Tobacco and Vapes Bill (First sitting)

Steve Tuckwell Excerpts

Committee stage
Tuesday 30th April 2024 Public Bill Committees

[Rachael Maskell]

Q Clearly, smoking is far more harmful than vaping, but research by UCL has shown that there are DNA methylation changes linked to carcinogens from vaping in the oral cavity, which quite probably translates to the lungs as well. Should we be looking at this legislation not with the naiveté with which smoking was looked at in the past, but rather as taking advance steps to ensure that we do not see an inducement of lung disease in the future?

Sheila Duffy: As I said earlier, it is a delicate balancing act. We need to move people away from smoking, and anything that does that is a good thing, but we need to look at the long-term effects of vaping. The balancing act in the proposals around restricting access to vaping—making sure that nobody under-age gets access to vapes, denormalising them by taking them away behind the counter and so on—all of those are good measures to reduce the number of children moving on to vaping, but they need to be enforced. We need to make sure that we have the right enforcement action in place to make sure that that actually happens.

Dr Griffiths: You gave a great example of early science that causes us concern, and it perhaps will not surprise you to know that as a body that is based in science and evidence, we at the BHF take statistics incredibly seriously. We are worried that the body of evidence will grow. We would hugely support and welcome a position where vaping was available to people as a cessation tool, but absolutely would discourage anyone else from taking it up as a starting point for nicotine consumption.

[Steve Tuckwell (Uxbridge and South Ruislip) (Con)]

Q Could you take us through the impact second-hand smoking has on health?

Dr Griffiths: It has a huge impact, and thanks to some of the previous legislation there have been some improvements that we can measure and track with great certainty. Second-hand smoke is undoubtedly a cause of cardiovascular disease, and for those people unfortunate enough to be exposed to it, it is a serious issue. Just over 15 years ago, there was a study that looked at coronary heart disease and cardiovascular disease in men. It showed a significant uplift for those exposed to second-hand smoke on a regular basis that was roughly the equivalent in risk of smoking nine cigarettes a day. So there is a very clear basis for saying that second-hand smoke causes heart and circulatory disease.

Sarah Sleet: I would add the legislation on smoking in closed places—there was of course the legislation back in 2015 about children and smoking in cars—was based on very good evidence and was introduced for very good reasons. It proved to be a popular measure. Second-hand smoke in this context as well is an important additional factor to consider in terms of the harms balanced against the need to restrict these particular products.

[Trudy Harrison (Copeland) (Con)]

Q Thank you. While the harms of vaping are becoming better understood, what do we know about the behaviours around vaping? I ask as an MP who represents the northern constituency of Copeland, where smoking levels are above the national average, where health inequalities are more prevalent, and where deprivation is also a factor. Are we seeing the same kind of mapping of deprivation in areas where people are starting to vape? Are we aware of copycat behaviour—children mimicking their parents or other people in their households—and are we starting to see some patterns in age groups starting to vape? That statistic—350 young people starting to smoke every day—is shocking. What do we know about vaping?

Dr Griffiths: Not as much as we would like. That is the headline, but I do not think it will surprise any of us to know that people follow cues in their environment. That is partly what happens around them in their social environment, but I would like to draw attention to what happens in shops and convenience stores where people buy vapes. I was looking around my local convenience store, which is not far from a school, and thinking about today. It does not take a lot to look at what is happening behind the counter and see the packaging, the marketing and the highly, brightly coloured products that are clearly labelled, named and flavoured in a way to be attractive to children, whether it be cherry cola vapes or cotton candy vapes. They are things that are deliberately sweet and targeted at children, so it causes us great concern that that will be such a huge influence on so many children. We see that playing out in prevalence. I do not know if there is anything that you would add, Sarah.

Sarah Sleet: I think you are right that there is no real evidence base around this. That research should be done and we would very much like to look at. Where smoking is very prevalent—as you say, in more deprived areas—people take cues from the people around them in terms of their behaviour. I have no doubt that look to similar cues for vaping. Are people around them smoking? Is it easy to get hold of vapes? Is it completely normalised? I think we would find a very similar pattern, but we need to get that evidence.

