Tobacco and Vapes Bill (Eighth sitting)

Sadik Al-Hassan Excerpts

Committee stage
Thursday 16th January 2025 Public Bill Committees

[Sadik Al-Hassan (North Somerset) (Lab)]

Would the hon. Lady’s amendments affect the financing of the actions of trading standards, and would more money need to go in to offset that?

[Liz Jarvis]

I do not know the answer to that, so I will refer that question to the Minister.

[Sadik Al-Hassan]

They are your amendments.

[Liz Jarvis]

I am sorry; I do not know about that.

Our amendments would also promote transparency and accountability by giving those with skin in the game a direct role in deciding how fines are used to address public health priorities in their area. They would strengthen the Bill’s public health focus while retaining the integrity of its enforcement mechanisms.

Tobacco and Vapes Bill (Sixth sitting)

Sadik Al-Hassan Excerpts

Committee stage
Tuesday 14th January 2025 Public Bill Committees

[Dr Johnson]

It is catching—it is the time of day, I think.

Paragraph 787 of the impact assessment says:

“We know that one of the main reasons children take up vaping is due to peer pressure…It is therefore worth considering that instances of vape vending machines in easily accessible areas might be an enabler for those who would not otherwise seek out a vape or who would be deterred by having to speak to an adult”.

Children would have to seek out an adult to make a purchase, because they have to go to a till or counter to get the vapes. Under the new legislation, that adult would look for ID, while a vending machine would provide a circumnavigation, so this is a sensible clause.

Most of us recognise that the vending machines currently selling disposable vapes have a finite lifetime, because this Government have banned them in the future under a statutory instrument in the competence of the Department for Environment, Food and Rural Affairs. However, British American Tobacco has already stated that it is working on a product to sell the Velo brand—one of its nicotine pouches—via “age-gated vending machines” and is hiring for the product. Again, that is taken from the impact assessment.

That further highlights the need for a blanket ban on vending machines, particularly given that, as things stand, they are clearly advertising tools for vaping. Wherever the machines are placed, they are visible to the consumer, and the consumer needs to know what is in the vending machine in order to choose what to buy. Given the regulations appearing later in the Bill, we will be looking at the display of such products. It therefore seems nonsensical to have restrictions on the display of products, but to allow vending machines, which allow the display of products, in contravention of that. One aim of the Bill is to ensure that non-smokers do not begin vaping and get hooked on nicotine. These provisions strengthen that through age verification and on the marketing front.

I will now deal with some of the issues to do with mental health hospitals. My hon. Friend the Member for South Northamptonshire said that the 2,400 vends were evidence of 2,400 positive choices. I am not sure that that is necessarily the case. The evidence is that 2,400 vapes were bought, but not that those individuals had ever smoked. We do not know whether the vending machines are being used by people who smoke or people who do not—[Interruption.] My hon. Friend the Member for Windsor comments from a sedentary position; if he wants to intervene, he is welcome to do so. A proportion of people out there smoke, and a proportion do not.

[Sadik Al-Hassan (North Somerset) (Lab)]

It is a pleasure to serve under your chairship, Sir Mark. Based on the behaviour of vape companies now, which is similar to that of tobacco companies previously, this proposal would allow further expansion of vending machines and further display on vending machines in more and more places. Is that the point that the hon. Member is making?

[Dr Johnson]

In essence, in relation to clause 12, yes. I do not think that vending machines including tobacco and nicotine products or vapes are a good idea, and I moved a new clause for inclusion in the previous Bill because a ban on nicotine and vaping products in vending machines had not been included at the outset. Without such a measure, we will see an expansion of vending machines as a way of selling products to children and getting children addicted. It will be done as a way of making products more available to adults, but its effect will be that the products are more available to children. I do not want to see such products available to children, because they are clearly harmful for them. All the medical evidence we have had states that clearly.

With regard to individuals in mental health hospitals, some may be there as voluntary patients, and some under a mental health section. When someone’s liberty has been taken from them because they are being treated for a mental health condition, we need to be careful that we are not restricting them in other ways in which we would not restrict other people. That is a fair point to make.

We also have to be mindful of the staff. As we go through the Bill, the Minister will rightly be looking at exposure to vaping inside hospitals and at extending the tobacco regulations that limit smoking in public indoor places to cover vaping in indoor public spaces. Indeed, he and you, Sir Roger, will have seen the signs placed in the Tea Room by the Speaker, who rightly wants to see that we do not have vaping there. The public do not want vaping in their tea rooms or in the public domain either, so that is the right thing to do. We need to consider that there are staff and other patients in mental health hospitals who may not wish to vape and should not be inadvertently and unnecessarily exposed to vaping products.

I do not support the idea that 2,400 vends means that this is a positive choice. For some of these people, vaping may have been a positive change from smoking, but for others it may have been a decision to vape.

--- Later in debate ---

[Jack Rankin]

I supported clauses 10 and 11 because I agree with the Government that under no circumstances should children be taking up vaping. I was heartened by the Minister’s comments on the principle of clause 10, the general point about evidence and balance when it came to vaping, and treating vaping differently from cigarettes and tobacco products.

However, I cannot quite go along with the Government on clause 12, because there they have the balance slightly wrong. I accept that vape vending machines should be prohibited, for the same reason that tobacco and cigarette vending machines were prohibited: vending machines cannot provide for age verification. That balance is well struck. However, I do not support the related measure for nicotine product vending machines. The Minister may seek to correct me, but I am not aware that any of the products described by the shadow Minister, such as nicotine patches and gum, is used recreationally or is attractive to children.

[Sadik Al-Hassan]

Does the hon. Gentleman not think that, if other items are restricted, people will end up buying those items? We are going to restrict what is available, and that will surely open them up as an avenue if we do not close it now.

[Jack Rankin]

I do not think that nicotine products are attractive to children in any way, shape or form today. My concern is that, as the Government are seeking to stop children using them by restricting them in vending machines—I do not think they should be using them—

--- Later in debate ---

[Jack Rankin]

I mean the former: nicotine patches and gum. The stated intention of the Bill, supported by the House on Second Reading, is to move to a smokefree generation, so it would seem sensible to make nicotine products pretty widely accessible, in so far as they do not attract children. We should largely welcome a vending machine selling nicotine patches or gum if the intention is to move to a smokefree generation. I do not think the Government have the evidence and the balance quite right on that point, so I cannot support clause 12 as it is currently written.

I would make a similar case in support of the amendment in the name of my hon. Friend the Member for South Northamptonshire. She has read to us evidence from a relevant professional, who has a legitimate concern. It might be sensible, in the interest of broader public health, to have such a vending machine. If the Government are concerned about evidence and balance, those are exactly the kinds of voices they should be listening to, and they should accept the amendment, which is very much in line with their intent.

