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.

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.

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.

Tobacco and Vapes Bill (Sixteenth sitting)

Sarah Bool Excerpts

Committee stage
Thursday 30th January 2025 Public Bill Committees

That intent is, of course, good, but the Minister does not appear to have laid out clearly how the Bill can be fully applicable to Northern Ireland while also compatible with the Windsor framework. For the benefit of the Committee, will he please do so?

[Sarah Bool (South Northamptonshire) (Con)]

I want to build on the shadow Minister’s point, because I raised that concern in one of the previous sittings. I want to refer to the words of the King’s counsel, Jason Coppel, of 11KBW chambers, in relation to this point. In an article published online, he notes that TPD2, the tobacco products directive,

“lays down various requirements concerning matters such as ingredients, emission levels and packaging which must be satisfied by tobacco products, vapes and other smoking products if they are to be marketed within the EU. Member States are not permitted to prohibit or restrict the placing on the market of products which satisfy these requirements (article 24(1)). However, TPD2 does not seek to harmonise domestics sales arrangements for these products and positively encourages Member States to introduce age limits on their sale (recitals (21) and (48)). The key issue is therefore whether a GSB”—

a generational sales ban—

“would be a selling arrangement or age limit which is compatible with TPD2 or a gradual prohibition on the placing on the market of tobacco and other products which meet the product requirements of TPD2, which would likely be incompatible with TPD2. There are, on any view, powerful arguments in favour of the latter view. The age limits referred to in TPD2 were limits on the sale of tobacco products to minors, not to adults. Unlike an age limit, the intention and effect of a GSB is to phase out the use of tobacco products entirely. It is equivalent in effect to an absolute ban on the sale of tobacco products, but a ban which is introduced very slowly, with an extent which increases day by day. If that analysis is correct then cl 68-69 of the Bill, if enacted, would likely contravene TPD2 regardless of whether they can be established by the Government to be a proportionate restriction in the interests of public health. It is reasonable to infer that the positions adopted by the Danish and Irish Governments were dictated by arguments along these lines. If a GSB would indeed contravene TPD2, it is relatively clear, from a series of decisions of the Northern Ireland courts applying the Windsor Framework, that TPD2 would have direct effect so as to override the GSB, pursuant to section 7A of the European Union Withdrawal Act 2018.”

I appreciate that that is heavy legalese, but it is important to stress Mr Coppel’s point. I do not feel that I had a sufficient answer from the Minister last time, so I would appreciate it if he could confirm that that has been considered.

[Andrew Gwynne]

Of course that has been considered. It is the responsibility of the United Kingdom Government to ensure that any legislation appertaining to Northern Ireland is compatible with the Windsor framework—that is clear. In drafting the Bill, the Government have taken into account all our domestic and international obligations. It has been put together following full consultation with Scotland, Wales and Northern Ireland, and we intend it to be United Kingdom-wide legislation for a smoke-free UK, in accordance with our international obligations.

Tobacco and Vapes Bill (Fifteenth sitting)

Sarah Bool Excerpts

Committee stage
Thursday 30th January 2025 Public Bill Committees

[Dr Johnson]

This is an interesting clause, because it applies the Bill to the parliamentary estate. According to Erskine May, there has been some confusion about whether statute law can apply inside the parliamentary estate, because of the principle of exclusive cognisance. That means that Parliament has control over its own internal matters and that not all laws automatically apply within Parliament. To quote from Erskine May directly:

“Actions in respect of which exclusive cognizance is claimed and has been admitted are not restricted to formal acts of either House. This privilege has been held to extend to the sale of intoxicating liquor within the precincts of the House, though those responsible did not hold a licence.”

Smoking, for example, has technically been prohibited in the Commons Chamber, public and Members’ Lobbies and Committee Rooms since 1694. According to Erskine May, MPs agreed

“That no Member do presume to take tobacco in the gallery of the House or at a committee table”.

Around the estate, however, historically it was the custom to smoke in the bars and the Tea Room, and in the Committee Corridor outside this very Committee Room we are in today. There are legal exceptions and exemptions that are worth discussing now.

The Office of the Parliamentary Counsel published guidance on Crown application in 2021 and noted that the Palace of Westminster is Crown land. The guidance explains the general presumption that an Act does not bind the Crown unless it does so expressly or by necessary implication. Often, an Act includes a clause on Crown application, specifying whether the Act applies to Crown land, but the Health Act 2006 does not include such a clause.