Tobacco and Vapes Bill (Second sitting)

Steve Tuckwell Excerpts

Committee stage
Tuesday 30th April 2024 Public Bill Committees

[Rachael Maskell (York Central) (Lab/Co-op)]

Q My question is for Greg Fell. The clarity and simplicity of knowing where you can smoke has meant that the universal principle of that bar has largely been applied, but it has not applied to vaping to date. Given that vapes contain not just nicotine but cannabis, Spice and other illicit substances, should the same restrictions be applied to vaping?

Greg Fell: Hopefully only illegal vapes contain cannabis or Spice, and not legally produced ones—I sincerely hope that is the case. I have mixed views on vaping in public. I think that Prof McNeill will talk later this afternoon. It is worth reading her evidence review for the Office for Health Improvement and Disparities, which has a whole chapter on the passive inhalation of vapes. The ADPH does not have an official position on the passive inhalation of vapes, but my personal view is that in open spaces I am not too worried about it. In enclosed spaces, I might be, particularly for people who have pre-existing respiratory conditions, but I do not think that the evidence supports it being as big an issue as people think. However, that is definitely a question for Prof McNeill, who is the expert on such matters.

[Steve Tuckwell (Uxbridge and South Ruislip) (Con)]

Q The LGA has previously called for strict enforcement measures for those selling tobacco to those under-age. Do you think the Bill goes far enough in achieving that?

Cllr Fothergill: I have already said that we believe the amount of the fine needs to be reviewed. We believe it is right to do it by a local penalty notice, which is issued locally and can be enforced. We do not believe that £100, reduced to £50 if it is paid within 14 days, is sufficient. It will not have the effect that it needs to have and it should be reviewed.

We are also keen, as part of the Bill, for a review of whether we should be brought into line with Scotland on age verification. Scotland has very clear guidelines that legally, people have to produce identification that they are of an age to buy, and we think this is an opportunity for us to bring that in as well. There are two things where we would like to see enforcement strengthened: mandatory age verification and an increase to local penalty notices.

[Nickie Aiken (Cities of London and Westminster) (Con)]

Q I have a question for Mr Fell. Obviously the Bill will cover shisha, so I would welcome your views on shisha smoking and whether there is more we can do within the Bill or in general to tighten up shisha smoking.

Greg Fell: I would say that we need a licensing scheme for shisha smoking, and probably more education about the fact that it is a potent way to consume large amounts of tobacco really quickly and is quite damaging for people’s lungs. I am not sure what more could be achieved in the Bill, but I would like to see a licensing scheme for shisha bars. We enforce the law to its limits, but there are some limits to it.

--- Later in debate ---

[Dame Andrea Leadsom]

Q Thank you so much for being here. You will be aware that, in putting together legislation, huge effort is made to be balanced and not excessive and to make it doable and achievable, nowhere more so than for those who are trying to enforce it.

May I press you a bit further on the point that Preet made about whether the fines are sufficient? You have said that it is a bit complicated and will require some lead-in time—which is obviously provided, with the 2027 date—to give appropriate training to shop staff. The quantum of the fine was intended to enable on-the-spot fines, rather than having lengthy litigation because the person who incurs the fine does not have the cash and needs to go away, may or may not pay it, may or may not have to be pursued, may or may not have to go to court, and so on. Understanding that there are different views on all sides, is the balance just about right or, if you could have put your own wish list together, are there things that you would have done differently?

Adrian Simpson: We would have liked to see more education provided to retailers who might have broken the rules. A fine can be life-changing for someone who is given one, so we like to see whether there might be a way around that; perhaps the shop worker could be educated first, rather than going straight to a fine, if at all possible. We would like to see that balance of education before strict enforcement, if possible. That would be our wish.

[Steve Tuckwell]

Q Thank you for coming in this afternoon. It is a pleasure to hear your thoughts. What will be the challenges for retailers in enforcing the ban on sales?