[Sadik Al-Hassan]

Does the hon. Gentleman have any evidence that there is a restriction on access to stop smoking products now? In my experience as a pharmacist, I have not seen that.

[Jack Rankin]

I do not think I can talk to that point, but I thank the hon. Gentleman for making it.

We have to find a balance. The Government can use their majority in the House to cast aside my hon. Friend’s amendment, but it seems to me that it is in line with the principle of the Bill, so it is a sensible thing to do.

Tobacco and Vapes Bill (Third sitting)

Sadik Al-Hassan Excerpts

Committee stage
Thursday 9th January 2025 Public Bill Committees

[Dr Johnson]

Once again, Sir Roger, I am very grateful for your guidance to the Committee. I was explaining the change in amendment 17, and my hon. Friend, like the very wise chap that he is, brings something forward that I had not really considered, despite my attention to this Bill over some time—and Members will be very much aware it is something that I have taken a long interest in.

My hon. Friend is absolutely right: some people argue that the Bill creates two tiers of adults—some who are allowed to smoke and some who are not. In fact, that is exactly what it does. Eventually, of course, people get older and older. I saw that the oldest person in the world sadly passed on in the last week or so, and she was 116. I am not quite sure about the age of the current oldest person in the world, but I suspect their age is similar. Therefore, I suspect that it will take quite a long time before my hon. Friend’s ideal of all adults being treated the same is once again achieved. I suspect that I will certainly be long gone before it does, and I anticipate that the rules we are proposing will last the rest of our lifetimes here today.

This modification shifts the approach from creating a tobacco-free generation to implementing a uniform age limit that applies universally, regardless of the buyer’s birth year. That simplifies enforcement because sellers would need only to confirm whether a buyer is under 25, and they would not need to do the mental arithmetic in their head that says, “Okay, that is their birthday, but how old would that make them?” The Minister, in his questions on Tuesday, raised the point repeatedly with one of our witnesses about whether it is simpler to have a date of birth or an age. My understanding is that a lot of tills nowadays will give a prompt to the person working behind the till to say, “If you are born before or after this date, that is where the 18 cut-off is.”

[Sadik Al-Hassan (North Somerset) (Lab)]

Will the right hon. Lady give way?

[Dr Johnson]

I thank the hon. Gentleman for the promotion—I shall mention it the Chief Whip and see how that goes!

[Sadik Al-Hassan]

My training and experience as a pharmacist over two decades involved working with systems such as tills that teach people how to ask for age verification. Does the hon. Lady agree that the Minister is spot on and that actually this is a moot point, because the software, support and training is already there across the country, including in independent shops, and age verification is quite easy to do?

[Dr Johnson]

I think it is straightforward to have an age and a date of birth to check. It could become more confusing if we ended up with a range of age-restricted products and the age for each of them was different, as that would require people to look at a whole spreadsheet of dates of birth.

[Sadik Al-Hassan]

Software systems I have worked with already have the facility to differentiate by product, including for razor blades and alcohol products. That already exists across retail and in a variety of retail premises.

[Dr Johnson]

The hon. Gentleman’s intervention highlights the fact that in Parliament we benefit from the experience of so many different people. Each of us comes to this place with our own history, backstory and experience of working in a whole range of different professions and jobs. That is one of the reasons why we go through these Bills line by line. It may seem to some extent slow and plodding to go through things so methodically, but that means that each person can, as he has, bring their experience forward and explain the ways that tills and such things work, which is really beneficial. I thank him for that intervention.

Tobacco and Vapes Bill (First sitting)

Sadik Al-Hassan Excerpts

Committee stage
Tuesday 7th January 2025 Public Bill Committees

[Dr Beccy Cooper (Worthing West) (Lab)]

I declare an interest as a public health consultant and a member of the British Medical Association.

[Sadik Al-Hassan (North Somerset) (Lab)]

I declare an interest as a practising pharmacist. [Interruption.]

[Mary Kelly Foy (City of Durham) (Lab)]

I cannot hear everything because of that noise, but I am co-chair of the all-party parliamentary group on smoking and health.

--- Later in debate ---

[Dr Cooper]

Q My question is around inequalities. How effective or otherwise do you think the Bill will be in reducing inequalities? Are there any areas of the UK that have specific challenges related to tackling smoking prevalence that you would like to highlight?

Professor Sir Michael McBride: That is a really important question. We talked before about the blatant marketing of tobacco and vapes. There is also the preying of the industry on those more socioeconomically deprived areas.

If we look at smoking rates in those more socio- economically deprived areas, they are two to three times higher than in less socioeconomically deprived areas. If we consider the death rate from smoking-related conditions, it is twice as high. If we look at lung cancer rates, they are two and a half times as high in those areas. That is a direct consequence of the smoking incidence in more socioeconomically deprived areas. The health inequalities associated with the consumption of tobacco are significant and great.

If we look at smoking in pregnancy and all its consequences in terms of premature birth, stillbirth and low birthweight, we see that smoking among women from more socioeconomically deprived areas is four and a half times higher than among those in less socioeconomically deprived areas. The health inequalities argument and the case to be made for addressing that within the Bill is huge. This is an opportunity that we must not pass up to narrow the adverse health consequences.

Professor Sir Gregor Ian Smith: It is my very clear view that the provisions within the Bill will help us to tackle some of the inequalities associated particularly with tobacco smoking. If I look at the situation in Scotland, 26% of our lowest socioeconomic group are smokers, compared with 6% of our highest socio- economic group.

The gradient that Sir Michael has spoken about in terms of the subsequent tobacco-related disease that those groups then experience is really quite marked, whether that be cardiovascular disease or the numerous cancers associated with smoking. All of those can be addressed by trying to tackle the scourge of these tobacco companies preying on more vulnerable groups within our society, whether that be those who experience socioeconomic circumstances that are much more difficult and challenging for them, or whether that be particular groups that are more likely to experience mental health conditions.

All of these must be tackled; people must be assisted not to develop addictions that lead to lifelong smoking and problems with their health thereafter. I am very clearly of the view, both in terms of smoking and, it is important to say, of vaping, that the targeting of those groups that creates those inequalities within our society is something that this Bill can address.

[Sadik Al-Hassan]

Q Thank you for the evidence submissions so far. In your opinion, will the Bill’s restriction of flavours for vaping products prevent the appeal to children and ex-smokers, if they can no longer access such products?

