Science and Technology Committee

Debate between Norman Lamb and Bob Blackman

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.

Christmas Adjournment

Debate between Norman Lamb and Bob Blackman

Thursday 21st December 2017 Commons Chamber

[Bob Blackman (Harrow East) (Con)]

I beg to move,

That this House has considered matters to be raised before the forthcoming adjournment.

Unfortunately, the Chair of the Backbench Business Committee, the hon. Member for Gateshead (Ian Mearns), had to return to his constituency earlier and has asked me to lead off in the debate.

I kick off by sending the sympathies of the whole House to the Chairman of Ways and Means and his family at this time of terrible tragedy. We hope that he has as peaceful a Christmas and new year as is possible under these dreadful circumstances.

I wish to begin with the matter of homelessness. I make no apologies for pointing out to the House that my Homelessness Reduction Act 2017, almost the last Act given Royal Assent before we broke up for the general election, is yet to enter fully and finally into law. It becomes law on 1 April 2018. The Government have just concluded a detailed consultation on a 180-page document on the advice given to local authorities on the implementation of the Act and how homeless people are to be treated in this country. The Select Committee on Communities and Local Government is making representations to that consultation, and I look forward in the new year to the Government coming forward with recommendations to amend the consultation document slightly to make it far more user friendly for the people who need help—the people who are homeless.

The Act was the longest private Member’s Bill in history and the most expensive. It is quite clear, therefore, that this will be a revolution in how homeless people are treated in this country. The secondary legislation required to bring the Act into full force will come before the House in February, I believe, so clearly there is still work to be done to get this in place as required.

[Norman Lamb (North Norfolk) (LD)]

I commend the hon. Gentleman’s amazing work on this important legislation. I was with an amazing group of people at the Shelter office in Birmingham yesterday and, in particular, spoke to peer workers, who had been through the experience of street homelessness and could provide incredible and important support. They raised the issue of how sanctions in the benefits system are applied to street homeless people, many of whom suffer from mental ill health and have addiction issues, and who, with the best will in the world, have no way to ensure they attend a benefits meeting a week or fortnight hence. They miss the meetings and then have no money for a month or longer. This, surely, is something we have to address in terms of the civilised treatment of these people.

[Bob Blackman]

Clearly, people who are street homeless—actually sleeping on the streets rough—have chaotic lives and do not work to the same sort of timetables as everyone else. It is clearly wrong in principle, therefore, that they be penalised when, through no fault of their own, they fail to attend such meetings and have their benefits taken away. We have to do far more. We know, above all else, that every single person who is homeless is a unique case and therefore should be treated as such and sympathetically.

This is the 50th anniversary of the founding of Crisis. One of my political heroes was the late Iain Macleod, who helped to fund and start Crisis. It started off as Crisis at Christmas, but has gone on to provide services throughout the year. All Members have an opportunity to make a difference. The Crisis Christmas single, a re-recording of “Streets of London” by Ralph McTell, commemorates its 50th anniversary. It features the Crisis choir and Annie Lennox as guest vocalist. All Members and members of staff can download the single, for 99p, and we can aim to make it the Christmas No. 1.

If I cannot convince Members to buy “Streets of London”, they could download Phil Ryan’s Christmas single. He has worked with Lord Bird, the founder of the “The Big Issue”, for 26 years, and has launched a self-penned single, “Walking Down this Lonely Street”. Homelessness and loneliness are two things that go hand in hand. It would be great for all Members to download and support those singles.

Budget Resolutions

Debate between Norman Lamb and Bob Blackman

Thursday 9th March 2017 Commons Chamber

[Bob Blackman]

The Government have to look at the matter very carefully and review the point at which someone will pay more national insurance as a result of the abolition of class 2 contributions and the increase in class 4 contributions. I do not think that the balance, as announced yesterday, is right.

[Norman Lamb]

The hon. Gentleman rightly highlighted the concern that this may be a case of having to look at the small print. Is the situation not worse than that, however? The small print actually came in the legislation that was introduced after the election; when the commitment was made in the manifesto, there was no small print. It was a very clear promise, which has been broken.

[Bob Blackman]

The right hon. Gentleman and his party are experts in broken promises. It is important that we are seen to be fair and reasonable in this process, and that we encourage people to become entrepreneurs. That is the key element.

I now move on to funding for social care. The Communities and Local Government Committee, on which I have the honour of serving, recommended that the Chancellor make available £1.5 billion to fund adult social care. I am delighted that the Chancellor announced an extra £1 billion for adult social care. I am also pleased that the Secretary of State for Communities and Local Government confirmed today at the Dispatch Box that that money will be added to local authorities’ baseline budgets, and that he confirmed the formula by which it will be distributed. I think that that will be warmly welcomed by local authorities up and down the country, and it is a continuation of much needed funding.

I hope that the Economic Secretary to the Treasury will be able to clarify in his winding-up speech one or two points in the Red Book that are slightly confusing for me and may be so for other Members, if they have looked at them. Line 9 of table 2.1 on page 26 mentions a spend of £1.2 billion on adult social care in 2017-18, which is more than the Chancellor announced yesterday in his speech. I hope that that can be clarified. However, the extra £1.2 billion does not appear to have been added to the CLG items in the table on page 21. It is not clear whether the money is ring-fenced for adult social care—I hope it is—and how the Government will ensure that it is spent in the intended manner. The funding was clearly needed, and I am delighted that it has been announced. It shows that the Chancellor and the Treasury are listening to concerns raised by hon. Members from right across the House.

I am equally pleased to see the additional funding that has been introduced for the national health service, particularly capital funding to provide much needed A&E improvements. Those improvements will take some pressure off A&E departments by allowing for the triaging of individuals who turn up at A&E when they should have gone to their GPs in the first place. That will clearly take the pressure off our health service, and it will be warmly welcomed across the country. I trust that we can get on with implementing those capital schemes as fast as possible, so that next winter A&E will not face the problems that it has experienced over the last couple of years.

I note that the Chancellor has allocated an extra £325 million of funding for sustainability and transformation plans. However, the estimated requirement is £9.5 billion. I just wonder where the extra money will come from to support that. The extra money for that in the Budget is welcome, but there seems to be rather a shortfall by comparison with the demand created by the various STPs.

On business rates, we all welcome the relief for pubs and the reinstatement of a three-year revaluation cycle. If we have learned nothing else from the process, we have learned that a seven-year revaluation period is ridiculous. Although many businesses across the country will be warmly happy about the fact that their business rates were effectively frozen for seven years, after the businesses are revalued they will almost face a cliff-edge. The implementation of a three-year revaluation period has to be the right approach.

I warmly welcome the £300 million given to local authorities to grant discretionary relief on business rates. My only concern is that we know that a large number of appeals will be lodged against the revaluations, and some local authorities may therefore be hesitant about granting relief while appeals are going on. In London and other parts of the country where 100% of business rates are devolved, that may have a huge impact on local authorities’ income. That is my one concern.

We need absolute clarity on what will happen about the billing of business rates and the reliefs that will be offered thereafter. Businesses up and down the country will receive their bills without necessarily knowing what reliefs they will get. In terms of cash flow, that will be a serious concern. The additional money to provide businesses with relief from the increase in business rates is extremely welcome, but the devil is in the detail, and we must resolve businesses’ uncertainty as quickly as possible.