cost of living, which we have provided through both energy price support and direct measures for poorer households, has been worth £3,300 for the average household over last year and this year—one of the most generous support packages anywhere in Europe. We are absolutely conscious of the challenges around the cost of food at the moment, caused by the Russian invasion of Ukraine.

Even as we focus on the cost of living, we are still very much focused on obesity, because it accounts for a significant cost to the NHS and the economy. That is what we are doing with our existing programme on obesity and healthy eating. We know that there is more to do, and we will do more. Our major conditions strategy has a call for evidence that runs until 27 June, seeking people’s views on how the healthcare system can support people to lead healthier lives, including supporting them to achieve and maintain a healthy weight. We know that diet has an important impact on health. My hon. Friend the Member for Stourbridge has raised important concerns about ultra-processed foods, which we are looking at.

Our existing policies support less consumption of many of the foods that would be classified as ultra-processed because they are high in fat, salt and sugar. We know that they are a problem, and that is why we regulate in the way we do. It is vital that we take a considered and robust approach to the emerging evidence on what ultra-processing is doing. That is what we are doing, and we will not hesitate to take action if the evidence suggests that it is needed.

Volume Price Promotion Restrictions

Neil O'Brien Excerpts

Tuesday 20th June 2023 Written Statements

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

The Government are announcing their intent to delay the implementation of restrictions on volume price promotions, such as “buy one get one free” or “3 for 2” offers, on less healthy products by 24 months. These restrictions will now come into force on 1 October 2025.

Given the current challenges caused by higher food prices, the Government do not want to take actions that may restrict consumer choice.

Therefore, we are delaying the restrictions until October 2025 in light of the unprecedented global economic situation.

The intention of the promotion restrictions is to shift the balance of promotions towards healthier options, encouraging people to make healthier choices. We will continue to work closely with food businesses to reformulate products to be healthier. We have already seen success in some categories of the sugar reduction programme including a 14.9% reduction in average sugar levels in retailer and manufacturer branded breakfast cereals and a 13.5% reduction in yogurts and fromage frais.

The delay to volume price promotions does not impact the location restrictions which are currently in force. Under these restrictions, less healthy products in scope can no longer be promoted in key locations, such as checkouts, store entrances, aisle ends and their online equivalents. The location restrictions are the single most impactful obesity policy at reducing children’s calorie consumption and are expected to accrue health benefits of over £57 billion and provide NHS savings of over £4 billion, over the next 25 years.

We intend to consult in the coming weeks on the secondary legislation to implement the delay to the volume price restrictions.

The Government remain committed to halving childhood obesity by 2030 and delivering on these measures.

[HCWS868]

Smokefree 2030 Target

Neil O'Brien Excerpts

Tuesday 20th June 2023 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Sharma. I thank my hon. Friend the Member for Harrow East (Bob Blackman) and the hon. Member for City of Durham (Mary Kelly Foy) for securing this hugely important debate, and I thank other hon. Members for some excellent speeches. I was haunted by the image, conjured up by the hon. Member for Birmingham, Erdington (Mrs Hamilton), of people with COPD being wheeled outside to have one more gasp—I think we have all seen things like that. It has also been a pleasure to have contributions from all four parts of the UK. I shall try to respond to as many of the questions as possible.

In 2019, the Government produced a Green Paper on preventive health, in which we introduced our ambition for England to become smoke free by 2030. The ambition aims to shift the focus from treating ill health to preventing it in the first place. That means three things: first, discouraging children and adults from starting; secondly, helping smokers to quit; and thirdly, moving smokers to less harmful alternatives, such as vapes.

That is exactly what we have been doing over the last decade, and we have made significant progress. In recent years, the Government have introduced a range of legislation. We have introduced a UK-wide system of track and trace for cigarettes and hand-rolling tobacco to deter illicit sales, and from May 2024 that will cover all tobacco products, including shisha and cigars. We have continued to invest in stop smoking services, to help smokers get the right support for them. We continue to support the NHS, and last year alone provided £35 million to the NHS long-term plan commitments on smoking. Of course, we have also doubled duty on cigarettes and introduced a minimum excise tax on the cheapest cigarettes. Between them, those measures have helped to ensure that adult smoking prevalence in England is at its lowest level on record, 13%, and that youth smoking rates are the lowest on record—in 2021, 3.3% of 15-year-olds were regular smokers.

