E-cigarettes

Norman Lamb Excerpts

Thursday 31st October 2019 Westminster Hall

[Norman Lamb (North Norfolk) (LD)]

I beg to move,

That this House has considered the Seventh Report of the Science and Technology Committee, Session 2017-19, E-cigarettes, HC 505, and the Government Response, Cm 9738.

It is a pleasure to serve under your chairmanship for the very first time, Sir Henry, in my last appearance in this Chamber, and it has been a pleasure to have you as my constituency next-door neighbour for the last 18 years. I am pleased to have secured a debate on this important work undertaken by my Committee before this Parliament draws to a close. It is great that we have been able to hold the debate in the month of Stoptober, the big anti-smoking initiative, which I think has been successful, and which I remember launching in my time as a Minister, back in the day.

Statistics released by the Office for National Statistics show that in 2018 in England, 14.4% of adults smoked. That represents a significant advance in reducing the prevalence of smoking in our country; ONS figures show that smoking rates in England have fallen every year since 2011. It is important to say that there is one exception to that advance, and it relates to mental ill health—something I care a lot about. People with severe and enduring mental ill health tend to die much younger than others, by as many as 20 years, one key reason being the prevalence of smoking among that group, around 40% of whom smoke. Although we have been very successful in reducing smoking rates in the population as a whole, we have not been successful in doing so for those with mental ill health. I will return to that.

In Great Britain in 2018, there were approximately 3.2 million vapers—6.3% of the population—which marks a significant increase since 2014, when the figure was 3.7%. Why does that matter? The tobacco control plan stated:

“Tobacco is the deadliest commercially available product in England”—

it is important to hold on to those words from the Government—

“with tobacco regulations serving to safeguard people, particularly children and young people from the avoidable disease and premature death it causes.”

The recent prevention Green Paper clearly articulated that some people are disproportionately likely to smoke, which we should all be deeply uncomfortable with:

“Smokers are disproportionately located in areas of high deprivation. In Blackpool, 1 in 4 pregnant women smoke. In Westminster, it’s 1 in 50.”

What an extraordinary contrast! Deprivation causes that significant risk to the health of mothers and babies.

According to Public Health England, vaping is at least 95% less harmful than smoking. That does not mean that vaping is safe, and it certainly does not mean that we should encourage non-smokers to start vaping, but based on all the evidence we have, vaping is considerably less harmful than smoking.

[Graham Stringer (Blackley and Broughton) (Lab)]

I put on record my thanks to the right hon. Gentleman for his time chairing the Select Committee on Science and Technology. It has been an interesting period, in which we have gone into great detail—effectively, I think—on many subjects. I was annoyed that NHS England, which has the time to put out often crass and obvious statements on health, did not have the time to come and give us advice on e-cigarettes, the use of which, as he says, is one way get people to stop smoking.

[Norman Lamb]

I thank the hon. Gentleman for that. I will call him my hon. Friend, because I am demob-happy and I do not care about the normal rules. It has been a great pleasure to work with him on the Committee. I share his concern. Given that the Government’s own tobacco control plan describes tobacco as

“the deadliest commercially available product in England”,

one would have hoped that the body that runs the NHS in England would show a strong commitment to confronting that clear risk. Despite it being very clear from all the available evidence that vaping is significantly less harmful than smoking, I none the less absolutely encourage continued research in this area. We should always be alert to anything that indicates a potential risk; that is exactly what our Committee recommends.

E-cigarettes are not only less harmful than smoking, but appear to be an effective tool for stopping smoking, as the hon. Gentleman made clear. A study published earlier this year in the New England Journal of Medicine randomly assigned adults attending UK NHS stop smoking services either nicotine replacement products of their choice, including product combinations, for up to three months, or an e-cigarette starter pack. That study of 886 participants found that the one-year abstinence rate was 18% in the e-cigarette group, compared with 9.9% in the nicotine replacement group. That is a significant difference, and we need to make sure that we act on that difference now that we have knowledge of the effectiveness of e-cigarettes as a stop smoking tool.

