Tobacco Control Strategy

Philippa Whitford Excerpts

Thursday 17th December 2015 Westminster Hall

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

The hon. Member for Harrow East (Bob Blackman) gave us a comprehensive summary of the situation, so I will bring us back to a few key points that we need to think about. What are the issues? They are not just the obvious things that people care about, or see mentioned in adverts, such as lung cancer; there is hardly a part of the body that is not affected by smoking. There are many problems that people are not aware of, such as stomach ulcers and bladder cancer. There are also the obvious ones, such as strokes, heart attacks, peripheral vascular disease and dementia—14% of Alzheimer’s is caused by smoking. Amputation is commonly due to peripheral vascular disease. Those are things that put people in a dependent situation and often result in them being in care homes. Not only does that have a direct cost for the NHS, but huge costs in our care world will become an increasing burden.

We have had quite a lot of success, but as was mentioned, 18.7% of people in England smoke. Unfortunately, while there has been a considerable drop in Scotland, the figure there is 20%. We started with the worst heart attack rates, and we still have 10,000 people in Scotland dying from heart disease every year. That number is almost equivalent to the population of Troon, where I live. That is a considerable number of lives lost every year. In England, the figure is 100,000. In addition to the question of the number of people who die, there is the painful journey to dying, and the amount of debilitation and suffering for the person and their family.

We have had success: in March 2006, Scotland was the first United Kingdom country to go for the smoking ban, so next year’s 10-year anniversary is approaching. I expect that there will be a re-evaluation of the ban’s success. We had a 17% drop in admissions for heart attack in the first year. That is a bigger effect than anyone expected. We saw an 18% drop in admissions for acute childhood asthma. Myocardial infarctions had been dropping slowly by 3% a year in the previous decade, but the rate accelerated to 17%. Childhood asthma admissions had been increasing by 5% a year until the smoking ban; there has been a 40% drop in smoking exposure for 11-year-olds. And so it goes on. We saw a much bigger impact in the first year than we could have hoped for. There has been success, and that has been UK-wide. It has all been done separately, but we were very much moving in the same direction.

We think of the debates that we have had here with the Minister with responsibility for public health on other issues, such as obesity. The whole public health agenda involves us taking radical action. It is interesting to hear about the earlier debates on banning sponsorship and banning smoking in public places, and how hard those things were to do, but look at what we and the NHS have recouped from that. We need to look at that going forward.

The impact of the cuts and changes to Public Health England has been covered in great detail. It is right that a lot of public health measures are integrated in local authorities, because they can bring about a more people-centred approach to such things as active transport, and the control of how tobacco is sold and how things are sold near schools. This is about looking at the whole person, because public health cannot always just be campaigns looking at one bit at a time. We need to challenge our whole lifestyle, and local authorities are in the best position to do that.

Unfortunately, Public Health England faced a significant cut of more than 6%, or £200 million, and it has been earmarked for significant ongoing cuts. That is a real problem. We have heard about the cuts to smoking cessation, including Manchester stopping all specialist services, and it being on a charitable or basically ad hoc basis in other places, and that just is not good enough. We need to think about how we go forward, and the lives being lost, the suffering being caused and the burden on the NHS.

In the five-year forward view, a shortfall of £30 billion was identified. Some £22 billion of that is expected to be found by the NHS. When Simon Stevens was in front of the Health Committee, on which I sit, he identified that the NHS was expecting about £5 billion to be saved through prevention, but at exactly the same time, we are talking about cutting public health funding. If that prevention does not come about, that £5 billion saving will not happen and the NHS will hit a brick wall. It is important that we look at all that local authorities do, including to prevent tobacco being sold to under-age people, and to prevent the smuggling of cigarettes and the selling of illicit cigarettes—the whole environment that people are facing.

The hon. Member for Harrow East mentioned the experience in New York, and the stalling of the drop there. That is already being seen here, with the slight increase in the prevalence of smokers, the decrease in quit attempts and the decrease in success. One of the biggest successes is an almost halving of young smokers starting. While the main drive of smoking cessation is helping people to stop, it is important that we do not create future generations who are in the same boat as ours. If we had listened to Wanless 12 years ago and got serious about public health then, we would be in a better place. He said that there would be a sudden surge of preventable and multimorbid diseases hitting the NHS, and that is exactly what we are living through.

It is timely that the debate in the Chamber is about the 1,001 critical days of pregnancy and the first two years of life. We need to invest in our children to try to have healthier, more successful generations in the future. We see odd patterns, such as the connection between smoking and people who end up in prison, and between smoking and those who have mental health problems. There has not been enough research to enable us to say that that is causal, but the fact that mental health patients smoke one third of all tobacco consumed does prompt the question: which one is the chicken, and which the egg? We need to think about our future generations; we need to ensure that pregnant women stop smoking—and do not start again as soon as the child is there, thereby exposing those young children to cigarette smoke. A lot of work has been done on smoking in cars. There has been a big campaign in our neck of the woods to try to get people to go outside the home and not smoke in the presence of children.

We have had a huge amount of success on this issue, due to the work of successive Governments who have ploughed forward, but we cannot afford to take our foot off the gas. We owe it to adults, to those who are approaching the age at which they might take up smoking, to the young, and to those not yet born to aspire to a future generation that is not burdened with the crippling diseases related to smoking. I saw this as a breast surgeon. People ask, “Why do people from deprived areas have poor success from cancer treatment?” Quite simply, I would meet someone aged 70 with breast cancer who had begun to collect morbid diseases from the age of 50. I could see straight away that they would not survive chemotherapy, and might not survive surgery. Treatment for a disease that is not related to smoking is therefore completely inhibited by their underlying disease. Smoking affects every part of people’s bodies. It affects the NHS and our society. We need to ensure that the smoking control policy we have at the moment is quickly replaced by one that is just as determined.