Smokefree England: Covid-19 and PHE Abolition

Baroness Winterton of Doncaster Excerpts

Thursday 12th November 2020 Commons Chamber

[Liz Twist (Blaydon) (Lab)]

May I start by congratulating my hon. Friend the Member for City of Durham (Mary Kelly Foy) on securing this debate and on her introductory speech? I am going to start in time-honoured speaking fashion by telling you, Minister, what I am going to ask you, and then elucidating on that—

[Madam Deputy Speaker (Dame Rosie Winterton)]

Order.

[Liz Twist]

Sorry. I will start by telling you, Madam Deputy Speaker, what I am going to be asking the Minister and then perhaps expanding on that. First of all, Minister, I will be asking you about the tobacco control plan, which my hon. Friend has already referred to. If we are going to achieve the smokefree by 2030 ambition, that needs to happen quickly, and I will be asking you what you can do—

[Madam Deputy Speaker]

Order. The hon. Lady really must refer to the Minister, because when she says “you”, she is talking to me.

[Liz Twist]

Sorry, Madam Deputy Speaker. I am getting carried away.

I will be asking the Minister what he will be doing to ensure that vital maternity safety programmes, such as the saving babies’ lives care bundle, can get back on track. I will be asking him what he will do to develop a national strategy for reducing rates of smoking in pregnancy among women from disadvantaged communities, learning the lessons from the areas where the greatest declines have been seen in smoking in pregnancy. I will be asking him how he will ensure that mental health trusts are required to implement National Institute for Health and Care Excellence guidance and that the Care Quality Commission is directed to assess that when it carries out its inspections. Finally, I will be asking him what steps he will take to ensure that smokers with mental health conditions receive evidence-based advice about switching from smoking to vaping.

I want to elaborate a little further on those issues. As a result of comprehensive action at national, regional and local levels, significant progress has been made over the years on bringing down smoking rates in England. The 2019 prevention Green Paper’s commitment to make England smokefree by 2030 was an appropriately ambitious and welcome commitment to continuing this important mission. However, a year on from the end of the Green Paper consultation, we have yet to see the Government’s response or their promised and much-needed further proposals, which would enable us to meet the 2030 ambition.

Despite our national progress, smoking remains the leading cause of preventable illness and death in England. Each year, smoking kills more people than obesity, alcohol, drug misuse, HIV and traffic accidents combined. Smoking is a particular challenge in my constituency of Blaydon, where 17.4% of adults smoke, compared with 15.3% across the north-east and 13.9% nationally. Smoking costs Blaydon £1.8 million every year, largely as a result of NHS treatment costs, lost productivity due to ill health and premature death caused by smoking. For communities such as Blaydon, achieving the smokefree 2030 ambition will be tough, but it remains essential for the health and wellbeing of our community. However, analysis by Cancer Research UK finds that on current trends, disadvantaged communities such as my own will not become smokefree until the mid-2040s. This rate of progress is not acceptable and not affordable for our most deprived communities.

The last tobacco control plan was two years late, as we have heard. It should have been published in 2015, and it was delivered in the summer of 2017 only because of the commitment of the then Health Minister, the hon. Member for Winchester (Steve Brine), who I am pleased to say has just joined us. The tobacco control plan that he introduced included the ambition for a smokefree generation, and now that the Government have committed to deliver this by 2030, the pressure is on. Our current tobacco control plan is set to run out in 2022, leaving an eight-year gap in which, according to Cancer Research UK, the rate of smoking prevalence decline must be 40% faster than our current trajectory if our nation is to meet the 2030 tobacco control plan commensurate with the scale of the ambition to be smokefree by 2030.

I shall turn now to the NHS long-term plan. The successful delivery of the plan is essential to the achievement of the smokefree 2030 ambition. The plan published in January last year sets out welcome commitments to tackle smoking in the NHS. By 2023-24, NHS-funded tobacco dependence treatment will be offered to all hospital in-patients who smoke; all pregnant smokers and their partners, too, if they smoke; and all long-term users of specialist mental health and learning disability services who smoke.

The evidence is clear of the benefits this will bring, both to smokers and to the NHS. Smokers are 36% more likely to be admitted to hospital and smoking is responsible for almost 500,000 admissions each year in England. One hospital patient in four is estimated to smoke. The increased demand that smoking places on NHS treatment capacity translates into an enormous financial burden. Each year, smoking costs the NHS around £2.6 billion, including avoidable secondary care costs estimated at £890 million a year. The cost in the north-east to the NHS is around £132.3 million a year, with smoking in Blaydon alone responsible for around £300,000 of that. Across the north-east, it is estimated that implementing the long-term plan commitments at just 40% coverage, as is aimed for by the end of 2021-22, would deliver net savings of nearly £12 million to the NHS in the north-east.

