Smokefree England: Covid-19 and PHE Abolition

Steve Brine Excerpts

Thursday 12th November 2020 Commons Chamber

[Steve Brine (Winchester) (Con)]

It is a pleasure to follow the hon. Member for Blaydon (Liz Twist), who I have been questioned by many times. Thinking about today’s debate, I remember in early summer 2017, when I was standing down there at the Dispatch Box answering Health questions, being pressed by my then shadow, the lovely lady the hon. Member for Washington and Sunderland West (Mrs Hodgson), on when I was going to publish the long-awaited tobacco control plan, which, as the hon. Member for Blaydon reminds us, was due to be out in December 2015. Rather to the surprise of my shadow that day and my officials sitting in the box, I said that it would be out “before the summer recess” and, true to my word, it was.

That was an early lesson for me in how to focus minds in the civil service, because I have never seen them move so fast, but more importantly, it set out some of the key ambitions for us to hit by 2022. The prevention Green Paper a few years later then set the course for England to be smokefree by 2030. I stand by the ambitions, both in the plan and in the Green Paper, 100%, and I believe with all my heart that they are completely achievable, but we will have to get our skates on, as has been said by the first two speakers, the hon. Members for City of Durham (Mary Kelly Foy) and for Blaydon. We will have to be very bold and make the most of one of the rare opportunities afforded to us by the covid pandemic.

I want to make just a few points today. On public health reorganisation, I have previously raised my concerns in the House about the future of Public Health England’s work to tackle issues such as smoking, obesity, inequality and air quality after the new National Institute for Health Protection comes online. I have no issue with the desire to take the health protection functions out and create the new institute based on the German model—it makes a lot of sense, and I have said so to the Health Secretary in public and in private. My concern is about the health prevention parts of Public Health England. On 1 September, I asked the Secretary of State whether he was considering bringing Public Health England’s expertise and significant experience in this area back into the Department. When I was travelling abroad representing the Government and I needed briefing on these issues, I always knew that there would be somebody who knew infinitely more than me inside Public Health England. I do not want to see that wasted.

I note that the Department has now established a programme of work to pick through this. The snappily titled population health improvement stakeholder advisory group has been formed and there are some notable names on there, such as Seema Kennedy, who was my successor as Public Health Minister; Professor Helen Stokes-Lampard, formerly of the Royal College of General Practitioners and now chair of the Academy of Medical Royal Colleges; Professor John Newton from Public Health England; Dr Jenny Harries, whom many of the public will be familiar with as deputy chief medical officer; and Professor Paul Cosford, emeritus medical director of Public Health England and a truly excellent official—one of the best I ever worked with. There are some good people on there.

On balance, I would restate my call for the Department to recover these functions, and I refer the Minister to a pretty comprehensive piece of work published just this week by Policy Exchange, examining how a new deal for public health can build a healthier nation. It calls for the creation of a new institute for health improvement housed in the Department of Health and Social Care, reporting directly to Ministers and the chief medical officer, for a new funded national mission to improve the health of the nation. There is a lot of sense in that, and I recommend the report to the Minister.

Let me dwell for a moment on the word “funded”. I do not think—the record will show that I was always lukewarm at best on this idea—that the Government should proceed with the idea of ending the ring fence of the public health grant. I think it would be a mistake. That should be kept. It should be measured much more tightly and, if anything, I think it should be increased to help our directors of public health to do what works towards smokefree 2030. I am not making unfunded spending commitments. The prevention Green Paper, which I helped to draft and still think is a very credible piece of work, talks about the principle of making the polluter—that is, the tobacco firms—pay, as has been done in France and in the United States, and we should progress that to create a smokefree 2030 fund. I would be grateful if the Minister could reassure me that the Government are at least considering this option and what it might look like in practice.

The Government’s ambition for what we call “smokefree” is for a smoking prevalence in England of 5% or less in the next 10 years, but, as we have heard, significant action is clearly needed if we are to achieve this. The rate in Winchester, which I represent, may be 8.3%, but the national average is 14.1%, so there is a way to go. Smoking remains the biggest single cause of preventable death in our country today, and it is a leading cause of health inequalities. The issue is also one of inequality. About one in four people in routine and manual occupations smoke—about two and a half times more than people in managerial and professional occupations—and this gap has widened significantly since 2012, according to the Office for National Statistics. The inequalities are also geographic, as we have heard.

