Tobacco and Vapes Bill

Preet Kaur Gill Excerpts

2nd reading
Tuesday 16th April 2024 Commons Chamber

[Preet Kaur Gill (Birmingham, Edgbaston) (Lab/Co-op)]

It is a pleasure to respond to the debate on behalf of the Opposition. We have heard powerful contributions from Members on both sides of the House in favour of the Bill to bring an end to the smoking epidemic and crack down on vaping companies that are preying on kids. I thank the right hon. Member for Bromsgrove (Sir Sajid Javid), my hon. Friends the Member for Stockton North (Alex Cunningham) and for Blaydon (Liz Twist) and the hon. Members for Winchester (Steve Brine), for Harrow East (Bob Blackman), for Erewash (Maggie Throup), for Boston and Skegness (Matt Warman) and for Stroud (Siobhan Baillie) for their moving contributions on the harms of smoking and the importance of the Bill. Let me also thank my hon. Friends the Members for North Tyneside (Mary Glindon), for York Central, (Rachael Maskell) and for Dulwich and West Norwood (Helen Hayes) for the excellent points they made about the growth in vaping.

We have also heard opposition to the Bill. The right hon. Member for Rossendale and Darwen (Sir Jake Berry) cited the example of people openly taking class A drugs in public without reprimand as evidence that bans do not work. I dare say that he made more of a point about the decline in policing and local enforcement under his Government than about age-of-sale legislation. To the former Prime Minister, the right hon. Member for South West Norfolk (Elizabeth Truss), I simply say that if wanting to stop future generations from getting addicted to products that may eventually kill them makes us the health police, then the health police we are.

There is no argument about the harm that tobacco does to the people of this country every day. Smoking is the single biggest preventable cause of ill health. It leads to 80,000 deaths a year in the United Kingdom, and it is responsible for one in four cancer deaths and more than 70% of lung cancer cases. Smokers lose an average of 10 years of life expectancy. As we have heard, smoking is not a free choice; it is an addiction. Raising the age of sale will help to reduce pressure on the NHS by improving health and wellbeing.

My constituent Eric knows that too well. He is one of thousands of constituents whose lives have been put at risk by smoking. Like the vast majority of smokers, he began smoking when he was a child, at age 14. It was not until his 50s that he was able to give up cold turkey, at the request of his daughter, who urged him to do so on behalf of his newborn grandson. Eric has suffered a heart attack and stroke, and he lives with hypertension, high cholesterol and COPD. As he said:

“COPD is an incurable, mortal disease and makes getting around harder and harder for me.”

The experience of people like Eric is why the last Labour Government took radical action with the smoking ban in 2007: a defining public health achievement. It is also why, while in opposition, we welcomed the Khan review and proposed the generational smoking ban a full 10 months before the Prime Minister made his announcement at his party conference.

There is wide support for the Bill from everyone in the NHS, in the wider health sector and among the general public. The only people who seem to be fighting it tooth and nail are the tobacco companies and Conservative Back Benchers. The former Member for Blackpool South called it “health fascism”, and the former Prime Minister, whose chief of staff worked for Philip Morris and British American Tobacco, has called it “unConservative.” What is it about the tobacco industry that some Tory MPs love so much? Every year the NHS bails out big tobacco to the tune of billions. The Prime Minister might not feel he has the strength to take on those vested interests and whip his MPs to vote against them, but he can rest assured that if they cannot get it over the line, Labour will.

As welcome as this Bill is, the Government have had 14 years to take stronger action on smoking. Four years ago, the Government said that their ambition was a smoke-free Britain by 2030, but they are currently estimated to be at least seven years behind their Smokefree 2030 target and not on course to meet it in the poorest areas until 2044. The generational smoking ban will help us get there, but it will not help the 6 million to 7 million adults who already smoke.

As many Members have said, stop smoking services have faced savage cuts. The number of smokers who quit through stop smoking services has dropped from 400,000 a year in 2010 to around 100,000 today. Does the Minister regret not doing more to bring down smoking rates over the past 14 years? The Government have belatedly committed more funding to stop smoking services, but the uplift in funding that the Minister offers will not take us back to the number of people setting quitting dates that we achieved in 2010. What assurance can she offer that her measures will get the Government on course to hit the 5% smoke-free target by 2030?

The Bill is strong on tackling the take-up of cigarettes and vapes by young people, but it does little to help those already addicted to quit. Recently, a school in my constituency had to apologise after handing out a leaflet to a child that suggested smoking as a self-help measure. Does the Minister agree that it is scandalous that the myth that smoking reduces stress and anxiety still persists? Does she agree that her Bill should include a requirement to make tobacco companies include information to dispel that myth in their products?

The Bill also includes a range of powers to tackle youth vaping, which Labour welcomes. For years, Labour has been warning about the explosion of young people getting addicted to nicotine with products that look like teddy bears and sippy cups, and come in flavours like unicorn shake. That is why Labour voted to ban the marketing and branding of vapes to children in 2021. Once again, Labour leads and this Government belatedly follow. In the meantime, an estimated 255,000 more children aged 11 to 17 have become addicted to vapes, according to ASH survey data. Does the Minister regret taking so long to wake up to this issue?

According to the Chartered Trading Standards Institute, while youth vaping has soared, so has the number of illegal products flooding our market, as many Members have raised. Up to one in three vapes sold in shops is estimated to be illicit, which means that children are being exposed to vapes that contain heavy metals, antifreeze and poster varnish, as well illegal levels of nicotine getting them hooked for life. Will the Minister explain how she expects to bring in effective new regulations on vapes when her Government are barely in control of the black market now? Does she agree that a cross-Government strategy is needed to tackle the smuggling of potentially dangerous products into our country? Has she considered giving the MHRA new powers to screen products before they come on the market? Will she confirm that her Bill will provide powers to tackle not just the sale but the import of dangerous products?

To conclude, after 14 years of the Tories, healthy life expectancy has dropped for the first time in modern British history. Labour supports this Bill but, after 14 years of failure and with the NHS in crisis, we regret that it marks a last desperate attempt of this Government to rescue a legacy on public health. For 14 years they have played politics with public health, putting off prevention measures, knowing that taxpayers tomorrow will pay the price. But the country is paying for this now. Labour will always put public health first, prioritise prevention to ease pressure on the NHS, improve access to smoking cessation services and take on the tobacco and vape companies that are profiting off people’s health.

Tobacco and Vapes Bill (First sitting)

Preet Kaur Gill Excerpts

Committee stage
Tuesday 30th April 2024 Public Bill Committees

[The Chair]

Thank you. I now intend to take two questions each from the Opposition spokesperson and the Minister. Given that we have very restricted time, I impress upon the witnesses that they need to be very brief in their answers.

[Preet Kaur Gill (Birmingham, Edgbaston) (Lab/Co-op)]

Q You will have seen on Second Reading that there is almost universal agreement on the basic point that smoking is bad, and that we want to see smoking rates come down and to have a smoke-free future. A lot of Members of Parliament raised other issues, especially about raising the age of sale. Can you explain why you support a complete ban as the right way to deliver a smoke-free future?

[The Chair]

Are you going to have just one question, or do you want to put two?

[Preet Kaur Gill]

Do you want me to ask the second question now as well?

[The Chair]

Yes, please.

--- Later in debate ---

[Preet Kaur Gill]

My second question is on the point that Sheila raised. Clause 61 gives the Secretary of State powers to regulate on packaging, vaping or nicotine products. Clause 62 makes regulations for the Secretary of State to have powers on substances that may be included and the flavour of vaping. Do you believe that the measures in the Bill to prevent vapes appealing to children are likely to work, and where can we learn lessons to ensure their effectiveness?

[The Chair]

Minister—your questions.

--- Later in debate ---

[The Chair]

We will now hear oral evidence from Dr Charmaine Griffiths, the chief executive of the British Heart Foundation, and Sarah Sleet, the chief executive officer of Asthma and Lung UK. We have until 10.40 am for this session. Could I ask the witnesses to introduce themselves and give their titles for the record? Then we will move into the questions.

Dr Griffiths: Good morning. My name is Dr Charmaine Griffiths and it is my privilege to be chief executive of the British Heart Foundation.

Sarah Sleet: My name is Sarah Sleet and I am the chief executive officer of Asthma and Lung UK.

[Preet Kaur Gill]

Q You will know that the Government have a clear target to narrow the gap in healthy life expectancy between the highest and lowest areas in the next five years. Do you think that smoking rates are particularly high in certain parts of the country, and are the health benefits following the ban therefore likely to be more prevalent in some places than in others? That is my first question. Secondly, I am concerned about the huge rise in youth vaping in recent years. Are you concerned about the increase in vaping even among groups who have not previously smoked cigarettes?

[The Chair]

We will also take the Minister, and then we can answer both sets of questions together.

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[Dame Andrea Leadsom]

Q I asked a specific question about children’s asthma and children’s heart damage. Could I urge our witnesses to respond to that question?

Dr Griffiths: Thank you, and apologies if we did not cover that as clearly as we could have. Obviously, there is no such thing as a safe cigarette, there is no safe number of cigarettes to smoke, and there is no safe age to start smoking at all. We would emphasise our concern for children starting to smoke, because the damage starts as soon as you start smoking. There is no safe number of cigarettes to smoke. Combined with that, the fact that nicotine is so addictive that it leads to most people—over two thirds of those who start—becoming long-term smokers, worries us enormously. In terms of both the risk and the damage of starting smoking, the number of people who start and the fact that they go on to adopt a lifelong smoking habit caused by nicotine is of deep concern to us.

Sarah Sleet: It is worth thinking about children’s wider environment. Children who live in households where the adults smoke are four times more likely to smoke themselves, and find it much harder to give up. Children are getting into a cycle of deprivation and damage to their long-term health right from the very beginning. For children, stopping smoking availability is going to be profoundly helpful for their future lives, their ability to contribute to the economy and their overall prospects. This Bill, which tackles the issue from childhood up, will be one of the most profoundly important health interventions that you can make.

[Preet Kaur Gill]

Q I think the Minister was referring to vapes and the evidence based around the impact on growing lungs and hearts. Is there anything you would like to say about that before we move on?

Dr Griffiths: As Deborah from ASH said, vapes are a fairly new product, so the research and evidence base, which we have in abundance for tobacco and smoking, is still forming for vaping. However, there are indications that it is not great for health. We are cautious and worried about the long-term implications. What we do know is that vaping can be an important cessation tool for those trying to quit smoking, and that many do want to quit, so we strongly encourage anything that stops smoking, but the people who are turning to vaping as an alternative to smoking for the first time is of deep concern to us. We do not understand the long-term health implications, but the addiction to nicotine deeply concerns us.

Sarah Sleet: We strongly agree. It is a very delicate balancing act between stopping the harm caused by smoking and looking to the long-term with regard to vaping. Quite clearly, smoking is far more damaging for adults and children. Anything that can steer people away from smoking will be healthier than continuing to smoke in the long run, but we do recognise that more attention and more research need to be put into vaping.

