Tobacco and Vapes Bill (Second sitting)

Sarah Bool Excerpts

Committee stage
Tuesday 7th January 2025 Public Bill Committees

[Andrew Gwynne]

Q Finally from me, in the previous iteration of this Bill, the fixed penalty notices were to be set at £100. There was criticism and concern from trading standards representatives, who advocated for increasing the value of the fixed penalty notice. Notwithstanding your answer to the shadow Minister’s question, do you think that doubling the fixed penalty notice to £200 strikes a better balance?

Lord Michael Bichard: Yes, I think we feel that. You might also consider an increase for second offenders before you move to prosecution. I do not think anyone wants to move to prosecution, because it is such a time-intensive process. I know we have limited time, but one thing we have not talked about is retailers. We also ought to be concerned about the online market—or rather, you should be concerned, as we are. It is a difficulty for us and for local authorities, because no single local authority thinks it should be responsible for enforcing legislation in an online marketplace.

We have a solution to that, which is that we have a lead authority that we think could deal with this and avoid the problem with individual local authorities. I think that will become an increasingly important element of the vape marketplace.

[Sarah Bool (South Northamptonshire) (Con)]

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

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

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

[Sadik Al-Hassan]

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

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

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

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

Tobacco and Vapes Bill (First sitting)

Sarah Bool Excerpts

Committee stage
Tuesday 7th January 2025 Public Bill Committees

[Sarah Bool (South Northamptonshire) (Con)]

My mother has some shareholdings in British American Tobacco, but that links to my parents’ having worked for Imperial Tobacco 50 years ago.

[Euan Stainbank (Falkirk) (Lab)]

I am an officer of the responsible vaping all-party parliamentary group.

--- Later in debate ---

[Dr Johnson]

Q Thank you; that is helpful. My other question is about the difference between indoor and outdoor exposure to smoke. In this country, we have had laws preventing smoking in certain indoor spaces for many years now. How does exposure to smoke inside differ from exposure to it outside? Imagine sitting next to someone smoking on a park bench and someone smoking at a neighbouring table in a restaurant—what are the comparative health risks between those two?

Professor Sir Chris Whitty: I think the first thing to say is that second-hand smoke is a very serious problem. I think that is underestimated among the general public because, if I am honest, the cigarette industry has been very successful in muddying the waters on this.

There are three key things that really make a difference. The first is the degree of concentration of the smoke. The second is the duration of exposure—let us say you sit next to someone for half an hour; the effect is more significant than if it had been just a couple of minutes. The third is the vulnerability of the people being exposed to it. That is one of the things that this Bill will help with.

Over 88% of the population do not smoke. There are roughly 6 million smokers still. There are significantly more people in the UK, non-smokers, who have medical vulnerabilities that mean that the smoke is particularly dangerous to them, perhaps acutely. They can be exposed to smoke and have an asthma attack, and that lands them in hospital. In severe cases it could land them in a very dangerous situation. The situation may also be chronic—for example, people living with diabetes already have a disease that is going to accelerate things like cardiovascular disease. If people are smoking on top of that, it will accelerate those things still further.

Although outdoor smoking is less in terms of passive smoking than indoor smoking, in most situations if you are close to someone, exposed for a long period or vulnerable, it can have very significant health impacts. In broad terms, if you can smell smoke, you are being exposed to significant amounts of smoke, and that is one of the things that the Bill is aiming to address.

I would like to make one additional point: the cigarette industry has been extraordinarily good at trying to pretend that to be pro-smoking is to be pro-choice. Nothing could be further from the truth. Smoking is highly addictive. Most smokers wish they had never started and want to quit, but they are trapped by addiction. Their choice has been taken away deliberately by these companies as part of their policy. And if you are talking about second-hand smoke, indoors or outdoors, the person downwind or next door has no choice at all at any point. They are exposed to the risks with no advantages at all. If you are pro-choice, you should be firmly in favour of the principles of the Bill. Frank, do you want to add to that?

Sir Francis Atherton: The only thing I would add is that there is no safe level of smoking. As Chris says, if you smell it, you are breathing it in, and there is no safe level. Obviously, indoors is worse than outdoors. The dose response is a big issue, but there is no safe level. I think that is a really important point.

