Tobacco Control Plan

Norman Lamb Excerpts

Thursday 13th October 2016 Westminster Hall

[Alex Cunningham (Stockton North) (Lab)]

I beg to move,

That this House has considered the tobacco control plan.

It is a pleasure to serve under you chairmanship, Mr Brady. I am grateful to the Backbench Business Committee for granting us the opportunity to debate this issue in the depth and detail required. The subject has an impact on all of us, and it is right that time is allocated for a meaningful and thorough debate. I am also grateful to my colleagues from across the House who helped to secure the debate and who will, I am sure, make some incisive and insightful contributions.

I am pleased to have been part of the team that has consistently advocated tobacco control, and I am proud of the achievements we have made. The great thing about those achievements is that they have been built on strong cross-party commitment in both Chambers, with the devoted support and drive of external organisations and charities across the country that are determined to keep the harm caused by tobacco very much in the minds of the public and, of course, Ministers. Those organisations have succeeded.

A recent Action on Smoking and Health survey of more than 12,000 people found overwhelming public support for Government action to limit smoking and strong support for the Government to go further and do more. That is no surprise, really, as tobacco control is an area where Government action is highly effective.

Let me start with a parochial statistic. Back in Stockton, 250 miles up the road, smoking prevalence was estimated at 27.5%—more than one in four people—as recently as a decade ago. However, by last year various policies and interventions had seen that figure fall to 18.4%, which is a decrease of about a third. That means that some 14,000 fewer adults in Stockton now smoke than in 2005. I, for one, am very proud of that achievement.

I speak not only as a member of the all-party parliamentary group on smoking and health, the secretariat for which is provided by ASH, but as an MP who, as a humble Back Bencher, successfully pressed for the legal changes around smoking in cars when young children are present, with the support of groups including the British Lung Foundation, Cancer Research UK and the British Heart Foundation. That is on top of the principled and unwavering support I have received from north-east organisation Fresh, which covers my patch in Stockton North and whose joint conference on the harms of tobacco and alcohol I was pleased to address just a fortnight ago.

The dedication to improving public health and promoting tobacco control runs deep not only in my own psyche but in that of colleagues across the House. Back in 1998, the Labour Government introduced the country’s first comprehensive tobacco control strategy. Legislation has moved on since then to prohibit tobacco advertising, smoking in public places and smoking in cars carrying children, and to implement controls on point-of-sale displays. I welcomed all those measures, but I am only too aware that there is much more to be done.

The most recent measure was the introduction of standardised tobacco packaging, which I repeatedly called for and supported. Although the original form of the Children and Families Act 2014 contained no measures at all to protect children from the dangers of smoking or to avert uptake, the amendment on standardised packaging tabled in the House of Lords by Baronesses Finlay and Tyler and Lords Faulkner and McColl was swiftly taken up by the Government and brought to fruition.

In the spirit of debating the issues and the evidence base rather than the politics of any decision, I thank the previous public health Minister and current Financial Secretary to the Treasury, the hon. Member for Battersea (Jane Ellison), for her consistent support for tobacco control and, in particular, standardised packaging. That was duly recognised by her receipt of the prestigious World Health Organisation director general’s special award to mark World No Tobacco Day earlier this year.

A great deal was achieved under the previous plan, “Healthy Lives, Healthy People: A Tobacco Control Plan for England”. Progressive tobacco control legislation was introduced, and the three key ambitions of the plan have been achieved. Smoking rates among adults and children have fallen below the target levels, and rates of smoking during pregnancy reached the 11% target earlier this year. That illustrates perfectly why Britain is a world leader in tobacco control, with the UK coming top in a European survey measuring the implementation of key tobacco control policies and passing legislation that goes further than the requirements set out in European Union directives—perhaps that is one area in which we can expect no negative impact from Brexit. Yet there is still much to be done.

Smoking is responsible for approximately 78,000 preventable and premature deaths each year in England alone, and nearly 100,000 across the UK. In the north-east, the number of deaths from smoking-related diseases is some 30% higher than the English average. Despite the fact that we have hit the national targets on smoking prevalence laid out in the previous plan, stark variations in prevalence persist regionally and among different groups. A national tobacco control strategy should therefore be introduced without delay.

In her Downing Street speech, the new Prime Minister committed her Government to

“fighting against the burning injustice that if you’re born poor you will die on average nine years earlier than others”.