[Rachael Maskell]

Q Clearly, smoking is far more harmful than vaping, but research by UCL has shown that there are DNA methylation changes linked to carcinogens from vaping in the oral cavity, which quite probably translates to the lungs as well. Should we be looking at this legislation not with the naiveté with which smoking was looked at in the past, but rather as taking advance steps to ensure that we do not see an inducement of lung disease in the future?

Sheila Duffy: As I said earlier, it is a delicate balancing act. We need to move people away from smoking, and anything that does that is a good thing, but we need to look at the long-term effects of vaping. The balancing act in the proposals around restricting access to vaping—making sure that nobody under-age gets access to vapes, denormalising them by taking them away behind the counter and so on—all of those are good measures to reduce the number of children moving on to vaping, but they need to be enforced. We need to make sure that we have the right enforcement action in place to make sure that that actually happens.

Dr Griffiths: You gave a great example of early science that causes us concern, and it perhaps will not surprise you to know that as a body that is based in science and evidence, we at the BHF take statistics incredibly seriously. We are worried that the body of evidence will grow. We would hugely support and welcome a position where vaping was available to people as a cessation tool, but absolutely would discourage anyone else from taking it up as a starting point for nicotine consumption.

--- Later in debate ---

[Dame Andrea Leadsom]

I understand that, but why?

Dr Griffiths: Because it is a really clear path to make sure that we move to a situation where we have a generation that is prohibited from buying cigarettes, and who are disincentivised from doing so.

Sarah Sleet: We have heard today the evidence about just how harmful and destructive smoking is, particularly for people in more deprived areas. If we really want to tackle that, we need to remove smoking as a normalised, available, legal option going forward. This seems to me a very measured and thoughtful way of introducing a smoking ban that will take hold. It is very important for our children going forward.

[Preet Kaur Gill]

Q I want to ask about the information that is given to parents, especially if their children have never smoked but have taken up vaping. We know that a generation of children is becoming addicted to nicotine because products that have been classified as 0% nicotine do actually contain it. One of the parents that I spoke to asked, “Well, how many puffs are there in one vape? If my child has two or three of those in a day, what does that actually mean?” It is about the information on that sort of risk, and how we share that information with parents who are trying to address this issue with their children. Is there anything you want to say about that, and is there any research being done to look at that?

Dr Griffiths: I would observe that there is so much variation between products and how people are consuming them. I think it is quite difficult to give advice in a standard way, and that it is part of it being an emergent product and market. As we have discussed, there is no doubt that, with nicotine being so deeply addictive, it is an incredible worry that a child has a single puff on a vape, given the potency of nicotine and where we know it leads people, having seen that over generations with smoking.

I should perhaps take a moment to emphasise that we also really support the £70 million investment being allocated to public health campaigning and cessation services, as well as enforcement. You are right that we need to be really clear with the messaging of the Bill to encourage support from parents and others around children in particular. We really applaud the decision to put resourcing behind this as well. We know that effective public campaigning can be an incredibly powerful tool. We were really proud to run the “Give Up Before You Clog Up” fatty cigarette campaign way back 20 years ago, and we know even that campaign led to 14,000 smokers seeking to quit. We know public campaigning works, and it was a great thought to allocate that resource as part of this work—it will be needed.

Sarah Sleet: The variation in nicotine levels and the method of delivery, which affects the uptake of the nicotine, is undoubtedly very concerning in vapes. I am a mother of three adult children who all vape, and I am very concerned about how often they are doing that and what impact that is having. We must also remember that, from what we know at the moment, it would appear that smoking is far and away the most damaging activity, compared with vaping. There is a little bit of concern that we overemphasise the harms of vaping to the extent that people say, “Well, I might as well smoke then. I’ll do that instead.” We need to be very careful about how we have this conversation.

[Dr Cameron]

Q I want to follow up on something that both of you alluded to earlier in the evidence you have given. Is there any research beginning to form that suggests that, while vaping can be helpful for cessation, it might also be a gateway to smoking itself for young people?

Dr Griffiths: That is an interesting question, and I can see the clear linkage you have described, but I am not able to provide any evidence. I am very happy to go back and provide that as a follow-up.

Sarah Sleet: I am not aware of any evidence around that either.

Dr Griffiths: It is a great question.

--- Later in debate ---

[The Chair]

We will move straight into the questions. Preet Kaur Gill will ask the first question, and then I will move to the Minister for her first question.

[Preet Kaur Gill]

Q Thank you, Chair, and I thank the witnesses for giving evidence today. First, is under-age smoking or vaping the bigger issue in schools today, and what is the impact on education, behaviour and so on? Secondly, will the measures in the Bill to restrict sales of vaping products to children under 18 work, in your opinion?

Matthew Shanks: It is an interesting question, whether vaping or smoking is more popular among children in schools. All I can say is that it has increased in the past three or four years. We see evidence of vaping; it is more difficult to catch children vaping, because of the size of the vapes, the fact that the smell is slightly different and does not set off smoke alarms in the same way, and so on. I think it is fair to say that smoking and vaping are still as popular as they were among younger children in certain areas, and vaping is being seen to be a safe alternative.

The marketing of vapes in different flavours and colours makes them akin to a progression from chewing gum for some families—with bubble gum flavours and so on. There is also anecdotal evidence of parents talking about, “If it’s grapefruit, it must be safe.” There is that evidence around it as well out there—because of the way in which vapes are marketed, and if you see them in shops, they seem safe and okay.

With behaviour, the size of vapes makes it very difficult to admonish children, because they can hide them very easily. They can look like mini hard drive sticks—I think that is deliberate targeting in how they are marketed, with the cleverness of it. Certainly in terms of behaviour, it is something else that we are dealing with, when we say to a child, a teenager, “You’ve been vaping”, but they say, “No, I haven’t”—there is nowhere for us then to go, which immediately sets up an issue.

The earlier question about toilets was interesting, because children tend to vape in toilets. It is easier for them to vape in toilets than it was for them to smoke in toilets. You just need to see people on public transport vaping—it is easy for it to dissipate and disappear quickly. So, yes, I would say that vaping is a real issue in schools for children.

Patrick Roach: I support fully what Matthew has just said. I do not think that it is an either/or; the reality is that smoking is a threat to children and young people, in terms of their health and wellbeing and their ability to participate and progress educationally, but so too is vaping.

The NASUWT, at the start of this academic year, published our own research into vaping in schools from the perspective of teachers and school leaders, and it very much reinforces what Matthew has just said, in that vaping is pretty much predominant as an activity taking place among secondary-aged pupils. But we are also seeing teachers reporting pupils vaping from as early as 10 years of age, so the primary phase is also impacted. Three quarters of teachers report a significant increase in the participation in vaping by pupils in their schools, so we are seeing an upward curve in respect of vaping activity within schools.

On the issues that have just been mentioned about the difficulty that schools have in detecting and controlling this kind of behaviour, the way in which vape products are available to pupils is that they are masquerading as hard drives, as highlighter sticks or as other things that it would be legitimate for a pupil to bring into school. This is not like a situation in which you catch a pupil with a packet of cigarettes and you confiscate it; first, you have to identify what on earth it is that that pupil has. At the end of the day, good order in schools is dependent upon there being trust and respectful relationships between teachers and students. You cannot go around every moment of every day asking pupils to turn out their pockets and then inspecting what is in them.

The reality is that we are seeing the impact of vaping not just on pupils’ health, because we are seeing pupils who are presenting as ill as a result of the overuse of vaping products—although, in fact, all of it is overuse—and therefore becoming ill in schools, but on educational participation, progression and achievement. When pupils are diving off into the toilets to vape, that interrupts teaching and learning. When pupils are late arriving at school, perhaps because they have been vaping en route, that impacts on pupils’ learning. We are also seeing bullying behaviours within schools because, quite often, vaping products are being informally circulated, exchanged or acquired. Therefore, it becomes another source of behavioural challenges for teachers and head teachers. So, from a teacher’s perspective, vaping is a serious issue within schools, and one that we are pleased that this Bill is seeking to address.

[Dame Andrea Leadsom]

Q Thank you so much for being here, and also particularly for the work that the NASUWT has done in terms of the impact on schools. Could you expand on that a bit further? I have done a couple of visits ahead of this Bill. I met enforcement officers, for example, who gave me anecdotal evidence that teachers say that pupils will return to the classroom with their eyes spinning and unable to concentrate because of the heady nature of whatever it is they have just been vaping or smoking. There was another anecdote about a school where children decided to drink the vape fluid and the school actually had to have a sort of emergency evacuation as a result of that.

Could you therefore expand on that, in terms of the specific health impacts and, at the one end, the ability of children to concentrate on the class when they are spaced out on vapes, and, at the other end, the very real risk to children from doing something stupid with a vape that was entirely unintended, with disastrous consequences?

Patrick Roach: I very much appreciate your remarks about the research that the NASUWT has undertaken. We come at the problem of vaping from the point of view of our members in classrooms, in schools the length and breadth of the country. What do teachers need in order to be able to teach effectively and what do they believe that pupils need in order to learn effectively? They need good order in the classroom.

My perspective is not that of a medical practitioner or of someone wanting to assume that I have the knowledge about the impact of vaping on a child’s physical development. Our concern is the impact on a child’s educational development, participation and achievement. The reality is that everything you have mentioned there is absolutely right, whether it is about the way in which vaping products might be unintentionally used by pupils; or about how they seek to conceal them about their person; or, indeed, the drinking of vaping fluids, as if somehow that will get the high without necessarily being detected; or about the use of vaping products as a stimulant, which impacts not only on concentration but on behaviour and, indeed, on a child’s wellbeing in the classroom.

Matthew has already referenced the difficulty of detecting vapes sometimes, because they can dissipate very quickly; and they can also trigger fire alarms in schools. We have had plenty of examples of teachers and headteachers reporting that their school has had to evacuate the building not just on one or two occasions in a day but multiple times—five or six occasions. That is a loss of learning not just for one pupil or class of pupils but the entire school. We are really concerned about the impact of all that.

Teachers are not just concerned about a child’s educational development, though; they are also concerned about a child’s wellbeing in the round. Teachers are reporting the very damaging impact that vaping can have on a child’s mental and physical development, just as smoking can. That is one of the reasons we have spoken out—and we are pleased that the Government have responded—to say that we need to be doing more to strengthen the enforcement of rules around vaping, access to it and the availability for school-age pupils. We need to do as much as we possibly can to prevent any school-age pupil from getting access to vaping products, whether in or outside school. We are pleased that the Bill seeks to do just that.

Matthew Shanks: I absolutely echo and reinforce what Patrick has said. Also, as school leaders we are looking after teachers, but we are caring for families as well. The Bill will help families to understand that it is not okay for their children to vape. Anecdotally we have parents saying to us that they let children vape at home, because it is better than them smoking or being out on the streets; parents do not see the harm in it. It is really important that that is recognised. The banning of tobacco sale was interesting in terms of the prescription of it; I would posit that at the moment vaping is seen as safe by the general public.