Results from a 2019 survey carried out by YouGov for Action on Smoking and Health—ASH—found that

“the three main reasons for vaping remain as an aid to quitting (22%)…preventing relapse (16%) and to save money (14%)”,

because people who vape spend much less money than people who smoke. That demonstrates that users perceive e-cigarettes as a stop smoking tool. E-cigarettes are therefore likely to help the Government to meet their ambition, announced in the prevention Green Paper, for England to be smoke-free by 2030. None the less, I accept that further research is needed on the effectiveness of e-cigarettes as a stop smoking tool. Will the Government or one of their agencies request further independent research on the effectiveness of e-cigarettes as a stop smoking tool?

Our report highlights the issue of what the NHS does on smoking cessation. Cancer Research UK recently pointed out that primary care clinicians face barriers to discussing e-cigarettes with patients who smoke; one in three clinicians is unsure whether e-cigarettes are safe enough to recommend. Given the death toll from smoking, it is extraordinary that it appears that clinicians are unaware of the clear advice from Public Health England in that regard.

[Gareth Johnson (Dartford) (Con)]

I agree with everything that the right hon. Gentleman has said. Does he agree that the Government could reach their ambitious target, which he alluded to, by embracing vaping, getting more information out there to those clinicians and working through the law, particularly post Brexit, to ensure that people who want to give up smoking have all the information they require in order to take up vaping instead?

[Norman Lamb]

I totally agree. The statistics that I am citing make the point about raising awareness, even among clinicians. We thought that it was just the general public who needed to understand better the relative risks, but clearly clinicians also need to understand the relative risks so that they can advise their patients more effectively.

Two in five clinicians feel uncomfortable recommending e-cigarettes to their patients who smoke. Again, that is an extraordinary finding. Fewer than three in 10 agree that their current knowledge is enough for advising patients about e-cigarettes. That extraordinary data reveals a clear need for the awareness raising to which the hon. Member for Dartford (Gareth Johnson) has just referred.

What assessment has the Minister made of the number of smoking cessation services in the NHS that are actively promoting e-cigarettes as alternatives to conventional cigarettes? It ought to be every single one throughout the country, but are they actually doing it? Do we know? Can the Minister tell us what work the Government are doing with NHS England on increasing knowledge among clinicians of the uses, benefits and risks of e-cigarettes for current smokers?

Our report recommended that NHS England should create a post for someone who is responsible for implementing the Government’s tobacco control plan. The response said:

“The Government broadly accepts this recommendation.”

However, no specific steps to implement our recommendation were set out. We pursued that with NHS England, which in January told me:

“It is our intention to appoint an individual with lead responsibility for this role. This will be an important part of our delivery programme for the NHS Long Term Plan.”

We would all assume that that person was appointed long ago and that active work is now underway to pursue this vital agenda, which will save lives, but can the Minister confirm that NHS England has created that post and, if so, is someone actually in post and doing the job?

The Government say that, in their long-term plan, provision is made for

“all smokers who are admitted to hospital being offered support to stop smoking”.

That is not due to be fully implemented until 2023-24. Again, given the extraordinary health benefits of stopping people smoking, I would have hoped for a tighter timescale than ’23-24 to implement that. Will the Minister tell us how implementation of that proposal is going and whether consideration is being given to implementing it fully before 2023-24?

Our report recommended that the NHS should have a clear policy on e-cigarettes in mental health facilities that establishes a default of allowing e-cigarette use by patients. This comes back to my point that approximately 40% of those with severe and enduring mental ill health still smoke. The attitude and culture within mental health trusts is critical if we are to enable and help people with severe and enduring mental ill health to give up smoking. We said that it should be the default that e-cigarettes should be made available in mental health facilities unless there are clear evidence-based reasons for not doing so.

The Government response said:

“NHS England will provide guidance to mental health trusts that sets out that existing vapers should be permitted to use e-cigarettes as part of smoking cessation programmes, and…tobacco smokers should be supported to stop smoking through smoking cessation programmes”.