Half of that difference in life expectancy is solely due to higher rates of smoking among the least affluent members of our society, with smoking rates among those with multiple complex needs reaching as high as 80%. I am clear that we should all share that commitment.

In Stockton, just under 30,000 people smoke—that is just over 18% of the population. However, it has been estimated that 539 children between the ages of 11 and 15 start smoking in Stockton-on-Tees every year, with 964 people dying from smoking-attributable causes from 2012 to 2014. Shockingly, that is the equivalent of almost 5,000 years of life lost due to smoking. That death and disease is disproportionately borne by the poorest people in my area.

Although smoking rates among the adult population fell throughout the life of the previous tobacco control plan, health inequalities have remained stubbornly high. In 2013, for instance, smoking prevalence among people in the routine and manual socioeconomic group was more than twice that among the professional managerial group—28.6% compared with 12.9%. The picture is even worse for those who are unemployed, with smoking rates of approximately 35%. People earning under £10,000 a year are more than twice as likely to smoke as those earning more than £40,000 a year. The higher rates of smoking place a significant financial burden on poorer members of society. If the costs of smoking were returned to households, 1.1 million people, including more than 300,000 children, would be lifted out of poverty.

In Stockton-on-Tees, when tobacco expenditure is taken into account, almost 6,000 smokers fall below the poverty line, including more than 1,300 dependent children. Those innocent children not only suffer from the financial burden of their parents’ smoking but are more likely to be exposed to second-hand smoke and to try smoking themselves. We all know that those who grow up in a household where parents or siblings smoke are far more likely to become smokers themselves.

Those children may experience considerable peer pressure to start smoking, and tobacco is often more accessible to them in the community and at home, thus creating a cycle of inequality and leading to the life expectancy gap noted by the Prime Minister. Perhaps worse still is that when poorer smokers attempt to quit smoking, they are less likely to succeed than their more affluent peers.

To tackle inequalities, support to stop smoking needs to be specifically tailored to meet the needs of those in lower socioeconomic groups. Although the ambitions in the previous plan have been met and smoking rates continue to decline, they remain stubbornly high in disadvantaged sections of society. Further action is needed from the Government and the public sector to reduce smoking rates and associated health inequalities, and the new strategy is necessary to drive that action forward.

With that in mind, and given that the policy development work for a new tobacco control plan was in place for publication this summer, I would welcome the Minister telling us when the new plan will be published. I say to her that there is a standard to live up to, because the last time there was a debate about the plan in this room, the then Minister confirmed the timing of its publication. I hope we will hear about that in depth today.

Perhaps the Minister will also oblige the British Lung Foundation and outline the Government’s plans to prioritise lung health as an area for health improvement. Will she tell the House whether an assessment of respiratory health could be included in the NHS health check?

[Norman Lamb (North Norfolk) (LD)]

I am grateful to the hon. Gentleman for giving way, and I very much agree with what he is saying. He has talked a lot about inequality, which of course spreads beyond this country. I understand that some 80% of smoking deaths, which will rise to 8 million by 2030, are in lower and middle-income countries. Does he share my desire to see the Government publish the plan before the meeting in India in November? We could then see what the special fund for developing countries will be used for, because we need to have an impact there, too.

[Alex Cunningham]

I agree. With the huge proportion of deaths in lower-income countries, which are suffering even more than we are in this country, it is imperative that the report is published so that we can show a lead. We are a leading country, if not the leading country, on smoking control, and we must continue to demonstrate that.

As colleagues will be aware, stop smoking services are one of the most effective healthcare interventions. Smokers are four times more likely to quit successfully with the combination of behavioural support and medication provided by those local services. Significantly, smokers from routine and manual socioeconomic groups are more likely to access the support of stop smoking services, which have real potential and are an effective way of beginning to address health inequalities. In 2014-15, for example, more than twice as many smokers from routine and manual groups set a quit date with a stop smoking service compared with those in professional and managerial occupations. Such services are not only effective in supporting efforts to quit but can prevent the disability and distress caused by smoking-related diseases without the side effects of many of the drugs used to treat such diseases. Indeed, the National Institute for Health and Care Excellence considers smoking cessation treatment to be among the most cost-effective healthcare interventions.