As a Conservative Member, I see becoming smokefree as a vital step towards delivering our manifesto pledges on extending healthy life years by five by 2035, reducing inequalities across the board, and, as the Prime Minister calls it, levelling up every part of our country. However, as the Green Paper concluded, this is an extremely challenging ambition for any Government. The all-party group on smoking and health has recommended a new tobacco control plan focusing on delivering the 2030 ambition, and that is an eminently sensible suggestion. Given how long it takes to get a tobacco control plan, even when making promises at the Dispatch Box, has the Minister commissioned officials to start work on renewing the TCP to set a course for the smokefree ambition? I think that Ministers will be doing that, with smoking prevalence going in the right direction, albeit not fast enough to meet our agreed ambition, but also off the back of the opportunity afforded to us by the by the pandemic.

The University College London smoking toolkit indicates that the pandemic has been a driver of quitting among smokers across all social groups, with the highest rate of people stopping smoking seen in the past 30 years. That is the good news. However, we cannot be complacent. Although it is true that many people have quit, there are signs that some have relapsed into smoking. In particular, there are worrying signs among the 18 to 24-year-old group that smoking rates may be increasing again and have certainly stopped declining.

Turning to the alternatives, the UK has long been a leader in traditional tobacco control measures such as the use of taxation, as we hear at Budget time; the smoking ban, which was a great credit to the Blair Government; plain packaging; readily available smoking cessation services; and numerous tobacco harm reduction policies using less harmful alternatives to smoking. I was often criticised in office both for promoting e-cigarettes too much and for not promoting them enough as an alternative. That suggested to me that I may have had the balance about right, but I will go further. Data from the ONS tells us that over half of smokers in this country want to quit and that, on average, smokers try some 30 times or more before giving up successfully. Of those who are successful, only 2% quit through stop smoking services, and over 40% use an e-cigarette. However, while many have quit using vaping, the fact remains—we cannot deny this—that nearly half of smokers in Britain have tried vaping but did not stick with it. On top of that, the figures now show that the number of vapers is falling, while some 1.3 million vapers have not fully made the switch and still continue to smoke at the same time.

Since the early 2000s, tobacco policy in the UK has been driven by the European Union through the tobacco products directive. That is about to change. May I therefore ask the Minister to speculate, as I know Ministers love to do, on what opportunities Brexit brings to advance our leading role as a tobacco harm reduction advocate? We may be leaving the political structures of the European Union, but I sincerely hope that we are not leaving our leadership role in this area when many countries around the world look to see what the UK does.

Our prevention Green Paper pledged—as, indeed, did I when in office—to

“run a call for independent evidence to assess further how effective heated tobacco products are, or are not, in helping people quit smoking and reducing health harms from smoking.”

The Government said that the call for evidence would be announced in summer 2020. Of course, we all understand why that has slipped, but I wonder if we might get a reaffirmation today, because recent word, including a parliamentary written answer on 21 September to my hon. Friend the Member for Broxbourne (Sir Charles Walker), who I know wanted to speak today, said that the Government would merely

“consider looking at this at a later date”.

It is imperative that the Government recommit to holding that call for independent evidence as soon as possible, so that the effectiveness of heated tobacco products can be assessed and smokers can have confidence that they are switching to a less harmful alternative.

I say that because there is growing evidence that adult smokers’ misperception of the risks surrounding vaping may be preventing them from transitioning to less harmful alternatives. Last month the excellent UK charity Action on Smoking and Health, otherwise known as ASH, which campaigns against smoking and is run by Deborah Arnott, published survey data showing that vaping in the UK had stagnated as a percentage of the total smoking population, after year-on-year growth. The charity blamed what it called

“unfounded concerns about the relative safety of e-cigarettes”

as a likely cause.

Given that public health authorities in the UK actively support and champion vaping as an alternative to smoking, that statistic shows how damaging inaccurate media coverage can be. To maximise the public health benefits of e-cigarettes, I think regulations should be risk-proportionate and reflect the scientific evidence base on the relative harms of cigarette alternatives and their potential for harm reduction. For example, when this Parliament’s Select Committee on Science and Technology, chaired so ably by my right hon. Friend the Member for Tunbridge Wells (Greg Clark), reviewed the scientific evidence on e-cigarettes, it recommended that the Government should move to a

“risk-proportionate regulatory environment; where regulations, advertising rules and tax/duties reflect the evidence on the relative harms”

of vape products compared with combustible cigarettes.

