Tobacco Control Plan

Sharon Hodgson Excerpts

Thursday 19th July 2018 Commons Chamber

[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

It is a pleasure to be here to speak about the tobacco control plan, which celebrated its first anniversary only yesterday, as the Minister said. We are here to discuss the progress of the plan so far in reaching the Government’s goal of a smoke-free generation by 2022. I start by thanking the Government for allowing time for this debate to take place after all the drama and commotion of this week. As the Minister said, my first outing as shadow Minister for public health was in a debate on this issue, and thanks to him, we have the new, updated tobacco control plan that we are debating today. I know that it holds a very special place in both our hearts and, like him, I look forward to the debate.

The Opposition welcomed the plan and its ambitious goals, but we remain concerned about how they will be achieved by 2022. It is true that smoking is now thankfully at an all-time low, but the Government must not be complacent—I know that the Minister is not—and must not quit when it comes to measures that reduce smoking rates.

There are still 7.3 million adult smokers in the UK but, shockingly, smoking is an addiction of childhood, with the vast majority of smokers starting to smoke before the age of 18. Between 2014 and 2016, more than 127,000 children aged between just 11 and 15 started to smoke in the UK. According to a recent study by the Society for Research on Nicotine & Tobacco, this amounts to 350 young people starting smoking each day. That is equivalent to 17 classrooms of secondary school children starting to smoke every day. The Government therefore have a huge challenge on their hands—as we all do in Parliament—to tackle smoking in childhood and to reduce the rate of children smoking to 3% or less.

Between 2013 and 2016, the rate of decline in smoking among young people slowed down and the proportion of 15-year-old regular smokers had fallen from 8% to 7% but, at this rate, we will fail to achieve the ambition for England of 3% by 2022. The Minister mentioned in his opening remarks that we really will need to accelerate our progress when it comes to the number of children taking up smoking. Tackling this issue will be the first step to achieving a generation that is not only smoke-free, but healthier.

Smoking remains the leading cause of preventable premature death, such as from cancer or lung disease, and accounts for around 100,000 deaths each year in the UK. Each of those deaths could have been prevented. In 2015-16, there were approximately 474,000 smoking-related hospital admissions, with smokers also seeing their GPs 35% more often than non-smokers. In 2017, 22% of hospital admissions for respiratory problems were directly attributed to smoking. In 2015-16, smoking-related respiratory diseases cost NHS England £167.4 million in adult secondary care costs. I am sure that the Minister agrees with me that an ounce of prevention is better than a pound of cure.

The National Institute for Health and Care Excellence estimates that every £1 invested in smoking cessation generates £2.37 in benefits. However, according to the King’s Fund, spending on smoking cessation services in 2017-18 was reduced by almost £16 million compared with figures for 2013-14. Furthermore, the Health Foundation has found that next year just £95 million will be spent on smoking and tobacco control services, which is 45% less than in 2014-15. Has the Minister made any assessment of the impact that those cuts will have on local smoking cessation services?

A study conducted by Action on Smoking and Health—ASH—and Cancer Research UK found that in 2017 budgets for stop smoking services were reduced in half of the local authorities in England, following reductions in 59% of authorities in 2016 and 39% in 2015. It is a wonder that there are any smoking cessation services left at all. What that means on the ground is that smokers who want to quit do not have access to the services that they need, and smokers who may need an extra push to seek help to quit are not getting that push.

Given that local smoking cessation services are on their knees, how does the Minister’s Department expect to reach the goal of reducing smoking rates to 12% by 2022? The Government’s own plan acknowledges that

“local stop smoking services continue to offer smokers the best chance of quitting”,

but cuts in local authorities’ funding have led to unacceptable variations in the quality and quantity of services available to the public. In my region of the north-east, the current smoking rate is 16.2%, which is down from 17.2% in 2016. That represents the biggest fall in smoking in England. It means that smoking rates in the north-east have fallen by more than 44% since 2005, when 29% of adults in the region smoked, and that there are about a quarter of a million fewer smokers.

It has to be said that that decline in smoking rates is due to the excellent programme Fresh north-east. I know that the Minister has commended the programme before, and no doubt he will take the opportunity to do so again. Its vision is to make smoking history and to reduce smoking prevalence in the north-east to 5% by 2025.