Sir Francis Atherton: The issue of flavours and colours speaks to the issue of marketing towards children that we have been speaking about so far. I have no reason to believe that taking away colours and flavours that are appealing to children would remove vaping as a stop smoking tool. It remains an important tool in the box that we have to have alongside nicotine replacement therapy and alongside education, and it will remain an important tool to stop people smoking.

The prime aim here, of course, is to stop the marketing towards children. If you think back to when tobacco was advertised in shops, we saw big gantries in shops, and what we have seen in recent years is that we now have vape gantries in almost all our shops. Taking away that marketing opportunity towards children—the colourful and flavoursome displays—can only be of benefit to reducing childhood vaping and the nicotine dependency that comes as a consequence of that.

Professor Sir Chris Whitty: Let us be really clear about this: the vaping industry will claim it is not marketing to children while putting in flavours, colours, cartoons and placements that are clearly aimed at children. You just look at them—you do not need anything else—and you see the rates going up in children. It is very clear that the industry is doing that, and it needs to be tackled.

Professor Sir Michael McBride: If you look at products with names “gummy bear” and “rainbow surprise”, who are they actually aiming those products at? Our Public Health Agency did research with more than 7,500 children and young people in Northern Ireland, using focus groups and online surveys. Some 77% of them told us that what appealed to them about vapes was the colours and flavourings. The public consultation had the strongest and highest support for banning flavours and colourings. More than 75% of the population in Northern Ireland supported that ban. We should not delude ourselves about the exploitative marketing of those products.

In terms of next steps, it is really important that those who want to use vapes to quit smoking, as Sir Frank has said, can continue to access them. The Government undoubtedly will consult carefully on those measures to ensure that we do not—as the question is rightly exploring—restrict access or discourage individuals from using vapes to quit smoking.

[Sadik Al-Hassan]

Q Comparatively, how addictive is nicotine in tobacco and vapes compared with other products? I seem to remember that it is harder to get off nicotine than methadone. Is that true?

Professor Sir Gregor Ian Smith: I am not sure we have the data or the evidence to back that up, but I have certainly heard people claim that in the past about the addictive nature of nicotine. One of the important aspects of this issue is the very rapid re-emergence of that addiction by small exposures after people have managed to quit. Certainly we should be in no doubt about the addictive nature of nicotine and the risks—going back to the harmful effects of passive smoking or being in the company of people who smoke—associated with the re-emergence of that addiction and of people’s tobacco smoking habits. That is something very real. Therefore, the best protection is never to start in the first place. If we can prevent people from taking those first nicotine products and prevent the addiction from forming in the first place, there is obviously a much greater chance that they are not going to suffer the health consequences.

[Euan Stainbank]

Q It is clear, from the comments made about display and advertising, that child vaping is an issue that needs to be tackled; I think it is an issue that many of our constituents and many people in the country recognise. Especially for adult smokers, do you believe that there will be any impact from the display and packaging restrictions on the effectiveness of vapes as a tobacco cessation tool?

Professor Sir Chris Whitty: Our view is that the benefits of preventing people who are not currently vaping, particularly children, from vaping through what is proposed in this Bill significantly exceed that risk. However, that risk exists; we all accept that. To go back to a previous point I made, that is why having these powers gives us the advantage that if, as a result of where we get to—remembering that this change will come after consultation and there will be secondary legislation going through Parliament—it looks as though we have gone too far, it will be possible to ease back. Our view, though, is that at this point in time, and subject to what the consultation shows, the net benefit in public health terms is positive for the prevention of children starting smoking, over any risk for adults.

The area of greatest uncertainty is on flavours. There is some genuine debate around that, with a range of different views from people who are quite seriously trying to wrestle with this problem—rather than doing marketing masquerading as wrestling with this problem—but in all other areas, most people think that the benefit outweighs the risk.

--- Later in debate ---

[Dr Johnson]

Q How do you think the Bill will address health inequalities? We have heard that smoking is more prevalent among poorer individuals than among richer individuals. Will the Bill help address that?

Sheila Duffy: We see that socioeconomic inequalities and smoking rates are closely patterned. ASH Scotland’s work with low-income communities in Scotland suggests that people regret beginning tobacco, but find it hard to move away from it. It also identified the dangers of less regulated novel products such as e-cigarettes in enticing their children and grandchildren into the kind of addiction that they themselves so regret. One of the real strengths in the Bill is the ability to bring some of these tobacco-related products into the kinds of control and regulation that we have fought so hard over decades to get for tobacco products.

[Sadik Al-Hassan]

Q Do you think the introduction of a generational ban on smoking could cause an increase in the use of other nicotine products, such as vapes or smoke-free tobacco?

Hazel Cheeseman: The purpose of the legislation is to reduce smoking. The Department’s projections in the impact assessment clearly show that, even on conservative estimates, it will achieve that goal over time. So the question then is, does that lead to displacement into other products? Given that the legislation is comprehensive in relation to tobacco products, it is to be hoped that it will not lead to displacement into other kinds of tobacco products, but it might lead to some displacement into other nicotine products. As the chief medical officer said in the previous session, it is unlikely that nobody will take up smoking in the affected age group. Some people will; some of the 15-year-olds who will be affected by this legislation have already tried smoking. So we need there to be a legal nicotine product that those people will be able to use, with the restrictions that are coming into place in relation to vaping and other nicotine products in this legislation. One would not expect the overall consumption of nicotine to be greater than it otherwise would be, if that makes sense, but there may be some displacement into other nicotine products as we transition away from smoked tobacco and from tobacco being used widely in that group.

Sheila Duffy: Dual use is a real concern in Scotland. Nearly 43% of people are dual-using cigarettes and e-cigarettes. The international longitudinal cohort evidence clearly shows a higher risk of progression to using combustible tobacco for young people that start vaping. I think this legislation has the real potential to move us away from that.

Suzanne Cass: We also have to remember that the killer in the room is tobacco. The generational ban is the most crucial part of this legislation that we need to push forward. Therefore, we need to keep our eye on the ball when we are looking at the health impact, and the potential public health impact, of this Bill, and to make sure that we focus on driving down that tobacco use.

Naomi Thompson: Just to reiterate what Suzanne has said, tobacco is the issue. The impact of tobacco was repeated multiple times in the previous session. If young people start, they continue, and they find it very difficult to stop. Therefore, if we can sort that, it is a great first step. There may be a small move towards other nicotine products, but we can work on that. Tobacco is the one that kills.

[The Chair]

Can I just, as is my job, remind everybody that we are finishing at 10.55 am, which is in about 15 minutes or thereabouts? I have six people who wish to ask questions, so can I ask that the questions and responses are as tight as possible? Thanks.

--- Later in debate ---

[Andrew Gwynne]

Q In a nutshell, how important is it that the measures in the Bill are passed?