The UK Government have invested a lot of resources to understand the science behind these products, which I think has informed the pragmatic and progressive approach that successive Governments have taken to vaping regulation over many years. The results have been impressive, suggesting that it would be a strong regulatory model for other countries to consider. Given competing public health priorities, of course I appreciate that it is not as simple as it sounds, but I believe we should dedicate sufficient time and resource to understanding the science around vape products and their potential to improve public health. That is why I would like us to recommit to what it says in the Green Paper that I partly wrote.

Will the Government consider increasing the age of sale from 16 to 21? That could be a useful tool in the toolbox. ASH has suggested that the Government should consult on that as a means of reducing youth uptake. The call has been backed by more than 70 organisations, including Cancer Research UK, the British Heart Foundation and the Royal College of Physicians. I think it is well worth considering.

In conclusion, we should keep the ambition. We have never been short on the ambition, across the last Government, the coalition Government and this Government. We should tighten and update the plan, to bring it in line with the ambition in the Green Paper. We should stick to what we know works and be honest enough to say what does not. We should fund the directors of public health on what does work, and I have given a suggestion as to where I think that can happen. There is a lot riding on getting this right. A lot of people’s lives depend on us getting this right, and we need to do so for their benefit and for that of the next generation, so that another generation of young people is not weaned on to the damaging lifestyle that smoking can lead to. I have given a few ideas and look forward to hearing the Minister’s response at the end of the debate.

--- Later in debate ---

[The Minister for Health (Edward Argar)]

It is a pleasure, as always, to appear opposite the shadow Minister, the hon. Member for Nottingham North (Alex Norris). It is happening with regularity: three times on three different days last week and again today. Indeed, it is happening with a fair degree of regularity that I am speaking in front of you in this Chamber, Madam Deputy Speaker, which is always a pleasure.

I thank all hon. Members for their participation in today’s debate with typically well-informed and important speeches. As the shadow Minister has alluded to, the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Bury St Edmunds (Jo Churchill), within whose portfolio this matter would normally fall, has been taking a simultaneous debate in Westminster Hall, so it is a rare pleasure for me to be able to speak at the Dispatch Box on this matter.

I thank the hon. Member for City of Durham (Mary Kelly Foy) for securing this important debate. As the hon. Member for Strangford (Jim Shannon) said, I think this is her first debate in her name in this Chamber, and, consistent with the principled approach that she adopts in this place to raising issues that she passionately cares about, she has done that today, and I pay tribute to her for doing that.



We should all recognise the significant achievements made on tobacco control over the past two decades through cross-party working. In that context, as my hon. Friend the Member for Winchester (Steve Brine) said, while I may not agree with everything that the former Prime Minister Tony Blair did, it is right that I recognise and pay tribute to him for his work in this space when he was leading the country. Smoking rates are now at their lowest ever level in England and the UK, and that is a great public health success story.

However, as Members have highlighted powerfully, there is no room for complacency. Smoking still causes more than 78,000 deaths each year, and there is much more still to do, which is why we announced our smokefree 2030 ambition. As Members will know, the UK is a global leader in tobacco control. Our commitment to tough tobacco control will continue after 1 January 2021. We laid the Tobacco Products and Nicotine Inhaling Products (Amendment) (EU Exit) Regulations 2020 on 28 September to reaffirm that commitment, which the hon. Member for Nottingham North and I debated recently.

The covid-19 pandemic, as we well know, has put a huge strain on our health and care system. The Government have published guidance regarding covid-19 and the risks from smoking, so this debate is very timely. The message has been clear that quitting smoking will improve a person’s health and recovery prospects if they are unfortunate enough to contract covid-19. It is important that we recognise the great work of local authorities—I will come to that later—and the NHS, along with the third sector, in their support to help smokers quit during these exceptionally challenging times. They have ensured that stop smoking services have continued and used the opportunity of the pandemic to reach out to more smokers to encourage them to quit. I thank them for the work they have done and continue to do.

