Health Bill

Sarah Bool Excerpts

2nd reading
Monday 1st June 2026 Commons Chamber

[Sarah Bool (South Northamptonshire) (Con)]

As an active user of the NHS, I welcome steps that can be taken to help improve patient experience and care, but the NHS is a delicate ecosystem: mistakes and errors do not just lead to a loss of money—they can be life-changing and, quite literally, a matter of life or death—so it is absolutely essential that we get these changes right.

Conscious of time, I will focus on a few points that I want to raise. The single patient record has already been mentioned a number of times. There is no hospital within the boundary of my constituency of South Northamptonshire, so my constituents can be treated at a variety of hospitals, including Northampton, Milton Keynes, Kettering, John Radcliffe or the Horton. Working cross-county and across the country, I can see the value in creating a single patient record, ensuring that notes are available. It really could transform care co-ordination. For example, the wife of one of my constituents was almost given medication that would have killed her—she would have had an allergic reaction—because of the use of old notes. Only her husband’s presence saved her life. We cannot allow that in this day and age.

As the Royal College of Nursing has indicated, we must ensure that any new system has robust safeguards around data privacy, transparency, access, procurement and secondary uses of data. I acknowledge that the Secretary of State has put an emphasis on looking at that, but I think we all need more assurances. Even the Royal College of General Practitioners is asking whether the Government will provide any assurances around indemnity for GPs to protect against liability if there are breaches of data protection regulations or instances of mishandling patient records.

All in all, the single patient record will work only if the system has the confidence of patients and staff. Nursing staff have been asking through the Royal College of Nursing if they will be involved in the creation and design of the single patient record, to make sure that it will actually work in practice. Will the Minister confirm whether that will be the case?

Without careful safeguards, structural changes could risk undermining some of most significant advances that we have seen in recent years. As many Members will not fail to know, I am a type 1 diabetic and I will always passionately talk about diabetes. Diabetes UK has highlighted concerns about some of the changes. We have seen some incredible movements in diabetic technology, including the development of continuous glucose monitoring and, most recently, of hybrid closed-loop systems, which I am wearing and using as I speak. Central co-ordination has ensured that funding agreements are secured and access is prioritised. A shift to purely local decision making risks fragmentation and widening inequalities.

Many new treatments are being created and progressed. For example, I introduced a ten-minute rule Bill about type 1 diabetes screening in children. We need to ensure that this is prioritised, along with access to emerging immunotherapies. As this is an incredibly specialised area, it requires expert national oversight and co-ordination. It would be inefficient and potentially ineffective for such developments to be pursued on a purely local basis. We want to ensure that we do not see any progress falling through the cracks as changes are made.

Finally, I want to touch on patient voices. The abolition of Healthwatch England has been mentioned numerous times during the debate. Many patients have to be incredibly vocal about the care that they need. Often, they cannot make those points as strongly as we might, so it is vital that we maintain bodies that can speak on their behalf, especially those that ensure the voices of young children and youth are prioritised. I am supportive of some of the changes that are coming, but we do need to exercise some care and caution.

Type 1 Diabetes: Infant Testing

Sarah Bool Excerpts

Monday 9th March 2026 Westminster Hall

[Sarah Bool (South Northamptonshire) (Con)]

It is a pleasure to serve under your chairmanship, Sir Alec. I start by paying tribute to Lyla Story, a little girl whose death, aged two, from undiagnosed type 1 diabetes has brought us here today. I wish I could have been giving her a tour of Parliament rather than talking in this capacity, but her name will go down in the history of Parliament, in Hansard, because of the dedicated work that has been done. I pay tribute to her parents, Emma and John, who are with us in the Gallery and who have campaigned tirelessly to raise awareness of this condition. I commend their courage and determination in the face of such grief. I think they have much greater strength than many of us would have in a similar situation.

If I had been asked about diabetes five years ago, on 9 March 2021, I would probably have said that my auntie had it, and that it was due to poor diet. If I had been asked the same question on 21 May 2021, I would have given a completely different answer. The change is that I was diagnosed as type 1 diabetic at the age of 33. In the space of 24 hours, from going for a blood test for something innocuous, my world entirely changed, and I was rushed into A&E to be given emergency care.

Like many people outside this Chamber, I had little to no knowledge of type 1. The concept of the four Ts—“tiredness”, “thinner”, “thirst” and “toilet”—were unknown to me. The fact that I started losing weight quite quickly was a bonus, I thought. I did not realise what the signs meant. The fact that 400,000 people in the UK have type 1 was news to me, and that more than one in four children with type 1 diabetes are diagnosed when they are in diabetic ketoacidosis was shocking.

What is diabetic ketoacidosis? It has been mentioned a few times today, and it is a complication that develops when the body lacks sufficient insulin, leading to high blood sugar levels and the breakdown of fat and muscle for energy. This produces harmful chemicals, known as ketones, that make the blood acidic, which is what proves fatal.

The petition before us today seeks to make testing for type 1 diabetes in babies, toddlers and young children a routine part of medical assessments at the point of care. John Story is also seeking to have the NICE guidelines on type 1—NG17 for adults and NG18 for children—updated to include performing a finger-prick test on site at the initial GP appointment, with blood glucose tested using a glucometer. That would occur when a child or adult presented with any symptoms consistent with type 1 diabetes. He would like to see a “test, don’t guess” approach, which we have seen be quite effective for meningitis—we know the signs—and sepsis, so I fully support this concept.

NICE has been receptive to making these changes, but ultimately it will be for the relevant NHS commissioning bodies to put the NICE recommendations into practice. We therefore have to look to NHS England and the Department of Health and Social Care to take up this campaign around increased visibility and testing of diabetic ketoacidosis. I echo the question asked by my hon. Friend the Member for Bromley and Biggin Hill (Peter Fortune): with the disbandment of NHS England, what will we be doing in that regard?

[Peter Fortune]

My hon. Friend is making an excellent and passionate speech. I think we all here agree that we need to do more to ensure that those with type 1 diabetes get the support they need. While we are here, does she share my concern that 90% of people diagnosed with diabetes are diagnosed with type 2 diabetes, and the total cost of that care in the UK is about £11 billion? Alongside the important support that we give to those with type 1 diabetes, we should be doing more and taking action to ensure that people do not develop type 2.

