Science and Technology Committee

Norman Lamb Excerpts

Thursday 6th September 2018 Commons Chamber

[Norman Lamb (North Norfolk) (LD)]

I want to make a statement following the publication over the summer of our report on e-cigarettes. May I start by thanking the more than 90 organisations and individuals who provided us with written evidence, and the 25 individuals who gave oral evidence? I also thank my fellow Committee members, several of whom are present in the Chamber, for their work on this inquiry. This is strictly an evidence-based report, and it would not have been possible without the input of so many organisations and individuals who submitted evidence.

The bottom line is that we conducted this inquiry because smoking kills. Despite the great strides that we have made in recent years, smoking remains the primary cause of preventable illness and premature death, accounting for approximately 79,000 deaths a year in England. That is a dreadful death toll that causes untold misery for families and communities up and down the country, but we know that nearly 3 million people in the UK are using e-cigarettes as a tool to help them to stop smoking.

The Government’s tobacco control plan points out:

“In 2016 it was estimated that 2 million consumers in England had used these products and completely stopped smoking and a further 470,000 were using them as an aid to stop smoking.”

E-cigarettes have been in the UK market since 2007, and we wanted to examine the evidence.

It is important to be really clear here: our report is aimed at those who are already smoking cigarettes and at the horror of lives being lost through smoking-related diseases. To focus on the evidence, there is growing consensus that e-cigarettes are significantly less harmful for a smoker’s health. This is not just our Committee’s view of the evidence that we have analysed; it is the view of Public Health England, which estimates that they are 95% less harmful than smoking. It is also the view of the National Institute for Health and Care Excellence, the British Medical Association, Cancer Research UK, the British Heart Foundation, the Cochrane Tobacco Addiction Group, the Royal Society for Public Health, the Royal College of Physicians of Edinburgh and many, many more.

The Government themselves have acknowledged that the

“evidence is increasingly clear that e-cigarettes are significantly less harmful to health than smoking tobacco”.

I want to quote the evidence from Public Health England and the Medicines and Healthcare Products Regulatory Agency, the regulator. They said:

“Levels of carcinogenic chemicals…are substantially lower in e-cigarettes’ aerosol compared with tobacco smoke. Biomarkers of carcinogen exposures (chemicals detected in the blood or urine of users) are also substantially decreased in current e-cigarette-only users compared with cigarette smokers and decrease when smokers switch to e-cigarettes.”

Clarity of the message on this is really important. Some people urge a more cautious approach because we do not know everything about long-term risk, but we conclude:

“any judgement of risks has to take account of the risk of not adopting e-cigarettes—that is, continuing to smoke conventional cigarettes, which are substantially more harmful”.

We know they kill, so there is a price to be paid in human lives through adopting a more cautious approach.

Our report made a number of recommendations, and today I am going to focus on three particular areas: the need for ongoing research into e-cigarettes, the use of e-cigarettes in mental health facilities and their use in public spaces. I hope today that I will be able to correct some of the inaccuracies in some of the media coverage of the Committee’s report.

Our report is not the end point—more evidence is needed. That is why we concluded that the Government should maintain their planned annual evidence review on e-cigarettes. We also say that they should support a long-term research programme, to be overseen by Public Health England and the Committee on Toxicity of Chemicals in Food, Consumer Products and the Environment, to ensure that health-related evidence is not dependent solely on the tobacco industry or the manufacturers of e-cigarettes.

Hon. Members might not know that 40% of adults with mental ill health smoke, compared with just 16% of the general population. Smoking is also the single largest cause of premature mortality for those with mental ill health. We know that people with severe and enduring mental ill health die 15 to 20 years earlier than other people. Therefore, as the Government warn, if we do not reduce smoking among this group, which, as I say, remains stubbornly high,

“we will have failed to reduce health inequalities”.

We surveyed mental health trusts to inform our work in this area. What we found was rather shocking. A third of mental health trusts still ban e-cigarettes within their facilities. We also found that three quarters of NHS trusts—these are health trusts, which ought to be on top of the evidence—are mistakenly concerned about second-hand e-cigarette vapour, despite evidence that it presents a negligible health risk. However, progressive trusts such as Nottinghamshire Healthcare NHS Foundation Trust use e-cigarettes to help patients give up smoking, while encouraging them to engage with treatments.

We conclude that all patients in mental health units should have the benefit of this more enlightened thinking. NHS England must set a clear central NHS policy on e-cigarettes in mental health units that establishes allowing e-cigarette use by patients as a default unless an NHS trust can show reasons for not doing so that are demonstrably evidence-based.

Let me now turn to the area of our report that created the biggest debate: the treatment of e-cigarettes in public spaces. Despite some suggestions to the contrary, we did not recommend that e-cigarettes should be allowed in closed public spaces or on public transport. We called for a public debate on how these products are dealt with in our public spaces. The coverage of our report has certainly kick-started a public discussion, and I really welcome that. We need such a debate because the evidence suggests no public health rationale for treating e-cigarettes and conventional cigarettes as one and the same.