Dr Ian Walker: Critical. Without a doubt, there is no single bigger action that you could take to reduce the cancer burden on the country. The cancer burden sits at a very personal, individual level for people getting their own diagnosis; it sits at a family level and at a friend level. It also sits at an economic level for the country and at an NHS level, in terms of the burden that smoking-related illnesses cause for the NHS.

From my perspective, this is a world-leading piece of legislation. It is absolutely an opportunity for generational change and a long-term legacy that will see our children and grandchildren never able to legally buy tobacco in the UK and never exposed to the harms that that would cause them.

[Sadik Al-Hassan]

Q Is there any research into passive vaping risks to bystanders, who do not have a choice if someone is vaping next to them?

Sarah Sleet: As I said earlier, the research evidence around vaping harms is currently very poor. There has not been enough. It takes a long time to build up evidence of things that are generally very progressive rather than having an immediate impact, so we will have to wait. We need to put that in place, and we are going to have to wait to get that evidence back.

We have had anecdotal reports from our beneficiaries and those who contact the organisation about places—particularly in closed spaces, but sometimes outside—where there is a concentration of vaping. It is that classic thing where you go through a door and suddenly everybody around you is vaping immediately outside it. We get reports that that exacerbates people’s asthma and sometimes their COPD, but they are anecdotal. We really need the evidence base to support what is happening.

Dr Ian Walker: The only thing that I would add specifically from a cancer perspective is that although there is very little long-term evidence, because the products have not been around long enough and the cumulative effects have not been seen yet, what we do know, based on the current evidence, is that vapes are far less harmful than cigarettes. You heard the advice earlier that if you smoke it is better to vape or take other nicotine products, but if you do not smoke you should not vape, because we do not know yet what the long-term effects will be. In particular, we are very light on evidence on what the impact of vaping will be on bystanders.

[Euan Stainbank]

Q Do you believe that there is a substantial health impact on people working in certain sectors who unavoidably encounter second-hand smoke in the course of their employment? What impact will the measures in the Bill have on that?

Dr Ian Walker: The impact of the Bill will reach every sector, on the face of it. Obviously the aim of making a smoke-free UK will impact everybody in whichever sector, but I think you are probably referring specifically to increasing smoke-free places, or places where smoking is not allowed. For people who are exposed unavoidably by their working environment, of course this will be good news and a good expansion.

As you heard from Sarah, we did not quite get to hospitality in the Bill, but it will be interesting, as we go through consultation, to review the evidence and understand the sentiment. Clearly, people working in hospitality are likely to be exposed to smoke in their work environment, even if that is outside. The Bill makes important steps in increasing the number of smoke-free places and reducing exposure to tobacco smoke.

Sarah Sleet: As the CMO said earlier, it is about the duration as well as the density of smoking. If you work in hospitality in those outdoor spaces, the duration will clearly be longer; if you work on a coach concourse, you will be exposed for longer. It is really important to remember that.

Another issue is inequality. There is a concentration of working lives that are more exposed to second-hand smoking, which is exacerbated by inequality.

Tobacco and Vapes Bill (Second sitting)

Sadik Al-Hassan Excerpts

Committee stage
Tuesday 7th January 2025 Public Bill Committees

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

Q Thank you; that is really helpful. What about the new licensing scheme that local government needs to bring in? Do you feel you have the resources to do that? Will it give you the discretion you need in terms of the location of such sites?

David Fothergill: We argued at the previous Committee hearing under the last Government—I think you may have sat on that Committee—that we needed a licensing scheme to make it effective. We still hold that view. We think that it is right. What we should not do, though, is to overcomplicate this. We already have licensing schemes. Many of you will have sat on licensing committees at local authorities. We have good local people who license alcohol outlets, taxis, gambling and gaming. We believe that licensing is the right route to go. While we think the legislation should be consistent, we do think there need to be local variations we can look at, so that we can bring in what works for our communities, very much as we do with the alcohol schemes.

[Sadik Al-Hassan (North Somerset) (Lab)]

Q Do you believe the measures in the Bill to prevent vapes appealing to children are likely to work?

Alison Challenger: The short answer is yes, I think they do. The need not to have children exposed to the marketing of vapes is very important. At the moment we see that children are exposed to that marketing and are encouraged to get access to vapes, so it is important that this is brought into the Bill. I think what is currently in the Bill will help us to address that significantly.

David Fothergill: I concur. From a local authority point of view, we have argued long and hard about vapes and have spoken with your colleagues in the Department for Environment, Food and Rural Affairs about disposable vapes, which we have been very concerned about; so it is great to see this legislation moving forward.

[Dr Beccy Cooper (Worthing West) (Lab)]

Q Thank you for coming to give evidence this afternoon. As we have two of my fellow public health colleagues giving evidence, could I ask what the general response to the Bill has been from the public health community? Are there any significant suggestions from the public health community of areas that we should consider further?

Professor Tracy Daszkiewicz: From the public health community, it is widely accepted and supported. It gives us a great opportunity not only to increase the conversation, but to broaden it. How we embed the legislation into practice will be key: making sure that we are getting it to the point of delivery where we can effect change in terms of protecting our populations in the most effective way, making sure that we have a focus on smoking cessation, that we have a consistent and unified approach, and that we have the agility and adaptability to target different cohorts and different populations effectively. From the public health perspective, though, the Bill is hugely supported.

Alison Challenger: Similarly, from the Association of Directors of Public Health, the Bill is very much welcomed. It will represent a sea change in reducing harm caused by tobacco, which is still our biggest killer. Significant numbers of people continue to smoke and are still addicted to smoking. The product itself is not only extremely dangerous but extremely addictive at the same time. We welcome these measures to address that.

--- Later in debate ---

[Mary Kelly Foy (City of Durham) (Lab)]

Q Can I ask a question to all of you? We know that the Bill will go a long way towards reducing health inequalities. In more deprived areas, which have the highest prevalence of smoking, will the Bill also have an impact on the economics of local communities?

Professor Tracy Daszkiewicz: That is exactly the focus: reducing health inequalities and ensuring we get good health equity across all of our populations. When we look at preventable premature mortality, we know that smoking is a huge driver around that. We need to think about this across the life course. If we can stop the harms that second hand smoke causes to children, we can then think about deprivation across the life course and people who are dying early from preventable harms, with smoking being one of the risk factors.