[Sarah Bool]

My hon. Friend is absolutely right that 90% of cases are actually type 2. That is probably also why we fail to understand the true signs of type 1, because there is real confusion and conflation of the two. I think it would actually give clarity if they were named slightly differently.

My hon. Friend is also right that a tsunami of cases of type 2 will be hitting us in the years to come, and we have to do a lot more to raise awareness of that, whether that is about diet or by sharing the technology. Many of us are trying to be visible in wearing the technology and the patches, such as FreeStyle Libre and Dexcom. I think that is very good for removing the stigma and helping people to understand what we need to do in the future. We definitely need to see that tech rolled out for type 2, as well as for type 1. It can still be a bit of a postcode lottery for type 1 at this stage, which is something else that we have to work on.

We must not just rely on some of the jabs that have recently become popular. They are a means of helping people to lose weight, which can be a significant part of type 2 diabetes, but they may not be the answer. There are events going on at the moment, saying that we should exercise some caution and make sure that any jabs that are taken are actually legitimate and proper, and not counterfeit. That is a sad side of this: people are seeking medical treatments that could also be harmful.

To go back to type 1, I have managed to secure today that I will introduce a 10-minute rule Bill on Tuesday 14 April to make provision for a universal national programme of screening for type 1 diabetes in children, building on all the work that John has been doing. I am working with medical professionals and charities, including Breakthrough T1D—as it is now called—and Diabetes UK, to look into the Italian model that was mentioned, in the hope that we can one day establish a programme that would catch type 1 before symptoms appear, transforming how we diagnose the condition in the future and helping people to prepare earlier.

A lot more research is needed, because the key thing is the age at which someone can be diagnosed. We are working on three potential age ranges at which there would be repeat tests. That is vital and fundamental for the future, to make sure that we do not have one in four children being diagnosed when in a state of DKA.

In the meantime, I reiterate what the hon. Member for Harrogate and Knaresborough (Tom Gordon) said: we want to see the four Ts built into training and education for all healthcare professionals. The four Ts are very important, but that does not necessarily mean that someone has to have every single one of those symptoms. I did not obviously show the signs of all four Ts, but when I had an HbA1c of 95—[Interruption.] That reaction! To put that into context, a normal person might have an average HbA1c of 20, while the threshold for diabetes is 48; I was at 95 at that stage. My ketones at the point of diagnosis were 2.7. At 3, you are at risk of going into DKA, and anything higher—I understand that Lyla may have been at 6 at the point that she was diagnosed—is critical. Clearly, I was very ill, but I had not picked up on all of those signs; I was not aware. Nevertheless, it is important that we have the four Ts in mind, at least as a baseline.

We also want to make sure that all GP practices actually have the finger-prick test—the glucometer—available. Numerous practices have been contacted and they do not always have that, which I think is quite shocking. As a baseline, we also need to make sure that provision is there.

As John has been campaigning hard for, we want to see the NICE guidelines updated to make sure that this is in the mindset of all our medical practitioners. We also want to see it in the personal child health record—the red book—and within the digital Best Start programme. We the CQC’s role in diagnosing type 1 in primary care to be clarified and strengthened—for example, inspections could assess whether staff receive appropriate training.

We want local commissioners to commit to learning from incidents where type 1 is missed. We want NHS England—or whatever the equivalent is when that is disbanded—to work on this further, and we want the Department of Health and Social Care to review opportunities for national initiatives to drive improvements, such as the Getting It Right First Time programme.

Everyone should rest assured that there are many fantastic representatives in Parliament who are type 1, and we will continue to fly the flag: my right hon. Friend the Member for Louth and Horncastle (Victoria Atkins), who sitting in front of me, is type 1; Mr Speaker is type 1; and, of course, Baroness May in the upper House has been a fantastic advocate over the years. I hope that we can also work with some more celebrity figures, whether that is Nikita on “Strictly Come Dancing”, the actor James Norton, the rugby player Henry Slade or the comedian Ed Gamble. There are figures out there, and we just need to make it much more visible and approachable.

Type 1 diabetes is not a scary condition—although it is a very difficult one, don’t get me wrong. We live with it 24 hours a day, whether we are too hot, too cold, tired, stressed or whatever. From what we are eating to when we are exercising, there is a lot we have to think about, but it is completely manageable with the right support. I want to end my speech with the memory of Lyla and say thank you to John and Emma for their efforts. I say to everyone: please remember those four Ts—“thirst”, “toilet”, “thin” and “tiredness”.

[Sir Alec Shelbrooke (in the Chair)]

Order. I will now set a two-minute limit, because I will be calling the Front-Bench speakers at 7 pm and I am keen to get all colleagues in.

Oral Answers to Questions

Sarah Bool Excerpts

Tuesday 13th January 2026 Commons Chamber

[Stephen Kinnock]

My hon. Friend and I have discussed this matter. I hope that her issues in accessing the commission, which I know has made contact with her, have been resolved. The commission is, of course, an independent body, but I am in no doubt at all that parliamentarians will hold it to account through the mechanisms at their disposal—the Select Committee, for example. The Government are not sitting on our hands; we are delivering the fair pay agreement, we have delivered the biggest uplift to unpaid carers since 1976, and we are pursuing a range of other measures to get our adult social care system fixed and fit for purpose.

[Sarah Bool (South Northamptonshire) (Con)]

We have just been notified that William Blake House in my constituency—a residential home for people with severe learning disabilities—has been issued with a winding-up notice, and the court hearing is tomorrow. The families were given no notice of any of this, and no consultation was carried out, so naturally they are worried about what provision will be in place for their loved ones. Will the Minister meet me urgently to discuss putting a contingency plan in place for them?

[Stephen Kinnock]

I thank the hon. Lady for that question. I am not familiar with the details, of course, so might she write to me with the clear details? I am sure that officials will then take the matter up as a matter of urgency.