[Steve Brine]

I am happy to place on record my thanks for the work of Fresh north-east, whose representatives I have met. It is a good example of what I was talking about—local systems working together. It is not just about what local authorities commission and the state provides. Fresh north-east is a coalition consisting of the public sector and the third sector.

[Mrs Hodgson]

That is important, especially when, as the Minister has acknowledged, we are in such straitened times when it comes to local authority budgets. I am sure that Fresh north-east will be very grateful for what he has said.

Sadly, other areas are not as lucky. They do not have a Fresh north-east; if only they did. Stop smoking services are roughly 300% more effective than quitting by going cold turkey, but in some places the specialist services are being decommissioned altogether. For example, in Blackpool, smoking prevalence is 22.5%, while the average for England is 15.5%, yet Blackpool Council recently decommissioned its specialist smoking cessation service, citing a number of factors including public sector budget cuts.

That example leads me to my next point. Between 2012 and 2014, the healthy life expectancy for newborn baby boys in England was the lowest in Blackpool at 55 years. Again, the shortest life expectancy among men was in Blackpool too, at 74.7 years. Interestingly, in 2014, Blackpool had the highest smoking prevalence at 26.9%. Wokingham had the lowest smoking prevalence at 9.8%, but the highest healthy life expectancy of 70.5 years. That is a 15.5 year difference between healthy life expectancies, and while there will be several factors in play in these figures, it is clear that smoking is one of the largest causes of health inequalities in England.

Some 26% of routine and manual workers now smoke, compared with 10% of those in managerial and professional jobs. This has slightly increased rather than decreased the inequality from 2016. Some 28% of adults with no formal qualifications are current smokers compared with only 8% of those with a degree. It is these people—manual workers or those from low socioeconomic backgrounds—who suffer the most when the Government cut spending to public health services. I therefore ask the Minister what steps his Department is taking to ensure that these people are reached by local smoking cessation services. What assessment has the Minister made of the impact that smoking rates have on widening health inequalities, and how does he intend to address them?

Finally, I move on to smoking in pregnancy. The Government’s ambition to reduce smoking in pregnancy to 6% or less by 2022 is laudable. In 2015-16 the rate was 10.6%. However, new data published recently showed that the rate of smoking during pregnancy in 2017-18 had increased slightly, to 10.8%. It is therefore deeply concerning that the Smoking in Pregnancy Challenge Group, which I recently met, has warned that this ambition is unlikely to be met unless urgent action is taken.

In 2010, 19,000 babies were born with a low birth weight because their mothers had smoked during pregnancy. Up to 5,000 miscarriages, 300 perinatal deaths and around 2,200 premature births each year have been attributed to smoking during pregnancy. In addition, many other children will be three times more likely to take up smoking in later life because they live in smoking households. If we are going to have a smoke-free generation in the future, the Government must take urgent action to ensure that rates of smoking in pregnancy fall. We must not forget that it will be those very babies who will become the smoke-free generation that we all hope to see.

The current target is to reduce smoking in pregnancy to 6% or less by 2022. If that is achieved, it could mean around 30,000 fewer women smoking during pregnancy, leading to between 45 and 73 fewer stillborn babies, 11 to 25 fewer neonatal deaths, seven to 11 fewer sudden infant deaths, 482 to 796 fewer pre-term babies, and 1,455 to 2,407 fewer babies born at a low birth weight. That is something to aim for, but it will only happen if the Government take urgent steps to reduce the number of women smoking during pregnancy.

[Bob Blackman]

On behalf of the all-party group on smoking and health, I thank the hon. Lady for speaking at the launch of our recent report. Does she agree that we must encourage not only pregnant women to give up, but their partners, too, so that pregnant women no longer have to face the challenge of not only being deprived of smoking, but of seeing their partner smoke in front of them? This should be a partnership for both parties.

[Mrs Hodgson]

That is a very pertinent point. We all know the damage of passive smoking. It is all well and good if the mother gives up smoking—that will definitely help her and the baby during pregnancy—but if smoking is still going on in the household, the children will still be growing up in an environment of passive smoking. I thank the hon. Gentleman for making that important point and for his excellent work as chair of the all-party group.