[Sarah Bool]

Q You mentioned that 88% of the population do not smoke, and the numbers are now declining. Can I ask why you supported a generational ban as opposed to raising the age from 18 to 21 or even 25? It is predominantly younger people whom we want to stop smoking.

Professor Sir Chris Whitty: I might ask Michael to come in. I can have the first go and Michael might want to come in after that, because this is a critical point. Historically, the cigarette industry, despite what it claims, has always targeted children. It always deplores it in public, but if you look at its internal documents you discover that that is what it has been aiming to do. Most people, the great majority, start as teenagers before they are 20—you are, of course, correct. To refer back to Dr Johnson’s original question, the same thing is now being done with vaping and exactly the same playbook is being followed. You get people at their most vulnerable and you addict them. That is the aim.

However, were we to stop at, let us say, 21, the cigarette industry, which is extraordinarily good at regrouping around whatever regulations are in place, would simply regroup around 21. To go back to my very first point about addiction, if you are a 21-year-old and you start, you become addicted and then you wish you had stopped. That does not change the fact that your choice has been taken away. So the logic of saying 21, 25 or 30—various people have looked at various ages—is no better than the logic of the current situation.

The advantage of the current model, which was first put forward by Conservative Prime Minister Mr Sunak, to whom we should all pay great tribute on the basics of the Bill, was to ensure that current children are not addicted and do not have their choice taken away, but that rights are not taken away from existing smokers. That is the reason why this particular model was chosen. Michael, do you want to add to that? You are on mute.

[The Chair]

We cannot hear; we will come back to you in a moment.

--- Later in debate ---

[Dr Cooper]

Q Thank you so much to our witnesses for being here. I just want to take you back to a conversation you were having with a previous questioner about smoking cessation in hospitals. Could you give us your thoughts about vaping being available in hospitals, to allow people in hospitals who are quitting smoking, or who want to continue quitting, to continue vaping? Our CMOs talked about a smoke-free place being a vape-free place. What are your thoughts about vaping in hospitals—where it is a smoke-free place—and about access to vapes?

Suzanne Cass: In Wales, we have obviously implemented smoke-free legislation. We have seven different health boards and various approaches to that legislation when it comes to the implementation alongside vaping. When it comes to indoor spaces, there is already a huge amount of compliance with voluntary bans. People generally do not smoke in indoor spaces, so there is already that public consensus in those areas. When it comes to the outdoor spaces, there is not necessarily a consistent approach across Wales regarding smoking and vaping, which can cause confusion among the public.

I think that we need to be considering this very carefully, in terms of providing as much support to smokers as possible in these areas. We need to be considering exemptions to vape-free spaces, particularly in smoke-free spaces in hospital settings, mental health units and places where vulnerable patients who smoke are situated. That would be the message: we need to really consider those exemptions.

Sheila Duffy: In Scotland, we put medicinally therapeutic products front and centre with smoking cessation. Smoking cessation is vital, but we need to remember that there is no medicinally licensed e-cigarette product anywhere in the world, and that medicinally licensed products have a very different set-up. With e-cigarettes, you are talking about more than 30,000 different variants listed with the Medicines and Healthcare products Regulatory Agency, and four or five generations of devices, with very different health profiles.

Most of the comparisons are made with the toxins in tobacco, but there are different additional toxins in e-cigarettes, and there is new research—for example, AI modelling—on the impacts of heating some of the chemicals in e-cigarettes to vapour point, where they produce highly toxic outcomes. We need to bear that in mind. We also need to look at the research on air quality, because e-cigarettes conclusively contain the kind of particulates that we worry about for air quality and that cause harm to health. I think that that is an issue arguing for vape-free spaces.

In Scotland, we are supporting people to quit smoking in whatever way works for them—we are supporting individuals—but we are actively recommending only medicinally licensed products, because they have that context of appropriate use, safety and quality control, which e-cigarettes do not have.

[Sarah Bool]

Q I want to follow up on that point, because clause 12 of the Bill will actually include a ban on vending machines for vaping, but I know that there have been mental health trusts that have said that, actually, they would call for those to be exempted. Is that one of the exemptions that you would perhaps go for, and actually allow those vending machines in hospitals?