Oral Answers to Questions

Sarah Bool Excerpts

Tuesday 17th June 2025 Commons Chamber

[Karin Smyth]

Such contraceptives are an emerging technology that will be subject to clinical and other relevant assessment before being considered for use in England. The Government remain committed to ensuring that women can access their preferred method in a timely manner. A range of contraception is available free of charge from a range of settings. That includes a copper coil, which is a non-hormonal, non-steroidal contraceptive device.

[Sarah Bool (South Northamptonshire) (Con)]

In Prime Minister’s questions last week, I raised the need for a universal national screening programme for type 1 diabetes. Will the Secretary of State agree to meet me to discuss this, so that it could form part of the 10-year plan, given that it fits so neatly into prevention of issues such as diabetic ketoacidosis over treatment?

[Wes Streeting]

I was in the Chamber to hear the hon. Member’s question. Obviously we are led by clinical advice when it comes to decisions on screening programmes, but I understand the case she makes. I would be delighted to ensure that she gets a meeting with the relevant Minister.

Type 1 Diabetes and Disordered Eating Services

Sarah Bool Excerpts

Wednesday 5th March 2025 Commons Chamber

[Josh Newbury]

It is a pleasure to take my first intervention from the hon. Gentleman. I pay tribute to him for his campaigning on this issue and the personal experience that he brings to the House. I will come later in my speech to my experience of mental health services. I absolutely agree that we need to ensure that people with type 1 and type 2 diabetes have all the support they need for their mental health and managing their condition.

For some, type 1 diabetes morphs into a the deeper challenge of disordered eating—it is not difficult to see how that can happen. Given the strict attention to diet and nutritional information that type 1 diabetes necessitates, unhealthily restrictive and avoidant approaches to food can sometimes, at least to begin with, be indistinguishable from healthy diabetes management. As we know, in some cases, one side effect of insulin-based treatment can be weight gain. That leads some people with type 1 diabetes to realise that by restricting their insulin intake, or even stopping it altogether, they can essentially eat what they like and lose weight. However, the medical consequences of that are stark, including kidney problems, bone wastage, amputations, blindness and even death.

One of the most insidious aspects of T1DE is how difficult it can be to identify until its devastating consequences for both physical and mental health begin to manifest themselves. People suffering with T1DE often say that the isolation that comes with trying to navigate both a chronic illness and disordered eating is unimaginable for anyone who has not experienced it.

[Sarah Bool (South Northamptonshire) (Con)]

I thank the hon. Gentleman for securing this debate. As someone with type 1 diabetes, having been diagnosed only four years ago I completely understand the feeling of isolation just from having diabetes, let alone having to deal with disordered eating as well. Does he agree that we need to destigmatise both conditions, so that we can ensure the right support for patients?

[Josh Newbury]

I completely agree with the hon. Lady, and I thank her for the lived experience that she brings to this House, and for how candid she has been in sharing her experiences. I could not agree with her more.

Many people are falling through the cracks of a system that often fails to recognise the unique needs of people who live with both type 1 diabetes and disordered eating. While disordered eating in those with type 1 diabetes is sometimes referred to as “niche” or “rare”, it is becoming increasingly clear that it is simply under-recognised, and it is often missed. Evidence suggests that up to 40% of women and girls, and up to 15% of men and boys with type 1 diabetes experience some form of disordered eating. That is a quarter of the 400,000 people in the UK with type 1 diabetes.

Department of Health and Social Care

Sarah Bool Excerpts

Wednesday 5th March 2025 Commons Chamber

[Sarah Bool (South Northamptonshire) (Con)]

The Government came into office making all the right noises about tackling waiting lists and delivering a better healthcare service, which all our constituents want to see. However, since their election, I am concerned that Ministers are giving out more money—about £22.6 billion —for the day-to-day running of the NHS, without plans about how that may be spent to reform our health service, make it more efficient and support priority areas, such as dentistry, general practice or hospice care.

The Government are seemingly giving with one hand but taking with the other. No one should overestimate the impact of the increase of the employer national insurance contribution on our GP surgeries. Both Towcester and Brackley medical centres in my constituency have said that that increase will cost at least £40,000 to £50,000 and may result in redundancies, stopping the growth of their practices. Our surgeries are not here to make profit, but to deliver care, and attacks like this make care unsustainable.

The Darzi report said:

“The NHS budget is not being spent where it should be—too great a share is being spent in hospitals, too little in the community, and productivity is too low.”

[Gregory Stafford]

I agree entirely with what my hon. Friend says, but has she seen anything from this Government that suggests that there will be a significant shift from acute care in hospitals to community care, despite the rhetoric that we have heard from the Government Benches?

[Sarah Bool]

I concur that I have not seen anything, which is why today’s debate is so important. My GPs tell me that more attention needs to be given to GP practices: they are the praetorian guard who can ultimately protect the NHS. Access to timely appointments is crucial, as is rebuilding the key relationship and contact between a GP and their patient.

[Josh Fenton-Glynn]

Under the last Government, 20% of NHS doctors were thinking about moving overseas. Does the hon. Lady agree that solving GP contracts is a first step towards keeping GPs working in this country?

[Sarah Bool]

I want to encourage all our GPs to remain in the UK, giving back, so I am always fully supportive of anything we can do about that.

[Ben Coleman (Chelsea and Fulham) (Lab)]

On that point, will the hon. Lady give way?

[Sarah Bool]

I will make some progress.

That key relationship and contact between a GP and their patient was reinforced by the Public Accounts Committee report on NHS financial stability, published in January, which concluded that a reallocation of funds was needed to focus attention from sickness to prevention.

I am a massive advocate of prevention. Many hon. Members will know that I talk about being a type 1 diabetic; if they have not heard me talking about it, they may have heard one of my sensors going off for a low blood sugar. There is so much we could do in preventative measures in the treatment of diabetes. Treatments can be expensive as an initial outlay, but they will solve many long-term problems. We cannot prevent type 1 diabetes, but we could have earlier testing in children, for example, so that we could avoid them being diagnosed when in a state of diabetic ketoacidosis, which can be fatal. Families could be prepared and ready, and children could avoid hospitalisation, saving costs to the NHS while also saving lives.