Can the Minister tell us whether that guidance has been issued? I very much hope that it has. If not, when will it be issued and what is the reason for the delay in issuing such important guidance? If it has been issued, what assessment has been made of how it is working?

The UK is making good progress in getting people to stop smoking and use e-cigarettes to achieve that, but that is at risk from recent concerns about e-cigarette use. Those concerns have been expressed particularly in other countries. We have put the concerns to Public Health England. The first is the claim that deaths in the US have been linked to the use of e-cigarettes and vaping products. The reality is that the US operates in a totally different regulatory context and “illicit products” were

“implicated in this outbreak…including vaping cannabis derivatives.”

That is from Public Health England. It has also explained that

“the suddenness of the outbreak across many USA states in just a few months, suggests that this is not a gradual effect of long-term use, but because of a specific agent coming into use in the affected population.”

Next are the concerns that flavoured e-cigarettes are “luring” children into vaping. Public Health England’s response explained that the data it had seen so far was reassuring that e-cigarettes were not re-normalising smoking. Furthermore, the UK and the US have different rules on advertising, nicotine concentration and education on vaping, which explains why flavours of e-cigarettes are less impactful in the UK compared with the United States.

The next issue is the introduction of a ban in India on the production, import and sale of e-cigarettes because of concerns about the risks that they pose to health and to the young. Again, an assertion has been made that is at risk of infecting the debate that we have in this country. However, Public Health England has explained:

“India is one of several countries that appears to be responding to the outbreak of lung disease among cannabis”

vapers

“by proposing a ban on nicotine inhalers.”

It has also explained that smoking is far more prevalent in India and causes 7 million deaths a year there.

[Sir Kevin Barron (Rother Valley) (Lab)]

Is it not true that India has a massive vested public interest in the tobacco industry?

[Norman Lamb]

I suspect that the right hon. Gentleman knows better than I do, but I note the point that he makes. My view, based on the evidence that the Committee heard, is that the action taken by India is not based on evidence and is likely to result in more people dying of lung cancer. I think that is shameful.

I encourage all right hon. and hon. Members to read the helpful and comprehensive reply that we received from Public Health England on these issues and others, and which we have published so that anyone can delve into the detail. I am reassured that Public Health England is in “close dialogue” with a range of international partners, and I agree with Public Health England when it says:

“It is no exaggeration to say that inflating fears about e-cigarettes could cost lives.”

Incidentally, I have concerns about the attitude at the World Health Organisation, which does not take the same evidence-based approach, as far as I can see, as this country has done. Again, that has implications through the potential loss of life for millions of people across the globe.

It seems to me that people often conflate the fact that we do not have all the long-term evidence on vaping impact with an assertion that that should lead us to conclude that we should not be recommending vaping as an alternative to smoking. Frankly, that is stupid as a public policy approach, because we know that smoking is killing—I think—more than 70,000 people in England every year, and all the evidence so far shows that nothing like that is happening from vaping. According to Public Health England, it is 95% less dangerous than smoking. Therefore, the clear public health advice has to be that vaping is an appropriate way to help people give up smoking. Of course, the best thing of all is not to vape and not to smoke, but if that is not possible for someone, the clear public health advice needs to be that vaping is better than smoking.

Will the Minister set out what contact the Government —she or other Ministers—have had with other countries on international approaches to e-cigarettes? In particular, what are they doing at the World Health Organisation to encourage a more enlightened approach? What assessment have the Government made of the effects of those international approaches on public perception of e-cigarettes in the UK? What steps will the Minister take to ensure that this misinformation on e-cigarettes is challenged?

[Graham Stringer]

It is not only the World Health Organisation that is not using evidence for its advice, but the EU. The EU’s directive on the size of the bowls used and the amount of substance put in is not based on evidence. It is likely to mean that those people getting a nicotine kick—much less dangerous than cigarettes—will not find the products satisfactory and will go back to smoking.

[Norman Lamb]

I share the hon. Gentleman’s concern about the directive and the proscriptive rules relating to vaping, which do not appear to be sufficiently evidence-based.