Smoking cessation treatment is also cost-effective for those who already have smoke-related diseases. Take chronic obstructive pulmonary disease, for instance. Some 900,000 people in England have been diagnosed with smoking-related COPD, out of about 3 million sufferers. Some 25,000 people a year die from the disease, and the NHS spent £720 million on treatments in 2010-11. The British Lung Foundation estimates that in my constituency, people are as much as 60% more likely to be admitted to hospital with COPD than the UK average. We also discovered recently that the rate of lung disease in my constituency is the second worst in the country.

Yet COPD is a disease that is almost entirely preventable. Smoke is the cause of more than three quarters of COPD cases, and in this country exposure to such smoke is primarily through smoking. Although it is clearly better to prevent COPD through the provision of smoking cessation treatment to help smokers quit before the disease develops, that treatment can help improve quality of life even after the onset of COPD and is highly cost-effective compared with other treatments. Indeed, it is the only treatment that can prevent the disease from progressing in smokers. The cost of smoking cessation treatment for people with COPD is estimated to be £2,000 per quality-adjusted life year, whereas the cost of drug treatment for those with the disease ranges from £5,000 per QALY at the bottom end of the scale to £187,000 per QALY for triple therapy.

I am mindful that this is a co-operative debate with cross-party support, but I believe it is fair to highlight the impact of some of the Government’s economic measures on smoking cessation programmes. In 2014-15, despite all the evidence of their cost-effectiveness, approximately 40% of local authorities cut the budgets of their stop smoking services, with half of all services being reconfigured or recommissioned. It is not just local authority cuts that are happening; we are now hearing that clinical commissioning groups are also cutting funding for prescriptions to stop smoking medications and refusing to fund smoking cessation services.

Local authorities faced with huge cuts to their budgets are reducing investment not only in stop smoking services but in other areas essential to effective tobacco control. Trading standards staff, who are crucial to tackling illicit tobacco and under-age sales, are increasingly under threat. During the past six years, the total national spend on trading standards has fallen from £213 million in 2010 to £124 million today. Teams have been cut to the bone, with a 12% drop in staff working in trading standards since 2014, on top of the 45% drop over the previous five years identified by an earlier survey.

The importance of trading standards, working in partnership to deliver concerted multi-agency enforcement activity, is shown in my region, the north-east. After setting up a regional illicit tobacco partnership, the region has seen a significantly greater fall in the illicit tobacco trade than has been seen at national level, to the benefit of both public health and Government revenues. Between 2009 and 2015 the illicit market declined by more than a third in the north-east, from 15% to 9%, whereas the decline at national level was less than a fifth, from 12% to 10%.

Without sustained funding, such services are simply unable to continue to operate effectively. The new tobacco control plan therefore needs to prioritise cutting health inequalities rather than budgets, and in so doing must protect public health funding for tobacco control. I hope the Minister will confirm today that the Government will take steps to sustain protected funding for tobacco control, and will outline what those steps will look like.

I would similarly welcome hearing the Minister commit to bringing mass media spending in line with best practice evidence. Research has shown mass media campaigns to be highly effective in promoting quit attempts and discouraging uptake. In the UK, however, we are currently falling far below best practice spending on such campaigns. When funding was cut back in 2010 there was a noticeably negative impact on quitting, with a whopping 98% decrease in requests for quit support packs, a fall of almost two thirds in quit-line calls and more than a third fewer website hits. That should hardly come as a surprise, with year-on-year cuts seeing only £5.3 million spent on mass media in 2015, which is less than a quarter of the amount spent in 2009. Spending has actually declined further this year to £4 million. To make matters worse, it is not even clear how much, if any, of that budget is reserved for televised mass media campaigns.

This year’s annual Stoptober campaign, for instance, is being run without any televised advertising. Yet the evidence confirms that it is precisely such mass media campaigns that are essential to motivate quitting and to inform smokers of the useful resources provided by Public Health England to help smokers quit. Those campaigns, which discourage smoking and encourage quitting, are most effective when they are sustained and sufficient, with the best results being achieved when people are exposed to televised anti-smoking adverts around four times a month.

Again, I draw attention to my own patch and the “Quit 16” mass media campaign co-ordinated by Fresh and Smokefree Yorkshire and Humber, which focused on the damage smoking does to health. Some 16% of those exposed to the campaign, or roughly 53,300 people, cut down on their smoking. A further 8.4% made a quit attempt, and 4% switched to electronic cigarettes. That shows the clear impact that mass media campaigns have on triggering quit attempts and changes in behaviour, and the Government need to take such evidence seriously and commit to investing in mass marketing campaigns without delay.