We can also ensure access to technology that can avoid huge complications. Poor blood sugar control can result in loss of eyesight and limbs, alongside heart and other conditions. Making continuous glucose monitors and even insulin pumps available across the country can significantly help the patient and, again, in the long term save the NHS money. At the moment there is a very unfair postcode lottery, so I ask the Minister to consider ways to tip the funding balance, to ensure both prevention and community care measures are properly funded.

Finally, any reforms to the NHS must consider the computer operating systems in place. Many of my constituents must go out of the constituency for their hospital care, be it to Northampton general hospital, the John Radcliffe hospital, Horton general hospital, Milton Keynes university hospital or Kettering general hospital, but all those trusts operate on different systems, with the result that my constituents often cannot have their scans or medical notes shared easily. That is frustrating for residents, and potentially fatal. One resident noted that his wife was nearly given a drug that she was allergic to, because her notes had not been able to be shared correctly—it was only his presence that saved her.

We must ensure that money is spent to look at that and to change the systems, which my hon. Friend the Member for North Cotswolds (Sir Geoffrey Clifton-Brown) has explained very conclusively. We owe it to our constituents to work across the House to better our healthcare and to support the fantastic work of our doctors and nurses.

[Madam Deputy Speaker (Judith Cummins)]

I will start to call Front-Bench speakers at 3.15 pm.

Tobacco and Vapes Bill (Thirteenth sitting)

Sarah Bool Excerpts

Committee stage
Tuesday 28th January 2025 Public Bill Committees

[Gregory Stafford]

I completely agree that we could very easily ban tobacco and vaping for everybody at every age. That would be the biggest incentive for people to quit. The Government—I think rightly—are not doing that, because they are not looking to criminalise people who are currently addicted to tobacco and vapes. If we are allowing people to do something legally, there should be places where they can do so safely and not harm others, such as their own children. I am sympathetic to the public health argument that the hon. Gentleman makes but, in practical terms, there may be areas where this is a problem.

My final point is really a question for the hon. Gentleman: under what regulations would the local authority be enforcing such byelaws? Would it be through the penalties and enforcement activities in this Act itself —if it becomes law—or would there be some sort of fine or penalty system that the local authority could use? While there are potential fines and enforcement activities on the face of this Bill, if there were local regulations, would these be in line with what is in the Bill, or would there be some other fining system that a local authority could dream up itself?

[Sarah Bool (South Northamptonshire) (Con)]

Taking on board what you said, Mr Pritchard, I just want to build on the point that my hon. Friend made about enforcement—I always talk about enforcement in practice. I want to know how rules will be advertised between different jurisdictions. I think we will end up spending an inordinate amount of money on trying to run a campaign that could have been better spent on helping with smoking cessation or on more practical measures.

[Dr Johnson]

My hon. Friend is talking about the enforcement and practicalities of such a move. If we have a national campaign and national uniformity about the areas in which one can and cannot smoke, that will be quite straightforward for people to understand and there will be no real excuses for breaking the rules. If the advertising has to be done locally, it will have to be continuous to reach all the visitors and tourists who come to that town or city.

[Sarah Bool]

I absolutely agree, and my hon. Friend makes a powerful point. I would like us to consider this issue when we look at whether to take these proposals any further. I cannot see how we can ensure in practice that everyone knows what is happening without there being a national campaign.

[Jim Dickson]

Perhaps I can try to answer a couple of the questions from the hon. Lady and other hon. Members. If a byelaw were enacted, it would need to be well publicised, and there would need to be signage. Clearly, it would be impossible for a local authority to enforce a byelaw against which the defence was, “We had no knowledge of the fact that there was a byelaw.” Therefore, doing those things would be very important, and that would obviously be part of the consultation. The local authority would also have to set out a plan, and it would ultimately have to be approved by the Secretary of State, who I am sure would ensure that it was adequate. In terms of the penalties, the local authority has the power to set out its own penalties, but only within the quite tight legal framework set out in the Local Government Act. It would be for the local authority in this instance to define the level of penalty and what was proportionate.

[Sarah Bool]

I thank the hon. Member for clarifying that point. Many Members would prefer that local councils were dealing with potholes rather than advertising those different spaces, but I thank him for his amendment and his proposal.

[Dr Johnson]

Amendment 14 defines a local authority as

“a county council…a district council, a London borough council, the Common Council of the City of London in its capacity as a local authority, the Council of the Isles of Scilly, a combined authority or a combined country authority.”

By the time we get to next summer, Lincolnshire will probably have district councils, a county council and a mayoral authority—I do not agree with having a mayoral authority, because I think that is too many tiers of government, but that is an aside. What if those authorities do not agree? If we give them all the power to make regulations, they could all make different regulations based on different opinions—as is currently the case in Lincolnshire, the various authorities are not always under the control of the same political party.

--- Later in debate ---

[Mr Barros-Curtis]

I am grateful for that intervention. I point the hon. Member to proposed new subsection (4), which reiterates that the Secretary of State “must consult” before any such regulations can be made. I am sure that will assuage his concerns about whoever the future Secretary of State may be, whether they are from this side of the House or, God forbid, the other side in a few decades’ time.

I will point out a couple of issues about the drafting of the amendments. Although I understand the position of Opposition Members, I think the proposals inadvertently cause issues and risk causing more confusion than may have been intended. For example, does

“an NHS property or hospital building”

include private healthcare providers that are undertaking NHS work either on NHS premises or off-site? What about subcontractors? When the amendment mentions

“a nursery, school, college or higher education premises”,

are we talking about where premises have had to be vacated because of the RAAC—reinforced autoclaved aerated concrete—crisis and where children are being taught in portacabins in a council car park, one or two miles away from the original site? These definitions are lacking and may inadvertently cause gaps in the application of the measures, if the amendments were successful. What about premises used for youth prisons? Should that be captured or not, given what was said about protecting children from the dangers of smoking?

Notwithstanding the fact that I understand the intention behind the amendments and what Opposition Members have said, I think the drafting may inadvertently cause issues and undermine what the Minister has said, both here and at the Dispatch Box, about the parameters in which this set of regulations would be brought in. Those would be underscored by consultation and the commitments that have been made at the Dispatch Box. Although I appreciate and understand hon. Members’ comments, I suggest that the amendments are not necessary, for the reasons I have outlined, and I would encourage them, if the amendments are not withdrawn, perhaps to vote against them if they are pushed to a Division.