We need to focus really narrowly on that, because it is not just about life expectancy, but about the number of years we live in good health. In my patch across Gwent in Wales there is huge variance, with up to 14 years’ difference in healthy life years between the richest and the poorest parts of the population. It is about not only the health outcomes around that, but the economic part of it, in terms of work productivity and work days lost. When we think about the cost of the NHS, which we often do, that is the cost of healthcare, but if we look at the economic picture of employability, productivity and those kinds of things, it increases that sum tenfold. We need to think about this so that when we look at the inequalities associated with smoking, we do so through a social, cultural, economic and environmental lens, to ensure that we get the full cost impact. It is something that we need to be mindful of.

Alison Challenger: I wanted to make a point about household income. We know that cigarette smoking is incredibly expensive. If one or both parents smoke in a household with a low income, that will have a considerable impact on the family’s spending capability for other things. It is not a matter of choice, either; smoking is an addiction. Seven out of 10 smokers really do not want to smoke, but it is incredibly difficult because of the level of addiction. If one or both parents smoke in a family household, that has huge repercussions for the funding of all the other household commitments.

[Sadik Al-Hassan]

Q We have touched on local variations. How do you think local variations should take into account the small variations in health inequalities that exist in different areas? You gave an example of a shop being the only shop in a village, but if that village was also an area of high deprivation, how should that affect the outcome?

David Fothergill: That is where local knowledge comes in. Taking that shop in the village, we would not say that it should not sell tobacco, but we would say that it should not be selling tobacco during these periods—for example, 8.30 am to 9.30 am, or 3.30 pm to 4.30 pm. Knowing the local communities and being able to put in local restrictions would help us to really have an impact. Clearly, in urban areas it would be very different.

When the Minister asked questions about England, Wales and Northern Ireland, I should have said that what we would really like to see—it is in the Scottish legislation—is verification, where people are required to verify their age. Challenge 25 seems to work really well with alcohol, and we would like to see that brought in. We understand that that is in the Scottish legislation, and we would like to see it brought in in England as well.

[The Chair]

If there are no further questions from Members, I thank the witnesses for their evidence today, and we will move on to the next panel.

Examination of Witness

Professor Linda Bauld gave evidence.

--- Later in debate ---

[Mr Barros-Curtis]

That is really helpful. Thank you.

[Sadik Al-Hassan]

Q We have spoken a bit about the gradual change and about that preventing uptake, but how does the gradual change in the age of sale affect the impact on tobacco and vaping behaviour, compared with increasing the age of sale in one go? That is based on comments we have heard about the difficulty in asking people’s ages at 34 or 35—I think most people have no problem knowing I am old enough for most things nowadays.

Professor Linda Bauld: That is an interesting question. My colleagues at UCL did a study that looked at what happened when they raised the age of sale from 16 to 18. I have to be honest with you: at the time, the tobacco control research community would not have pointed to that as the most ambitious measure that you could do; we did not think that changing the age by just two years would make an impact. But, from the data, it actually created 1.3 million more people who could not be sold cigarettes. We also know that, at the same time, due to the action on illicit tobacco, which is really important, the amount of illicit tobacco consumed fell by about 25%. So it is about those two things in partnership: tackling illicit, which of course is really important, and changing the age of sale.

The promise of the smoke-free generation is more ambitious, however. Rather than just raising the age of sale by a few years, we are gradually changing it over time. That protects future generations, because we do not have the big jump to being suddenly ineligible to be sold cigarettes. To go back to the evidence in the annexe to the legislation, which shows the modelling done by my colleagues for the Department of Health and Social Care, it looks pretty robust. I think that this will have a big impact over time. I hope that is helpful.

[The Lord Commissioner of His Majesty’s Treasury (Taiwo Owatemi)]

Q We have spoken briefly about this. Are you concerned that introducing a generational ban on cigarettes might cause other forms of tobacco use to increase among younger generations?

Professor Linda Bauld: That is interesting. I think a similar question was asked earlier. I do not think that history bears that out. Often, a concern is that if we take action on one product, we displace youth use to other products. With action that we have taken on smoking over the years, we have not seen a dramatic increase in, for example, youth alcohol use or use of other legal products. There are still major issues with young people consuming alcohol but, actually, the number of young people drinking at harmful levels has reduced in recent years, at the same time as tobacco measures have been introduced over time.

I do not think that we will see a big displacement to other substances by introducing this set of measures, but we need to keep our eye on getting that balance right. In terms of the other products that we are concerned young people might use—obviously, there are illegal drugs, which we have separate legislation on, and we need to keep an eye on alcohol control for young people—all those things need to happen together. But I have not seen any evidence to suggest that taking this kind of action will cause some other public health issue that we need to be overly concerned about.

--- Later in debate ---

[Sarah Bool (South Northamptonshire) (Con)]

Q To build on a point my hon. Friend the Member for Sleaford and North Hykeham made a moment ago, the Scottish Grocers’ Federation has indicated in some of the information it sent to us that, in its latest crime report, the most prevalent cause of threatening behaviour in stores is the refusal of sale and asking for proof of age. I am concerned about that rise in retail crime and what more can be done. I know that the education piece is needed, but is any thought being given to how we can further prevent some of these problems?

Lord Michael Bichard: It seems to me that it is now such a part of life that it is not as big a problem as it was; I think it is a problem that will diminish.

Wendy Martin: Certainly the retail violence is of concern and has been well publicised. It is clearly a policing issue rather than a trading standards issue. I guess it needs activity to make sure that everyone understands what is being done and why it is being done, and to make sure that there is a policing response, if possible, where there are issues. I know that local authorities work through community safety partnerships and things like that in local areas if there are particular incidents. Again, it is not specifically a trading standards response, but local authorities and local police forces will work together to do their best to address these things, because nobody wants anyone to be threatened with violence.

[Sadik Al-Hassan]

Q Thinking specifically about vapes, do you feel that this Bill goes far enough in providing tougher regulations and more resources for enforcement, while balancing the burden on businesses that probably have not had this level of regulation?

Lord Michael Bichard: We think it does. You have to look at the package, because you do not just have age regulation or display and promotion regulation; you also have the proposal for licensing—which, by the way, we do not see trading standards being equipped to do; that is a local authority business and, as a former local authority man, I would have to say “with the resources”, because there is always a danger that you give local authorities more power but you do not give them the money.

You have regulation, you have licensing and you have registration of products. If you put all that together, I think it is quite a powerful package, but it does need to be backed up with the resources, because it is delivering it that really matters. We are all used to legislation that sounds great and never gets delivered.

Wendy Martin: I agree; we think the balance is there, hopefully with good communication to businesses. Again, in a similar way, this is not going to be entirely new territory—certainly for those businesses that are already involved in the sale of alcohol and tobacco in particular—in understanding where to go for support and the kind of controls that are in place. Certainly, if the changes are made to the product registration scheme, which should then make it more effective for businesses to be able to check that a product they are stocking is legal and compliant—if the package is right, as Michael said—it should not be too complex for businesses to comply with it.