--- Later in debate ---

[The Chair]

Q We will now hear evidence from Paul Farmer, who is the chief executive of Age UK. This brief session will last only until 11.25 am, so the time will need to be snappily used. Mr Farmer, this seems unnecessary, but for the record can you simply state your name and title?

Paul Farmer: Good morning, everyone. I am Paul Farmer and I am chief executive of Age UK, the charity supporting older people.

[Preet Kaur Gill]

Q Welcome, Paul. It is good to have you here. My first question is simple and straightforward: what is Age UK’s view on the Bill?

My second question is this. I know that over-65s are much less likely to smoke. I have a constituent, Eric, who has suffered from a stroke and has suffered with chronic obstructive pulmonary disease and is now a tobacco campaigner in his 80s. Why is this Bill important to the people Age UK works with?

Paul Farmer: Age UK fully supports the proposed legislation, and we have been working alongside the Richmond Group of Charities to highlight the significant health benefits of phasing out smoking, which will help individuals and have a wider impact on society. It will have particular benefits for the NHS, which as we know faces significant challenges at the moment.

Our job at Age UK is to think about not just the health and wellbeing of older people as they are now—I will come to your second question in a moment—but issues affecting future generations of older people. This is quite a rare opportunity for us to have a significant impact on those future generations for reasons we will look at later.

It is worth noting, however, that this Bill is heavily supported by older people. Polling shows that 69% of over-65s support it. Why is that? That goes to your second question. We know from older people and the work we are currently doing that health and wellbeing in later life is pretty much the top priority for older people. Age UK has recently published our blueprint for older people for the next few years, as we enter an election year. It is very clear from the work we have done with older people that health and wellbeing is right at the heart of what is most important for people.

Of course, that is logical: the ability to feel well, remain active and maintain our independence is a major determinant of the quality of life that we aspire to in later life. We also know that there is a huge gulf in life expectancy and life experiences between those who have the opportunity to age well and those who do not. I will not go into the points your earlier witnesses made about the importance of healthy life expectancy in detail, but that is right at the heart of older people’s considerations. It is important that we do something about the fact that healthy life expectancy for those who are most disadvantaged is quite so stark.

How does that affect smoking? As you know, smoking is a leading cause of death and disability. It is responsible for half the difference in healthy life expectancy between the most and the least affluent communities. People living in the areas with the lowest healthy life expectancy are 1.7 times more likely to smoke than those living in the highest healthy life expectancy areas. These are fundamental reasons why the intervention of this legislation will make a difference.

[Dame Andrea Leadsom]

Q I really appreciate your being here—thank you. I would like to tackle the fact that young people tend not to consider either their own mortality or their health and wellbeing. The majority of young people tend to take those for granted, and yet there is a complete correlation: the age at which you take up smoking—or, indeed, vaping—is when you are young and feel pretty immortal, or are at least not concerned about later life.

Could you give us a view, as an Age UK representative, of the sort of advice that older people who have smoked all their lives and are now bearing the brunt of the decisions they took would give to those who argue, “It’s a matter of personal choice. Everyone should be free to smoke if they want”? What would an older person say to that young person?

Paul Farmer: I think a lot of people would say that they wish they had never started. Those are certainly the conversations we have been having with older people in preparation for this session. The reason for that is that, as you enter into your later life, you start to understand the consequences of smoking through your personal experience. The list is frightening.

Tobacco and Vapes Bill (Second sitting)

Preet Kaur Gill Excerpts

Committee stage
Tuesday 30th April 2024 Public Bill Committees

[The Chair]

We will now hear from Councillor David Fothergill, deputy chair of the Local Government Association, and Greg Fell, president of the Association of Directors of Public Health. We have until 2.30 pm for this session. I ask the witnesses to introduce themselves for the record—I do not really need opening statements, because we will have plenty of questions for you, but if you want to add a sentence to your introduction, I will not object.

Cllr Fothergill: Thank you for the invite this afternoon to speak on behalf of the Local Government Association, which speaks for all councils across England and Wales. I will present a combined view to you. I am chair of the community wellbeing board, the lead policy board, which is responsible for adult social care and health matters. I am delighted to be here. On the whole, we are supportive of the Bill, and that will be the thrust of the evidence I give.

Greg Fell: I, too, thank the Committee. I am Greg Fell, director of public health in Sheffield and president of the UK Association of Directors of Public Health, thus representing DPH. Similarly, all DPH strongly support the Bill—I have yet to find a public health professional who does not, as I do not think that one exists, particularly on the smoking elements. No other product is as uniquely dangerous as smoking; we strongly support both the smoking and vaping elements of the Bill. I look forward to talking more.

[Preet Kaur Gill (Birmingham, Edgbaston) (Lab/Co-op)]

Q36 Effective enforcement will be key to the success of part 1 of the Bill, yet some local authorities tell me that they do not have even a single full-time trading standards officer. The illicit market in vapes is substantial—in Birmingham, 17,000 illicit vapes were removed. Do you think that local authorities have the resource needed to enforce the new measures on age for the sale of tobacco, and the new regulations on vapes?

Cllr Fothergill: Our view is that enforcement is key to the success of the legislation, and enforcement has to be through trading standards. Over the past few years, trading standards has had a number of reductions in its budget and cuts, as well as a restriction on the number of people being trained to come through in this area. We believe that we need clarity from the Government as to what the responsibilities for trading standards will be, and we need clarity about the funding that will be allocated. We also want to see an apprenticeship fund set aside for the training of new trading standards officers to come through. We need a longer-term view of trading standards. It is worth noting that trading standards is responsible for enforcing more than 300 pieces of legislation, so this is just another one, but it will add strain unless we get those clear responsibilities, clearer funding and apprenticeship levy put aside for the future.

Greg Fell: I agree with all those points. There has definitely been a reduction in funding for trading standards over the years. It still exists—many local authorities spend quite heavily on trading standards—and it makes a difference. Enforcement against illegal vapes and tobacco is a clear example. Our trading standards team in Sheffield regularly confiscate very large quantities of illegal tobacco, which we know are linked to organised crime. Trading standards still exists and it does make a difference, but to make the Bill—hopefully Act—as successful as possible, we will need to invest sustainably in trading standards and other enforcement.

[Preet Kaur Gill]

Q In what circumstances do you envision that local enforcement would not be enough and the Secretary of State would need to use the powers to intervene granted to her by the Bill? That is in clause 64.

Cllr Fothergill: We fully support the local penalty notice being issued by the councils. We believe that that is the right way to go and that it will not clog the courts, but there is always the option to refer to the magistrates court if required. Our big concern is the size of the fine, which we believe needs to be reviewed: £100 or, if paid within 14 days, £50 is hardly a penalty. We argue that we need to have greater opportunity to fine those in contravention of the law. Then, we believe, there would be less and less need for the Secretary of State to be involved. The reason he or she would need to be involved is if we cannot contain it—because we cannot issue enough penalty notices to contain it locally.

Greg Fell: A similar issue would be multi-local authority enforcement scenarios. We know that organised crime networks are not linked to an individual area, so it stands to reason that there will be a need for enforcement that cuts across many authority areas, hence there is a need for networked trading standards. That might also include, possibly, the borders—stopping the imports of illegal vapes and tobacco.

Additionally, as Councillor Fothergill said, we are concerned about the size of the fine. Certainly I hear through DPH parochially, who talk to their trading standards and licensing teams, that when there is a much larger fine that may or may not be linked to the removal of an alcohol licence, that will make a retailer really sit up and think.

[The Parliamentary Under-Secretary of State for Health and Social Care (Dame Andrea Leadsom)]

Q I appreciate you being here. Can you give me an idea of the LGA’s view of a licensing regime? That is not proposed in the Bill, but some people say that licensing would be a better alternative than the measures we are proposing here.

Cllr Fothergill: Certainly. Although we fully support the Bill, we think there could be one or two changes, which I have already referred to—we would like to see amendments—and there is the option of a licensing scheme, which we would support. If it was done on a similar basis to liquor licensing, we would be able to enforce that, because it would be backed by legislation. Of course, we would need to make sure that trading standards were fully funded for that. We would support that, if it was something that the Government brought forward.

Greg Fell: I cannot speak for the LGA’s position; ADPH does not have a formal view on licensing. I would broadly support it, but there is a danger that putting that into the mix delays getting the Bill through Parliament and turned into an Act, and getting the Bill through Parliament is arguably the most important thing.

I would broadly support that, but I come back to the complexity. Vapes are sold in hairdressers and beauty parlours and so on, so we would need to think it through. Arguably, if we are going to get into a licensing scheme, that should be for tobacco and nicotine-containing products, not just vapes; I would personally go to tobacco as well. Critically, the resourcing to make it work properly would need some very careful thought and consideration. All of that would need to be in the mix, but broadly I would support it, with those caveats.

--- Later in debate ---

[Mary Kelly Foy]

David, do you want to add anything?

Cllr Fothergill: I think Greg summed that up perfectly.

[Preet Kaur Gill]

Q Why do you support the complete ban as opposed to raising the age from 18 to 21, as many people often say? I know the Khan review has talked about not getting to a smoke-free future if we did that, but is there anything you would like to say about that?

Greg Fell: Years and years ago, the narrative was about raising the age of sale to 21, but I think the evidence has shifted. I hear from a number of stakeholders and sources that the tobacco industry is targeting its public relations at slightly older young people—the 18 to 25 age group. If you were to stop at 21, the tobacco industry would just change its marketing and you would therefore get a new target group recruited into smoking. Nobody thinks that that is a good idea, so the evidence is shifting.

The ban sets a really important norm. We can all remember walking out of a pub smelling of cigarettes. We cannot imagine that now, so continually shifting the norm changes population behaviour just by norm shifting, which is important and often underplayed. I would support the lifting lid—I think that is the right phrase.

Cllr Fothergill: I think Greg is absolutely right. At the LGA, we support the progressive lifting of the age as opposed to raising it to 21. We think that is the right way to go. It will then move through the population over a number of years rather than just being static at a single point.

[Kirsten Oswald (East Renfrewshire) (SNP)]

Q We heard in an evidence session earlier about the challenges in schools, with children vaping in increasing numbers. There is an impact on their education because of their becoming addicted, and that causes challenges in their interactions with the learning process. Do you think that the measures in the Bill are sufficient to deal with that growing problem? Do you have a view on whether we have a handle on the quantum of that problem, and are the measures on advertising sufficient to try to remedy that?

Greg Fell: Yes, in part, in terms of the measures in the Bill. I would treat vapes like I would treat cigarettes in terms of colours and marketing, with plain packs out of sight behind the counter and strongly enforced. I would take care, though: we use and want to continue to use vapes as a route out of smoking cigarettes, so getting the balance right remains important, but I would be quite aggressive about the regulation and the deterrent.

Education in schools by itself will not be sufficient. It might or might not be effective, but it will not be sufficient. Action on Smoking and Health has co-produced with a number of local authorities a range of resource packs for parents, teachers and others, which are fairly widely used, but they are not sufficient by themselves to stop the rise in young people vaping, so we need strong regulation with the enforcement of that to boot.