The position set out by case law is that the Health Act 2006 does not apply to the Crown, as in the 2017 case of R (on the application of Black) v. Secretary of State for Justice. In that case, the prisoner, named Mr Black, was serving an indeterminate sentence at Her Majesty’s Prison Wymott. He was a non-smoker with a number of health problems that were exacerbated by tobacco smoke—we talked about prisoners and vaping earlier. He complained that the smoking ban was not being properly enforced in the common parts of prisons, and issued proceedings for judicial review of the Secretary of State’s refusal to provide access to the NHS smoke-free compliance line to prisoners.

The Supreme Court unanimously dismissed Mr Black’s appeal, holding that Parliament must have intended the Crown to not be bound by the smoking ban, otherwise it would have made an express provision for it in the Act. In the words of Lady Hale:

“there are powerful indicators in the language of the Act itself that the Crown was not to be bound by the smoking ban.”

In 2013, the Joint Committee on Parliamentary Privilege noted that the ambiguity had led to many inconsistencies in statute law. That Committee considered that it was not practicable to resolve the inconsistencies without sweeping retrospective change, which could have unforesee- able consequences. It concluded that in the absence of legislation, the safest way forward—however undesirable it might be as a statement of principle—was to reiterate and formalise the current presumption that legislation does not apply to Parliament unless it expressly provides otherwise. That was agreed on, and now there is a rule that legislation creating individual rights that could fit with parliamentary activities must expressly say that it applies within Parliament.

Here we are today, with clause 159, which stipulates that the Bill and regulations made under it will apply to the parliamentary estate. The Bill does not replace the smoke-free provisions in the Health Act 2006 and does not otherwise provide directly for the smoke-free restrictions discussed above. There is no obvious means by which clause 159 will place the parliamentary estate within the scope of the 2006 Act. However, clause 136 enables Ministers to add to the list of places designated as smoke-free by introducing new regulations under proposed new section 4(1) of that Act. It is therefore possible for new regulations to designate the parliamentary estate as smoke-free, but I have seen no indication from the Government that they plan to do that. Clause 136 also enables Ministers to make exceptions to smoke-free legislation.

The extent to which the Bill can be used to place the parliamentary estate within the scope of smoke-free legislation is therefore a matter for legal interpretation, and I would be interested to know the Minister’s thoughts on that. Earlier in the debates that we have been having during line-by-line scrutiny of the Bill, we talked about the snuff that is kept outside the door, with the Doorkeepers, and the Minister suggested there was no reason why that could not continue, but I am interested to understand his thoughts in relation to clause 159.

[Sarah Bool (South Northamptonshire) (Con)]

I concur with the rationale and explanation that my hon. Friend has just given. The question about how we will deal with snuff and other products in the House is an interesting one, because we do not want to see any of our Doorkeepers perhaps being criminalised for having something on the estate or how they have supplied it. I know that earlier discussions focused on the BBC—

[Dr Johnson]

I thank my hon. Friend for her support in this discussion. Is it not also the case that the House has a lot of peculiarities and traditions that are sometimes eccentric, but interesting, and that although we would not necessarily want to create exceptions for MPs to use a product that is not available to members of the public, the inability to have the box there would be a loss of a tradition, which would be a bit of a shame?

[Sarah Bool]

I agree. One of the things that I have most enjoyed over the last few weeks and months has been learning all the different traditions and the meanings behind them. Having done my original degree in history, I appreciate all that, so the many history lessons that we have had from the shadow Minister in the course of these debates have been much appreciated by me. It is interesting that that is why clause 159 has been put in place, but I would like the Minister to expand on how he thinks that it will work in practice. Will we see the removal of the snuffbox? How will that work in the future?

--- Later in debate ---

[Dr Johnson]

I thank the hon. Lady for her explanation, which was really helpful. I am grateful that she, as a Labour MP, understands that a tax on business will be passed on to the consumer, because it seems that the Chancellor does not. Perhaps the hon. Lady should apply for a new job.

The hon. Lady is right that if taxes are applied to a business, the business will pass them on to the consumer. The only way to avoid that is through price control. Nevertheless, I do not think that makes price control a desirable thing for the Government to interfere with. That level of regulation would go too far, and other measures in the Bill already seek to restrict and disincentivise smoking in so many different ways. I hope that they will be effective and that there will be no need for such onerous regulation.