If we are to achieve our 5% ambition by 2030, however, we must move faster and be bolder. That is why on 11 April I introduced a package of new measures to help make more progress. To help smokers quit and move towards less harmful alternatives, we announced funding for a new national “swap to stop” scheme, which is the first of its kind in the world at a national level, to encourage 1 million smokers to swap cigarettes for vapes. We have begun to set up pathfinders, where local authorities can apply for starter kits, and the first shipments of vapes should begin going out later this summer. Local authorities across the country have expressed an interest, and we are also working with social landlords, homelessness charities, jobcentres, food banks and all the other groups that can help smokers to quit.

Despite its effectiveness as a tool to quit smoking, we must be aware of the risks that vaping poses to children and non-smokers, as various Members have pointed out. Over the past couple of years, we have seen an alarming rise in children vaping, and that is why we are taking action. We recently held a call for evidence to look at all the opportunities to reduce the number of children using vape products. It closed on 6 June and we are analysing the responses. We will publish our response within 12 weeks.

To stop children buying vapes, we need to get businesses to comply with our regulations and abide by the standards we have set. Of course, there are retailers out there selling vapes to children. That is why we recently created a new enforcement unit, which has three priorities: to tackle products imported and traded illicitly, to remove illegal products from the market that do not comply with our regulations, and to stop under-age sales to children. The unit will help remove illegal products from shelves, stop them coming through our borders and stop the sale of vapes to children.

[Dr Hudson]

I thank the Minister for articulating some of the risks around disposable vapes. I want to raise the risks they pose to animals. Just the other day, I was out walking my young dog Poppy and she came out of the undergrowth with a bright pink, melon-flavoured disposable vape in her mouth. I was able to get it out of her mouth, but, as a vet, I shudder to think what would have happened if she had chewed, crunched or swallowed it. Does my hon. Friend agree that we need more public awareness of the risks of vapes to health, the environment and even animals?

[Neil O’Brien]

That is a fascinating point, and my hon. Friend is absolutely right that we need to be aware of the environmental and wider impacts of disposable vapes as we consider our next steps.

At the end of May, the Prime Minister announced several further measures to address youth vaping, including closing the loophole that allowed industry to give out free samples, increasing education and supporting dedicated school police liaison officers to keep illegal vapes out of schools. The measures support our wider approach to tackling youth vaping—not only preventing supply, but reducing demand. We also need to take action against businesses that break the rules and protect businesses that abide by them.

As well as non-compliant vapes, the illicit trade in tobacco undermines our work to protect public health. To answer the question from the hon. Member for Arfon (Hywel Williams), His Majesty’s Revenue and Customs will produce a new strategy to tackle illicit tobacco later this year. The strategy will outline joint efforts to catch and punish those involved in the illegal market and will build on the work we are already doing—my hon. Friend the Member for Harrow East alluded to it—to use the registration system as a way to improve enforcement.

Another big priority is to help pregnant women quit smoking. The rate of smoking in pregnancy remains stubbornly high; increasing the number of women who have a smoke-free pregnancy is crucial. To help expectant mothers, we have set up a financial incentive scheme, married with behavioural support. We aim to ensure that every pregnant mother who smokes across England gets help to quit. That work is based on a successful scheme in Greater Manchester, which has seen one of the biggest drops in smoking in pregnancy anywhere in the country.

To help more smokers quit, we need to be more innovative in how we connect with them, with the right type of support and messaging at the right time. To address the question asked by the hon. Member for Blaydon (Liz Twist), we are going further on mental health and are ensuring that everyone who is in mental health treatment is signposted to stop smoking services, because there is a link between the two.

Another potential opportunity that hon. Members have raised is our plan to provide pack inserts in smoked tobacco packets, with positive messages and information to help more smokers quit. We intend to launch a UK-wide consultation shortly and are engaging with devolved Administrations on the matter. To answer the question raised by the hon. Member for Strangford (Jim Shannon), we are absolutely having those conversations.

We are committed to doing all we can to prevent people from starting smoking, to give smokers the support they need to quit, and to tackle the damage from the illicit market. I talked about some of the measures that I recently announced, but we will have more to say in the major conditions strategy in the not-too-distant future. I thank my hon. Friend the Member for Harrow East and the hon. Member for City of Durham for securing this hugely important debate, and I look forward to making further progress towards our ambition for a smoke-free England and a smoke-free UK by 2030.