[Tristan Osborne]

Q I have two questions. First, on digital taxation, I understand that under the previous Government, in March, vapes were to become digitally registered—with a digital tax—which should make it easier to identify fraud and misaligned products effectively. Is there any commentary around the implementation of that? Have you seen that come forward? Are you working with HMRC on the sort of digital tax regime around that? Do you think that that is important, in your job, to reduce fraudulent products?

Secondly, in the United States, you can have products with up to 60 mg-worth of nicotine; that is a standard product in the United States. In the UK, it is 20 mg, or significantly less. Is there an awareness within trading standards of just how much we are potentially out of kilter with some of the key markets that we are aligned to? Our limit is significantly lower than those of other major economies, so do you think that we might therefore have a problem with products perhaps coming in from other sources that are not the same as tobacco? Is that a concern for your Department?

Lord Michael Bichard: I will pass that one to Wendy, if it is not unfair. On the first point, you are right that we think that that is going to make regulation enforcement easier but I will have to leave the second question to Wendy, I am afraid.

Wendy Martin: Just to reinforce Michael’s point around the digital stamps, I am not close to this myself, but I know that trading standards colleagues who are operational experts in this field are working in response to the various HMRC consultations about the implementation of excise and tax stamps, and those sorts of things. I know those conversations are happening, and I think the view is that that kind of simple identification is really important for trading standards.

In terms of the 60 mg versus 20 mg, I am afraid I do not have any detailed knowledge of that personally, but I would certainly anticipate that those kinds of challenges and issues would be built into the guidance and information being put to officers and any planned training programmes once we know the final form of the Bill, the excise duty and all the other changes coming over the next few years as the Bill and other legislation progress. I am sorry that I do not have a detailed answer.

Lord Michael Bichard: But we can get it for you.

--- Later in debate ---

[Andrew Gwynne]

Q I can assure you that there will be consultation with the sector. What would you want to see from a licensing scheme? Are there any lessons from supporting the implementation of alcohol licensing, for example?

Inga Becker-Hansen: We would like to see a licensing scheme as a level playing field where small, independent and larger retailers are viewed on the same level. Again, we would encourage the multi-stores to require only one licence rather than looking at individual premises licences, because that will make things more difficult.

In terms of the tobacco scheme, ideally things would be grouped together so that there is less administrative burden and therefore less cost for retailers, so that, if the aim for the Government is to transfer from the idea of selling tobacco to people to selling vapes because of the health benefits, that transition is made easier for retailers. Adding on an additional licensing scheme with additional costs and a separate administrative system makes it more difficult for retailers to handle those things at the same time, particularly smaller retailers and independents.

[Sadik Al-Hassan]

Q We talked a little bit about the new licensing scheme’s impact on retailers, and you have talked about a level playing field. You say that large companies should have one licence across multiple branches. How does that balance the risk that these measures will disproportionately impact small and independent retailers, which will have to apply for a licence for every individual premises?

Inga Becker-Hansen: It is a bit difficult for me to give you specific details, but in initial response my thinking would be that it would be a discussion between retailers and their primary authority and how that is handled, bearing in mind smaller retailers versus larger retailers. I am happy to follow up in writing and give evidence that way, but I cannot give specific details currently.

[Sadik Al-Hassan]

Q From my point of view, if I had one shop, I would have a larger burden with an individual licence. If I had 1,000 shops, I would have the same burden. That does not seem to balance on the proportionality of it. Do you think the best way forward is to have one licence for large groups and one licence for small shops?

Inga Becker-Hansen: Again, I cannot give a conclusive answer at this point, but if you have different shops under one retailer that have different licensing schemes, it devalues customer confidence in the products they are selling across the country, if that makes sense.

[Sadik Al-Hassan]

Q I can understand how it would increase complexity for a large retail organisation, but I cannot understand how it will individually affect the confidence of an individual consumer who goes into that shop.

Inga Becker-Hansen: Okay.

[Sadik Al-Hassan]

Q Would you like to explain how it would affect the confidence of the individual going into that shop?

Inga Becker-Hansen: If you have certain branches of a certain brand selling alcohol in one shop, and then in another shop, they are selling alcohol and vapes, when you are going to purchase your product, you will think, “Okay, I will just pop to the shop”, but they may not have exactly what you need. But if you see it as a national product per se for the brand, then you have confidence in going into the retailer.

[Sadik Al-Hassan]

Q The only thing I would say to that is I can go into a small Tesco and it sells different things from the other small Tescos.

Inga Becker-Hansen: Precisely. But then it should be up to the business or the retailer to decide that strategy for themselves rather than it being implemented.

[Euan Stainbank]

Q Do you believe the measures in the Bill,such as restrictions on advertisement, display and flavours, will prevent e-cigarettes from appealing to children?

Inga Becker-Hansen: It is difficult for the BRC to comment on that, given that we are not public health experts or behavioural economics experts. I would therefore ask that you confirm that with public health experts, rather than the BRC.

--- Later in debate ---

[Dr Beccy Cooper]

Q Thank you for coming along this afternoon. I want to hear a little more about the online issue—children purchasing vapes or perhaps being influenced to purchase vapes there. Given your experience as a headteacher and working in schools, how influential do you think the online environment is? Would you like to see the Bill develop more to look at that as it goes forward?

Matthew Shanks: Yes, I think the online area is hugely influential for children. It is where they spend a lot of their time—a huge amount of their time—so it would be really good if this Bill could look at that as well. I do not receive any online marketing adverts for vaping, but I am not 13 years old. I bet if I was, I would, so I think that is an element to look at.

[Sadik Al-Hassan]

Q You have listed a couple of bits, but do you think there are any further measures that would help to limit the appeal of vapes to children and young people?

Matthew Shanks: I think the appearance and location of vape shops are important, so there could be better regulation around that. We have talked already about sponsorship bans. We have talked about raising the age of sale for vapes. I think vape packages should have the same kind of warnings that cigarette packages have on them. I really think so, because at the moment, they do not—and why would they not, if it is a cessation? “You are going to stop that, but you could still get this, so actually, we want to stop that.” Ultimately, that is what we should be aiming for.

I think the young people parenting support provisions are engaged in that, because as I have said, parents see this as a way of enticing children back into school or helping them or taking away an argument. You have to appreciate that I am not criticising parents, because they have a tricky job to get them back in. They see this as something safe and think they are caring for their child, so if we make it clear that actually it is not, that will be really important.

I have talked about vape detectors being useful in schools, but would it not be good if actually these things were banned? Then they could not be there. From that point of view, I think it is important.