Members will be aware that the decline in smoking prevalence in the UK since the first comprehensive strategy was published in 1998 has been comparable to that in Canada and Australia, both of which have consistently addressed the harms caused by smoking through comprehensive and sustained tobacco control strategies. Smoking prevalence has declined rapidly among adults and children in England since the Government first implemented such strategies from 1998. The latest figures show that adult smoking prevalence in England has declined by more than a third, falling from 27% in 1998 to 16.9% last year. The proportion of 15-year-olds in England who are regular smokers fell by two thirds between 1998 and 2014, hitting 8%, and the proportion of 11 to 15-year-olds who have ever smoked fell from 47% to 18% over the same period. Those are the lowest figures ever recorded for both adults and children.

None the less, smoking remains the leading cause of preventable premature death and the major reason for differences in life expectancy between the richest and poorest in society. Experience elsewhere shows what can happen if we do not review and renew our tobacco control strategy and ensure that it is properly funded. While the UK has seen a significant decline in smoking because of its comprehensive approach, the prevalence of smoking in France and Germany, which have not had any such strategies in place, has barely shifted over the last 20 years. We cannot rest on our laurels and assume that the long-term declines we have achieved will continue unabated if we do not take decisive action to review and renew our strategy.

On 14 September, Lord Prior committed the Government to publishing a new plan, with renewed ambitions to reduce smoking prevalence further and new ambitions on health inequalities and mental health. However, he would not commit to a publication date, so I repeat my appeal to the Minister to reassure Members across the House by filling that gap today. There is no clear reason to delay publication of a new plan further. If the Prime Minister’s ambition to reduce health inequalities is to be achieved, Ministers need a comprehensive strategy on tobacco control sooner rather than later.

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[Norman Lamb (North Norfolk) (LD)]

It is a pleasure to serve under your chairmanship, Mr Brady, and to follow the hon. Member for Harrow East (Bob Blackman). I find myself in agreement with everything he said. Anyone who has come here hoping to see violent disagreement and robust debate will be disappointed, because we all agree about the importance of this issue.

The hon. Gentleman talked clearly about the nature of this lethal product, which, as we have heard, kills 96,000 people a year across the UK. He also touched on the issue of the developing world. It is anticipated that 8 million people across our world will die from smoking in 2030, and that 80% of them will be in low or middle-income countries that do not have strategies to tackle the problem. Companies based in this country are selling this lethal product to the developing world and killing so many people. We need to be clear that that is shameful.

Many hon. Members, including the hon. Member for Totnes (Dr Wollaston) and the hon. Member for Stockton North (Alex Cunningham)—I congratulate him on all the work he has done and on leading this debate—have talked about the inequalities that are associated with smoking tobacco, including wealth and income inequalities. Smoking hits people from low-income communities much harder than others. As Members have said, smoking is about half of the reason for the difference in life expectancy between the richest and the poorest in our country.

I want to talk about another inequality, which the hon. Member for Harrow East touched on at the end of his contribution: the impact on people with mental ill health. A substantial part of the reason why such people, particularly those with severe and enduring mental ill health, die 15 to 20 years earlier than others is higher smoking rates. Here’s the thing: we have been very successful in this country—I will come back to this in a moment—at reducing the smoking rate. Public health strategies have worked effectively, although we all recognise that there is much further to go. But as the smoking rate has come down in the population as a whole, it has remained stubbornly high among those with severe and enduring mental ill health; there has been hardly any shift at all. That has been a failure of public health strategies.

Back in 2013, when the smoking rate across the population was 21%, it was 40% among those with severe and enduring mental ill health, 60% among those with psychosis, and 70% among people in in-patient care. We can start to see why those people end up dying so much earlier than everyone else. That amounts to a neglect of those people’s need for support in combating this highly addictive product, and it makes me absolutely driven—as is everyone else in the Chamber—to do more to combat the problem.

Let me come back to the successes of smoking cessation strategies. I join other hon. Members in congratulating the hon. Member for Battersea (Jane Ellison) on her work. The hon. Member for Harrow East was right; there are Government Members who take a different view. I remember hearing the hon. Member for Battersea speaking and wanting to tell her to watch her back, because there were quite a few Members behind her who took a different view. She was brave in standing her ground, particularly in pursuing the plain packaging policy. The right hon. Member for Rother Valley (Kevin Barron) has a plain packet in his pocket. The previous Government were in my view a coalition Government, not a Conservative-led Government; the Liberal Democrats played our part in important strategies such as plain packaging and ending smoking in cars with children on board, which will have a big impact on saving people’s lives.