Adrian Simpson: The first challenge is education of all the shop staff. Our members are the very large, household-name retailers, and it will take a long time to get that education out to the hundreds of thousands—in some cases—of shop workers throughout the UK. We also think that there will be issues to do with changing our point of sale systems, things like where we are going to store some of these products if we need to, and even things like the size and nature of the tobacco notices. Retail operates in many different ways—we think of the large supermarkets, but there are very small stores as well—so a lot of thought needs to be given to the technical parts of the legislation, which of course we always work with you on.

[Preet Kaur Gill]

Q What conversations has the British Retail Consortium had with local authorities? They have a lot of data locally on the amount of illicit vapes or illicit tobacco being sold. They are already enforcing trading standards, so there should already be a level of awareness. What kinds of conversations have you been having with local authorities?

Adrian Simpson: Certainly. Ever since the point at which a potential vape ban and the rolling age restriction on tobacco were announced, we have been working very closely with the Chartered Trading Standards Institute, which represents local authority trading standards officials. Ever since the beginning, we have been in close conversation with them, talking about our concerns on the points I made about education and enforcement. Many of our members are closely linked to trading standards already, through the primary authority scheme. I am pleased to say that many of our BRC members have long-standing primary authority relationships, so they already work very closely with trading standards. Certainly at the BRC, I have been working closely with colleagues in the Chartered Trading Standards Institute.

--- Later in debate ---

[The Chair]

I think we have received that message very loud and very clear.

Kate Pike: Good.

John Herriman: Did I mention that? [Laughter.]

[Steve Tuckwell]

Q You may have touched on this in some of your previous answers, but are there any tobacco and vaping products that are not covered by the Bill but which you think should be?

Kate Pike: We think that the tobacco age of sale should definitely apply to all tobacco products, and that the enabling regulations for vapes also allow the opportunity to add other nicotine products. The definition of nicotine is really helpful. The closing of the loopholes is really helpful. Loopholes are not helpful to enforcement, but closing the loopholes is really important to enforcement, so we are happy with that.

[Preet Kaur Gill]

Q To come back to your answer about the track and trace that you have for tobacco, have you had any conversations with Border Force and the MHRA about perhaps doing this for vapes? As you said at the beginning, you did not imagine that the industry would grow in the way it actually has around illicit and illegal vapes.

Kate Pike: Yes. As I say, we are already in the consultation that HMRC has running now about a vape excise tax. One of the questions is, “Would you want to see these products subject to track and trace?”, and the CTSI will go back and say, “Yes, but let’s get the vape excise tax in now,” because of what that is going to give us. A number of you have said your worry is illegal vapes. HMRC being involved in this enforcement picture will be a real game changer, because there will be extra boots on the ground in addition to ours, and that will really help in tackling illegal vapes.

Tobacco and Vapes Bill (Third sitting)

Steve Tuckwell Excerpts

Committee stage
Wednesday 1st May 2024 Public Bill Committees

[Dame Andrea Leadsom]

Q That is very harrowing to hear. Could you further expand on the impact on families of losing a baby due to stillbirth as a result of smoking? How does that impact on their mental health? As you said, parents will do everything they can to protect their baby, but the addiction to cigarettes is so strong that for many it must lead to them blaming themselves for the death of their baby.

Kate Brintworth: The birth of a child is so happily anticipated by every person who gets pregnant. From the moment that you see a thin blue line, you are having a baby. You have hopes and dreams for the expansion of your family, but not just for that individual family: a baby is born, and it is a niece, a nephew, a grandchild, a cousin. It really ripples out across the entire family. When there is then a 35% risk of miscarriage and a higher risk of ectopic pregnancy and, as you said, the absolutely awful, tragic and devastating news that your baby has died when it reaches term, that is something that no parent should ever have to face unnecessarily. It just feels like the worst thing you ever have to do as a clinician to tell someone that their baby has died. Every time I have ever had to do that, it has been the worst point in my career. It is difficult to explain how destroying it can be for families, and we see the long-term sequelae in terms of mental health, to the point where we have put in extra perinatal mental health support for families that have suffered that kind of trauma.