[Tristan Osborne]

Q My question is about price. In this Bill, we are looking to ban disposable vapes, which, as a former teacher myself, I used to see in toilet bowls and other exciting locations in secondary schools, sadly. Do you think that that is going to have a major impact in the form of kids perhaps not being able to afford these products, and so we will see a reduction? Do you think that the price differential is going to be an important factor?

Matthew Shanks: Yes, but not on its own. It would help, but people will find a way to get something if they want it—we know that. The price hike without the education might increase other instances of unpleasantness between people, such as bullying, bribing, theft and so on. It has to come alongside education. The whole message needs to be that vaping is not something for children to engage in. It is something to help people to stop smoking. That is my view and the view of educators.

--- Later in debate ---

[Taiwo Owatemi]

Q May I ask one more question? What is the MHRA’s capacity to handle the increased workload that the new legislation will require?

Dr Laura Squire: With the current notification scheme, we have the resource that we need to do that. As the registration scheme becomes more detailed and demanding, and as there is more in it, I would expect that to require more resource. That is something that we need to continue talking to the Department of Health about as it develops the policy, and we will do that.

Also, as part of that, the impact on us will depend on not only what is in the regulation but who does it. I know that there are conversations about where it is best done, and there are registrations for other consumer products that already exist, so there are conversations happening with the Office of Product Safety and Standards. It is important to learn from those sorts of schemes that are already happening. Where that goes is a policy decision for the Department of Health and Social Care, and we will continue to work with it. I think it would also involve being clear about what resources we might need if we carry on and need more. At the moment, we have what we need to do what we need to do under the current law.

[Sadik Al-Hassan]

Q When we give a new medicine to somebody, we give them advice and explain what it is and what it is safe to do with it. When people get vapes, do they get the right level of information and advice about what that product actually is and about the risks?

Dr Laura Squire: They would do if it was a licensed product.

[Sadik Al-Hassan]

Q I thought you said that there are no licensed products on the market?

Dr Laura Squire: There are not, which is why that is the way we would prefer to do it. Again, if we licensed these consumer products as a medicine, there are very strict requirements on labelling and on what needs to be given to the patient to explain what the product is and its risks. That is not there with these consumer cigarettes. It is going to get stricter under the new rules, but my preference would be that we give people more information.

[Dr Ahmed]

Q Thank you, Dr Squire, for being with us. The Royal College of Physicians has called for manufacturers to limit the production of toxic substances and for the MHRA to independently verify some of the contents of e-cigarettes. Do you think that that can be achieved through the measures in the Bill as it stands?

Dr Laura Squire: It depends on what happens with the actual regulations. At the moment, we do not have powers to test consumer e-cigarettes—that power sits with trading standards. Again, if we license something as a medicine, we go into absolute detail about what is in it. At the moment, it depends on what is in the regulations that come round. We do not do testing at the moment, and it would be important to think about the point at which any testing is done. If it is done at the point where something goes on to the register, that is fine and it tells you that the sample we saw at that point was compliant. But what happens later down the track? I think the role that trading standards has in doing that testing is really important, because it can do it post-market at any point. The question really is about the role of the MHRA—a medicines and healthcare products agency. Is it getting deeper into these consumer products where the risk is not outweighed by the benefits? That is an uncomfortable position for a medicines regulator.

--- Later in debate ---

[The Chair]

I think Mr Al-Hassan wants to come back in.

[Sadik Al-Hassan]

Q Thank you, Chair. In a couple of your answers it seemed that you were almost putting the point that maybe a vape should be a medicinal product. Is that the view of the MHRA?

Dr Laura Squire: I do not have a view on whether a vape should be a medicinal product. I have a view on the role of the Medicines and Healthcare products Regulatory Agency in regulating products that are not medical products, which is a little confusing at the moment. As I said, when something is a medical product, as with any medicine, you would not take it if you were not ill, because the benefits are not outweighed by the risks. That is really my point. I am pleased to see the strengthening in this area. There are conversations that are still to happen, as the consultation goes through and we understand exactly what the new registration scheme will involve, as to the best people to do this, to give the right message out to the public.

[The Chair]

Are there any more questions to this panellist? If not, I thank Dr Squire on behalf of the Committee. I am sure that a lot of your evidence will be taken into consideration.

Examination of Witnesses

Professor Steve Turner and Professor Sanjay Agrawal gave evidence.

--- Later in debate ---

[Sadik Al-Hassan]

Q From what I remember, vapes really started in the UK around 2010. Do you think that the Bill is sufficiently future-proof for the next evolution of nicotine or oral tobacco products? Whatever is coming next, do you think the Bill has enough to protect us from it?

Professor Sanjay Agrawal: I have not yet had the chance to say this, but first, I think the Bill is really well balanced. It is bold and world leading; all nicotine products and non-nicotine containing vapes are part of it. The people who put this together should be congratulated, but we also have to be aware that industry never sleeps. It will try to adapt to regulation and legislation, and we need to be wary of that and make sure that we use the powers in the Bill in the future, depending on how industry responds.

For example, with disposable vapes, which are due to be banned later this year, I am sure that there will be a lot of companies right now changing their products to make them look as though they are not disposable vapes when, to all intents and purposes, they are. There will be lots of adaptation by industry that we must be wary about. The Bill provides those future powers for us to adapt to industry.

[Mary Kelly Foy]

Q As we know, we have very high levels of child poverty in this country. Much of that poverty is in the areas where there is high smoking prevalence, as well as many other health issues. How important do you think the Bill is for the health of children as they grow into adulthood, for the impact that it will have on the communities they live in, and for addressing inequality?

Professor Steve Turner: Touching on what I have said before, there are communities, invariably the poorer communities, in something called the tobacco map. If you look at the areas where tobacco use is greatest, it maps totally on top of deprivation. We have an opportunity to break that generational social norm of, “It’s okay to smoke.” The people who come to the greatest harm from cigarette smoking and nicotine addiction are invariably the poorest. What is proposed here will be a good step towards narrowing the divide we see in this country in health outcomes, which is totally determined by poverty.

Professor Sanjay Agrawal: We estimate that around 350 children a day start to smoke. A lot of those will be from the most deprived communities. In addition, smoking in the UK brings around a quarter of a million families into poverty, and those families have children. The Bill will go a long way to not only reducing the health harms to individuals, but reducing poverty and hopefully smoking-related deprivation.

To answer one of the questions earlier about the cost of smoking to the NHS, it is estimated that it costs secondary care about £1 billion a year. With primary care in addition, that is a total cost of £2.6 billion to the NHS, around £20 billion a year to social care, and about £50 billion a year in lost productivity. That is the overall cost of smoking to our society, whether at the level of the individual, poverty, deprivation, social care or workforce productivity, and that is why the Bill is so important.