In the north-east, progress towards implementation of the long-term plan’s commitments on smoking is well under way. Treating tobacco dependency is one of two key priorities for the north-east and north Cumbria integrated care system population health and prevention work stream. To focus efforts across the region, a dedicated north-east Smokefree NHS/Treating Tobacco Dependency Task Force was established in 2017. The taskforce has provided strategic direction, developing regional resources and facilitating partnership working with all stakeholders, including NHS trusts, local authority tobacco commissioners, Public Health England and primary care.

As of April 2020, all NHS trusts in the north-east had achieved smokefree NHS status by implementing updated smokefree NHS policies and pathways to identify and treat smokers from admission, in line with national guidance. Across the north-east, trusts have established good links between hospitals and community stop-smoking services funded by local authorities to ensure treatment started in hospital is continued after patients leave hospital. Trusts are training staff to build capacity. They have also signed the NHS smokefree pledge as a clear and visible way to show commitment to helping smokers to quit and to providing smokefree environments.

Elsewhere, progress has not been so heartening, and it is clear that the funding and focus promised by the long-term plan are much needed. An audit of smoking cessation advice and services in NHS acute hospitals, published earlier this year by the British Thoracic Society, concluded that there is poor adherence to national standards and slow progress in identifying and treating smokers. In fact, in many cases the situation is worse than at the time of the last audit in 2016. One smoker in two is not asked whether they would like help to quit. Only one hospital in three has a hospital-funded smoking cessation practitioner, compared to one in two in 2016. Referral to hospital smoking cessation services is available in only four out of 10 hospitals. In 2016, the figure was more than half.

Progress on the long-term plan’s commitments has also not been immune from the impact of the covid-19 pandemic. Early implementation sites chosen to stress test the new tobacco dependency treatment pathways set out in the long-term plan were due to start in April, but this had to be delayed until last month. With winter approaching, and the risk of co-circulation of covid-19 and seasonal flu looming, there is a real risk that work to deliver the long-term plan’s commitments on smoking could be derailed. If we are to achieve the smokefree 2030 ambition, addressing smoking where contact with smokers is greatest is an opportunity that must not be missed

Let me turn to smoking in pregnancy. The Minister is as concerned as I am about this issue, on which there is too little progress. This needs to be a major focus of the next tobacco control plan. Ensuring that more pregnancies are smokefree not only protects the baby as it grows and reduces the risks of complications such as stillbirth and miscarriage; it also gives children the best start in life. NHS England has included addressing smoking as a key part of the initiative to reduce stillbirth and neonatal deaths through its saving babies’ lives care bundle, which is designed to encourage trusts to implement evidence-based measures to improve the safety of pregnancies. However, as with other aspects of NHS activity, this work has been undermined by the impact of covid-19, with a key aspect—carbon monoxide breath tests for all women—currently suspended. I understand that there are also reports from local authorities’ stop-smoking services that fewer pregnant women are being referred for them for support by maternity services. What will the Minister do to ensure that those vital maternity services get back on track as a matter of urgency?

Despite work in the NHS, progress has not been made anywhere near swiftly enough. There are big variations in the performance of different parts of the country. In a soon-to-be published analysis, Action on Smoking and Health finds that rates of smoking in pregnancy have increased in the past five years in a third of clinical commissioning groups, while declines have been seen in less than half, or 44%. It is therefore hardly surprising that the Government seem so unlikely to achieve their ambition of reducing rates to 6% by 2022. In the north-east, we continue to have some of the highest rates of smoking in pregnancy in the country. These are driven by high levels of disadvantage in the region, but, unlike in some regions where rates have even increased, rates in the north-east have fallen in the past five years, from 17% in 2016 to 15% in 2020. Progress has been driven by the regional tobacco programme in the north-east and by the work of NHS England, Public Health England and local government.

The Minister might be interested to hear that a recent analysis by The Times found that areas of the country that were likely to have seen big drops in rates of smoking in pregnancy were also more likely to have implemented financial incentive schemes to support pregnant women to quit. Evidence on the effectiveness of these schemes has been accumulating for many years; they have been shown to increase quit rates when implemented alongside evidence-based quit support. Such incentive schemes are in place in Greater Manchester and South Tyneside. Madam Deputy Speaker, I can see you looking at the clock, so I shall press on.