Action on Smoking and Health has estimated that around 1 million smokers may have made a quit attempt during the pandemic, and that is good news. The Government have provided funding to support ASH’s “Today is the Day” campaign, to enable the stop smoking message to reach as many smokers as possible in some of the most deprived areas, and I pay tribute to ASH for its work. Public Health England’s Better Health Stoptober annual campaign has also continued at a national and local level to support people quitting during the pandemic.

I thank the hon. Member for Strangford for his speech, which brought an important perspective from Northern Ireland to this issue. He mentioned two things that I want to pick up on. He asked whether I would engage with the Health Minister in Northern Ireland, Robin Swann, on this issue. Although this comes under the portfolio of the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Bury St Edmunds, I am due to talk to Robin Swann next week about other matters, so I will endeavour to shoehorn it into the conversation in the way that the hon. Gentleman so elegantly does with a number of topics in this Chamber in various debates. I thank and pay tribute to Robin Swann for all the work he is doing in partnership with us at this difficult time.

The hon. Gentleman also mentioned the role of Ofcom. I know that the Under-Secretary of State for Digital, Culture, Media and Sport, my hon. Friend the Member for Mid Worcestershire (Nigel Huddleston), who is due to respond in the Adjournment debate, is very near to the Chamber, if not present at this moment, and I suspect he will have heard the points made by the hon. Gentleman and will reflect on those in his work.

The Government are committed to levelling up society to ensure that no communities get left behind. That is why we announced our bold ambition for England to be smokefree by 2030 in the prevention Green Paper consultation. I am grateful to the hon. Member for Nottingham North for rightly highlighting the importance of this being a cross-party issue, which typifies the approach that he takes to these matters in the House.

I pay tribute to my hon. Friend the Member for Winchester, who was an incredibly effective public health Minister. He is missed in that role and in Government, and I hope one day he will return to the Dispatch Box. He played a hugely important role in drawing up the current tobacco control plan for England. He also gave us some very good tips on how to speed up delivery within our excellent civil service if a Minister decides that he wants to accelerate clearance and implementation of a policy. The recent prevention Green Paper highlighted the urgency of tackling disproportionate smoking rate harms in deprived areas, which the hon. Members for City of Durham and for Blaydon highlighted. The Green Paper also highlighted the disproportionate smoking harm rates among the LGBT community, pregnant women and those with mental health conditions, which again goes to points that hon. Members made. I will endeavour to address those in just a moment.

In terms of that tobacco control plan, the points made about what happened last time and the fear of a gap, I reassure Members who highlighted the need for no gaps and for continuity that it is something of which my hon. Friend the Member for Bury St Edmunds is very much aware. I know she would want me to reassure the House that she is working extremely hard on ensuring that effective measures and effective planning continue to be in place to address the challenges of smoking. Smoking, as has been alluded to, is one of the biggest behavioural drivers of health inequality in England and reduces life expectancy by 10 years on average. That accounts for half the difference in life expectancy between the richest and the poorest, which again Members have made very clear.

Turning to some of the points made by the hon. Member for Blaydon, although rates for smoking in pregnancy are the lowest recorded, they remain around 10%. Clearly she is right to highlight that that must remain a concern for all of us in government, in this House and in this country. More needs to be done to reach our national ambition of a rate of 6% for smoking in pregnancy by the end of 2022.

Public Health England continues to work closely with NHS England and NHS Improvement on their long-term planning commitments to offer all patients NHS-funded treatment services over the coming years, including a new smokefree pathway for expectant mothers and their partners. I am confident that progress will continue to be made to hit that target, but I know from experience that the hon. Lady, in her typically courteous but firm way, will continue to hold Ministers to account in achieving that.

[Steve Brine]

While we are on the subject, as the song goes:

“The saddest thing that I’d ever seen / Were smokers outside the hospital doors”—

name the band. It is not a national problem, but it is a big problem in some areas, which is why I made the point to the Minister—will he convey this to the public health Minister?— that it has to be a regional and local approach through the directors of public health. It is a much bigger problem in some towns than it is in others.

[Edward Argar]

I will not seek to outdo my hon. Friend in his knowledge of music or, possibly, his expertise in this area, but I will certainly convey that point to my hon. Friend the Member for Bury St Edmunds.