Cllr Fothergill: It is not part of this Bill, but it is part of LGA policy that we would like to see a ban on disposable vapes. There are 5 million sold every week, with the vast majority sold to younger people. The vast majority are thrown away. Those that are thrown away responsibly finish up in one of our recycling lorries where the lithium batteries cause major problems with fires. It is not part of this legislation, but we think that that needs to be tackled separately; I think it will be.

Greg Fell: One point that I just remembered on the resource pack that has been widely circulated to headteachers and schools: a line was taken in that to tell the truth—not to over-egg the pudding but to tell the truth and say what we do and do not know, because in my experience scaring kids usually switches them on to something rather than turning them off something. In the pack, we have also told the truth about the methods and tactics that the tobacco industry has used to get kids hooked on vapes, and that as a rule makes kids pretty angry. It certainly makes parents pretty angry when they realise what has happened.

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[The Chair]

We now move on to our next witness, Ailsa Rutter, who is the director of Fresh and Balance North East. I am looking forward to find out what that is. We have 20 minutes for this session. Ailsa, could you kindly introduce yourself for the record? By all means, add some more if you wish to, but the Committee will have plenty of questions for you.

Ailsa Rutter: Thank you so much. I am absolutely privileged to be here with you this afternoon, speaking on behalf of the north-east and the many partners in the region who will give you their overwhelming support for this absolutely crucial, complete once-in-a-lifetime opportunity to have the single biggest impact in addressing the biggest cause of cancer. For those of you who might not know what Fresh and Balance is, we are a regional tobacco and alcohol programme based in the north-east of England. We have been going for 20 years, we are funded by our local authorities and our NHS trusts, and we are doing a lot of work to drive down the harms on both tobacco and alcohol.

[Preet Kaur Gill]

Q My first question to you is, what is the impact of tobacco smoking on public health? Secondly, do you think the Bill’s measures to prevent vaping products from being sold to children will be successful? That is essentially clauses 61 and 62.

Ailsa Rutter: Tobacco is devastating. It is devastating to every individual who dies way too young, and to the family who lose their loved one. In my region alone, just since the turn of the millennium, 120,000 of our loved ones have died from smoking. It is not an adult choice, but a childhood addiction. The vast majority of those smokers reach a point where they deeply regret having got hooked in childhood, not thinking that first puff on a cigarette would be so addictive. It is really important that we remember the 6.4 million remaining smokers in the UK and the fact that 350 18 to 24-year-olds will get hooked on lethal tobacco smoking today.

I would like the Committee to imagine that cigarettes did not exist. It is 2024, and here we are discussing a product that is designed to hook, kill, maim, and be completely addictive. This discussion today needs to be about the future world we want to strive for. We can talk a lot about how we will enforce it, which is very important, but for me this is about imagining that in 20 years’ time we have created an entire new generation protected from this uniquely lethal product. That is why in the north-east, all 12 local authorities, all 10 NHS trusts, our integrated care board—the biggest in the country—and our Association of Directors of Public Health have given whole-hearted, unanimous support to the “stopping the start” proposal on the age of sale of tobacco.

We absolutely recognise that smoking is much more harmful than vaping, but vaping is not risk-free. Vaping is playing a pivotal role in our region—with our higher levels of deprivation and addiction—to get people off lethal smoking, but that is not to say that we do not absolutely agree that much more needs to be done to reduce the appeal of vaping to young people. We wholeheartedly believe that we must address the inappropriate packaging that is too youth-friendly. Some of the in-store promotions are completely inappropriate, where children are really noticing it. We must ensure that we recognise that children are growing up within a family context; children do not live in isolation. There is also the importance in our region of sending clear, evidenced-based messaging. We can also see the positive impact on children’s health if we can get the parents and carers off lethal tobacco smoking and if we can reduce second-hand smoke harm. Really important as well is more money in people’s pockets, because cigarette smoking has such a negative effect on your income.

[Dame Andrea Leadsom]

Q Thank you so much for being here and for all you do in the north-east. It is fantastic.

As you will know, rates of smoking during pregnancy in the north-east are some of the highest in the country. Do you think this legislation will help to reduce those very high numbers? The rate is somewhere in the region of 14% in the north-east.

Ailsa Rutter: We have made really good progress in the north-east in reducing maternal smoking; that has come through very good collaboration between our local maternity services and our local authorities, as well as the fantastic leadership from key people in the local maternity and neonatal system, the LMNS, and the direction from directors of public health.

As with anything, there is not one magic solution; it is about taking comprehensive measures. The tobacco age of sale increase will undoubtedly have a really positive impact on reducing maternal smoking. It needs to be coupled with important things that we must continue to do as well, so we also welcome the increased investment for stop-smoking services.

We hugely welcome—thank you—the reinvestment in the evidence-based health harms campaigns. We are thrilled that nationally you are using our fantastic “smoking survivors” TV advert featuring Sue Mountain. The role of financial incentives is also really important; we know that they have a very strong evidence base. This will have a positive impact on maternal smoking.

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[The Chair]

We now turn to our next witness, Adrian Simpson, a policy adviser at the British Retail Consortium. Colleagues, we have until 3.10 pm for this session, which is 20 minutes—it flies by when the witnesses are so good. Caroline, you can have the first question after Preet if that would help you. Witness, would you please introduce yourself and say an additional sentence, and then we will throw lots of questions at you?

Adrian Simpson: Good afternoon. My name is Adrian Simpson. I am from the British Retail Consortium. We are the trade association for large retailers throughout the UK.

[Preet Kaur Gill]

Q Hello Adrian. I know that ASH has done some surveys that show that the majority of small retailers are in support of age-of-sale legislation, and I know that the Association of Convenience Stores is equally supportive. Would you say that the retailers are broadly supportive of this Bill?

Adrian Simpson: Yes, the large retail sector, which we represent, is broadly in favour of the Bill. We recognise that these products do require regulation. Putting forward this Bill at this time certainly feels like the right thing to do. Our members take their responsibilities around safe, responsible retailing very seriously indeed, but we feel that, for all this to be successful, there needs to be strong and robust enforcement behind it all.

[Preet Kaur Gill]

Q As you know, as well as introducing the £100 fixed penalty notice, the Bill grants new powers to trading standards to make restricted premises orders and restricted sale orders. Do you think that those new powers get the balance right between providing an effective deterrent and proportionality, and do you think that, at £100, the spot fines are set at the right level?

Adrian Simpson: I am not sure I can comment on whether the amount is right, but one thing we would like to caution on around fines is the need to make sure that businesses are adequately notified of those fines. Some of the big retailers might not always be aware that a fine has been issued at the store level. For this to be effective, we think that trading standards officers will need to work with, for example, head offices as well. Something to be aware of is that some of these fines will have substantial personal effects on the shop workers who are given them. We need to think about how that is communicated to the shop workers themselves, but also to the head offices of these large retailers.

[Preet Kaur Gill]

Q Is there anything you want to say on the age-of-sale verification process?

Adrian Simpson: In the large retail sector, we have worked on things such as Challenge 25 for many years, so we are used to challenging consumers buying products. One thing that we would like to make clear is that this can be a very controversial issue. We know that challenging consumers for proof of age leads to violence and aggression against shop workers. We think it would be beneficial if a long period were given for these regulations to come into effect, to give retailers the chance to educate their staff on these issues and to educate consumers.

[Dr Johnson]

Q I want to ask you about the licensing regime. You have to have a licence to sell alcohol and tobacco, and some have suggested that you should have to have a licence to sell nicotine full stop because it is an addictive substance. That would mean that you would need to have a licence to sell vapes, partly as a way of making them less accessible to children in the places that they may be sold. Would you support that?

Adrian Simpson: It is not an issue that we have discussed at any length in the British Retail Consortium. We are aware, of course, that there are parts of the UK where licensing is required for certain tobacco products. We are well used to the alcohol licensing that has been going on for many years. Unfortunately, I cannot comment on whether the whole sector would be in support of that. We would perhaps need to see how a potential licensing system would operate before we gave our full support to it.

[Steve Tuckwell]

Q Thank you for coming in this afternoon. It is a pleasure to hear your thoughts. What will be the challenges for retailers in enforcing the ban on sales?

Adrian Simpson: The first challenge is education of all the shop staff. Our members are the very large, household-name retailers, and it will take a long time to get that education out to the hundreds of thousands—in some cases—of shop workers throughout the UK. We also think that there will be issues to do with changing our point of sale systems, things like where we are going to store some of these products if we need to, and even things like the size and nature of the tobacco notices. Retail operates in many different ways—we think of the large supermarkets, but there are very small stores as well—so a lot of thought needs to be given to the technical parts of the legislation, which of course we always work with you on.

[Preet Kaur Gill]

Q What conversations has the British Retail Consortium had with local authorities? They have a lot of data locally on the amount of illicit vapes or illicit tobacco being sold. They are already enforcing trading standards, so there should already be a level of awareness. What kinds of conversations have you been having with local authorities?

Adrian Simpson: Certainly. Ever since the point at which a potential vape ban and the rolling age restriction on tobacco were announced, we have been working very closely with the Chartered Trading Standards Institute, which represents local authority trading standards officials. Ever since the beginning, we have been in close conversation with them, talking about our concerns on the points I made about education and enforcement. Many of our members are closely linked to trading standards already, through the primary authority scheme. I am pleased to say that many of our BRC members have long-standing primary authority relationships, so they already work very closely with trading standards. Certainly at the BRC, I have been working closely with colleagues in the Chartered Trading Standards Institute.

--- Later in debate ---

[The Chair]

John Herriman and Kate Pike, will you introduce yourselves, please?

John Herriman: I am John Herriman, chief executive at the Chartered Trading Standards Institute. We welcome the Bill, as I hope has been clear from the stuff that we provided before. It provides important clarity for businesses and enforcement agencies, as well as the public. We have also welcomed the early engagement in the development of the Bill.

Kate Pike: I am Kate Pike, lead officer for tobacco and vaping at the Chartered Trading Standards Institute. I have been involved for many years on the regulatory side. I was a member of the Department of Health tobacco expert group for many years, and I am now a member of the vaping expert panel as well, so hopefully I can answer your questions—fingers crossed.

[Preet Kaur Gill]

Q Can you talk a little bit about your work on illicit vapes and tobacco, and talk us through how trading standards works and how you share information between the Medicines and Healthcare products Regulatory Agency, Border Force and His Majesty’s Revenue and Customs? One thing that I am concerned about in Birmingham, for example, is the fact that 17,000 illicit vapes were removed by trading standards. The notification process sits with MHRA. Is there triangulation in the feeding back of that information, so that products can be removed? Can you say something about that?