[Sarah Bool]

The hon. Member for City of Durham has proposed a very interesting concept. Although she may not be pressing the new clause to a vote, it is interesting to discuss the concept in principle, so I thank her for tabling it.

Essentially, the proposal is that the Secretary of State would have to consult on a scheme that would regulate prices and limit profits, and then they would calculate the tax:

“by reference to sales or estimated sales of those products”.

That is an interesting concept, but I wonder whether it could be deemed anti-competitive. I know that the ultimate aim is to close down the tobacco companies, and that is essentially what the measure would drive towards, but in the interim, when many people will still be legally able to smoke, what arguments might the companies make in that regard? The Chancellor says she is pro-business and is encouraging business. The tobacco companies are perhaps not the businesses she has in mind, but the provision would have wider repercussions that could flow into other areas.

--- Later in debate ---

[Dr Johnson]

I certainly agree that it is immoral to sell products that they know are addictive, are dangerous and kill people.

[Sarah Bool]

I am almost glad that my hon. Friend the Member for Windsor is not here, because at this point we would probably be launching into a much longer and more protracted debate, so we are lucky in that regard—[Interruption.] I am being chastised by the shadow Minister.

We should consider that interesting point and its knock-on impact because, in common with the hon. Member for City of Durham, I have concerns about the illicit tobacco market. I very much agree that we should be moving to a new system of preventive medicine. As I have mentioned, I have type 1 diabetes, and I want to see a greater and earlier use of technology to prevent long-term problems. The new clause provides a useful point for discussion, and I thank the hon. Lady for tabling it.

[Andrew Gwynne]

I am grateful to my hon. Friend the Member for City of Durham for tabling the new clause, because it allows us to have a debate about a really important matter. As has been discussed, the new clause would require the Secretary of State for Health and Social Care to consult and report on a scheme to regulate and to raise funds from the prices and profits of tobacco manufacturers and importers.

Duty on tobacco raises around £8.8 billion a year. The Government’s preferred approach is to continue with a proven and effective model of dealing with tobacco products through increases in tobacco excise and through duties. This generates finances that can support a full range of public services, including public health and the NHS, as well as smoking cessation services. We believe the proposed scheme would be complex to implement and might take several years to materialise.

Alongside the Bill, we are taking strong action to reduce the affordability of tobacco, which is an effective measure to trigger smoking cessation. The United Kingdom already has some of the highest tobacco taxes in the world. The World Health Organisation recommends that total taxes on tobacco are at least 75% of the retail price on typical cigarettes. The United Kingdom comfortably meets this target, with taxes at around 80% of selling price.

As announced at the autumn Budget 2024, duty rates on all tobacco products were increased in line with the tobacco duty escalator by 2% above retail price index inflation. The duty rate on hand-rolling tobacco was increased by a third of 10%, to 12% above RPI inflation, to reduce the gap with duty on cigarettes. Those changes came into effect on 30 October 2024.

Cigarettes are also subject to minimum excise tax, which sets a minimum amount of duty collected on a pack of cigarettes. That discourages manufacturers from selling cheap cigarettes, as it reduces the profitability of cigarettes sold at or below minimum excise tax trigger prices. The new minimum excise tax is £8.93 for a pack of 20, and it applies to cigarettes sold at or below £13.59 for a pack of 20.

We are still going further on tobacco tax. As announced in the autumn Budget, there will be an additional one-off increase for all tobacco duties. That will come into force on 1 October 2026, when the vaping duty comes into effect. From a financial perspective, that will maintain the incentive for smokers to switch to vaping once the new excise duty on vaping products comes into force.

On one last technical note, His Majesty’s Treasury can consult on tobacco taxation and fiscal policy at any time, so that does not need to be set out in the Bill. For those reasons, I ask my hon. Friend the Member for City of Durham to withdraw her new clause.

--- Later in debate ---

[Dr Johnson]

I thank the hon. Gentleman for that important intervention. He is absolutely right that these items are a huge danger to the environment, and it is sad when we go to parts of our world that are still not well explored, such as the Mariana trench, and find evidence of damage caused by the human race, such as plastic pollution. Although I have huge sympathy for people who have become addicted to nicotine and find it difficult to quit smoking, there is no excuse for the litter that it creates all over our beaches and our urban and rural areas.