E-cigarettes are positive in helping current smokers to stop smoking, and they are significantly less harmful than smoking conventional cigarettes. Yes, there are unknowns about long-term risks, and we need to maintain research on e-cigarettes, but doing nothing is not an option when people’s wellbeing and lives are at risk. I look forward to the contributions of other right hon. and hon. Members, and to the Minister’s reply.

[Bill Grant (Ayr, Carrick and Cumnock) (Con)]

It is a pleasure to serve under your chairmanship, Sir Henry. I congratulate my friend, the right hon. Member for North Norfolk (Norman Lamb), on securing this important debate.

E-cigarette use in the UK has followed a gently rising trend over the past few years, and last year, statistics from the Office for National Statistics showed that 6.3% of those over 16 were regular users—a rise of less than 1% over five years. In our August 2018 report, the Science and Technology Committee concluded that e-cigarettes should not be viewed in the same way as conventional cigarettes. They are an effective stop smoking aid and should be formally considered as such.

In its response to the letter sent on behalf of the Committee by the Chair, Public Health England confirmed that it believed, as the Committee did, that e-cigarettes are around 95% less harmful than conventional smoking. As our Committee found:

“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.”

Existing smokers should be encouraged to give up, but if that is not possible, they should switch to e-cigarettes as a considerably less harmful alternative.

We must acknowledge that there are uncertainties about the longer-term health effects of e-cigarettes. They have not been in circulation long enough for any scientific research to be certain. Concerns have been raised in the United States, as was mentioned, about an isolated outbreak of serious lung injury linked to illicit vaping products, but I suspect, as the right hon. Gentleman said, that there may have been other factors at play in that instance. In any event, we have not seen that replicated in the UK, largely because, as ASH confirms, we have a strong regulatory system in place, which is not yet the case in the US.

The Government mandate strict conditions, namely a minimum age of sale, a ban on advertising in broadcast media, print or the internet, and a stipulation that products containing over 20 milligrams per millilitre of nicotine need a medicinal licence. Products must also be child-resistant and tamper-evident, and packs must carry a health warning covering over 30% of the surface area.

Moreover, to be balanced, any judgement on the future of e-cigarettes must take account of human nature and the most likely alternative to vaping, namely returning to harmful conventional cigarettes, which have proven to be a serious health risk over time. While some groups would prefer the firmest possible line—Cancer Research UK, for instance, is pressing for a tobacco-free UK within the decade—most groups agree that e-cigarettes can provide a useful route towards quitting harmful conventional cigarettes.

We have seen clear evidence that e-cigarettes are an effective quitting aid for adult smokers and, crucially, the percentage of young smokers trying e-cigarettes in Britain is small, with continued use smaller still. They flirt with the e-cigarette, but do not continue with it. There is little evidence to suggest that such products act as a gateway to conventional smoking—they are not, as some would suggest, a stepping-stone to conventional smoking—and figures show that almost 3 million people in the UK today are using e-cigarettes as an aid to quitting harmful conventional cigarettes.

Unfortunately, the Committee found that some aspects of the regulatory system for e-cigarettes are holding back their use as a stop smoking measure. Restrictions on the strength of refills and maximum tank size have led some users to move away from e-cigarettes and return, sadly and regrettably, to conventional smoking. There seems to be little scientific basis for these limits, and I am pleased that the Government, in response to our report, intend to consider these anomalies and how to address them. It is good to see that the Government also agree with our conclusion:

“There should be a shift to a more risk-proportionate regulatory environment; where regulations, advertising rules and tax duties reflect the evidence of the relative harms of the various e-cigarette and tobacco products available.”

Such a move might well bring about the welcome improvements in health that we, as a society, desperately seek, particularly from lung cancers and other by-products and unintended consequences of smoking. It is proven beyond doubt that conventional smoking is harmful. I look forward to seeing those changes implemented.