Community Pharmacies: Devon and the South-west

Sadik Al-Hassan Excerpts

Tuesday 17th December 2024 Westminster Hall

[Sadik Al-Hassan (North Somerset) (Lab)]

It is a pleasure to serve under your chairship, Mr Betts.

Over the past two decades I have had the privilege of working in a range of community pharmacies across the south-west and elsewhere. I thank the hon. Member for Tiverton and Minehead (Rachel Gilmour) for the best birthday present I could ask for: an opportunity to talk about a passion that has defined my life and that I am still proud to practice today. I started my journey in community pharmacy studying at that pearl of south-west education, the University of Bath, more birthdays ago than I care to admit. From there, I went on to work in community pharmacies across the region, from Bideford in north Devon to the heart of Bristol, and even in Clevedon—a town I am honoured to represent as its Member of Parliament.

During my time working in village pharmacies, town pharmacies and even online pharmacies, I was witness to the irreplaceable value that pharmacies and their teams provide to some of the most vulnerable in our society. I am sad to say that I also experienced many of the challenges that the sector now faces. Indeed, it was living with those challenges and seeing the unnecessary suffering caused by the decline of community pharmacies that prompted me to run for Parliament earlier this year.

Over the past two decades working in community pharmacies across the south-west, I have seen at first hand the consequences of 14 years of pharmacy neglect by the previous Government, not least through their bad Brexit deal. By weakening our co-operation with our nearest neighbours, we have cut off the supply of pharmacists coming from Europe, we have greatly exacerbated our supply chain issues, resulting in medicine shortages, and we have contorted the Medicines and Healthcare products Regulatory Agency into a role it was never designed for and has since failed to live up to.

Undoubtedly the worst thing the previous Government did for our industry was freeze the funding settlement for 10 years, resulting in a 40% reduction in real terms. With ever-growing demands on prescribing and the introduction of the new role for pharmacists with Pharmacy First, the Conservatives prescribed pharmacy a tough pill to swallow and it will take years to undo the side effects. That is why we must not waste any more time. We must stabilise the sector today with a fair funding settlement while we begin the arduous task of reforming the role of pharmacy and the role it plays in our healthcare system.

Pharmacy First was a good step but, with only seven conditions eligible for treatment, it falls far short of Wales’s 27 and Scotland’s 30, with the scheme in England fraught with issues, not least in payment. Although the obvious priority is to expand Pharmacy First and relieve pressure on GPs, we must first expand pharmacies’ capacity, which can be done only by finally implementing the hub-and-spoke legislation that was inexplicably shelved in September without warning or explanation.

Hub-and-spoke model 1 would allow smaller independent community pharmacies finally to take advantage of the technologies that larger chains have been using for decades, thereby greatly increasing their efficiency and freeing up time previously spent on dispensing to be used for the delivery of clinical services to patients under an expanded Pharmacy First scheme.

I am eager to see this Government avoid the mistakes made during the past 14 years that have brought the sector to crisis point. I thank the hon. Member for Tiverton and Minehead for securing the debate, and the Minister for listening to our concerns. We have a once-in-a-generation opportunity to rewrite the story of pharmacy, which has a long and rich history of healthcare provision in this country but now faces an uncertain future, with some in the sector concerned that we might not survive past 2039.

The prescription for pharmacy is an immediate funding settlement for this year to stabilise the sector with a sticking plaster while we look at the longer-term changes the industry needs. Having been on the ground for the past 20 years, I am here to say that pharmacy has cut every ounce of fat that can be cut, and all that is left is bone. Without advancing the modernisation agenda, the sector has no more efficiencies to make. For that to happen, we need the Government to commit to implementing the hub-and-spoke model to increase capacity, and to expanding Pharmacy First to use that capacity. Pharmacy has an important future role to play in relieving pressure on other parts of our healthcare system, but it can play that role only if we proactively engage with the sector, rather than leave it out in the cold for another 14 years.

--- Later in debate ---

[Vikki Slade (Mid Dorset and North Poole) (LD)]

It is a pleasure to serve under your chairmanship, Mr Betts, particularly because I speak after the hon. Member for North Somerset (Sadik Al-Hassan) indicated that it may be his birthday, which means that he and I share our birthday with the Pope.

[Sadik Al-Hassan]

I congratulate the hon. Member on having the best birthday.

[Vikki Slade]

I thank the hon. Gentleman for that intervention.

Like my colleagues, I get a lot of correspondence about community pharmacies, which comes from my constituents and also from the pharmacists of Mid Dorset and North Poole. One of my constituents, Ruth in Wimborne, visited Quarter Jack Pharmacy for me at the weekend to get some data. I asked her to get some examples of drugs for which the price differential between what was paid and what was reimbursed was particularly high. The pharmacist gave her a whole list of drugs for which the money received was substantially less than what he got. He said that the precise amount varied from week to week, including for apixaban, which is prescribed to prevent strokes and which presumably saves the NHS a lot of money. Does the Minister agree that that is unacceptable? What commitment will he give to update the contract urgently?

On the medicines shortfall, I cannot tell Members how many people have told me about having to go around the county to try to find the medication they need. Patients with epilepsy, attention deficit hyperactivity disorder, Parkinson’s and sight loss have all contacted me worried about their health. David explained his issue with epilepsy, which is that stress can increase the chance of seizures. I have a personal example: my husband Paul also has epilepsy, which is controlled by drugs, but if he has one seizure, he will lose his driving licence again. He has just got it back after two years and I really do not want to be driving him around. The idea of people being unable to work or drive is mad. The list of medicines available under prescription includes epilepsy, but not Parkinson’s. Does the Minister agree it is high time that the list was updated, given that it was last changed in 1968?

There has been a recent consultation on allowing non-pharmacists to give out bagged medication, and on pharmacists being allowed to give approved persons the right to issue medication. I wrote to the Minister to ask when we were going to get a result and was told that it was still being considered, so I really hope that, today, he might give us a timeline for when we can expect that for our pharmacists.

Finally, in one of my local villages the GP dispenses out of a side window of the surgery, with patients expected to wait in the cold. When I asked why they could not reduce this inconvenience for patients, who are often out there for 45 minutes, I was told it was because they cannot make up prescriptions for three months instead of one because they get paid per prescription and not for the drugs, so the GP would be out of pocket if they made the prescription for three months. That seems outrageous. If it is true, will the Minister urgently review how that works so that dispensing GPs and pharmacists are not out of pocket for providing a better service to their patients?