It is imperative that the new strategy is published and becomes operational. Given the leadership role that we have played for so many years, it is important that we go to the meeting in India in November and demonstrate our continued leadership. If there is any way for the strategy to be published before that meeting, and for it to include a focus on how we will use the fund that has been established for combating smoking in developing countries, I urge the Minister to do everything possible to ensure that that happens.

Let me speak a little more about what the tobacco control plan needs to include. I come back to what I said about mental health, which the plan needs to address directly. I do not know whether the Minister has seen the iterations of the plan, which we hope will be published soon, but I hope very much that it will address directly the failure of public health strategies to reduce smoking among people with mental ill health. The plan needs to focus on the recommendations of the report “The Stolen Years”, which was published by ASH and produced in collaboration with the Royal College of Psychiatrists, and its ambitious targets for reducing smoking among people with mental ill health. We can no longer fail to confront the failure of past strategies in that respect. Interestingly, that report highlights the therapeutic benefits of stopping smoking for people with mental ill health, not only for their physical health but for their mental health. Ironically, many people with mental ill health smoke because they see it as an escape from the pain that they are suffering and a way of coping with stress, yet smoking increases stress and the risk of aggression, particularly in in-patient services.

[Kevin Barron]

I went to the launch of that report. Some 70% of people who are discharged from mental health secure units smoke, yet we have in our midst a product—e-cigarettes—that could have been designed to be put into such institutions, some of which are now putting e-cigarettes on their shopping lists. That would allow people to satisfy their addiction without creating secondary smoke and the many ailments that occur when people smoke. Does the right hon. Gentleman agree that we need more leadership to ensure that e-cigarettes can be used in institutions where, for control reasons, it is difficult to keep the customer satisfied, as it were?

[Norman Lamb]

I completely agree. If we want to focus effort where it is most needed and where smoking rates are highest, we should focus on those very mental health institutions. As well as making vaping available for people who need help to give up smoking, we need to do much more to focus on training staff in such institutions so that they know the importance of smoking cessation being one of the objectives in the care of individuals there, because of its potential therapeutic benefit.

I should also mention the move towards smoke-free in-patient settings, a strategy that I supported as Minister and that I am pleased is continuing. Guidance was published by Public Health England and NHS England in June 2015, and that strategy is having a beneficial effect on the environment in in-patient settings by reducing aggression and stress and improving physical and mental health. I encourage the Government to keep pursuing that objective.

On electronic cigarettes and vaping, although I was a committed remainer in the EU referendum debate, the tobacco products directive is flawed, because it takes an inappropriately tough approach to electronic cigarettes. I therefore hope that the Government will review that directive regularly. One of the potential benefits of leaving the EU—there are not many, in my view—is that we will gain the ability to differentiate more between the effective regulation on tobacco in that directive and the regulation on electronic cigarettes, and do much more to recognise the evidence that already exists, as the right hon. Gentleman has made clear, on the benefits of electronic cigarettes.

I will end by saying something about public health funding. The hon. Member for Totnes made the point clearly, and I totally share her view. The Health Committee has pointed out that the £8 billion or £10 billion that we keep being told will be given to the NHS by 2020 is actually nearer £4.5 billion. Extra money is being found for front-line NHS services partly by cutting other parts of the Department of Health budget, including, distressingly, public health and health education. As she said, that is completely counterproductive. When NHS finances get tight, crisis management takes over. The hon. Member for Stockton North made the point that CCGs are focusing on propping up established traditional services—the repair services, as it were—and in so doing, tragically, are cutting the prevention services that prevent people from ending up needing care in the first place. That is so counterproductive. A new settlement for the NHS and the care system, which I keep calling for, must recognise the imperative to invest more in prevention and public health, particularly given that there is so much evidence that that has a beneficial effect.

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[Norman Lamb]

On the adequacy of public health budgets, does the Minister think it is rational in any way to increase in real terms the budget for the NHS while reducing in real terms the budget for public health?

[Nicola Blackwood]

Prevention is a core part of the NHS five year forward view and should be embedded in NHS funding, public health funding and social care funding, as the right hon. Gentleman has stated. We are looking for the STPs to show a joined-up plan for how prevention, acute delivery services and social care will work together. PHE can and does advise and support local councils to tailor their services effectively, but we need to see how we can improve that. The local tobacco control profiles are one way in which we are doing that, but we must ensure that we see some of that work implemented.