Suzanne Cass: Absolutely. I think we need to consider the vulnerable smoker at the heart of this and how they are managing to abstain from that addiction. It comes back to that addiction all the time. With smoking, nicotine is such an addictive substance that it is very difficult just to tell somebody that they cannot do it. You need to give them the right support, as well as the support that they want. When it comes to choice, that is where we need to be looking at what their choices are and how they choose to move away from that deadly tobacco use.

Hazel Cheeseman: On the mental health settings, we have done a lot of work in England with mental health trusts, and vending machines have been one way in which they have been facilitating access to vapes in quite a large number of mental health trusts. It is certainly something that we would be interested in looking at, because it will make it a bit more challenging for them to implement smoke-free policies in mental health settings if the vending machine rule applies across the NHS estate.

Also, going back to Dr Cooper’s question, in mental health settings and those places with vulnerable smokers, vapes have been really important in England in facilitating. We do not have legislation in relation to smoke-free grounds in England, but obviously it is the policy across the NHS estate that they are smoke free. Allowing vaping, particularly in those mental health settings, has been very facilitative of creating smoke-free grounds and supporting those people to maintain their smoke- free status as they move out of mental health settings as well.

Sheila Duffy: Scotland already has a ban on e-cigarettes in vending machines and has had for some years.

[Mary Kelly Foy]

Q I notice in your submission that you have a recommendation:

“The government should make good on their pledge to publish a ‘roadmap to a smokefree country’…with a strong focus on tackling inequalities.”

I am from the north-east region, where we have high deprivation and high smoking prevalence. It is the only region that has a clear vision—if you like—and declaration from Fresh and the directors of public health for how to achieve a smoke-free country. Could you explain a bit more why we need that vision and that strategy going forward?

Hazel Cheeseman: The legislation is fantastic; it is world-leading and brilliant, and it will really set us on that path toward being a smoke-free country. However, it will not be the last word in how that is achieved. We have 6 million smokers across this country, and we need to ensure that all of our agencies are lined up to do the job that they need to do to help those people stop smoking—the NHS, local government and integrated care boards across the system need to have the right approach. We also need to ensure that the funding is there to do that too. The Government have committed to the funding in stop-smoking services in local government, but we also need to see funding in mass media campaigns. The chief medical officer was talking earlier about people’s waning understanding of the harms of second-hand smoke. One way to address that would be to go back on TV and radio and explain to people what the harms of second-hand smoke are. That package of measures alongside this legislation would really help us to accelerate progress.

The Bill will massively raise the saliency of the harms of smoking with the public—there is no doubt about that. There has been, and there will continue to be, a strong public debate on the measures in this Bill. By really riding the wave of that public understanding through that coherent strategy and that investment, we could really see smoking rates start to drop, particularly in those disadvantaged populations where we continue to have persistently high levels of smoking.

Diabetes Treatments

Sarah Bool Excerpts

Tuesday 29th October 2024 Westminster Hall

[Carolyn Harris (in the Chair)]

I will call Sarah Bool to move the motion, and then call the Minister to respond. There will not be an opportunity for the Member in charge to wind up, as is the convention.

[Sarah Bool (South Northamptonshire) (Con)]

I beg to move,

That this House has considered diabetes treatments.

It is a pleasure to serve under your chairmanship, Mrs Harris. On 21 May 2021, my world changed forever when I was diagnosed with type 1 diabetes at the age of 33. While my diagnosis was a shock, given its late onset, the feelings of fear, disbelief and sadness are shared by all those diagnosed—young or old, with type 1 or type 2.

Diabetes is a complicated condition that has been done the great disservice of being stigmatised through misunderstanding. It is not necessarily that we have eaten too many sweets or not looked after ourselves. Type 1 is an autoimmune condition—we did nothing to cause it—and people can develop it later in life; Mr Speaker and I can attest to that. Type 2 is not just for the over-40s and the unfit; someone can be slim and active, like Sir Steve Redgrave, and still be diagnosed. That is why I have secured today’s debate. Breaking down the stigma and investing in early treatment of diabetes is so important to allow patients to live fulfilled lives, and to do so in the most long-term, cost-efficient manner for the Government.