[Sarah Bool]

I respect the points made by the hon. Member for Cardiff West, because I understand that we do not want any unintended consequences. However, I would counter that by saying that although we perhaps need better definitions—that may be something we can consider—clause 136, as drafted, is incredibly wide, and any of the assurances that have been given to hospitality are merely words. There is absolutely no carve-out for the hospitality sector as this stands.

As much as I think the Minister is honourable in his intentions, unfortunately, we all know that we can go only on the law in front of us in black and white, and there is currently no security for the hospitality sector in this regard. We need to be incredibly clear about this with the hospitality sector, and we need the exclusion. One of the bigger concerns is that if people are not able to smoke—perhaps in a pub garden—it will force them into their homes, where they are actually more likely to drink and smoke more because they are not within that limited capacity of being out in public. We have to think about what the dangers are. Are we actually forcing people to take up worse habits in their private residence than if we allow them a little bit of flexibility in an open space?

I have a question about NHS properties generally. I appreciate that we want smoke-free places and that one wants to go into hospital and walk past people smoking, but I worry about those who have an addiction. Where do they go if they need to smoke, as they would if they are going through a process of cessation? What ends up happening as a result of all these provisions is that the smokers will just be forced down the road away from the property, but that has not really addressed the issue. We have just pushed the problem a few metres away.

We need to think in the round about how we best achieve our aim, how we deal with addiction, and how we clean up the hospital environment in a balanced and proportionate way. Perhaps the Minister has some other ideas, but I do not like the idea of just pushing some smokers down the road, rather than dealing with the issue at hand.

[Andrew Gwynne]

I am grateful for our debate on amendments 4, 94 and 95. I am even more grateful that a lawyer, my hon. Friend the Member for Cardiff West, is sitting behind me—as a non-lawyer, I note that it is always good for somebody to have one on their side. Indeed, the hon. Member for South Northamptonshire is a lawyer as well; in matters of law, there are always disagreements.

Amendments 4 and 95 would remove the power in the Bill to extend smoke-free places to any area that is a workplace or open to the public, including outdoor spaces in England. That would be replaced with a limited power to extend smoke-free places only to healthcare and education settings and to playgrounds. Amendment 94 would reinstate the test present in the Health Act 2006, which requires, in the Secretary of State’s opinion, a significant risk of exposure to significant quantities of smoke before being able to designate an additional place as smoke-free.

On extending smoke-free places, as we heard from a range of public health experts, evidence for the harm from exposure to second-hand smoke is well established. People exposed to second-hand smoke are at increased risk of cancer, chronic respiratory disease and cardiovascular disease. The World Health Organisation estimates that, every year, second-hand smoke kills up to 1.3 million people worldwide.

The science tells us three things about second-hand smoking. First, it poses a risk to health even outdoors. Secondly, it is particularly dangerous for vulnerable people, including children, pregnant women and those with pre-existing but usually invisible health conditions, such as asthma and diabetes. Thirdly, in some public settings, exposure to second-hand smoke can be high. If you can smell it, you are inhaling it.

It is important that the powers are broad, so that the Bill is appropriately future-proofed, as we have discussed in relation to other measures in the Bill.

[Andrew Gwynne]

The future-proofing element is if the science changes or, more likely, that over time public attitudes change. Smoking is already a minority pastime, and we expect that, in 25 years’ time, the prevalence of smoking among those aged 30 or below will be near to zero, so we will want to protect people from the scourge of second-hand smoke in other places. But that is a debate for other Ministers in other Sessions of other Parliaments at some stage in the future.

I do not want to tie the hands of my successors, so that they have to find a slot before the House for primary legislation to make simple changes. A far more practical and workable mechanism is for my successors to be able to come to the House to say, “The evidence has changed”, or, “Public opinion has changed”, and, “We now seek to consult the outside world on introducing further areas under the powers in the Bill”, and then to lay secondary legislation following the statutory duty to consult. Other areas can therefore come within the scope of the Bill.

[Sarah Bool]

I take the Minister’s point, but there is only a requirement to consult, so actually, completely unlimited powers have been given to make this change. We are trying to argue that we want the spaces to be clearly defined. It is important and right that we should come back to Parliament to make a change at a future point, if we want to extend the Bill further. But that will only be consultation, based on the current drafting, and a change could be pushed through regardless. The Labour party says that it is trying to support and back hospitality, so making this absolutely clear on the face of the Bill at this point will give hospitality the reassurance that it needs. I cannot see why there is any objection to more clarity, rather than overarching and wide powers. We are binding the hands of future generations and telling them that they cannot smoke and cannot vape—that right has gone—and then, on the other hand, we are saying, “I cannot bind the hands of my future successors”. We need reassurance and clarity for hospitality, and that is not in the Bill.

Tobacco and Vapes Bill (Eleventh sitting)

Sarah Bool Excerpts

Committee stage
Thursday 23rd January 2025 Public Bill Committees

[Dr Johnson]

I thank the hon. Gentleman for his intervention, but while pharmacists are highly trained clinicians with the capacity to prescribe a number of products in specific cases, they are also businesses. One’s local pharmacy is a business. Pharmacists sell products; they take money and make variable amounts of profit. A GP is a private entity, as the Minister will have learned during the national insurance contributions debate. Some GP practices are dispensing practices—the GP prescribes a product, which is dispensed from that practice. There are also private clinicians who provide GP surgery or stop smoking services at a price. I do not think that “in the course of business” necessarily provides the distinction that the hon. Member for Cardiff West hopes it does, but perhaps the Minister will provide further clarity.

It might be possible for the Minister to include an extremely narrowly drafted exemption for medical professionals providing advice in relation to stop smoking services and antenatal clinics giving advice to a current smoker, but perhaps he feels that those clinicians are covered already. One of the reasons for tabling the amendments is to have this debate and ensure that the clauses are carefully considered. All of us, on both sides of the Committee and the House, want to improve the health of the nation; we all want the Bill to improve the health of the nation. If the chief medical officer’s advice is that for adult smokers, vaping is better, those products need to be available to adult smokers.