Sight Testing in Special Schools

Neil O'Brien Excerpts

Monday 19th June 2023 Written Statements

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

I am pleased to announce that NHS England will make available sight testing to all special schools from 2024-25.

We know that children with a learning disability are 28 times more likely to have a serious sight problem, and over 40% require glasses. Whilst free NHS sight tests are available for all children, the Government acknowledge the particular challenges faced by children and young people who attend special school settings in accessing high street sight testing services and also the benefit of these settings in receiving personalised advice on optimising the environment for learning.

The NHS Long Term Plan made a commitment to provide sight testing in special residential schools. To meet that commitment, NHS England commenced a proof-of-concept programme in 2021 to pilot a potential sight testing service model. This pilot was subject to an independent evaluation. As a result of that evaluation, NHSE is proposing to build upon the Long Term Plan commitment and extend provision to all children in special education day schools.

NHS England now intends to undertake a period of engagement with key stakeholders, schools, and the public over summer 2023, in order to share the learning from the proof-of-concept scheme and further develop the care model that will underpin the proposed future of the new expanded sight testing scheme. Following which NHS England will publish a revised service specification and roll-out plans.

Whilst this engagement is undertaken existing contractors will continue to operate under the current proof-of-concept arrangements until such time as NHS England complete its engagement and confirms the future commissioning arrangements.

I hope this will be welcome news and I thank those from across the eye care sector who have helped to shape this valuable service.

[HCWS861]

Prescription Charge Upper Age Exemption: Consultation Outcome

Neil O'Brien Excerpts

Thursday 15th June 2023 Written Statements

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

In 2021, the Department of Health and Social Care held a public consultation on aligning the upper age for the NHS prescription charge exemption with the state pension age (SPA), which is currently 66, and due to increase to 67 and 68 in future years. The upper age for NHS prescription exemption was introduced in 1968 to be in line with the women's state pension age, which was 60 at that time. In the decades since, there have been increases to the state pension age, but the upper age exemption for prescription charges has remained the same.

The consultation received over 117,000 responses, the majority of which were opposed to the proposed change. Responses cited, among other issues, cost of living pressures and risk to health of people not taking prescribed medication correctly as reasons for retaining the current upper age exemption. The Government are committed to tackling cost of living pressures and has decided that the prescription charge upper age exemption will remain at 60, meaning that it will not change to align to state pension age.

It should be noted that, in England, a broad range of NHS prescription charge exemptions are in place to help those with greatest need. These measures include a variety of charge exemptions, and eligibility depends upon whether people are in receipt of certain qualifying benefits or tax credits, their age, receipt of a war pension or have a qualifying medical condition. The current exemptions mean that around 89% of NHS prescription items dispensed in the community in England are free of charge, in addition, those on a low income who do not qualify for an automatic exemption can seek help under the NHS low income scheme. For those who do not qualify for an exemption or the NHS low income scheme, prepayment certificates (PPC) are available to help those who need frequent prescriptions. The annual PPC can be paid for through 10 instalments, and covers all prescriptions in that period for just over £2 per week.

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Stem Cell Transplant Patients

Neil O'Brien Excerpts

Monday 12th June 2023 Commons Chamber

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

I congratulate the right hon. Member for Alyn and Deeside (Mark Tami) on securing this important debate, and I congratulate the other hon. Members on speaking interestingly about their personal experiences in this field. As chair of the all-party parliamentary group on stem cell transplantation and advanced cellular therapies, the right hon. Member for Alyn and Deeside speaks from particular personal experience and I think everyone will have been delighted to hear the wonderful update about Max.

For people living with blood cancers and blood disorders, stem cell transplants are a potentially life-saving treatment. That is why we continue to invest in improving clinical outcomes and access to transplants. Since 2011, Government funding of more than £28 million has made possible the establishment of a unified stem cell registry, a cord stem cell bank, and a strategy to recruit donors to meet the needs of our increasingly diverse population. Over the next three years, we are investing £2.4 million more to increase the resilience of the UK stem cell supply and to address health inequalities with targeted campaigns to recruit donors from ethnic minorities. The right hon. Gentleman mentioned Anthony Nolan, which gives me the opportunity to thank that charity for its tremendous work with the NHS to build up the stem cell register.