I take this opportunity to speak directly to conventional smokers. Despite being a fire officer for 31 years, sadly I was a 50-a-day smoker for many years, although I have long since stopped. Believe me: being a smoker was a costly, smelly and unhealthy mistake in my life. I only realised that afterwards. Yes, I enjoyed my cigarettes then, as the smoker today does. Even in my time in the fire service, when I left a fire with my breathing apparatus on and pulled the face mask off, some kindly colleague would have a pre-lit cigarette for me. It was certainly madness at the time, and I indulged in it. It is not easy to stop, but anything that is good is not always easy. Believe me, it can be done. My plea to those who do smoke is: you can stop if you put your mind to it, and it is absolutely worthwhile.

[Norman Lamb]

The hon. Gentleman kept that information very quiet on the Select Committee.

[Bill Grant]

It is something to be neither proud nor ashamed of. It was part of the culture of the time. I was part of that culture. There are two things in life that I have never regretted: marrying my wife, Agnes, and giving up smoking. They are equally wonderful.

I have had the pleasure to serve on the Science and Technology Committee since shortly after I was elected to this House, and it has been a fascinating and often inspiring journey. I am incredibly proud of the work we have undertaken as a Committee, ably assisted by a very fine secretariat, and I wish to put on record my thanks to them for their support. Indeed, as my friend the right hon. Member for North Norfolk and I both intend to retire at the forthcoming election, this will be our last debate together, and I wish to thank him for his fine stewardship over the two years.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health and Social Care (Jo Churchill)]

It is a pleasure to serve under your chairmanship, Sir Henry. I congratulate the right hon. Member for North Norfolk (Norman Lamb) on securing the debate, and I thank the whole Committee for the report, for its tone, and for the intelligent way in which it has approached the difficult subject of trying to stop behaviour that is detrimental to individuals.

We want smoking to reduce to zero, and for us to be smoke-free by 2030. It is an ambitious programme, but it will benefit many more people than just the individuals who smoke themselves, as it affects those around them. I thank the right hon. Gentleman, whom I have always highly respected, for his important work leading the Science and Technology Committee, and for his broader work on the health agenda. Although today’s debate might be his last in this place, I hope that it will not be the last time I hear him waxing lyrical on the airwaves about this subject. I say the same for the right hon. Member for Rother Valley (Sir Kevin Barron), who has really been quite formative in this area, both on the Health Committee and in his work with the all-party parliamentary group on smoking and health.

It is timely that we are having this discussion at the very end of this year’s Stoptober campaign; I pay tribute again to the right hon. Member for North Norfolk for his work in starting it. There is never a better time to stop smoking, and I encourage everybody who is thinking about doing so to visit their local stop smoking service, or to go online, and consider all the options available to help them to quit.

I am really proud of the tobacco control work over the past two decades and the progress that has been made, for which we have been recognised internationally. According to the Association of European Cancer Leagues’ tobacco control scale, the UK has been rated consistently as having the most comprehensive tobacco control programme in Europe. As we have heard from the numbers discussed, it is working—but we are not there yet.

Smoking remains one of the leading causes of preventable illness and premature death, with more than 78,000 deaths a year. That is not only a waste but a personal tragedy for all families affected. We are determined to do more, as set out in our tobacco control plan, the NHS long-term plan and the prevention Green Paper, which only concluded on 14 October. I am looking forward to seeing the results of that consultation.

Our ambition is to be smoke-free by 2030. We know that we need to work harder in certain groups, including pregnant women and those with mental health issues. Like the right hon. Gentleman, I was struck by the extremely high prevalence of smoking in some areas. He mentioned Blackpool but, as he knows from representing a coastal region, in many coastal areas there is a very high prevalence of pregnant women who smoke. They interact with many healthcare professionals during what should be the enjoyable, exciting time when they are expecting a baby. We should use every single one of those interactions to help them to quit.

I have already asked officials whether there are other forms in which we can message that particular group in a way that helps them to understand the risk, as well as the things that are available to help them. I listened to the right hon. Gentleman’s point about people with enduring mental health issues. Facilities should allow e-cigarettes and provide more support. That is an ongoing part of the agenda. I will write to Simon Stevens to see where we are, and I will let the Committee know.