Kate Pike: I will separate out illicit tobacco and illegal vapes, if that is okay. Illicit tobacco is the day job, which we have been doing for years. You are probably aware that HMRC came up with the first strategy on tackling illicit tobacco around the turn of the century, and since that time the amounts of illegal tobacco consumed in this country have come down hugely. Seventeen billion illegal cigarettes were consumed in 2000 and we are now down at 2.5 billion to 3 billion— I always say that as though it is a small number, but I know it is still huge. We have the latest strategy from HMRC to tackle that. Trading standards undertakes a really important role locally on illicit tobacco—your colleagues in Birmingham will be doing that work locally—but we work closely with HMRC and Border Force overseas, at the borders and inland, so we are on that.

With vapes, however, it is a different story. Obviously, the illegal vape market is much newer. Trading standards is responsible at ports and borders, and inland. The rise of illegal vapes probably took us by surprise, but we are now getting all our ducks in a row and starting to seize the products that are illegal. We work incredibly closely with our colleagues at HMRC. The notification system is helpful—it could be better, so we welcome the Bill clarifying that it can be extended and strengthened. We are getting on to the case now. There is a huge illegal market for vapes at the moment, but we can learn from what we have done on illegal tobacco and apply it to vapes, to ensure that we tackle those as well.

[Preet Kaur Gill]

Q The Bill will ban the sale, rather than the import, of illicit vape products. Is that the right approach?

Kate Pike: The Bill gives enabling regulations to ensure that vape products can be reduced in attractiveness to children. There will be restrictions on the flavours, on the packaging and on the display to reduce the attractiveness of vapes to children. That is really important, because no problem has ever been solved by enforcement alone, whatever industry says. The approach has to be holistic: demand reduction as well as supply disruption. No problem has ever been solved like that, so the enabling powers, on sale and supply, will be brilliant.

Other bits of legislation are going through, such as the statutory instrument to ban single-use disposables. Potentially, that is an opportunity to look at an import ban on such products. Obviously, we will never get an import ban on something that we make here and sell overseas, because that is just not allowed under international trade law, but we talk all the time about how the ports and borders are such a pinch point.

[The Chair]

John, did you want to say anything?

John Herriman: I want to pick up on Kate’s point about the ports and borders. One of the challenges is that stuff coming in through the ports and borders is not being detected. Something will be flagged—we produced a manifesto in the past couple of months to highlight the importance of ensuring the right level of enforcement and activity at the ports and borders. If we think about it in the context of vapes—or any other illicit product, to be honest—the reason they get on to the high street is that they come through the ports and borders. At the end of the day, we are an island, so if we have the right level of activity there, in co-ordination with other agencies, hopefully we will stop it getting through to the high street, and that reduces the burden of activity on trading standards.

[Preet Kaur Gill]

Q Finally from me, in your response to the Government’s “Creating a smokefree generation” consultation, you called for a fixed penalty notice of £200 and maybe the option of increasing that. Do you think that the fines and the monetary penalties in the Bill are appropriate?

Kate Pike: We really welcome the addition of a fixed penalty notice to our enforcement toolkit, but we absolutely want to have our own range of sanctions, which includes the opportunity to go to prosecution for persistent or egregious offenders. The fixed penalty notice can be a really quick solution, potentially against an individual salesperson, depending on the setting and the nature of the offending. I think that £100 can be quite a lot; £200 would be more. I think that is enough, given the opportunity in the Bill to increase it at a later stage if it is not working or having the impact that we want.

John Herriman: It is all relative at the end of the day. It needs to be tested first. To some illegitimate businesses, that will be seen just as a business cost. Whatever the amount is, we need to ensure that it is not seen as a business cost that can just be absorbed. It has to be a tangible deterrent: that is the key.

[Dame Andrea Leadsom]

Q It is great to see you—thanks for coming today. I think you are saying that at the moment the fine is set at the right level. It is a really important issue: by no means do we want it to appear to be a cost of doing business. Our previous witness was suggesting that for some shop workers it is a very significant sum and is quite problematic for them, so perhaps there should be training in the first instance.

We have sought to get the right balance, with a £100 fine that can be reduced to £50 if it is paid on the spot. For any of us, a day when we have to dish out £50 because we have done something wrong is a significant bad day. On the other hand, there is an escalation process to criminal prosecution. I am really keen that we get the balance right up front, notwithstanding that there will be powers to change it. Can I press you a bit further: is this or is this not the right place to start?

John Herriman: Can I make a broader point, and then maybe Kate can come in on the specifics? This is all about the market surveillance activity that allows you to understand what is happening on your local high streets and your ability to take enforcement action where necessary, whether that is a £100 fine or a prosecution. Fundamentally, that is the challenge at the moment. It is about the ability to have the right level of market surveillance and the right level of enforcement activity. I am sure it is a question that will come up. It is a challenge for trading standards at the moment, because over the past decade or so it has had significant cuts, in the region of 50%.

There are two halves to this question. First, is this the right legislation and are the amounts right? Secondly, legislation is only as good as the ability to enforce it. It feels as though the legislation is right—I will let Kate comment further on that—but the ability to enforce it is critical.

Kate Pike: Absolutely. Whenever we look at a new piece of regulation—as I think somebody mentioned earlier, we enforce more than 300 pieces of legislation across the spectrum—we ask, “Do we have the powers to enforce?” In the Tobacco and Vapes Bill, yes, we do. “Are there criminal penalties in there?” Yes, there are. The key things from our point of view—the building blocks—are there.

Across the spectrum, how many businesses sell tobacco? The impact assessment for the Bill says that there are something like 60,000 or 70,000 across the United Kingdom. On that spectrum, there are big businesses that know what they are doing and do not need a lot of support from us. There is a big chunk in the middle that might need a bit of support and guidance—they may make a mistake, but we can support them, help them and train them. Then there are a small amount at the other end that are the dodgy ones. We need to focus our enforcement efforts on them, because we will never be able to put one trading standards officer outside every business to be watching all the time.

--- Later in debate ---

[Trudy Harrison]

Q You are both very effectively articulating the complexity of your programme of work within trading standards, but 2027 seems like a terribly long timeframe. Given what we know about nicotine addiction and the outcomes, is it the right timeframe, and what will you need to be doing in that timeframe to achieve the deadline?

John Herriman: I think this is all about strategic resourcing. As I have already articulated, the profession has had a significant cut in resources over the last decade or so. Actually, we now have to go into a phase where we are rebuilding the capacity. We can do this; we know that we can enforce regulations, because we have seen that we can do it successfully within the world of tobacco. It is now about what we are doing as a profession to start building back that capacity. We are taking some new steps: for example, there are now apprenticeship schemes running in England, both at level 6 and level 4, and we are supporting the level 4 apprenticeships in Scotland and Wales.

One of the things that I think is really good about the Bill, and the work that DHSC and other Departments have been doing, is the taking of a strategic view. We have to build this capacity gradually—fairly swiftly, actually—into trading standards, but we also have to be clear on expectations with businesses, so that they know what is coming and we can therefore make sure that we are moving at the same sort of pace. By taking that strategic approach, it allows us to build the capacity at the right level and make sure we have trading standards officers who are qualified—it can sometimes take two to three years to train somebody as a fully-qualified trading standards officer. That way, we have a sustainable platform to make sure that the legislation can be enforced. Essentially, that is what we are seeing here. We have not seen this level of strategic approach to resourcing and tackling a problem in many other areas, so it is quite welcome.

[Preet Kaur Gill]

Q You mentioned that trading standards has faced huge amounts of cuts, with many telling us that in some places there is not even a single trading standards officer. The enabling regulation and the powers within that will be really important, especially when making it clear what trading standards officers must look for when they go into a shop, how vapes are being marketed, and so on. The Government have already consulted on that. Do you think the Government should release that information now, so that they can work with you and do the preparatory work? What kind of timescales do you think there should be? We heard today from ASH that there is some evidence—for example, from Canada—around descriptors that we could already put in the Bill, or that we could implement immediately—why should we wait? Would it have been helpful to have some of that consultation around the enabling regulations already there?

John Herriman: The Bill itself is helpful in that it has enabling regulations within it. It is about a phased approach. We cannot turn a switch overnight: we have to build it up gradually. We will need to do a lot of training—and not just training, but recruitment of new apprentices, students and trainees into local authorities, as well as doing the business education part, alongside that—and move in a very structured way. The worst thing that could happen is that we have the regulations, we have the law in place, but cannot enforce it. That would mean that it became ineffective. It is about having a phased approach, and the Bill does that quite nicely. It fits within where trading standards is as a profession. We need to build back that capacity over time. We are still waiting to hear the outcome of the discussions on funding, which are happening at the moment.

[Bob Blackman]

Q You probably heard the previous witnesses giving their views about a licensing scheme. From your members’ perspective, would that make the issue of where tobacco and vaping products can be sold more enforceable? You made a comment in relation to other tobacco products. I have raised the issue of chewing tobacco and paan, in particular, which does not come within the scope here but has no enforcement from Trading Standards at all. Do you see that happening in the future?

Kate Pike: We pushed for tobacco licensing for many years. Since the last time we did that we have had tobacco track-and-trace sanctions come in and the regulation around track and trace, which ensures that every single business selling tobacco in the UK has to have an economic operator identifier, so that, using our scanner, we can see whether a particular product is legal for sale, or whether a business is legally able to sell. Although that is not a licensing system, it does give us many of the advantages of a licensing system that we would look for. Although there are potential benefits in thinking about a licensing system for nicotine products, I am not sure that it is a silver bullet to some of the answers. We have said before that the issues are not just around tackling supply, which licensing does; they are also about tackling demand. We just need to get to grips with a holistic approach to vapes in order to do that. In terms of licensing on the tobacco side, we are probably okay now, as long as we can make use of the track-and-trace sanctions. We might be able to use those for vapes as well, further down the line, given the vape excise duty.

--- Later in debate ---

[Steve Tuckwell]

Q You may have touched on this in some of your previous answers, but are there any tobacco and vaping products that are not covered by the Bill but which you think should be?

Kate Pike: We think that the tobacco age of sale should definitely apply to all tobacco products, and that the enabling regulations for vapes also allow the opportunity to add other nicotine products. The definition of nicotine is really helpful. The closing of the loopholes is really helpful. Loopholes are not helpful to enforcement, but closing the loopholes is really important to enforcement, so we are happy with that.

[Preet Kaur Gill]

Q To come back to your answer about the track and trace that you have for tobacco, have you had any conversations with Border Force and the MHRA about perhaps doing this for vapes? As you said at the beginning, you did not imagine that the industry would grow in the way it actually has around illicit and illegal vapes.

Kate Pike: Yes. As I say, we are already in the consultation that HMRC has running now about a vape excise tax. One of the questions is, “Would you want to see these products subject to track and trace?”, and the CTSI will go back and say, “Yes, but let’s get the vape excise tax in now,” because of what that is going to give us. A number of you have said your worry is illegal vapes. HMRC being involved in this enforcement picture will be a real game changer, because there will be extra boots on the ground in addition to ours, and that will really help in tackling illegal vapes.

[The Chair]

Q There are no more questions around the table, so thank you to John and to Kate for your excellent and very clear evidence, and thank you for coming to see us.

Examination of Witness

Laura Young gave evidence.