As we know, the very nature of these transplants means that patients are among the most vulnerable in society. They are left with seriously weakened immune systems, for all the reasons the right hon. Gentleman has given. To help households and individuals to cope with the rising costs of living, we are providing some of the most generous cost of living support in Europe, worth an average of £3,300 per household this year and last. As well as the action on energy prices, that includes payments to more than 8 million UK households receiving eligible means-tested benefits, and to 6 million people across the UK in receipt of eligible “extra-costs” disability benefits.

For those needing extra support, the Government are providing an additional £1 billion to allow the extension of the household support fund in England this financial year. Our energy price guarantee is helping millions of people to deal with rising energy costs, and, as the Chancellor announced in the spring Budget, it will be extended, at £2,500, for an additional three months from April until the end of June. That means that by the end of June we will have covered nearly half a typical household’s energy bill, with a typical household saving about £1,500.

The right hon. Gentleman rightly raised the importance to patients of keeping warm, and the warm home discount is a key policy in our programme to tackle fuel poverty and help low-income households with the cost of energy, whatever the reason for their low incomes. It gives low-income and vulnerable households throughout Great Britain an annual £150 energy bill rebate every winter, and since it began in 2011 we have provided more than £3.5 billion in direct assistance for households. The scheme obliges participating suppliers to provide rebates for eligible low-income and vulnerable households.

In order to target fuel poverty better and provide the vast majority of rebates automatically, we have expanded and reformed that scheme for England and Wales from 2022-23 onwards. That includes those receiving universal credit, for which stem cell transplant patients may well be eligible. Depending on their specific needs, stem cell transplant patients may be entitled to financial support to contribute towards their extra costs, which may include the personal independence payment. PIP can be paid in addition to the other financial and practical support that may be available through universal credit.

The Government are committed to ensuring that people can access this financial support in a timely manner. While waits are still too long, they are coming down dramatically and we are constantly improving the service. Claimants are kept informed and are updated at each stage of the process—for instance, through a text message service—and in most instances any awards can be backdated to the date of the claim.

I know—not least because of the right hon. Gentleman’s comments this evening—that rising travel costs represent a significant burden for stem cell transplant patients and their families. Recipients of certain benefits, including the personal independence payment, can apply for extra help with travel costs, such as a disabled person’s railcard, a blue badge or a vehicle tax reduction. NHS trusts can also exercise discretion to provide accommodation and other support, including transport, depending on local and individual patient circumstances. Depending on their financial circumstances, patients may be able to access extra help with travel costs, such as the NHS low-income scheme and healthcare travel costs scheme.

[Mark Tami]

Does the Minister accept that if we require patients to attend specialist centres—which I fully support; indeed, perhaps we need to go further in that regard within the NHS—we should think about how we can help those who have to travel long distances to cover their costs, given that they cannot receive that treatment at the hospital down the road?

[Neil O’Brien]

I would agree with the hon. Gentleman. I was talking about one scheme, the healthcare travel costs scheme, but patients might also be eligible for non-emergency patient transport, on which we spend about £500 million a year across England. We will continue to look closely at the future of that, not least because of the hon. Gentleman’s comments this evening.

[Jim Shannon]

Patients in my constituency who come to me feel almost compelled to go back to work because they do not have the finances, but they cannot do so because they are not fit enough. Could the Minister’s Department ensure that those people who find themselves in difficult financial circumstances have someone to speak to who could perhaps direct them through the process so that they can get help?

[Neil O’Brien]

The hon. Member makes a good point, and I am happy to continue this conversation with him after the debate. He always provides thoughtful ideas and I am keen to continue talking about that one with him.

For those people who are going through all this at the moment, I have mentioned some of the schemes that are available for transport, such as the healthcare travel costs scheme and non-emergency patient transport, but we will continue to look at those to make sure that they are adequate to get patients to the specialist treatment they need.

In closing, let me again thank the right hon. Member for Alyn and Deeside for securing today’s really important debate and for his thoughtful contribution. Stem cell patients and their families and carers show tremendous courage in the face of incredible challenge, and we will continue to do whatever we can to support this vulnerable community.

Question put and agreed to.