At national level, to help drive a reduction in variation, the Government are committed to publishing the new tobacco control plan that all Members have mentioned, which has tackling inequalities at its heart. The plan will build on our success so far and will include renewed national ambitions. We have to maintain the proactive, comprehensive and non-partisan approach we have seen so far. The UK is recognised as a world leader in tobacco control strategy, and we intend to maintain that. However, I am afraid that on this occasion I will not be able to match my predecessor by announcing the date of publication. [Hon. Members: “Oh!”] I know; I feel inadequate.

My hon. Friend the Member for Harrow East is right in identifying my desire to ensure that the plan is evidence-led. It is reasonable for a new Government to want to check that the plan offers the best possible strategy, based on evidence. On something as important as a tobacco control plan, which is a golden moment, we have to ensure that we do not publish the plan until we get it right. It has been valuable to have the opportunity to listen to and engage with this debate, so that I can hear from colleagues as expert and engaged as those present before going forward. I assure all Members that the Government see the issue as a matter of urgency and are pressing forward with the plan as quickly as possible. I will certainly take away the suggestion from the hon. Member for Stockton North about incorporating respiratory health monitoring into the NHS health check.

I would like to go through a few of the points that we have discussed before I finish. As I have highlighted, it is right to turn our focus to population groups in which smoking prevalence remains higher than elsewhere. In particular, we must turn our attention to reducing health inequalities in populations who already suffer from poorer health and social outcomes, such as those in routine or manual occupations or those who suffer from mental health conditions.

As my hon. Friend the Member for Totnes said, improving maternity outcomes and giving children the best start in life is an important priority for this Government, and supporting pregnant women to quit smoking will be an important factor in working towards that. We all know that smoking during pregnancy increases the risk of stillbirth, as the shadow Minister said, and of problems for a child after birth. We also know that babies born to mothers who smoke are more likely to be born underdeveloped and in poor health. Tackling that was a priority under the previous tobacco control plan, during the period of which smoking prevalence among that group fell by three percentage points, but more can be done to reduce it further and, most importantly, to tackle the variation I mentioned. We will look at that.

Alongside limiting babies’ exposure to smoke during and after pregnancy, we must continue to work to end the cycle of children taking up smoking in the first place. As the percentage of 15-year-olds who regularly smoke has fallen to 8% and continues to fall, we must press our advantage and work towards our first smokeless generation. That would be something that we could genuinely be proud of. Restricting access to tobacco remains key, and we will want to maintain the enforcement of measures mentioned today, such as age of sale laws. Evidence shows that children who have a parent who smokes are two to three times more likely to be smokers themselves. Continuing to support adults to quit is therefore vital to ending the cycle of children taking up smoking and must remain a key part of tobacco control in the future.

In order to achieve our ambitions for the population groups I have mentioned, and to reduce smoking prevalence across all populations to even lower rates, we have to continue to draw on the things that we know work. This is an area in which we have a strong evidence base, and that work will include continuing a programme of evidence-based marketing campaigns such as Stoptober and monitoring the evidence base for e-cigarettes.

Finally, the right hon. Member for North Norfolk is right to say that tobacco use is a global issue and an international priority. Our new tobacco control plan will need to reflect that. As a world leader on tobacco control, the UK will continue to work closely with others to reduce the burden that smoking places on individuals, families and economies across the globe. As he said, we are investing official development assistance funds over five years to strengthen the implementation of the WHO’s framework convention on tobacco control. The project will be delivered by the WHO, and through it, we will share the UK’s experience in tobacco control to support low and middle-income countries to put effective measures in place to stop people using tobacco. That will happen through capacity sharing. We will carefully monitor the progress of that initiative to ensure that it delivers results, using very effective evaluation measures. I am happy to have further discussions about that with the right hon. Gentleman, if he would find that helpful.

We can be proud of the progress that successive Governments have made on helping people to quit smoking, preventing them from starting in the first place and creating an environment that de-normalises smoking. With prevalence rates at an all-time low, there is no question that good work has been done, but as the issues raised in this debate clearly show, there is more work to be done. The Government are committed to doing that work as a matter of urgency. I will take away the comments made today, which are incredibly helpful to me as a new Minister, and I will ensure that as we finalise the new tobacco control plan—