Cigarette filters are neither biodegradable nor effectively recyclable. They are made, as I said, primarily from cellulose acetate—a plastic material that does not biodegrade. Even after two years of decomposition, cigarette filters will have lost only about 38% of their mass, and the remaining material continues to persist in the environment. During that time, filters leach harmful substances, including heavy metals and toxic chemicals such as arsenic, that have been inhaled through the filter and into the surrounding environment, further contaminating soil and water sources.

Cigarette butt waste has been shown to impact marine and coastal environments. Studies have demonstrated that cigarette filters affect the micro-biodiversity of coastal sediment and that they pose harm to marine animals that ingest them. That is a growing concern, as the hon. Member for Winchester said, as plastic waste continues to accumulate in the ocean, harming wildlife and disrupting ecosystems. The Ocean Conservancy’s international coastal clean-up has, over the course of 32 years, collected more than 60 million cigarette butts from the ocean. Although that sounds like a lot, that accounts for just 0.00001% of all cigarette filters thrown away in a single year, so this is a difficult thing to clean up.

Despite the growing awareness of the environmental impact of single-use plastics, cigarette filters have not been subject to the same regulations as other plastic products. For example, the European Union banned many forms of single-use plastic in 2019, but cigarette filters were not included, leaving a significant loophole. As cigarette consumption remains widespread, the environmental impact of the filters continues to grow. In October 2024, Santa Cruz county in California became the first jurisdiction in the world to approve a ban on filtered cigarettes and cigars.

One of the questions I have for the hon. Member for Dartford who tabled the new clause—he sadly is not here—is why he has chosen to use the 1990 Act. The previous Conservative Government banned a number of single-use plastics on the basis that they were harmful to the environment, that there were non-plastic, more environmentally friendly and more suitably priced items available, and that it would help to improve the environment, which is a very good thing. However, one of the reasons for introducing those bans through secondary legislation under the 1990 Act was that there was not an opportunity to do so in primary legislation, because of the time constraints of the parliamentary calendar. The Minister has talked about getting time for primary legislation already.

This Bill is a piece of primary legislation, and to add cigarette filters to it only requires the Government to write in clause 1 “and cigarette filters too”, and to make consequential amendments through the Bill on that basis. I agree with the principle that cigarette filters are a bad thing for the environment, and they are not good for people’s health, but I am not entirely sure why the 1990 Act is being used and why the Minister has not included filters in clause 1 and consequentially throughout the Bill. Perhaps he can tell us in winding up.

[Sarah Bool]

I thank my hon. Friend for her explanation. I did not know that it was cork that gave the colouring, so that is another benefit of her history lesson. We are aware that the previous Conservative Government took strong action to try to remove plastics in the environment. We introduced the UK-wide prohibition on the use of plastic microbeads in the manufacture of some cosmetic and personal care products, such as face scrubs, toothpastes and shower gels, where the little beads could wash into the sea. That was one of the reasons why those beads were banned. It is therefore an interesting argument to make that we should ban cigarette filters with their plastic content, because we do not want further pollution of our beautiful natural environment.

The World Health Organisation has advocated for banning those filters. As my hon. Friend compellingly said, there are no health benefits to such filters being used—which I had not appreciated. One would assume that those filters would have helped, but it is interesting that they do not. I note that the UN General Assembly is also advocating for a ban on filters, particularly given their plastic content.

[Dr Johnson]

My hon. Friend makes the point about the plastic content. I just spotted that in the explanatory statement for new clause 4 from the hon. Member for Dartford, he talks about wanting specifically to ban cigarette filters that contain plastic, as opposed to other cigarette filters. That would improve the environment, but a question is raised by the fact that when a cigarette filter is in use, the toxic chemicals present in the cigarette flow through that filter and becoming lodged in it. So as well as the plastic pollution as the filter is littered into the environment, causing a hazard, there is also the fact that as it decomposes, those other toxic chemicals present in the tobacco smoke are in the filter and leach out into the environment. That presumably would be the case even if the filter was not made of plastic, although the plastic is clearly extra harmful.

[Sarah Bool]

I agree. That is a good conclusion to have worked through, which we perhaps had not had the opportunity to turn our attention to. I would like to see a provision of this nature. I am intrigued, as my hon. Friend said, by why the Minister has not included filters in the outright initial ban. That should be considered, perhaps on Report.