[Norman Lamb]

I thank the Minister for her very kind comments. I am pleased that she will write to Simon Stevens, because pressure from Government Ministers on NHS England to recognise the significance of the subject is really important. I am conscious that I asked a lot of questions in my contribution, and she may well be unable to answer them all, but will she write to me before Parliament rises next week, if possible, to answer those questions that she is able to, so that we get that on the record?

[Jo Churchill]

I will do my very best. If there is anything I have not covered, I hope that the answer will be winging its way to the right hon. Gentleman on Monday.

The Government are absolutely clear that quitting smoking and nicotine use entirely is the best way for people to improve their health. We recognise that e-cigarettes are not risk-free, as has been stated by all Members who have contributed; however, they can play an exceedingly important role in helping smokers to quit for good, particularly when combined with stop smoking services. It is an addiction, and we are trying to achieve a step change in people’s practices and behaviours that enables them to quit entirely. We do not know the long-term harms of e-cigarette use, and no authorities in the UK assert that they are harmless. Based on current evidence, Public Health England and the Royal College of Physicians estimate that e-cigarettes are considerably less harmful than smoking because of the reduction in levels of exposure to toxicants in e-cigarette aerosols compared with tobacco smoke. However, I reiterate that quitting smoking is the best option.

It is fair to say that opinions on e-cigarettes are divided, both in the UK and globally. It is important that we listen to concerns, while looking objectively at the evidence base and seeking to build it further, which I think is the point that the right hon. Member for North Norfolk was making. On the question of research, I assure him that there is an NHS England dedicated lead—a director for prevention—in place, overseeing the NHS long-term plan commitments. I note the right hon. Gentleman’s comments about India and the fact that making decisions too quickly, not based on the research that is available, has unintended consequences.

As the House is aware, we have introduced measures in the UK to regulate e-cigarettes: to reduce the risk of harm to children; to protect against e-cigarettes acting as a gateway to starting smoking—another important point that has been made today—to provide assurance on relative safety, and to give businesses legal certainty. Regarding what has happened in the United States of America, we take those concerns seriously—we are aware of the tragic deaths associated with vaping in the United States and are monitoring the situation carefully. Public Health England and the Medicines and Healthcare Products Regulatory Agency are in close contact with the US agencies. Investigations are ongoing; they have not yet been able to confirm the definite cause of the deaths, although it appears that the majority of those who died had used illicit cannabidiol with THC products, which led to those unfortunate deaths.

To date, there have been no known deaths from e-cigarette use in the UK. The MHRA yellow card reporting system is in place to report any adverse effects. It has been running for three years and, to date, has been notified of about 85 individual cases; all have been minor, and none has been considered life-threatening. However, I assure the right hon. Member for North Norfolk and all other Members who have contributed to this debate that we remain vigilant on the issue and are grateful for all research done in this area, including—my hon. Friend the Member for Dartford (Gareth Johnson) alluded to this—by those within the charity sector who do a great deal of work in looking at the harms caused.

In our tobacco control plan, we made strong commitments to monitor the impact of regulation and policy on e-cigarettes and novel tobacco products. To inform future policy, we are looking closely at the evidence on safety, uptake, health impact and the effectiveness of these products as smoking cessation aids. Public Health England will continue to update its evidence base on e-cigarettes and other novel nicotine delivery systems.

The use of e-cigarettes by young people was mentioned by the right hon. Member for Rother Valley and by my hon. Friend the Member for Dartford. Such use currently remains low, at 2%, and we have not seen the rise that has occurred in the United States. However, we will monitor the data closely to ensure that regular use does not increase and it is not seen as a gateway to tobacco use, and will also keep a close eye on any new evidence about long-term harms caused by flavourings. If the evidence shows that we need to address either or both of these issues, we will consider taking action, including further regulatory action where necessary. I would like the industry to show stronger leadership in the areas of e-cigarette product labelling and, in particular, design to ensure that its products do not appeal to young people. Some of the current naming appears to lean in that direction.