--- Later in debate ---

[Kirsten Oswald]

Q I have kept you as a constituent, Laura, despite your being away studying. I know that you will have handled conversations probably significantly better than the rest of us on the prevalence of vapes in all our communities, particularly in areas near schools and the coast, where they can lead to plastic pollution. Can you tell us what change you have seen over the last couple of years in terms of the numbers and explain why that is problematic to the environment ?

Laura Young: The environmental impact cannot be overstated. Vapes are a huge issue, especially for waste, and we have seen the numbers growing and growing. Material Focus, an environmental electronics charity, did some research specifically looking at disposable vapes in 2022 and 2023 and the number quadrupled. In 2023 we were looking at about 5 million a week. Jam-packed inside each and every vape are lots of precious materials, which of course are going to waste after one single use. We know they are not being recycled, so those materials are just being wasted. We are not getting them back.

We also know that vapes pose a huge risk to our waste workers. They have lithium batteries inside them and we have seen some devastating fires already because of them. That represents what we have been hearing today. Walking down any high street you will see the prevalence of these being sold in almost every type of shop everywhere. We see them sold everywhere, wasted everywhere, and having a huge impact on the environment and the health of people and children who get their hands on them.

[Preet Kaur Gill]

Q Would you like to say a little more around how tobacco and vaping products impact the environment? There was an opportunity for the Government to do a lot more on cigarette butts. Do you want to say anything about that?

Laura Young: Of course, one of the obvious things is litter. Every single street has cigarette butts on it and that is very harmful. We do not want any litter, if possible. Disposable vapes have become an increasing site of litter as well. They are not just litter; they are electronic devices and are very damaging with lots of chemicals inside them. We have even had garage owners talking about people popping tyres with these shards of metal as they get squashed and run over, so they are very damaging.

All the way through the process of particularly vapes we see a lot of material resource—lithium, copper and cobalt, things that have to be mined around the world—put together for these devices to be used just once before they run out and are thrown away. The disposability speaks to a lot of the other problems. These are made as disposable. They are throwaway and cheap, and that leads to the fact that so many young people buy them because they are cheap, accessible and throwaway. Something that is absolutely an environmental issue with waste and litter is also a big problem in terms of accessibility for young people.

[Preet Kaur Gill]

Q What impact do you think the Bill will have on improving the environmental outcomes?

Laura Young: I think the regulations and how those are designed will be crucial. I know there will be follow-up legislation mopping up other parts of the issues, with disposable vapes hopefully being banned, but it is important that we look at the design. How we get the most circular economy version of vapes is crucial: limiting as much as possible single-use plastic, looking at how we can make them modular, making sure we do not just shove a charging port at the bottom and hope for the best, but actually looking at how they can be circular by design.

On design, it is also important that we are beginning to see vapes that are legal—there are the illegal ones, which are to one side—that I believe are getting around existing legislation in terms of capacity. You now see ones that have different cartridges, so it is almost like the pens that you had where you could switch between the inks. You can now do that with vapes that are being sold legally. They are getting over the limits because they are saying, “This isn’t one big cartridge. This is four small ones.” We are already seeing the industry innovating in a negative way to get around the legislation, so we need to make sure that that does not happen when we bring in environmental topics as well as all the other ones for public health.

[Trudy Harrison]

Q You have expertly explained the concerns around plastic pollution from vapes, but what do we know so far about the impacts on nature and biodiversity from cigarette butts? Also, are you aware of any concerns about the air pollution risks on biodiversity from cigarettes?

Laura Young: This may be something that has gone under the radar: the No. 1 item littered is cigarette butts, particularly when you look by number. They have a huge environmental impact, particularly because plastic is inside the filters, and the filter is the butt that is let behind. Although there has been a lot of campaigning around the environmental impact of vapes, there have been amazing efforts to raise awareness of the environmental issues around tobacco by organisations like ASH Scotland and the Marine Conservation Society, one of which I know has already given evidence.

Globally, we also need to look at this as a huge industry. Of course, kind of like any other industry, they need to be looking at their footprint and their sustainability measures. We know of course that air pollution is absolutely key to the conversation, and that has an impact as well on wildlife and biodiversity. Neither tobacco or nicotine products, such as vaping, are good for the environment; they are very harmful to the environment. We are just beginning to see those harms with disposable vapes in particular, but we know that cigarette butts have had a longstanding impact on the environment. They are also just a nightmare to collect. They are so small and so problematic. On beaches, you will see them as much as you see sand. We definitely need a lot more action across both those sectors.

Tobacco and Vapes Bill (Third sitting)

Preet Kaur Gill Excerpts

Committee stage
Wednesday 1st May 2024 Public Bill Committees

[The Chair]

Q I think everybody would say that that was a very clear rebuttal. Would any other members of the panel like to introduce themselves before we open the floor to questions?

Sir Francis Atherton: I will briefly say hello. I am Sir Frank Atherton—rather than Francis, if I may, Chair. To echo what Sir Chris has said, it is rare to achieve such a high degree of consensus across the medical community as there is around this Bill. It really matters for people of the UK, and it really matters for the people of Wales.

Professor Sir Gregor Ian Smith: I would reiterate every word that Sir Frank has just said. The consensus across the medical profession, as far as I can see, is absolute. Chris has spoken very clearly and represents the views of all the CMOs and our deputies. From conversations we have had with past CMOs, we know that they are supportive for the same reasons. We have the weight of professional opinion behind us, certainly from the medical profession.

Professor Sir Michael McBride: I am chief medical officer in Northern Ireland. I would echo all that has been said. To add to Sir Gregor’s point about the weight of professional opinion, in Northern Ireland we also have the weight of a huge majority of the public. They are hugely supportive of the smoke-free generation and of measures on displays, point of sale and flavours of vapes.

[Preet Kaur Gill (Birmingham, Edgbaston) (Lab/Co-op)]

Q We have heard compelling evidence, and we will hear again from the health sector today. Lots of people will say that the Bill could essentially just raise the age of sale from 18 to 21, but we have heard good evidence for why that is not the case. For the record, what would you say to the people who think we will not be able to do the age verification, which we know already exists in Scotland?

Sir Francis Atherton: To echo what Sir Chris said earlier, nicotine is uniquely addictive, and it is addictive across all ages. Simply raising the age to 21 may have a limited effect and may well not have a long-term effect. The tobacco industry is incredibly adept at adapting its tactics to target smokers, whatever their age. It would seem likely to us that people could quite reasonably become addicted beyond the age of 21, but the legislation would prevent that from happening because of the rising age across the course of life.

[Preet Kaur Gill]

Q Do you want to say anything about age verification?

Sir Francis Atherton: Age verification is a relatively simple matter if there is to be a cut-off at 2009. It is much clearer to retailers that that would be the age at which people would not be eligible to buy tobacco products.

[Preet Kaur Gill]

Q One facet of the Khan review recommendations that was touched on a little yesterday is the measures to protect pregnant women and unborn babies. What will be the impact of the Bill on pregnant women and unborn babies, and when do you think the target could be met?

Professor Sir Chris Whitty: Shall I have a first go? One of the first groups to be enormously positively affected by the Bill will be pregnant women and their unborn children. I know you will be hearing from the chief midwife, but briefly, stillbirth, premature birth, “small for dates” babies and birth deformities are all things that happen as a result of smoking. It is extraordinarily dangerous. All mothers want the best for their children; but, to reiterate, smoking is so addictive that people’s choices have been removed. They wish to get rid of the smoking in pregnancy, and they cannot because their choice has been removed.

What is clear is that the age band at which the greatest amount of smoking in pregnancy occurs is the youngest women. People who have babies in their late teens or early 20s have by far the highest rate of smoking. Those, therefore, will be the ones who would be positively affected by this Bill the most quickly, because then they would not be going into a pregnancy already addicted to smoking, with all the consequent harms for their baby and subsequent child, which may be lifelong. I do not know whether any of my colleagues want to add to that.

Professor Sir Michael McBride: One of the most concerning aspects of smoking tobacco is the health inequalities that it accentuates. In Northern Ireland, rates of smoking in the most deprived areas are over three times the rate in the least deprived. As a consequence, lung cancer rates are two and a half times higher in the most deprived areas.

If we look at pregnancy, pregnant women in Northern Ireland in the most socioeconomically deprived areas are five times more likely to smoke than those in the less socioeconomically deprived areas. The consequences for their health, and for the health of their children and unborn child, are very significant. They are addicted to a habit that is causing them harm and their unborn child harm.

Professor Sir Gregor Ian Smith: To add to Sir Michael’s data, in Scotland in 2023, there were just over 50,000 pregnancies; 11% of those pregnancies—that is 5,500 pregnancies—were booked where the mother was recorded as still being a smoker. A further 6,000 were booked where the mother was a former smoker. These are still really significant numbers. Of course, as Sir Michael has just said, this not only has implications for the mother and the health of the pregnancy; it has longer-term implications for the baby as it develops and grows. We know that anything that we can do to reduce the number of women in these age groups who are coming to pregnancy as smokers will have a beneficial effect not only on them and the health of their pregnancy, but on the health of future generations.

[Preet Kaur Gill]

Q Finally from me, and this question is for Frank and Michael, the latest ONS figures in 2022 show smoking prevalence in Wales and Northern Ireland remaining constant rather than continuing to fall in the way that it did in England and Scotland. Do you think Wales and Northern Ireland have specific challenges related to smoking prevalence?

Sir Francis Atherton: It is certainly true that we are not going as fast in Wales as we would like to see. Smoking prevalence has dropped, from about 22% in 2020 down to 13% at present, but our target is to reach 5% by 2030, and we are not currently predicting that we will meet that target unless we go further and faster. We believe that this Bill will enable us to do that.

You asked for the reasons. One of the reasons is that we have deep-seated sociodemographic problems in Wales, which you have been referring to. Given the inequity that we see, meeting the needs of current smokers from those really deprived socioeconomic groups is really quite a challenge. We are doing everything we can in Wales to try to address that through “Help Me Quit” and smoking cessation support, but we really need to prevent the next generation from coming on board with smoking.

Professor Sir Michael McBride: Just following on from Sir Frank’s comments, you are absolutely correct that, while population prevalence of smoking sits at around 14% at the moment—behind the 12% in England and the 13% in Wales—we are doing slightly better than Scotland at the moment, which is sitting at about 15%. The figures for the Republic of Ireland are somewhere in the region of 18%. There is absolutely no doubt that we have the same socioeconomic drivers, in terms of social deprivation and health inequalities, that are fuelling this. Should the Bill succeed and pass into legislation, I see this as a once-in-a-generation opportunity to make a significant change to protect future generations and their children from all the harmful consequences of smoking tobacco and other forms of tobacco use.