I will move on to clause 115, which extends the offence in clause 114 of publishing advertisements to those who design the advertisements for regulated products, such as tobacco products, herbal smoking products, cigarette papers, vaping products and nicotine products. As in clause 114, to commit the offence the person must know that the advert has the purpose of promoting one of the regulated products and that it will be published in the UK. The latter part is important. Again, I would like the Minister to ensure that there is no loophole for people to design things and say they are expecting them to be promoted abroad, and then they are promoted in the UK. That could be quite a significant loophole. Businesses could get around that with contract clauses, I suspect.

Subsection (2) establishes the penalties for the offence, which are a conviction on indictment of two years, a fine or both. Summary convictions carry varying penalties based on the jurisdiction in which the offence was committed. That does leave the situation where somebody who has committed the same offence in England, Scotland and Wales by publishing it across those jurisdictions could face several different fines in different jurisdictions for exactly the same advert.

Another question is about the designers. Individuals may be involved in the design of advertisements, but not have full control over the final content or how the advertisement will be published. Should liability be extended to individuals working on the design, or should it lie more squarely with the business or entity that ultimately publishes it? Is it fair to hold designers accountable for advertisements over which they have limited control? If they have only designed part of the advertisement, and it is not the bit in which the product is promoted, will they still be liable for the whole advertisement?

Clause 116 introduces another offence, this time for businesses that print advertisements that promote tobacco products, herbal smoking products, cigarette papers, vaping products and nicotine products. They must know or have reason to suspect that they are printing an advertisement for those products—if they are printing it, they should know what they are printing—and that the advertisement will be published in the UK. Again, that will presumably have to be dealt with by contract law and involve some quite significant fines.

Clause 117 makes it an offence for persons acting in the course of business to distribute the advertisement. The question here is about physical and digital adverts. If a person is distributing the adverts on a sheet of paper, putting billboards on the wall or driving around a truck with a billboard on the back, it is clear that they know what they are doing and it is clear who is doing it. If adverts are appearing online or being distributed online, can the Minister specify who will be held responsible? Could somebody sharing an image that was produced by somebody else be a loophole?

Clause 118 expands the scope of responsibility to those who cause advertisements to be published and distributed within the UK. That seems sensible.

Clause 119 is the Government’s attempt to focus on the businesses that provide internet services. The provision is quite broad. Not all providers are UK-based, though. If they are not, how can they be held accountable? The provision could be seen to apply to various types of online platform, including social media search engines and website hosts. The key issue is whether a business that merely provides a platform or service for the publishing and distribution of advertisements can be held liable for content that is uploaded or shared by third parties, particularly where there is a huge volume.

The clause places responsibility on service providers that know or have reason to suspect that advertisements promoting tobacco or vaping products will be distributed through its services. That could apply to a wide range of internet service providers, from major global tech companies that are household names to the smaller, niche providers that operate in the UK market. I understand why that is important, but will the Minister say more about the person who is paying for the advertisement? The Bill covers publishing, designing and distributing an advert and providing it on the internet, but what about the individual paying for it? Ultimately, an advertisement rarely comes for free. How is that to be regarded?

The measures to reduce advertising for vapes and smoking products are sensible public health measures to reduce uptake. As we discussed in the debate on diet and obesity earlier this week, advertising clearly works. I recalled in that debate some of the adverts I remember from my childhood, such as “The red car and the blue car had a race” for Milky Way—I was pleased that the blue car won in that case, Sir Roger—and “A finger of fudge is just enough to give your kids a treat”. Those memories stick in the mind for many years. Advertising is effective and induces children to try products, so banning advertising for vaping and smoking products should be very beneficial, but I urge the Minister to consider whether he has covered the full scope of those who are responsible for adverts and at the same time excluded those who may play only a very small part in the advert and not realise that it will later become an advert for a smoking or vaping product. Has he considered carefully how a medical professional, clinician, pharmacist or similar person can still provide and openly discuss vaping products with their patients and clients, so that they can use them as a quit aid?

[Sarah Bool (South Northamptonshire) (Con)]

It is a pleasure to serve under your chairmanship, Sir Roger. I just want to go through something again. Obviously, the purpose of part 6 of the Bill is to establish the rules about advertising, which I completely understand. It sets out that it is an offence for a person in the course of business to publish an advertisement, to promote products, to design advertisements, to print an advertisement, to distribute an advertisement, to cause publication, design, printing or distribution in the UK, or to provide an internet service by means of which an advertisement is published or distributed.

Tobacco and Vapes Bill (Twelfth sitting)

Sarah Bool Excerpts

Committee stage
Thursday 23rd January 2025 Public Bill Committees

However, will teams from other nations that are coming to play in the UK be allowed to display such advertisements? For example, across the channel in 2023, Paris Saint-Germain announced a partnership with Geekvape. If the team comes to play in the UK, will the players be allowed to wear their usual shirts or will they need to be amended? Likewise, if a British team travels abroad to play in the champions league, or something like that, will they be able to wear shirts with such branding while they are abroad, on the basis that it is legal in the country that they are playing in, despite the awareness that the kit will be viewed on television by people in the United Kingdom? Would that be sufficient to invoke clause 124(1) to ensure that they cannot do so? We must think carefully about the potential for clever lawyers to try to work a way out of this.

[Sarah Bool (South Northamptonshire) (Con)]

That is a very interesting point, and it goes to the heart of commercial contracts. Money talks and money is very powerful, but we must be careful about that when establishing these rules, because the legal system will always find a way to argue. I can imagine some big cases being brought in relation to this if we are not careful.

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[Jack Rankin]

I will bring my remarks to a close, Mr Dowd, but I will make the point that some of these sponsors are online crypto casinos. I would argue that they are worse than vapes, so I think some inconsistency is being introduced in the law.

Let me suggest one way in which we could un-work that inconsistency, which I have seen in the Six Nations. Guinness Zero now sponsors the competition, rather than Guinness. It seems to me that we should allow low or no-alcohol beers to engage in these activities, and I see vaping as analogous. I believe that there is an analogy there, but an inconsistency is being applied by this clause.