There are, however, nuisance justifications for restricting e-cigarettes’ use in public, such as in enclosed spaces and on public transport. I personally would not support any proposal that permitted the use of e-cigarettes on public transport, specifically because many people find the smell of many vapours unpleasant and intrusive. However, that is quite different from restricting usage in all public spaces based on misplaced health concerns and treating this issue in exactly the same way as we treat smoking.

It is surely the duty of policy makers to understand what the evidence says about the relative harms of e-cigarettes and conventional cigarettes and to make policy based on that evidence, in consultation with experts. We call for a shift to a more risk-proportionate regulatory environment, where regulations, advertising rules and tax duties reflect that evidence on the relative harms of the various e-cigarettes and tobacco products that are available. We need to take action so that we can encourage current smokers—given the death toll of 79,000 in England alone every year—to make the switch to e-cigarettes and to improve their health. The potential to save lives is clear.

[Bob Blackman (Harrow East) (Con)]

I thank the Chair of the Committee for his report and for his clarification of what the Committee’s recommendations actually were.

I declare an interest as the chairman of the all-party parliamentary group on smoking and health. The clear message to smokers is that the safest way to restore their health is to give up smoking completely. However, as an alternative route towards that, taking up e-cigarettes is clearly a better health outcome than smoking.

I urge the right hon. Gentleman to clarify once again his Committee’s position on the use of e-cigarettes in enclosed public spaces such as public houses and restaurants and not just transport facilities and so on. In many ways, there are two aspects to this issue. There is the nuisance aspect of smelling vapour, which often has a particular scent. There is also the aspect that many people will be trying to give up smoking, and seeing people using e-cigarettes in an enclosed space may induce their craving for cigarettes. It is very important to have a clarification on that issue. Personally, I would oppose any relaxation in the use of e-cigarettes in any enclosed spaces.

[Norman Lamb]

I thank the hon. Gentleman for that really helpful contribution. First, on the case for encouraging smokers to shift to e-cigarettes—that is clearly a big concern of his—let me quote Dr Jamie Brown of University College London:

“Any perceived risk associated with offering reassurance before we have the long-term data…must be balanced against the risk associated with the opportunity cost of failing to inform the millions of people who are currently smoking uniquely dangerous products that e-cigarettes are safer when they believe”,

wrongly, that

“they are not.”

That is a really important public health message to get across.

With regard to public spaces, we wanted to clearly distinguish between the public health justification for policies and the nuisance issue. The evidence clearly says that secondary vaping—someone taking vapour into their lungs because of the close proximity of people who are vaping—carries nothing like the same risk as secondary smoking, which carries a very serious risk and led to the legislation passed in this House to ban smoking in public areas.

However, there is a good justification, which I totally accept, for not allowing vaping because of the nuisance—because people find it invasive. I personally dislike the sweet strawberry flavours and so on that we are often confronted by at close quarters. What is frustrating is that some of the graphics used in relation to the report, including by the BBC, showed people vaping on public transport, but we were not making a recommendation on that; we were just saying, “Let’s have a public discussion informed by the evidence and then reach our conclusions.” We should not just automatically treat vaping in the same way as what the academic I mentioned described as the “uniquely dangerous” activity of smoking tobacco.

[Chris Elmore (Ogmore) (Lab)]

I welcome the right hon. Gentleman’s Committee’s report. Health is of course a devolved function in Wales and it is not for this House or any Member of it to suggest what policies should be implemented in Scotland or Wales. However, does he agree that it is important that when Select Committees of this House conduct these sorts of inquiries that information can be shared with the devolved Administrations, so that they can take part in a wider debate around these issues? At the end of the last Assembly term, there was a Bill to ban e-cigarettes in Wales. It was lost for various other reasons and not passed in the last days of the Assembly sitting. Does he agree that, with this new information and evidence coming forward, it is proper that Select Committees of this House do shared working on public health issues and pass on evidence where they think it is of worth for UK-wide issues, because smoking is not reserved to England or any of the other nations of the UK?

[Norman Lamb]

I thank the hon. Gentleman for his helpful contribution and totally agree with him. I will make sure that we specifically send the report to the devolved Administrations, and he highlights the fact that there is now such strong consensus through all the organisations I referred to—Cancer Research UK, the British Heart Foundation and so on—of the relative harm reduction through adopting e-cigarettes as opposed to smoking. Any confusion of that message will result in fewer people giving up smoking and more people in our country dying, and we must stop that.

[Mr Philip Hollobone (Kettering) (Con)]

I was staggered to read in the right hon. Gentleman’s report that NHS England does not have a dedicated person responsible for implementing the Government’s tobacco control plan and failed to provide a representative to the Committee and that there is no one in NHS England in charge of the oversight of e-cigarette policies among NHS mental health trusts. Given that e-cigarettes are, according to NHS England, 95% less harmful and that early morbidity for mental health patients can take 15 to 20 years off their lives, is this not a shocking state of affairs that NHS England must address urgently?