HIV Action Plan: Annual Update 2022-23

Neil O'Brien Excerpts

Thursday 8th June 2023 Written Statements

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

I am pleased to update the House on the publication of the first annual update to Parliament on the HIV action plan. In January 2019, the Government committed to an ambition to end new HIV transmissions, AIDS diagnoses, and HIV-related deaths within England by 2030. Achievement of these ambitious commitments—including our interim commitment to an 80% reduction in transmissions by 2025—is within our grasp, and we should be encouraged by the progress already made. This progress is testament to the collective and ongoing efforts of many organisations across the UK Health Security Agency, local government, the NHS and wider health system, statutory agencies, and the voluntary and community sector.

As part of the plan, we committed to update Parliament each year on the progress made towards our ambition to end new HIV transmissions, AIDS, and HIV-related deaths within England by 2030. I am proud to present to Parliament a summary of the work undertaken towards these objectives in 2022-23.

Despite the challenging backdrop of the covid pandemic, England has seen a 33% fall in new HIV diagnoses since 2019. NHS England has committed £20 million in funding for 2022 to 2025 to expand HIV opt-out testing in emergency departments in areas with the highest HIV prevalence. This has helped diagnose 2,000 new cases of blood-borne viruses (hepatitis B and C as well as HIV) in the first year of the programme. During National HIV Testing Week 2023 almost 22,000 free HIV testing kits were ordered by the public—with self-testing kits that provide instant at-home results available for the first time. We have also established the HIV Action Plan Implementation Steering Group to oversee progress, as well as a Community Advisory Group and four task and finish groups to support PrEP access and equity; workforce; HIV control strategies in low prevalence areas; and retention and engagement in care, and I look forward to seeing the impact they will make.

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Tackling Obesity

Neil O'Brien Excerpts

Wednesday 7th June 2023 Written Statements

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

The Government are committed to helping people live healthier lives. The 2019 health survey for England estimated that over 12 million adults were living with obesity—28% of the population in England.

Tackling obesity, which increases the risk of a range of serious and chronic diseases such as cardiovascular disease and diabetes, remains a key priority.

The Government are announcing that up to £40 million of funding will be provided over two years to pilot ways to make the newest and most effective obesity drugs accessible to eligible patients living with obesity outside of hospital settings.

Earlier this year, the National Institute for Health and Care Excellence (NICE) recommended the use of semaglutide (Wegovy) when it launches for adults with a body mass index (BMI) of at least 35 and one weight-related health condition—such as diabetes or high blood pressure. There is evidence from clinical trials that, when prescribed alongside diet, physical activity and behavioural support, patients taking Wegovy can lose around 15% of their body weight after one year, reducing the risk of obesity-related illnesses. Some patients taking this weight-loss drug can begin to lose weight as quickly as within the first month of treatment. Another drug known as tirzepatide is expected to be assessed by NICE for weight loss. Losing weight can help to reduce the risk of obesity-related illness, which in turn can reduce pressure on the NHS, cut waiting times and realise wider economic benefits.

NICE advises that weight-loss drugs are prescribed within a specialist weight management service. Currently, these services are mainly based in hospitals, which means that only around 35,000 people per annum have access to weight-loss drugs, when millions more could potentially benefit.

The £40 million pilots will explore how approved drugs can be made safely available to more people by expanding specialist weight management services outside of hospital settings. This includes looking at how GPs could safely prescribe these drugs and how the NHS can provide wraparound support in the community or digitally. This could increase dramatically the number of people who have the opportunity to benefit from these treatments and provide more equitable access.

The pilot will be delivered by NHS England working closely with the Office for Health Improvement and Disparities (OHID) and NICE. The pilots will be designed with input from primary and community care organisations and existing specialist weight management services. There will be a robust and independent evaluation led by the National Institute for Health and Care Research to ensure any wider roll-out is informed by the best possible evidence.

The pilot builds on the firm action the Government are already taking to tackle obesity. This includes introducing the soft drinks industry levy, which has seen the average sugar content of drinks decrease by 46% between 2015 and 2020, and investment of £350 million to boost school sport to help children and young people have an active start to life.

Last year the Government announced £20 million for the Office for Life Sciences’ obesity mission. This is in addition to the £40 million announced today and will explore innovative ways to best utilise promising medicines and digital technologies to help NHS patients achieve a healthy weight.

The Better Health: Rewards app is also being piloted in Wolverhampton. It is offering incentives such as vouchers for shops, gym discounts and cinema tickets for people who eat healthily and exercise more.

The Department for Health and Social Care launched a call for evidence in May to inform the major conditions strategy, including further work to tackle obesity.

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