Alongside tackling smoking in pregnancy, a big challenge is to reduce smoking rates in those with mental health problems, as the hon. Member for Blaydon said, which remain significantly higher than the general population at 42%. The NHS long-term plan will also offer a new universal smoking cessation offer, available as part of specialist mental health services for long-term users of those services and in learning disability services. The Minister for Patient Safety, Mental Health and Suicide Prevention, my hon. Friend the Member for Mid Bedfordshire (Ms Dorries) will be looking into that, working in close partnership with my hon. Friend the Member for Bury St Edmunds, because it is important that we have a joined-up approach. The hon. Member for Blaydon highlighted in her speech the excellent practice in some parts of the country and in some parts of the NHS and the fact that that is not replicated everywhere, which goes to the point made by my hon. Friend the Member for Winchester. It is important that we level up, to coin a phrase, across the country in using and sharing that best practice.

The Government are committed to a smokefree 2030, and we are developing the plans to ensure that is a reality. The plans will build on the good work already under way in the tobacco control plan and the commitments being delivered in the NHS long-term plan, to which, while the pandemic has obviously impacted on the NHS, we remain committed.

I said in my introduction that the UK is a world leader in tobacco control. That is demonstrated by how seriously the Government take our obligations as a signatory and party to the World Health Organisation’s framework convention on tobacco control, the FCTC. Tackling the harms caused by smoking is a global effort, with 8 million deaths a year worldwide linked to tobacco, 80% of which are low and middle-income country deaths.

The Government have invested up to £15 million in official development assistance funding to support the WHO’s FCTC 2030 five-year project, supporting up to 24 countries to improve their tobacco control and improve their population’s health. The project has received considerable praise from global public health and development communities and helped to raise the UK’s profile and strengthen our global reach. I am proud to say that the Department recently received a UN Inter-Agency Task Force on the Prevention and Control of Noncommunicable Diseases award for 2020 for the project. The project is in its final year and we are considering plans to extend it, depending on the Department’s spending review settlement for official development assistance. In a second, I shall address the point about the spending review raised by the hon. Member for City of Durham—I shall be very brief, as I am conscious that I need to leave a couple of minutes for her to reply at the end.

We continue to review the evidence on e-cigarettes, including their harms and usefulness in aiding smoking cessation. Although they are not risk-free, there is growing evidence that they can help people stop smoking, and they are particularly effective when combined with expert support from a local stop smoking service. The Government’s approach to the regulation of e-cigarettes has been and will remain pragmatic and evidence-based. The current regulatory framework aims to reduce the risk of harm to children, protect against the re-normalisation of tobacco use, provide assurance on relative safety for users and provide legal certainty for businesses. We will continue our work to appraise the evidence on new products, including e-cigarettes, and their role in helping smokers quit.

I note comments about proposals for future regulatory changes to help smokers quit smoking. Post transition period, this country will no longer have to comply with the EU’s tobacco products directive, and there will be opportunities to consider in the future regulatory changes that can help people quit smoking and address the harms from tobacco. Although there are no current plans for divergence, I would reassure the House that any future changes will be based on robust evidence in the interests of public health and will maintain this country’s ambitious and world-leading approach in this area.

The Department will be carrying out a post-implementation review of the Tobacco and Related Products Regulations 2016 and the standardised packaging of tobacco products by 20 May 2021 to see whether the regulations have met their objectives. Part of this review process will involve a public consultation to start before the end of the year for people to submit their views and evidence, and I hope that gives some greater clarity about timescales.

The Department has already conducted another post-implementation review and public consultation on various tobacco legislation, as the hon. Member for City of Durham mentioned, and we will publish a Government response shortly. I understand that the aim is to do so before the end of this year, although obviously a lot of work is being put into tackling the pandemic.

I hear what Members have said about the importance of public health grants and local authorities. Like the shadow Minister, I am a former cabinet member for public health. He would not, I suspect, like me to be tempted to try to fulfil the role of the Chancellor of the Exchequer by pre-empting the spending review. As for Public Health England and the future, we are engaging with stakeholders and will consider the best future arrangements for the wide range of non-health protection functions that currently sit in PHE. Our commitment to smokefree 2030 and to working collaboratively to maintain our ambitious agenda and our high standards in this area is undiminished; indeed, it is enhanced.