Our understanding of how to treat diabetes has come on leaps and bounds since the discovery of insulin back in 1921, but there is still so much more that we can do. Some 5.6 million people in the UK are diagnosed with diabetes. That includes 4,329 people in my constituency of South Northamptonshire—more than 6% of the population. However, last year, just 54% of my constituents with diabetes received all eight of their essential checks, which are important for identifying and preventing complications.

The total cost of diabetes to the NHS is estimated at £10.7 billion, and 60% of that is spent on the costs of diabetes complications. Every week, complications from diabetes lead to 2,990 cases of heart failure, more than 184 amputations, 930 strokes and 660 heart attacks. Those should be preventable with the right education, the right support, and the right attitude from individuals and the Government.

There is so much that I could talk about on diabetes, but this is a short debate, so my initial ask of the Government, on type 1, is that we end the postcode lottery, with equitable treatment for those living with diabetes wherever they live in the UK.

[Jim Shannon (Strangford) (DUP)]

I commend the hon. Lady for securing the debate. I declare an interest: I am a type 2 diabetic. In our discussion before the debate, I informed the hon. Lady that, when I was first diagnosed some 18 years ago, believe it or not, I was at least 17 stone and probably getting bigger by the minute. I went on a diet because that was what the doctor recommended; I am down to a nice trim 13¼ stone.

I am thankful for the NHS and the treatment offered, but there is a clear disparity between the treatment offered in different areas of the United Kingdom. Does the hon. Lady agree that diabetes does not have to be a death sentence, but does not have to adversely affect quality of life either? We must ensure that, no matter where someone is in this great United Kingdom of Great Britain and Northern Ireland, they should get a level of diabetic care that enables them to live life to the fullest. Does the hon. Lady agree?

[Sarah Bool]

Absolutely. I totally agree, and the hon. Gentleman makes a very powerful point. It does not have to be a death sentence; it can even lead someone to No. 10 Downing Street, if they are Baroness May, so it should not prevent anyone from achieving anything.

Going back to my asks for type 1, we must also commit to greater access to technology for diabetes, such as hybrid closed loop technology, and increase awareness of the condition and treatments in schools and among the public. We also want to see the expansion of early testing for type 1 diabetes to identify children who are living with the condition and to make sure that they and their families get the right support.

I apologise in advance to hon. and right hon. Members if I suddenly start to beep during this debate, or in the Chamber in the future. They can be assured that it is not because I am some form of 21st century R2D2; it is because I wear an insulin pump and sensors. When my blood sugar is running low, it will alert me so that I can consume a lifesaving sugary treat. This hybrid closed loop system has dramatically improved the quality of my life with type 1. It does not just benefit adults with diabetes like me; there are parents of young children with a HCL who feel they can finally sleep at night without fear of missing a nighttime low blood sugar for their little ones.

Type 1 is also a condition that creates a serious mental burden on those who live with it and their loved ones. As a condition where someone’s pancreas stops working and no longer produces insulin, it requires constant thought and calculations alongside normal activities. Each day, a person with type 1 is assessing how many carbohydrates there are in their food and how much insulin they should dose, taking into account whether they have exercised, will be exercising, or generally rushing around; how hot or cold it is; how tired they are; how stressed they are, with public speaking adding to the mix for me; for women in particular, what their hormones are doing; and, when they have low blood sugar, how quickly they can access a sugar supply.

My insulin pump and sensor have ensured that many of those burdens have been eased. I just wish that more of my fellow diabetics had the same opportunity. I know of one lady from the south-west of England whose local integrated care board did not prescribe HCLs, so she had to move to London, away from her support network, just to access that vital technology. That cannot be right. As part of building an NHS fit for the future, Ministers should ensure that wherever someone is in the UK, they can access vital treatments for diabetes, such as the HCL.

There are other treatments that the Government should commit to fully exploring, such as early detection and new drugs. As with my diagnosis, more than 80% of type 1 diagnoses occur in people with no known family connection to type 1 diabetes. Many people are not aware of the four “T” symptoms that they should look out for: thirst, toilet, tiredness and thin. Early detection is vital in preventing complications such as diabetic ketoacidosis, which one in four children with type 1 are diagnosed with, and which can be lethal. Early detection can also identify people who would benefit from early intervention clinical trials and treatments.