[The Parliamentary Under-Secretary of State for Health and Social Care (Dame Andrea Leadsom)]

Q I thank all you chief medical officers for being here; we appreciate it. You will understand that your witness evidence is crucial to easing the passage of the Bill. I would like to get you on the record talking, first, about the start of life. The shadow Minister has just asked about pregnancy and, only this week, I was talking to a neonatal nursing lead, who said of the pregnancies of women who smoke that the children had a low birth weight and go on to have severe learning difficulties throughout their lives. That is heartbreaking, but also has significant implications for NHS and educational services, and for whole-life costs to the taxpayer. I would be grateful for your comments on that.

At the other end of the age range, elderly people who have smoked all their lives end up with decades of ill health brought on by a lifetime of smoking. I would be grateful, too, if you talked about some of the health outcomes for those who have smoked all their lives—some of the horrors of that. Sir Chris, you told me an anecdote of when you were a young vascular surgeon. For the record, it is important to talk about some of the heartbreak for those who wish they could stop smoking.

Professor Sir Chris Whitty: I completely agree with all the points you made. Starting off with the beginning of life, there are clear and significant increases in stillbirths, premature births, birth abnormalities and long-term effects from smoking just in the pre-birth period. Then, of course, if parents are smoking around babies and small children, that affects lung development and, if children have asthma, that will trigger asthma effects. Young children are significantly affected by passive smoking from their parents. The parents, of course, want the best for their children, but the problem is that they are now addicted to a product that has taken their choice away. We get those problems right from the very beginning, and we have talked about some of the issues in young pregnancies and where that leads.

Moving to the other end of the age spectrum that you were talking about, the full horrors of smoking for most people start to take effect from middle age onwards. At this point, people get a range of things. Everyone knows about lung cancer, I think, and most people know about heart disease, but there are effects on stroke or increases in dementia, which are significant—one of the best ways to delay dementia is not to smoke or to stop smoking at an early stage. That is a huge problem for all of us. Smoking also exacerbates any problems people have with diabetes—it makes that much worse—and people have multiple cardiac events leading to heart failure. In heavy smokers, we see extraordinary effects, like people having to lose their limbs. As you and I discussed, it is a tragedy to be on a ward with people with chronic obstructive airways disease, or on a vascular ward as a vascular surgeon with someone who has just had an amputation, weeping as they light up another cigarette, because they cannot stop, because their choice has been removed. I cannot hammer that point home firmly enough: this is an industry built on removing choice from people and then killing them in a horrible way.

Sir Francis Atherton: Minister, you also pointed out the cost to the NHS. In Wales, we estimate that we have about 5,500 deaths every year from smoking-related diseases. If we look at admissions to hospital, about 28,000 in the over-35 group is about 5% of overall hospital admissions. That is an enormous burden to the NHS. On a more personal basis, in a former life I was a GP, and I remember sitting with an elderly gentleman who at the end of his life was suffering with chronic obstructive pulmonary disease. There is no worse death than not being able to breathe when just sitting there. I remember sitting with him as he was trying to talk to me and trying to express that same level of regret that Sir Chris talked about. If you talk to any smokers towards the end of their life, who are facing such terrible ends to their life, the sense of regret that you hear as a doctor is quite overpowering.

Professor Sir Michael McBride: It is estimated that in Northern Ireland there are more than 2,000 deaths each year directly attributable to smoking cigarettes; over the past five years, smoking makes up 12% of all deaths in Northern Ireland. Sir Frank and Sir Chris have clearly described the horrors of the impact that it has at an individual level, and as doctors we have all experienced that. We have all had those conversations with individuals who look back on a lifetime of regret.

On a more personal level, I also think at this moment about the impact that premature death, and the morbidity and mortality associated with smoking, has on families and children. My own father died at 46 years of age, when I was 16, from acute myocardial infarction as a consequence of a lifetime addiction to smoking cigarettes. So, we need to bear in mind the very human costs, family costs and wider societal costs as well. It is not just the cost to the health service, but the societal cost, the family cost and the cost to the wider economy.

Professor Sir Gregor Ian Smith: We should never forget the societal cost that Sir Michael just spoke about. I am the child of two smokers who died in their mid-60s from smoking-related disease. We see it all too often in Scotland. In fact, in Scotland we still have 9,000 deaths a year attributed to tobacco addiction and smoking. That is one death every 61 minutes that families suffer across Scotland as a consequence of addiction to smoking.

As a clinician, one of the diseases that I had become quite specialised in treating and led a lot of work on is chronic obstructive pulmonary disease. That is a smoking-related disease that people develop, often at too young an age, and begins to really impair their ability to participate fully in life—not only in employment, but in the pastimes that they love. Gradually, over time, it becomes worse.

Sir Frank touched on the sense of regret that people have that they ever started smoking in the first place and find themselves in this position. Beyond that, there is an even sadder element: many of the people who experience these chronic life-limiting illnesses have not only regret that they ever started, but guilt about the burden that they place on the health service and their family because of the illness and disability that they develop. That guilt sometimes reaches to the extent that they do not seek full care. Many people’s attitude is, “I deserve this. I started smoking; I need to pay the consequences.” That is a terrible psychological position for any person to find themselves in. Removing the starting point for that addiction, so that people will not experience that through their life, is the aim of the Bill.

Let me make one last point. We talk about the health impacts of all this. The Scottish burden of disease study projects that over the next 20 years, up until 2043, we will see a 21% increase in the general burden of disease across our population in Scotland, despite having a falling population during that time. Much of that projected burden of disease is smoking related; it relates to cancers, cardiovascular disease and neurological conditions such as dementia, which are all influenced by smoking. It is absolutely necessary for us to address this in a preventive way, and I believe that the Bill is a very good way of doing that.

Professor Sir Chris Whitty: I want to reinforce the point that Sir Gregor just made, with which I am sure the Committee fully agrees, that individual smokers should never be blamed for the situation they are in. An incredibly wealthy, very sophisticated marketing industry deliberately addicted them to something, at the earliest age it could get away with it, and they have had their choice removed. It is important that people do not feel guilt and come forward for care, and that no one blames them for a situation that was deliberately put on them by industry marketing.

--- Later in debate ---

[Angela Richardson (Guildford) (Con)]

Q I have just looked online and found the top influencers on social media for vaping. I know the Government sometimes use influencers in order to change behaviour. Has the NHS been involved in paying influencers for vaping? Related to that, a lot of young people and children feel under pressure a certain way, and nicotine is known as an appetite suppressant. What message do you have for young people on that basis?

Professor Sir Chris Whitty: I wonder whether I can turn to Sir Gregor first, and then maybe Sir Michael.

Professor Sir Gregor Ian Smith: I am not aware of the NHS ever engaging any of these influencers, in terms of how we approach the subject of vaping. There is certainly a real danger that social media is sometimes used by younger people, and they see things that become really attractive to them in terms of lifestyle. The misinformation and disinformation that exists across those platforms can lead them to participate in activities that are potentially harmful.

Directly to your question, my very strong answer to any young person thinking about using one of these products as an appetite suppressant is: please don’t. Please safeguard your health. Do not begin the potentially addictive journey of using these products. Do not do it for any reason.

Going back to the point we made earlier on, I would love to see a society where our sports organisations promote much more healthy behaviours, where we have a much better understanding of the huge variation in body image we have across our society, and where we promote the very positive and broad representation of who we are as the general public, because there is no “one size fits all” answer to who we are. We are beautiful in our diversity. Anything we can do to have a more positive representation of society across these platforms would be very beneficial.

Professor Sir Michael McBride: Believe it or not, I was a teenager once too, and I remember what it was like. Teenagers tend to push boundaries and experiment. It is all about finding yourself and your place and space in life. It is not cool to vape. It is not cool to succumb to peer pressure. Be yourself. Make sensible choices about what it is right for you. That is the message I would add to Sir Gregor’s point. We have an unfortunate situation where teenagers like to experiment and push boundaries and we have an industry that is only too willing to exploit that and market products at them with, as we heard, cartoon figures on the front, attractive colours and flavours that taste and smell nice. They are extensively marketed by opinion leaders. So don’t follow the crowd. Be yourself.

[Preet Kaur Gill]

Q We should all be concerned about the increase in the use of vapes by young children, so it is important that the Bill will ban the sale of vapes to under-18s. It will also close the loopholes for under-16s, because we know that vapes are being marketed and given out for free. That is the issue we must address. My concern with the Office for Health Improvement and Disparities being disbanded is on public health messaging. Parents and families are really concerned that some of their children are going through a number of these vapes per day or per week, and they do not know what is a safe amount.

There is a growing illicit vape market, but how would parents know what is illicit or what the Medicines and Healthcare products Regulatory Agency has notified as being compliant? Where is the public health messaging to support schools? We heard really good evidence yesterday from the union. This is my concern: where can people access support and information? We already have a generation of kids addicted to vapes that are marketed as having 0% nicotine, but we know that there is nicotine contained in them. What would you say to that?

Sir Francis Atherton: There is some messaging going on through the various Governments. In Wales we have a “No Ifs. No Butts.” programme, which tries to work at an individual level, to alert people to the dangers that we have been discussing, and with wider society, about the dangers and links between illicit tobacco and illicit vaping and organised crime. Bringing that awareness to the population is really important for those two reasons.

We work with trading standards to try to tackle the issue of illicit tobacco and vapes. It is important that we continue that. My understanding is that wherever we have been successful in reducing demand, which the Bill intends to do, the illicit supply also decreases. We would expect that to be a consequence of the Bill.

Professor Sir Chris Whitty: One of the many talking points of the cigarette industry is, “Well, any kind of downward pressure on cigarettes would lead to an increase in the illicit market.” All the evidence shows that the reverse happens. When you bring in reduced demand, the illicit market decreases.

[Dame Andrea Leadsom]

Q I think we might be out of time, but I have one more question. In the passage of the Bill, there is a concern that some may wish to fix flavours on the face of the Bill, rather than allow the powers. Sir Chris, can we have a comment on the record on how damaging that would be?

Professor Sir Chris Whitty: That would be very damaging, because we know that this is one of the most innovative marketing industries in the world. That is how they have managed to sell to people something that will addict them and then kill them. If we give them room for manoeuvre by nailing things down, they will find a way around it, because they always have found a way around regulations. I am absolutely supportive of the comment you have just made.

--- Later in debate ---

[The Chair]

Q We have until 10.55 am for this session. Would the witnesses like to introduce themselves briefly?

Professor Sir Stephen Powis: My name is Professor Sir Stephen Powis and I am the national medical director of NHS England.

Kate Brintworth: Good morning, everyone. My name is Kate Brintworth and I am the chief midwifery officer for NHS England.

[Preet Kaur Gill]

Q You have raised concerns about the rise in youth vaping. You have said that this needs to be nipped in the bud. Do you think the measures in the Bill will lead to decreased rates of youth vaping?

Professor Sir Stephen Powis: Yes, I do. As you have heard from the chief medical officers, vaping has a role in tobacco cessation and supporting those who want to quit smoking. That is the guidance from the National Institute for Health and Care Excellence, which we follow and support in the NHS. Evidence is increasing that starting vaping and the use of nicotine-based alternatives to smoking is likely not to be safe. As far as the NHS is concerned, we would support the limited use within smoking cessation, but we have real concerns around the impact that vaping might have over time. At present, we see a relatively small number of admissions into hospital as a result of vaping, but that is growing; it has grown over the last few years. Clearly, as you discussed earlier, the evidence base that these products are not safe is growing.