I will also make a point about the technicality of some of the clauses—I hope that the Minister can point to some of this later. Clause 125(1)(c) mentions sponsorship of

“a herbal smoking product…cigarette papers…a vaping product…a nicotine product,”

but annex B of the explanatory notes on page 102 mentions

“any device which is intended to be used for the consumption of tobacco products or herbal smoking products”.

Will the Minister provide clarity on what other devices we are seeking to capture? For instance, will tobacco filters fall under the sponsorship ban? Will his Department propose a Government amendment to update the text of the Bill to provide clarity and remove that potential loophole?

[Sarah Bool]

I will make two points. First, I understand where my h F the shadow Minister is coming from in terms of the questions about enforceability and when these things come into effect. Clause 124(1)(a) states that for tobacco products:

“A person commits an offence if…the person is party to an agreement (entered into at any time),”

which will obviously be consistent; but clause 125(1)(a) states that a person commits an offence only if

“the person is party to an agreement entered into on or after the day on which this section comes into force”.

I can see the point that the Minister is making. Will we see a rush of sponsorship agreements on vaping coming in in the next few weeks before we get this Bill on the statute book? That is a legitimate question to raise, and we should all be aware of that possibility.

Generally, it is important that we tackle and take on seriously the role of sponsorship. I do not think that I am alone in recalling the impact of Pepsi and its sponsorship of the Spice Girls when I was young. Its campaign aimed at Generation X had 92 million cans with the Spice Girls on them, which obviously had a big impact. I will be honest and say that I loved the Spice Girls, but seeing anything like that has a massive impact when we are children, so tackling it is absolutely right. Pepsi sponsors the National Football League, Coca-Cola sponsors the Olympics and I think Carlsberg has always sponsored Liverpool FC, so we can see that brand alignment.

[Dr Johnson]

I thank my hon. Friend for making the point much more eloquently than I did that there is a difference in the clauses between the days when they come into force. As she is a lawyer who has been involved in contracts, can she confirm that there is no limit to how long someone can enter into a contract? If a contract were entered into in terms of sponsoring vaping or nicotine products before the Bill comes into force, it may last for quite some time.

[Sarah Bool]

That is a possibility. It always depends on the terms of the contract itself, but in theory they could agree a 10 or 15-year contract and sponsorship deal. It is interesting that this could be one of the overhangs that we see, so we have to be aware of it going forward.

[Andrew Gwynne]

The clauses make it an offence for a person to be involved with a sponsorship agreement where the purpose is to promote in the course of business tobacco products, herbal smoking products, cigarette papers, vaping products or nicotine products. Anyone convicted of an offence under the provisions may be subject to imprisonment, a fine, or both. Tobacco sponsorship is currently banned under the Tobacco Advertising and Promotion Act 2002. There is a long-standing, well-established relationship between tobacco advertising and tobacco consumption.

Clause 124 restates the current position for a person involved in the sponsorship of a tobacco product. We are consolidating existing tobacco legislation in the Bill to provide a coherent narrative for readers, rather than have it spread over lots of different pieces of legislation. A large part of the Bill brings the legislation into one place, so that from Royal Assent onwards, the go-to place for anybody with any questions about tobacco control will be this piece of legislation, rather than it being dispersed across different Acts of Parliament.

Tobacco sponsorship is already banned, but importantly, the Bill expands the offence to include herbal smoking products, cigarette papers, vaping and nicotine products. The restriction will mean that vaping and other nicotine product companies will, for example, not be permitted to sponsor sports teams, which is something that we have seen in recent years. It might upset the hon. Member for Windsor, but I have to say that not a single child should ever be able to look up at their favourite sports stars—people who should be role models—and see them covered in branding for products that are harmful and addictive. That is the point here.

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[Andrew Gwynne]

The hon. Lady raises an interesting point; I will take that away and look at it. Perhaps with the exception of the hon. Member for Windsor, everyone on the Committee agrees that we do not want our footballers, rugby stars or athletes to be emblazoned with adverts for vaping products, so the more we can do to tighten up the legislation further, the better.

I will just politely correct the hon. Member for Windsor that the term for someone from the historic County Palatine—including yourself, Mr Dowd—is a Lancastrian. My late father was the Lancashire cricket correspondent, first for Cricket Call, which was a BT paid-for service, and then for BBC North West. He was there in 1990 when Lancashire won both the NatWest and Benson & Hedges cup finals—the double at Lord’s. I still have copies of my late father’s book, “Double Delight”. I would say that they are available at all good booksellers, but they are available from me if the hon. Gentleman wants one.

The hon. Member for Windsor made an important point. I had just come out of secondary school in 1990, which shows how long ago it was, but it was pretty commonplace for tobacco companies to advertise at major sporting events like Lancashire cricket matches and others. The fact is that that was a long time ago, and things have changed for the better. The Benson & Hedges cup final, in cricket of all games, is a thing of the past. Hopefully, at some stage in the near future, we will look back at vape sponsorship of football clubs as a thing of the past, because that is where it deserves to be.

[Sarah Bool]

This is just off the top of my head, but on a technical point about clause 125(1), in terms of vape sponsorship, a person will be guilty of an offence only after the provision comes into force. I appreciate that there is the two months, but they also have the window of time while the Bill goes through Parliament, so they potentially have a couple more months for that.

I do wonder about how this is going to work in practice, because, in theory, a company that is offering sponsorship—if they enter into that agreement now—will not be in trouble for the next couple of years for doing that, yet under preceding clauses anyone who designed or printed material for any of those sponsorship deals would be guilty of an offence. We suddenly have a position where, potentially, the sponsors themselves are not guilty of an offence while the actual designers, and those who are publishing the sponsorship material, are. That is an interesting nuance.

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[Andrew Gwynne]

The shadow Minister is right. There will be a narrow window in which that will be possible—[Interruption.] She asks why, and it is because once the Bill receives Royal Assent, it will bring in a two-month window. That is how the law is shaped, to give us the scope to get these measures right and ensure that we make the framework as watertight as my hon. Friend the Member for Cardiff West wants. We believe that that is the proportionate way forward. We cannot make retrospective decisions; if contractual arrangements are under way at Royal Assent, an immediate cut-off could leave the Government open to challenge.

[Sarah Bool]

I understand that two-month period, but does it also apply to the earlier provisions on the creation of offences relating to publication? If we had some alignment there, neither party could potentially be in breach. That is merely a technical point, however.