Professor Sir Stephen Powis: Can I pick up on the health inequalities aspect, because I think that is really important and I have the figures in front of me? In 2021-22, 21% of pregnant women in the most deprived areas smoked at the time of delivery, compared with 5.6% in the least deprived areas. That is a really stark difference. Smoking is widely accepted as the most significant driver of health inequalities in the UK. Detailed analysis has concluded that 85% of the observed inequalities between socioeconomic groups could be attributed to smoking. We spend a lot of time in the NHS quite rightly targeting our interventions and support to deprived areas to address health inequalities. At a stroke, this Bill would have the greatest impact that we could possibly see.

[Steve Tuckwell (Uxbridge and South Ruislip) (Con)]

Q Thank you for coming to address us this morning. We heard compelling insight from the chief medical officers earlier. Will you update the Committee on how you see this Bill supporting the NHS in the long term and the short term?

Professor Sir Steven Powis: I have already highlighted some of the short-term impacts, and there will undoubtedly be short-term impacts. Some conditions are exacerbated by smoking, with asthma in children being an obvious one. I have talked about mental health conditions and the way that smoking exacerbates conditions such as depression and chronic mental health illness.

We will start to see immediate effects, but those effects will grow over time. I have given you some of the conditions that are impacted on by smoking—there are well over 100 of them—but I can give some more stats. By stopping children from ever starting to smoke, we estimate that we will prevent about 30,000 new cases of smoking-related lung cancer every year. More than 1.4 million people suffer from chronic obstructive pulmonary disease, which is a chronic disease of the lungs caused by smoking—it causes nine out of every 10 cases. As I said, that is a disease that clinicians commonly see. A common cause of admissions to emergency departments, through the winter particularly, is other respiratory infections on top of COPD—these are diseases that future clinicians will see rarely. They will not see them in the way that clinicians of my generation have had to manage them. The impact will begin immediately, but over time that impact will get greater.

[Rachael Maskell]

Q As you have just set out, we understand the harmful impact of tobacco, but I want to look at vaping. Is there any evidence of the impact on individuals who vape, or of a secondary impact, such as on triggering asthma or NHS admissions, or of an impact on admissions from the contents of vapes? We often talk about vapes, which are a delivery mechanism for substances. How should we regulate so that people understand what they are vaping, not least because it is now moving to an illicit market?

Professor Sir Stephen Powis: As I outlined earlier, the impact on the NHS of vaping at the moment is relatively small compared with the impact of smoking. Nevertheless, there is an impact, and we are seeing growing numbers. I have highlighted the number of admissions per year, but they have doubled over the past few years, so that impact is becoming apparent. For example, yellow card reporting to the MHRA is a mechanism for reporting harm, and again the number of incidents related to vaping is increasing, although still in relatively low numbers.

As I said earlier, however, what is important here is that the evidence base, although emerging, is growing. This is an opportunity for us not to get into a position where, in years to come, we regret that we did not take the steps early on to change the trajectory. Instead of seeing rising impact on the NHS—small at the moment, but with the potential to be greater—that trajectory should be changed. This is a golden opportunity for parliamentarians to step in early and to prevent further pressure building over time on the NHS, while recognising that the evidence is still emerging.

I agree with the chief medical officers you heard earlier: I do not believe that vaping is safe. It is undoubtedly safer than smoking, which is why we support its use as a means of smoking cessation, but beyond that the evidence is building that it is not safe. Unquestionably, it will have a building impact on the NHS.

--- Later in debate ---

[The Chair]

I just want to advise the panel that we have about 13 or 14 minutes to go, and four Members want to ask questions, so be kind to your colleagues.

[Steve Tuckwell]

Q Thank you for coming along this morning. I am really interested to know whether you think there is a risk that the Bill’s restriction on vapes will lead to an increased use of illicit vapes.

Professor Turner: That is a fair question. We recognise that there is a thriving illicit vape market, and the vaping industry is aware of that. As to whether the legislation will exaggerate that should it be passed, that is difficult to tell because, by definition, we do not know how much illegal activity there is. It is a reasonable consideration, and probably a lot of illicit vapes are already being sold. It is one of those things that you might consider when you vote, but I do not think the problem is sufficient to mean that the Bill should not go through.