As a general principle, we need to look after our natural environment. A ban on the plastic contained in cigarette filters would surely be a sensible move. As my hon. Friend has said, however, the filters do not achieve what anyone was hoping and do not make smoking safer. I therefore think we must have further discussion. Will the Minister give a little more explanation on some of the rationale and whether the measure can be included in the Bill?

[Andrew Gwynne]

I am grateful to the shadow Minister for moving this new clause for debate and to my hon. Friend the Member for Dartford for tabling it. New clause 4 would require the Secretary of State to make regulations under the Environmental Protection Act 1990 to prohibit the supply of cigarette filters that contain plastic or cigarettes containing cigarette filters that contain plastic.

I am incredibly sympathetic to the premise of the new clause. Cigarette filters, as we heard from the shadow Minister, have historically been marketed as making smoking safer, and we know that smokers can perceive cigarettes with a filter as tasting smoother and being of lower risk. Evidence shows that there is no proven health benefit to cigarette filters. All tobacco products are harmful to health.

However, as with all regulations, it is important that any measures are fully considered and evidence-based, to ensure that there will not be any unintended consequences—[Interruption.] Did the hon. Member want to intervene?

[Sarah Bool]

The hon. Member for Dartford has now arrived, so perhaps the Minister would be so kind as to allow him to intervene.

[The Chair]

Hang on. It is for the Minister to decide who he wants to give way to. Minister, carry on speaking; if somebody catches your eye, it is up to you whether you allow them to intervene.

--- Later in debate ---

We have heard that the pouches have levels from 6 mg up to over 100 mg, depending on the brand, but they are commonly sold at levels higher than 20 mg. I do not know whether 20 mg is exactly the right level—we would need research into that—but it would appear to be a greater level of nicotine than that provided by a cigarette. On a personal level, I would support 20 mg as a starting point, but if the Minister wants to reduce the level further, I am prepared to consider that. We need a cap on the strength of these products.

[Sarah Bool]

I find high-strength nicotine pouches incredibly concerning, as I had not been aware of their existence. There is a Member of the House who happens to use them; I had simply thought that that hon. Member was partaking of mints, but that is clearly is not the case.

This is an interesting area. As the shadow Minister has noted, pouches are discreet. When they are aimed at children, it is hard for parents to know what their children are taking, so they are particularly pernicious in their effect.

Many hon. Members will know that I often go back to social media. Apparently one of the main brands is called Zyn and is now trying to promote the trending of “Zynfluencers” via Instagram. The aim is to appeal to the younger generation. I do not think that that is acceptable, especially when some of these pouches are of a strength of up to 100 mg, as the shadow Minister mentioned.

Like the shadow Minister, I ask whether the Minister has any thoughts about whether the cap should be reduced further, because 20 mg may not be the right number. Given that the impact of long-term use of these pouches, which I happened to raise with the Member I saw taking one, includes mouth sores, gum irritation and oral cancer, I think we probably need a further discussion about them. I welcome any comments that the Minister may have.

[Andrew Gwynne]

I am grateful to the shadow Minister for moving the new clause tabled by my hon. Friend the Member for Newcastle upon Tyne East and Wallsend.

New clause 5 would introduce a ban on the manufacture and sale of high-strength nicotine products, with the maximum level of nicotine in a pouch set at 20 mg. Unlike nicotine vapes, there is currently no set nicotine limit for nicotine pouches; as we have heard, nicotine strengths vary from 2 mg per pouch to as high as 150 mg per pouch. There is also significant variation in these products internationally.

I am incredibly sympathetic to the arguments from the shadow Minister, from the hon. Member for South Northamptonshire and indeed from my hon. Friend the Member for Newcastle upon Tyne East and Wallsend. It is important to define the correct and safe nicotine level of a nicotine pouch. That is why we are already taking powers in the Bill that would allow the Government to limit the amount of nicotine in a pouch and to ban any other ingredient in a pouch that might be harmful.

We believe that secondary rather than primary legislation is the appropriate way to legislate on these matters, for all the reasons we have already debated. Legislation always has to be flexible enough to be amended based on new and emerging evidence. That allows the Government to set the right level of technical detail to ensure legal clarity. We will therefore consider the matter very carefully in our consultations post Royal Assent. I note that the shadow Minister referred to “if” we decide to use these regulations. Let me be very clear: these are precisely the kinds of things we will be looking at when we are moving like the clappers to get the regulations through.