I welcomed what the Minister said about tackling smoking in pregnancy, but will he also tell us how he will target work to encourage younger women and women from more disadvantaged backgrounds to give up smoking during pregnancy? Teenage mothers are nearly four times as likely to smoke before or during pregnancy than those aged 35 and over. Young mothers are less likely to quit before or during pregnancy, and only 38% of mothers under the age of 20 did so, compared with 58% of mothers aged 35 or above. It is clear that the Government need to tackle smoking in pregnancy, and smoking in childhood, as a matter of urgency to achieve their ambition of a smoke-free generation.

The Minister and his Department have a huge challenge on their hands if they are to meet the ambitious targets set out in the tobacco control plan. I still welcome the plan as the right thing to do, as I am sure the Minister does. Anything that is worth doing is going to be hard. We have four years to go before the target date, and the Minister must now look at how the Government can properly fund smoking cessation services to drive down smoking rates and support those who need extra help to stop smoking. I look forward to the remainder of the debate and the Minister’s closing remarks.

--- Later in debate ---

[Mrs Hodgson]

With the leave of the House, I would like to start my closing remarks by thanking the hon. Member for Harrow East (Bob Blackman) and my hon. Friend the Member for Stockton North (Alex Cunningham), the chair and vice-chair of the very influential and active all-party parliamentary group on smoking and health, for their excellent speeches today and their leadership on this issue. I also thank my right hon. Friend the Member for Rother Valley (Sir Kevin Barron). As we know, he has campaigned in this House for decades on this issue. I thank the hon. Member for Linlithgow and East Falkirk (Martyn Day), who speaks for the Scottish National party, and, last but by no means least, the hon. Member for Strangford (Jim Shannon). It has been an excellent debate.

I will begin by touching on e-cigarettes, which I mentioned in my opening remarks and several hon. Members mentioned in the debate. For the first time, e-cigarettes were mentioned in the updated tobacco control plan, with the aim of maximising the availability of safer alternatives to smoking. There has been a significant increase in e-cigarette usage since the publication of the previous 2011 strategy. There were 700,000 e-cigarette users in 2012. That figure rose to 2.8 million by 2016. In 2016, Office for National Statistics data found that 470,000 people were using e-cigarettes as an aid to stop smoking, while an estimated 2 million had used the products and had stopped smoking completely. I am therefore pleased that Public Health England’s Stoptober campaign now includes e-cigarettes as a smoking cessation aid and that e-cigarettes have been found to be about 95% less harmful than smoking. We should encourage people to use smoking cessation aids, such as e-cigarettes, to help them to stop smoking, while keeping a watchful eye on any negative health outcomes, if there are any.

Earlier this year, I joined the Minister, Action on Smoking and Health, Fresh North East and a host of NHS professionals to launch the NHS Smokefree Pledge. During my speech at the launch, I said that smoking cessation should become a central theme of healthcare staff’s engagement with patients, making every contact count to help people to quit smoking. Has the Minister made any assessment of the success of this pledge so far and will the Government make any further assessment of how many people have quit smoking because of the NHS Smokefree Pledge?

While the proportion of adults who have never smoked cigarettes has increased over the past 30 years, from 25% of men and 49% of women in 1974 to 56% and 63% respectively in 2016, we must ensure that that steady increase continues. However, the deaths attributable to smoking continue. Of the 115,000 lung disease deaths each year, up to 58,500 are attributable to smoking. This includes 86% of all lung cancer deaths and 77% of all chronic obstructive pulmonary disease deaths. The UK currently has one of the highest premature mortality rates from lung diseases in Europe. Smokers are almost twice as likely to have a heart attack compared with people who have never smoked and about half of all regular smokers will eventually be killed by their habit. This is unacceptable.

The Government have a duty to ensure that their citizens are healthy, which means properly funded public health services and implementing policies that encourage healthier lifestyles. Will the Minister tell the House if further funding will be granted to local authorities to deliver public health services such as smoking cessation? I truly believe that the ambitions in the tobacco control plan cannot be achieved without adequate funding. I know that like me, he is truly passionate about reducing smoking rates and rightly passionate about achieving a smoke-free generation, so I look forward to his response.