In future, we will have the opportunity to reappraise current tobacco and e-cigarette regulation to ensure that it continues to protect the nation’s health. I thank all Members who have spoken today, particularly the right hon. Member for North Norfolk, who will be leaving this House. Today has been a bit of a goodbye party for him, for my hon. Friend the Member for Ayr, Carrick and Cumnock (Bill Grant)—I am staggered by the revelation that he smoked 50 a day; I wonder that he had time to do much else, let alone run around being a fireman—and for the right hon. Member for Rother Valley. I am sure that all of them will continue to work in this area.

I reiterate the Government’s commitment to help people quit smoking, which is ultimately the best course of action, and to seek evidence on reduced-risk products. We will continue to be driven by that evidence. Although we can celebrate the fact that adult smoking in England has fallen by a quarter and regular smoking among children has fallen by a half, I will truly be able to celebrate—like all right hon. and hon. Members present, I am sure—if we reach the goal, which both the report and the Government are aiming for, of being smoke-free by 2030.

[Norman Lamb]

I thank the Minister for her response to the debate and for her kind comments. There has been a remarkable consensus about the action we are taking in this country, and the need for it to be evidence-based. It is clear that the United Kingdom is ahead of the game internationally on smoking cessation work, and that is something we should celebrate. However, we should never allow ourselves to feel that we have done the job. We have so much still to do, particularly given the number of people who die every year from smoking, as the right hon. Member for Rother Valley (Sir Kevin Barron) made clear. The carnage—the death toll—is enormous, so the work needs to continue.

We have heard some wonderful admissions. The right hon. Member for Rother Valley and the hon. Member for Ayr, Carrick and Cumnock (Bill Grant) have admitted to smoking heavily in the past; they are both wonderful living examples of life after smoking. [Interruption.] Less coughing, please. They are wonderful examples to others of the potential value of giving up smoking, and I wish both of them a very happy retirement from this place.

I will quickly pick up on one or two points. I agree with the right hon. Member for Rother Valley that inserts in packs are a very good way of targeting an important public health message directly at people who need to hear it, and who need to be reassured that giving up smoking and vaping instead is going to help their health—a point we made in the report. I also agree with him about the case for the tobacco industry making a contribution to the cost of smoking cessation services, on the basic principle that the polluter pays.

My hon. Friend the Member for Brecon and Radnorshire (Jane Dodds), who has had to leave, made some important points about cross-border health issues. I applaud her for championing access to mental health support in Wales, which is incredibly important. The point in this debate is that every mental health facility and, in particular, every in-patient mental health facility, whether in England, Wales or Scotland, should offer the same access and support to enable people to give up smoking, using vaping as the mechanism to do so. Giving up smoking will lead to significant gains in not only people’s life expectancy, but their mental health; smoking harms their mental health as well as killing them earlier.

The hon. Members for Dartford (Gareth Johnson) and for Blackley and Broughton (Graham Stringer) both made the point that regulation must always be evidence-based. That has not been the case with the European Union directive or internationally, given the debate we have had about the World Health Organisation and the approach that is taken in America. In this country we want our regulations to be evidence-based, to give people the best chance of giving up smoking and having a healthier life.

On a personal basis, not in my role as Chair of the Select Committee, I agree with the hon. Member for Washington and Sunderland West (Mrs Hodgson) that investment in public health is important. There is much evidence that investment in early prevention work of all sorts, and in public mental health, provides—in brutal economic terms—a return on investment. It also changes lives. The plea to whomever becomes the Government after 12 December is this: make the investment in public health, because we will all benefit.

I thank you, Sir Henry, for your stewardship of the debate, and I wish all hon. Members well for the next few weeks. I am very relieved that I am not fighting to retain my seat in the middle of winter.

Question put and agreed to.

Resolved,

That this House has considered the Seventh Report of the Science and Technology Committee, Session 2017-19, E-cigarettes, HC 505, and the Government Response, Cm 9738.