In addition, nicotine pouches will be covered by all our other measures designed to reduce the appeal and accessibility of such products to children, such as powers to restrict flavours and regulate packaging, as well as those on general advertising. The shadow Minister gave an example of promotions that give out iPads in exchange for empty pouches. We clearly need to look at that specific promotion, but we are confident that it would be banned under the advertising restrictions that we have already debated and agreed to in Committee. I therefore ask her to withdraw the amendment.

Tobacco and Vapes Bill (Fourteenth sitting)

Sarah Bool Excerpts

Committee stage
Tuesday 28th January 2025 Public Bill Committees

[Dr Johnson]

The Minister is right to say that the clause recasts an existing regulation-making power in section 3(5) of the Health Act 2006, whereby the Secretary of State may make regulations that allow performers to smoke during a performance

“if the artistic integrity of the performance makes it appropriate”,

and is allowed, on that basis, to create a defence to the offences of smoking in a smoke-free place and of failing to prevent smoking in a smoke-free place.

The act of smoking in film, theatre and other forms of art can be a character-defining gesture that speaks volumes about the person’s identity or emotional state, or about the period in history they represent—think of images of Clint Eastwood, John Wayne, Humphrey Bogart and James Dean. It can also establish the period in which a person lived. It was commonplace for virtually everyone to smoke in the 1940s and 1950s, and the smoke swirling around characters became as much a part of their onscreen presence as their dialogue or expressions. Although smoking in real life is certainly not cool, and comes with myriad negative health implications, its role in art and culture can deepen the portrayal of certain iconic figures and their stories.

The Minister says that the exemption has been part of law for a long time, and that it has worked. There are essentially two ways in which a performance can mimic smoking. The first is to have a fake cigarette, six of which can be bought on Amazon for less than a tenner. They look a bit like a cigarette and an actor can hold them, but they do not have any smoke coming from them. My understanding is that currently the most common prop cigarettes used by actors are cigarettes that contain no nicotine and no tobacco but some herbal items. They produce smoke but are less harmful than a cigarette because they do not contain tobacco, and less addictive because they do not contain nicotine.

The Bill provides for tobacco products to be banned for certain generations of people, and adds herbal smoking products to that ban. Could that inadvertently lead to individual actors and actresses smoking tobacco rather than the less harmful alternative, particularly if there is a price differential between the two? Has the Minister considered how the law will apply to actors and actresses who are born on or after 1 January 2009? Will there be an exemption from the other aspects of the Bill, either allowing them to buy the cigarettes themselves or allowing someone to give them cigarettes as a proxy sale, which would currently be banned under the first part of the Bill? At present, actors may be above the age of 18, but the Bill is intended to be future-proof, so if we roll forwards 15 years or so, when younger actors will be banned from smoking and buying cigarette papers and the like, how does the Minister envisage it working in practice?

Freedom of expression is essential to the arts, but the laws and practices that protect and nurture free expression are often poorly understood by practitioners and those who enforce the law. The question is, then: what is a performer? Section 3(8) of the Health Act 2006 states that “performance” can include

“the performance of a play, or a performance given in connection with the making of a film or television programme, and…if the regulations so provide, include a rehearsal.”

That seems a rather narrow definition of performance. Performance art can cross disciplines such as dance on the stage or on the street. If we go to the south bank, just opposite this House, we can see performers performing solo activities on the weekend. Contract law for those engaged in paid work offers some recognition and potential protection for performance-related work, defines it and outlines the conditions of the performance—it is indeed the performer and not other members of the performance who are included.

To create another hypothetical situation, suppose there is an interactive performance in which the performer on stage requires mass audience participation for their act and suggests that the people in the crowd have to join in with them. Would the artistic integrity of the performance trump the laws that prohibit smoking? The line between performer and audience can be blurred, so if an audience member were invited up on the stage by the performer, would they be allowed to try a cigarette or vape? Proposed new section 7(3) of the Health Act 2006 does not suggest that the performance needs to take place on stage or even in the theatre; some occur outside hospitality venues, as we have discussed.