The ELSA study is a programme funded by Breakthrough T1D that offers children between the ages of three and 13 a simple finger stick blood test to determine their risk of developing type 1 diabetes. The study is currently open to families across England, Scotland, Wales and Northern Ireland, with over 20,000 children having been screened so far. I ask that the Government work to have the programme expanded and implemented on the NHS nationwide, as it could drastically reduce the instances of future complications from type 1.

[Jim Shannon]

I thank the hon. Lady for giving way again. One of the things that we have noticed back home in Northern Ireland is that even if someone gets a type 1 diabetes diagnosis early on, it does not mean that their life is over—they can still go on. We have a high prevalence of young children in Northern Ireland who have type 1 diabetes, and for them it is rather scary but also a fact of life. I have seen some of those young boys and girls growing up and the diabetes has not affected their life at all. It is important to know that those being diagnosed early with diabetes can have a normal life and family.

[Sarah Bool]

I absolutely concur with the hon. Gentleman; people can live a fulfilling and fulfilled life, but they do need a little more help along the way. If we get that at the right time, it can literally transform a life so that they can live like everyone else.

One of the promising new treatments coming forward is teplizumab, which will delay the onset of type 1 in children by an average of three years. Approved by the Food and Drug Administration in the US in 2022, it is about to start a technological appraisal by the National Institute for Health and Care Excellence. In conjunction with the national early detection programme, teplizumab could drastically reduce the complications associated with type 1.

With the rise of social media, we have seen an ever-growing societal preoccupation with body image. Earlier this year Baroness May and Sir George Howarth released a parliamentary report into type 1 and disordered eating, also known as T1DE. T1DE is an eating disorder where someone might restrict their insulin to lose weight or experience an eating disorder such as bulimia or anorexia alongside type 1. Evidence suggests that up to 40% of women and girls and up to 15% of men and boys with diabetes experience some form of disordered eating, so we really must continue the work of Baroness May and Sir George in raising the profile of diabetes and its complications.

On type 1, I ask the Minister to ensure that the Government work with the NHS to increase awareness of the hybrid closed-loop technology, particularly among lower socioeconomic groups, and to fund its roll-out nationally; to provide comprehensive training for healthcare practitioners on HCL technology; and to establish a national diabetes registry to support technology adoption and track health outcomes.

Turning to type 2 diabetes, right hon. and hon. Members will have heard a lot about and might even have been tempted by Ozempic and Wegovy, known as the GLP-1 medications—seemingly magic solutions that have helped many in the public eye to shed unwanted pounds. However, that class of medication is an important treatment for those with type 2 diabetes as it is prescribed to lower blood glucose levels. My concern, and that of some of my constituents who have written to me, is that there is a real risk of a shortage of those medicines for type 2 diabetics while they are being prescribed for weight loss. It is therefore essential that the supply of those drugs is protected for diabetics. Will the Minister take action to ensure that everyone with or at risk of type 2 diabetes can access the medications that they can benefit from?

Alongside medications, we should ensure that newly diagnosed type 2 diabetics are given the right support. In some cases it is possible to put type 2 into remission, so it is essential that access to evidence-based services such as the NHS path to remission programme is increased for people in the first three years of their diagnosis. Likewise, people under the age of 40 with type 2 are at increased risk of developing diabetes complications, but are less likely to receive their essential care. The NHS type 2 diabetes in the young programme—T2Day—provides extra support for that group, including confirmation of diagnosis, additional checks, contraception and pre-conception planning, and assessment of cardiovascular risk. The Government must commit to sustainable long-term funding for the programme to ensure that the rise in type 2 diabetes in working age adults does not lead to a drastic increase in serious complications.

There are also inequalities across the diagnosis of diabetes. Those living in deprivation and people of black and south Asian ethnicity are more likely to develop type 2 diabetes but less likely to receive their diabetes care, and they go on to experience worse health outcomes. As the Government develop their plan for the NHS, they should use health inequality impact assessments for all diabetes-related policies to understand how reforms affect different groups.

As right hon. and hon. Members might have worked out by now, I could speak about diabetes all the way to the moment of interruption this evening, but I will draw my speech to a close. Acting as our own pancreas is hard and our illness requires 24-hour attention. Diabetes treatment is relentless, but so are we.