[Preet Kaur Gill]

Q You have mentioned the smoking cessation services we already have within the NHS, but there is no equivalent for vapes. Do you think there could be a case for these schemes to be made available for young people or pregnant women?

Kate Brintworth: Our position on vapes is that they are a tool for those who are already addicted to smoking. As Chris outlined earlier, this is a way of supporting people to move away from cigarettes. We would then expect that to be part of their journey to becoming a nicotine and smoke-free household.

[Preet Kaur Gill]

Q There is a growing industry in illicit substances, in terms of the vapes available in the market. Is that where you are seeing some of the impact with children in terms of hospital admissions? Have you seen any adverse reactions?

Professor Sir Stephen Powis: Yes, we have. If you look at admissions recorded in our statistics related to vaping, you will see that they are in the hundreds. They are relatively low, and of course much lower than smoking, but as I think you have heard from the chief medical officers’ evidence, these are not safe products. We are at the early stages of the evidence-base building around their impact. I think we should be nipping this in the bud. We should not be waiting for those admissions to increase and for those effects to be seen. This is an opportunity to reverse that direction, and I applaud parliamentarians for taking it.

[Preet Kaur Gill]

Q Would you like to say anything about admissions of young people in relation to smoking?

Professor Sir Stephen Powis: I will make a few broad comments on smoking, if I can. Seventy-eight years ago, Parliament passed the National Health Service Act 1946, which led to the formation of the NHS on 5 July 1948. In my view, the legislation that you are considering here today is one of the most important—possibly the most important—pieces of legislation since the passage of that Act. Why? Smoking has an extraordinary impact upon the health of the nation, and of course directly upon the NHS.

To put that into a bit more context—you have heard some of this already, but maybe I will provide some more detail—smoking is associated with, or causes, over 100 individual conditions that are managed and treated within the NHS. It impacts the NHS at all levels: almost every minute of every day there is a hospital admission related to smoking; there are over 100 GP appointments every hour for smoking-related disease; and 400,000 admissions a year are related to or associated with smoking. You have heard the chief medical officers briefly talk about the impact on specific diseases. Lung cancer is the one that everyone knows about, and 80% of lung cancers are caused by smoking. This Bill has the opportunity to transform lung cancer from a common disease into a relatively rare disease, and one that clinicians of the future will not see in any way as commonly as clinicians of my generation.

It is not about just lung cancer; you have heard about the impact on cardiovascular disease, and clearly, chronic obstructive pulmonary disease would again become a rare disease for the clinicians and the patients of the future. This Bill can also have an early impact on diseases that affect young people. Asthma is a disease not caused by smoking but a condition exacerbated by it. We see such admissions particularly over the months when asthma is worse and when there are respiratory infections, which are no doubt exacerbated by smoking.

In mental health, smoking doubles the risk of developing depression. More than one in two people with severe mental health conditions smoke, and the life expectancy of those with mental health conditions is reduced because of smoking. Mental health issues in our young people and children are well-known and well-described, and smoking simply exacerbates them. There is great potential, even in the early years, in the passage of this Bill for an impact on conditions that we see and manage in the NHS. Over the long term, that potential impact is extraordinary on those conditions, which number over 100.

You may know that I am a kidney doctor, but you may not know that smoking can impact on kidney disease. The kidney, like any organ, is supplied by blood vessels. When smoking impacts on the health of blood vessels and causes vascular disease, that can reduce the bloody supply to the kidney, which can cause kidney failure and lead to dialysis and transplantation. There is a large range of conditions that are impacted by smoking, and it will be extraordinary for those clinicians of the future not to have to do what we have done—tell patients and their families that people are going to die prematurely. That is an extraordinarily difficult thing for clinicians to do. Those are preventable diseases, and this Bill will prevent them.

[Dame Andrea Leadsom]

Q Thank you so much for being here today. As I said to the chief medical officers, you will appreciate that your words can be very helpful in smoothing the passage of this very important Bill. I would like to talk to Kate, please, about the impact of smoking on mothers who are pregnant. What is the impact on their babies, on the delivery of the baby, and on the baby’s health outcomes? If you could give us an outline, that would be very helpful.

Kate Brintworth: It is important to start with the fact that we know that smoking is the single biggest modifiable risk factor for pregnancy, and we know that every women who gets pregnant wants the best for her baby. As a midwife, I have never sat in front of a woman who does not want the absolute best for her baby. It is important to build on what Chris Whitty said around the removal of choice. Women will go to extraordinary lengths to protect their bodies and babies to ensure that their children have the best start in life, and yet the quit rates that we see in pregnant women are between 30% and 40%, showing how difficult it is for women to extricate themselves from the situation in which they find themselves.

The effects are devastating: stillbirths are increased by 47%; you are twice as likely to have a baby that has not grown properly; and you are 27% more likely to have a baby that is born pre-term. You are more likely to have complications of pregnancy, such as bleeding, the placenta not forming properly or the waters that surround the baby breaking earlier with the risk of infection, so there are immediate effects that we can see. If a baby is small, it goes into labour more vulnerable to the stresses of labour, so we can have more complications there. If a caesarean section is needed, the mother is more vulnerable to recovery and it can be a much harder road to recovery for her, with the risk of infection and blood clots, but also for the baby. If the baby is born early, obviously the risk then is that the baby and mother are separated and you have this unnecessary trauma to a family of a baby having to go into a neonatal unit. The risks that come from prematurity are well-documented for children, for educational attainment and for their lung and health development, but when the children go home, they are more at risk of sudden infant death syndrome—up to three times more—in a smoking household.

There are then the long-term effects. We have already heard about asthma, chest infections and obesity. All those are heightened in children born into smoking households. You have a situation where children are at risk and women are at their most vulnerable when they are pregnant, and it really feels like it is our duty to support this Bill to protect the most vulnerable in our society, because there are the effects of having a child born with possible behavioural problems and malformations, which have been described. Those are really shocking events. I was talking to service users yesterday who have had children in the neonatal unit, and it is incredibly shocking when your pregnancy ends early and you are separated from your baby. There is a mental health impact on the family. There is also the point that this affects those coming from the most socioeconomically deprived backgrounds, for whom having any kind of health challenge makes it a much higher bar to fight.

--- Later in debate ---

[The Chair]

Thank you. I call Preet Kaur Gill.

[Preet Kaur Gill]

Q The point of this Bill is to call time on a system that privatises the profit from nicotine addiction but socialises the social costs. What is the impact that you see on your profession, which we know is already stretched on the frontline in terms of managing long-term chronic illness associated with smoking?

Professor Hawthorne: Smoking-related illnesses cost the NHS about £2.5 billion a year. Everybody knows that lung cancer goes with smoking, but what I am really seeing is awful chronic obstructive airways disease. I work in a deprived area. Many of my patients have smoked ever since they were teenagers and find it very difficult to stop. Every winter, they come to see me repeatedly with severe chest infections that require courses of steroids and antibiotics and sometimes hospital admissions. It is really difficult.

I had a patient who sadly has passed away now with end-stage lung disease caused by smoking. The difficulty we had keeping her as well as we could at home was that she could not have home oxygen because she continued to smoke. It was a massive difficulty for her to stop smoking, even though it was causing her to virtually strangle herself. That just shows what a difficult thing this is.

Professor Turner: To follow on briefly, you might think that children do not demonstrate some of the impacts that Kamila has just described, but that is not the case. Following on from the conversation before, nicotine is not good for you. If you are a foetus inside of your mam, it will cause uterine arteries to spasm and effectively strangle you—reduce the oxygen to you.

We know that vaping contains nicotine. Nicotine makes you small and, if you are born small, you are already on a trajectory for all the non-communicable diseases that Kamila and her colleagues will see in primary care: cancer, heart disease, stroke and hypertension. From the paediatric perspective, there are issues. Children do not concentrate so well when they are addicted to something, so their attention in school is changed. That will affect their learning outcomes and their future economic productivity. The devices sometimes set on fire, so if you have one in your mouth, it can create burns. Fortunately, there are few serious life-threatening complications, but you might have heard of popcorn lung, which is fortunately rare but is very serious. With popcorn lung, when you look at the lungs on a scanner, it looks like they are full of holes.

[Preet Kaur Gill]

Q Do you think that the Bill goes far enough to protect young people from the harmful effects of smoking and vaping?

Professor Turner: Yes, absolutely. The tobacco industry knows that, at the age of 15, we as a species are at the sweet spot for becoming addicted to nicotine for life. The proposed Bill will effectively stop that. Protecting our children from becoming addicted to something that will shorten their lifespan by 10 to 15 years has to be a good thing for us as a responsible society to do.

[Preet Kaur Gill]

Q Finally, what are the harms of vaping to those who have never smoked?

Professor Hawthorne: We know that vaping can cause people to start smoking; it can lead to smoking. We do not have much evidence—I think you have been told this already this morning—as to what the long-term effects of vaping are. We have known about smoking damage since the work of Sir Richard Doll in the 1960s, so this is relatively new. We know there are chemicals in what people are inhaling—that is what causes the popcorn lung—but it is actually only one particular chemical that has been linked, and there are lots. Since 2016, vapes have not been allowed to actually have that chemical any more, but there are other chemicals, and we still do not know what long-term effects they might have.

[Preet Kaur Gill]

Q There seems to be an issue around what is contained in illicit vapes, which we know include things like lead, nickel and high levels of nicotine, versus other vapes that have gone through a notification process. Do you feel that the research on the impacts of illicit vapes is not there, or is it the impact of vapes that have gone through a compliant process?

Professor Hawthorne: There is probably very little research on either.

Professor Turner: If I could just bring a bit of clarity, it is well known that nicotine is bad for us. Sir Walter Raleigh brought it back with some potatoes, and we have known for hundreds of years that nicotine is an addictive drug. As I said previously, it will shorten your life expectancy by between 10 and 15 years. Because we know nicotine is in all nicotine-containing vapes, whether licit or illicit, it is harmful regardless of what the other components might be. It is likely that those other components add to the harm, but there is substantial and well-described harm from nicotine addiction to us as human beings.

[Dame Andrea Leadsom]

Q Thank you both so much for being here. As I said to the other medical professionals, your words today will be incredibly valuable in ensuring the smooth passage of the Bill. Professor Turner, could you explain to us what happens to a baby born addicted to nicotine in terms of the withdrawal symptoms and the impact on its health and development?

Professor Turner: There is not a lot of research on that. Certainly, we know that if you are in utero and your mother is smoking, you will get the harmful effects of nicotine. That is a very good question—I honestly do not know what the effects on the unborn child would be. Certainly, we know that children born to parents who are addicted to morphine or cocaine have learning difficulties. I have to be honest and say that I might have to get back to you on that one, but I can assure you that it is not good to be in utero and exposed to nicotine.