To give a colourful example, imagine there is a performance called “Smokers”, taking place in a pub in, say, Sleaford, in my constituency. It features performers smoking and chatting in a pub. It is quite an experimental, interactive performance, and the members of the audience —in other words, regular pubgoers—can take part in the performance and light up a cigarette themselves should they wish to. Technically, does this scenario not fall within the remit of the law? We have to bear in mind that the tobacco industry is creative in looking for loopholes. Smoking is required in order to preserve the artistic integrity of this alleged performance. Will the Minister provide clarification on this point? Although my examples may sound inventive, the tobacco industry does come up with inventive ways of circumventing the legislation.

My other point relates to performers who are born after 1 January 2009 smoking or vaping on stage. We need some clarity on that.

[Sarah Bool (South Northamptonshire) (Con)]

To follow on from what the shadow Minister said, the Minister said that performers who smoke during performances would not be a problem because the second-hand passive smoking would not be big enough of an issue. But why can a cigarette be smoked as part of a performance, yet a cigar cannot be smoked once a year by a single person? Why is smoking allowed for this artistic purpose, yet it is not allowed for someone who would like to smoke a cigar recreationally?

[Andrew Gwynne]

This is an existing power, in the Health Act 2006, that we have retained in the Bill at the request of the creative industries in England. I reiterate what I said in opening the debate: the exemption will be available only where smoking is justified to preserve the artistic integrity of a particular performance, so smoking would not be allowed in the hypothetical situations we have heard about. The provision is intended solely to allow the artistic integrity of a performance to be retained.

The shadow Minister asked whether the provision would merely encourage actors to smoke tobacco. Of course, that is not the case. Herbal smoking products are covered under “smoke-free” as well, so they are treated the same.

--- Later in debate ---

[Jack Rankin]

I will come on to the point about the relative effects of second-hand vaping and of smoking, but I will make some progress first.

My second point, which I have made throughout our debates on the Bill, is that we are potentially conflating vapes with cigarettes in legislation, which will exacerbate the misinformation that such alternatives are equally harmful to cigarettes. That will further undermine the Government’s goal of helping smokers to quit. Indeed, Action on Smoking and Health found:

“Half of all smokers…incorrectly believe vaping is more or equally as harmful as smoking…This is the highest ever proportion with this misconception across all waves of the survey and a significant increase on misperceptions found in 2023. Only one third of smokers understand vaping is less harmful than smoking.”

It seems to me that if we group vapes and cigarettes together and treat them in the same way, that misperception will only be exacerbated. That may further reduce the inclination of smokers to switch to vapes.

[Sarah Bool]

I concur. Cancer Research UK followed a similar argument in written evidence to the Committee:

“It is important that any measures to restrict vaping do not exacerbate harm misperceptions, and do not deter or reduce accessibility of people who smoke from quitting with the use of e-cigarettes.”

I put it on the record that I very much agree with my hon. Friend.

[Jack Rankin]

It is nice to have a fellow freedom fighter on the Committee—[Interruption.] I am trying to get the Minister to intervene.

My third point is one to which I think the Minister alluded earlier, but I ask him to repeat it in summing up. This part of the Bill will allow the Secretary of State to make decisions without really having the full approval of Parliament. The Minister has said that the Government will consult on the expansion of smoke-free areas, but as I understand it from the drafting, it is not necessary for the Government to consult on expanding vape-free and heated tobacco-free spaces in the same way. I think he might have touched on that point in his remarks, but I would welcome his confirmation.

My fourth point relates to the intervention of my hon. Friend the Member for Sleaford and North Hykeham on second-hand smoke. My understanding is that the rationale for smoke-free places, as initially envisaged, was that the smoker is affected as a result of them having made an informed decision, but people nearby are affected who have not. That is the point of the smoke-free place. Cancer Research UK, however, states that there is

“no good evidence that second-hand e-cigarette vapour is harmful”.

Public Health England has also found:

“Compared with cigarette smoke, heated tobacco products are likely to expose users and bystanders to lower levels of particulate matter and harmful and potentially harmful compounds.”

In my view, therefore, the point about second-hand smoke does not make anywhere near the same kind of sense for heated tobacco products as it does with cigarettes.

Even the Bill’s impact assessment states:

“There are currently no legal restrictions in the UK on where a person may vape. However, many businesses, venues, educational institutions, health service providers and public transport providers have voluntarily introduced their own rules preventing vape usage in these locations.”

We all recognise that that is the case. Given that the impact assessment also notes that

“There is currently limited evidence of health harm from ‘passive vaping’.”

should it not continue to be for the proprietors of such venues to make their own decisions, based on the needs and desires of their customers? That is my position.

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.