--- Later in debate ---

[Norman Lamb]

I agree. It was extraordinary that NHS England was unable or unwilling to provide a witness for our inquiry. There is a sense that it is almost subcontracting its responsibility for this to Public Health England. Public Health England obviously has a clear interest, but given the awful death toll and in particular the fact that smoking prevalence among those with mental ill health remains stubbornly high at over 40%, NHS England, which is responsible for NHS trusts across the country, should and must take central responsibility for this and appoint someone with responsibility for driving through this policy.

[Carol Monaghan (Glasgow North West) (SNP)]

Some of the evidence we heard during the Committee hearings was about e-cigarette users having to go out and use smoking shelters outside buildings, which one witness likened to an alcoholic being put into a pub situation and being expected to refrain. Does the right hon. Gentleman agree that we must have a more realistic view of the use of e-cigarettes in public buildings, with perhaps a room or a dedicated area set aside, so that e-cigarette users are not forced to come face to face with the thing they are trying to give up?

[Norman Lamb]

I thank my fellow Committee member for that helpful contribution. She describes exactly what we should be discussing, and it addresses points made earlier from the Conservative Benches. To simply send vapers to the cigarette shelter outside is completely counterproductive and makes it harder for people to give up. Having a room in their building may well be an appropriate step for many organisations to take, given that there is no health risk associated with vaping, as there is with secondary smoking.

[Vicky Ford (Chelmsford) (Con)]

It was most interesting to serve on the Committee during this investigation. Can the Chairman confirm that the report was not intended to suggest that e-cigarettes were zero-risk, because they are new products and the long-term risks are not yet known, and that the only zero-risk option is not to smoke?

[Norman Lamb]

The hon. Lady is absolutely right. This is about harm reduction and it is in a sense encapsulated in the positon that Public Health England takes: it says that, as an estimate, e-cigarettes are 95% less harmful. It is not saying there is no risk, and the clear message to smokers is, “If you can give up completely, that’s the best step to take for your health; if you can’t, this reduces harm and ought to be followed.”

[Nick Smith (Blaenau Gwent) (Lab)]

I want to take up that point, but first may I commend the Committee for this report, which will help a lot with public health across the UK? I note that the report says:

“A medically licensed e-cigarette could assist smoking cessation efforts by making it easier for medical professionals to discuss and recommend them as a stop smoking treatment with patients.”

That is very good. Does the right hon. Gentleman know what the Government are doing to encourage e-cigarette manufacturers to put products forward for licensing?

[Norman Lamb]

I thank the hon. Gentleman for highlighting that recommendation. I do not think the Government are doing anything in particular to encourage organisations to seek medical licensing, but the potential prize here is that if there were a medically licensed product, it would reach a proportion of current smokers who would be reassured that the medical licence in a sense guaranteed that it would be a sensible step for them to take and would help them give up smoking.

[Stephen Metcalfe (South Basildon and East Thurrock) (Con)]

I apologise for missing the very first hint of what the Committee Chairman was saying. This was an interesting inquiry and was as controversial as we thought it might be when we selected it. The evidence we received overwhelmingly suggested that it is 95% safer at least to take up vaping and to stop smoking. Will the Chairman speculate on why some persist in trying to put smoking and vaping side by side following the publication of the report?

On the debate on smoking in public places, there is a range of devices and flavours, and perhaps this will stimulate a debate that leads the industry to find devices that do not impinge on others’ airspace, so that we can expand the opportunities for people not to have to associate with smokers when vaping.

[Norman Lamb]

I pay tribute to the hon. Gentleman for his work in initiating debate about this issue in the previous Committee and for his work on this inquiry. On that final point, vaping without some of the offensive flavours—or flavours that some people find offensive—is certainly helpful in encouraging people to be tolerant of vaping. The great value of this report is to reinforce the public health messages and encourage people to understand the relative harm of e-cigarettes as against smoking.

On the hon. Gentleman’s first point, it is interesting that the United States, Australia and some other countries take a different approach that appears to be based on doing nothing until they have all the evidence. As the evidence quoted made clear, however, there is a price to be paid for that caution, which is that we are not getting the clear message, based on evidence, to smokers that shifting to e-cigarettes will save lives here and now. So I think this country is leading the way with this strong consensus—coalition of support—around this clear evidence. The great value of the report is to reinforce this message to people: “If you can’t give up smoking entirely, it is in your interests to shift to e-cigarettes because that will help save your life.”

[Darren Jones (Bristol North West) (Lab)]

I welcome the amount of public engagement received off the back of the publication of this report, which shows a desire by the public to understand the evidence on what is a relatively new product about which there are many misconceptions, but one of the key pieces of feedback I received from constituents was, I fear off the back of some misreporting, that our Select Committee report was recommending vaping on buses, so for clarity for this House, my constituents and the wider public, will the Chairman make it clear that we were not recommending that vaping be allowed on buses?

[Norman Lamb]

I believe the expression is “read my lips”: we were not recommending vaping on buses. I hope that is helpful.