The other point—perhaps for when the Minister goes back to the Department—is about force majeure, which the hon. Member for Cardiff West mentioned and which I would like more investigation into. Force majeure concerns acts of God, or something unexpected. I think lawyers would argue that a Government Bill was expected and foreseen, so there would have to be some other form of break clause or right. This debate is getting far too technical for this forum, but it is perhaps something that the Minister can take away.

[Andrew Gwynne]

As I said to my hon. Friend the Member for Cardiff West, we will take all this away and look at it in detail, and we will come back to Members. I am just about legally savvy enough to understand the point that the hon. Lady is making that a break clause or something like it would probably be required, because the coming into law of the Tobacco and Vapes Bill on Royal Assent is expected—it is not an act of God, and it will not come as a complete shock and surprise.

Finally, clause 133 allows us to extend all of part 6 to cover devices that enable a

“tobacco product to be consumed”

or

“an item which is intended to form part of such a device”,

but that are not in the Bill.

Tobacco and Vapes Bill (Ninth sitting)

Sarah Bool Excerpts

Committee stage
Tuesday 21st January 2025 Public Bill Committees

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

Good morning, Sir Roger. It is a pleasure once again to serve under your chairmanship on this important Bill.

Clause 47 is a somewhat standard clause protecting the Crown, providing that the Crown cannot be criminalised by the Bill, but the Bill does bind the Crown, which essentially leads to the position in which the courts can say that if the Crown commits an act or omission against or in breach of part 1 of the Bill, such an action may be unlawful. There was one question that I asked the Minister in relation to the Crown and to which I do not think we got a clear yes or no answer, although that is perhaps not unusual for this Government. The Minister will know that the House, despite its exemption from the smoking ban drafted by the Labour Government in the early 2000s, has a record as being one of the first places to have a no-smoking area. When Parliament—more precisely, the House of Commons—sat in St Stephen’s Hall, it was so smoky in there that Members could not see one another properly, so it was decreed that there would be a snuffbox for Members’ use at the entrance to the House of Commons.

That snuffbox exists today and is, I believe, used by a small number of Members now. It is occasionally used by a Member who wants to put it on record in their own mind that they have tried it—that does not include me. My question is this. With the Houses of Parliament being a royal palace, will the snuffbox still be allowed? I know that the Doorkeepers are interested to know whether they will be able to keep the snuffbox at the door, because the top of the box has on it a brass plaque that is engraved with the name of the current head Doorkeeper. It would be interesting to know whether the tradition can continue.

My other question on clause 47 is this. I presume that it covers England, Wales and Northern Ireland because there is not separate provision for Northern Ireland. I would be grateful if the Minister indicated whether that is the case.

Clause 66, entitled “Crown application of 2010 Act”, says:

“In section 36 of the Tobacco and Primary Medical Services (Scotland) Act 2010 (asp 3)…in subsection (3), after “on the application” insert “of the Scottish Ministers or”.

I had a little look at the Act to which clause 66 refers, and section 36(1) of the Primary Medical Services (Scotland) Act says: “This Part”—part 1— “binds the Crown.” Section 36(2) makes the Crown not criminally liable if it does breach, which is similar to clause 47. Section 36(3), with this insertion, will provide that “the Court of Session may, on the application of the Scottish Ministers or of the council in whose area the contravention is alleged to have taken place, declare unlawful any act or omission of the Crown which constitutes such a contravention.” For reference, the Court of Session is Scotland’s supreme court, which I am sure you know, Sir Roger. It has been Scotland’s supreme civil court since 1532 and sits in Parliament House in Edinburgh. Section 36(4) makes it clear that although the Crown itself is not exempt but cannot be criminally liable, public servants of the Crown can be, and are, covered by the relevant provision

“as it applies to other persons.”

Subsections (1) and (2) of clause 134 are similar to those in clause 47, in that subsection (1) binds the Crown and (2) makes the Crown not criminally liable. Subsection (5) is also the same, stating that subsection (2) will not affect the liability of persons in service of the Crown, so they remain criminally liable. However, clause 134(3) and (4) are slightly different from the measures in clause 47, in that they have a somewhat broader scope.

Subsection (3) provides that the High Court in England and Wales or Northern Ireland, or the Court of Session in Scotland, can declare the act or omission unlawful, so this is a UK-wide clause, unlike clause 47. Subsection (4) makes it clear that the Court of Session in Scotland can be applied to by either Scottish Ministers, in keeping with clause 66, or a local weights and measures authority. What clause 134 does not do, as far as I can see, is explain who can make such an application in England, Wales and Northern Ireland, so I would be grateful if the Minister answered that question in relation to these measures.

[Sarah Bool (South Northamptonshire) (Con)]

It is a pleasure to serve under your chairmanship, Sir Roger. I was interested by a point that my hon. Friend raised, particularly about the snuffbox inside the House of Commons itself. I think the Minister previously made the point that although the rules technically do not apply because this is a royal palace, we do apply them by convention—so there is now no smoking in the Smoking Room. However, it raises an interesting point in terms of enforcement, if they were to ban snuff in the future, about whether the Doorkeepers would be expected to be doing their ID checks as Members go through in many years’ time. I was just intrigued about the point about how we are going to apply it here. It is obviously easier with the ban on smoking at the moment—you do or you do not—but it will be interesting to see how we apply it to the to the Doorkeepers going forward.

[Dr Johnson]

My hon. Friend makes a very interesting point about how the snuff is given out. At the moment, the snuffbox sits with the Doorkeepers near the No Lobby entrance, and it is available to Members. Obviously—or perhaps not obviously—there is no charge to Members. In fact, my understanding from the Doorkeeper who had the snuffbox last week is that the stuff that they have currently was provided by the BBC—[Interruption.] I can see that is a surprise; it was a surprise to me too, but that is where I was told it came from.

It brings into question the earlier clauses that relate to sale, because clearly the Crown may purchase it—I suppose the BBC is funded by taxpayers—and it is in a royal palace, which is a Crown site rather than a retail site, and it is not being sold to Members. I wonder whether the Minister has had time to consider that.