Tobacco and Vapes Bill

Virendra Sharma Excerpts

2nd reading
Tuesday 16th April 2024 Commons Chamber

[Mr Virendra Sharma (Ealing, Southall) (Lab)]

I support the Bill in principle, and will vote for its Second Reading later, because it is an anti-smoking measure. Smoking is the forgotten killer of our society, and the Bill contains initiatives against child vaping that I and others have been urging for some time. Let us not be in doubt: the Bill will pass, but it will pass with Labour votes, so I will direct my remarks to its shortcomings.

The Bill is late, it is slapdash and it makes several big mistakes. It seems to have more to do with the Prime Minister’s legacy than with the need for effective interventions against smoking. Disposable vapes arrived in this country and started the youth vaping epidemic during pandemic lockdowns, the last of which finished three years ago. The Prime Minister is concerned about it only now, with his time in No. 10 drawing to a close but very little to show for it. The Government were too slow and slack to get out in front of the issue. Even after three years, they do not have precise proposals for vape regulation to put before the House. As others have said, no consultations have been conducted and nobody is sure what exactly needs to be done—although we all know that something must be done. Children vaping, fake vapes, fake cigarettes that are even more harmful than real ones—these are public health disasters, but they are already illegal, so will not be deterred any more than they are now.

What does the Bill do for the 6.4 million existing smokers? Nothing. In 2019, the Government set a target of bringing prevalence down to 5% by 2030. That was a stretch target and was to be applauded—it was ambitious, but it could have been done. Instead, the Government have dropped all mention of it, and are covering their tracks and distracting us with the generational smoking ban, which will do nothing to help those who already smoke.

What we really need is relentless, thorough and inescapable enforcement, including massive boosts to the resources of trading standards, so that local councils can blast the crime gangs out of their neighbourhoods and keep them out. The fact is that most vapes sold to our children are already illegal. It is illegal for them to be sold to under-18s, to have tanks exceeding 2 ml and 600 puffs, to not carry the right warnings, and to be sold without MHRA approval. While enforcement remains feeble, the disposable ban will make little difference.

[Adam Afriyie (Windsor) (Con)]

I am listening closely to what the hon. Gentleman says because I share his passion for driving cowboys out of this industry. Does he recognise my observation that those in the industry, and particularly small shop owners, who are quite often from ethnic minority groups, are equally keen to have greater levels of enforcement because they want to drive the cowboys out as much as we do?

[Mr Sharma]

The hon. Gentleman jumps to a point that I will cover later in my remarks.

Most of the vapes being sold to our children are already illegal. While enforcement remains feeble, the disposable ban will make little difference. The Government are offering £10 million per year for three years to trading standards. That would be good if there were only 20 trading standards departments across the UK; unfortunately, there are 197, so the offer is pure tokenism. Under the generational smoking ban, the Government want to make every shop worker a target for every shopper, just to cover their own failure, Shopkeepers in my constituency are greatly concerned about the pressure this ban will place on them as retailers and on their staff. Retail workers already suffer unacceptable behaviour from customers on a daily basis, which will only get worse. Age-restricted sales are the biggest cause of violence against staff, apart from shoplifting. This ban places often disadvantaged workers at threat of risky and dangerous working environments.

Smoking is a major driver of health inequality. Disproportionate numbers of sufferers of smoking-related diseases are from more disadvantaged backgrounds. Many are dyed-in-the-wool, hardcore smokers. They should give up—they know that—but most of them are not able to do so. None of them thinks that smoking is healthy or safe, so it is urgent that wherever possible they are helped to transition to less dangerous forms of nicotine such as vaping, nicotine pouches and heated tobacco products. No one alternative suits every hardcore smoker. It is an ideologically blinkered mistake to prevent future under-age smokers—those we can never stop—from accessing relatively safer heated tobacco products. I have stated before in this House the relative benefits of HTPs. I said earlier that this Bill does nothing for existing smokers; incredibly, this provision actually makes things worse for them. A pragmatic policy would have seized the potential of all these alternatives, not just vapes, and a smoke-free 2030 could have been a reality. Instead, the Government are playing with people’s lives and making the perfect the enemy of the good.

Finally, the Bill also overlooks the highly carcinogenic scourges of paan and betel in the south Asian community. Only a targeted, community-specific intervention would have any effect in tackling those scourges—I have been drawing attention to them for years. We have waited years for primary legislation on tobacco, but it seems that our needs have again been overlooked, and south Asians will remain at the back of the queue for years to come.

I will support the Bill on Second Reading, but there is huge room for improvement. In particular, trading standards should be given the tools it needs to break the hold that illegal products already have on the market, and while we still have smokers, heated tobacco products should be removed from the generational ban as part of a broad range of less harmful alternatives. I must say that all those ethnic minority shopkeepers are concerned but supportive of this move; they believe that the ban should be in place, but that they should be supported. They feel strongly that at present, not enough support is coming from the Bill and the Government. I hope that the Government will take on board some of what I have said, and that the Bill will emerge much amended on Third Reading.

COP10: WHO Framework Convention on Tobacco Control

Virendra Sharma Excerpts

Thursday 18th January 2024 Westminster Hall

[Mr Virendra Sharma (Ealing, Southall) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Vickers. I am grateful to the Backbench Business Committee for granting this debate on international tobacco control, and to the hon. Member for Northampton South (Andrew Lewer) for securing it.

In a mere few years, in this country at least, we have paved the way for our children and grandchildren to live healthier, fitter and longer lives. As a result of the hard work of doctors, nurses, charities, researchers and activists, we are on the edge of creating a future free from the shackles of smoking. Around the world, this pattern is being repeated, and along with many, I welcome global co-operation on ending smoking. The World Health Organisation’s framework convention on tobacco control will be discussed at the 10th conference of the parties, COP10, between 5 and 10 February in Panama. That is a great step towards our goal.

COP10 will present amazing opportunities, but also grave challenges. In the UK, we are clear that there is no silver bullet in the fight against smoking. Any strategy must accommodate an integrated approach—an approach that understands that targeted social support works with Government regulation, and that combines powerful new tools to help smokers quit with measures to prevent our young people from ever beginning this terrible habit.

Stopping people smoking is not cheap. After years of calls for a smoke-free future, only 67% of local authorities have enough funding to provide targeted specialist services. The evidence shows that without such services, people have low motivation to quit, and are more likely to relapse if they try to. That means that deprived areas, in which we should be most active with our efforts, are being left behind in the fight against smoking. It is no surprise that when we reduce funding for targeted social support, the siren call proves stronger than our critical messaging. We cannot afford to wait and treat only the symptoms; we have to treat the cause.

As things stand, we will miss our own targets. Without further action to encourage people to never start smoking in the first place, Britain will miss its Smokefree 2030 targets by seven years, with the poorest areas missing the target by at least 14. Modelling is clear, and is a lesson for countries around the world: the poorest areas will be the first to miss out. My concern is that the WHO and the FCTC are getting this wrong; they are putting the cart before the horse, and pretending that “abstinence only” works.

There is a strong link between illegal sales and under-age smoking, so tackling the problem at its source is by far the best approach. In the UK, we have missed opportunities to do that. I see it in my own constituency; illegal and counterfeit tobacco products are under-policed. Communities need a strengthened trading standards, able to impose the fines that His Majesty’s Revenue and Customs can. That was a missed opportunity in the middle of last year. Trading standards can only pass evidence to HMRC. The lack of action provides a safe harbour for criminal gangs and organised crime to generate cash.

In every country, we also need to tackle the alarming growth in vaping among children. Undoubtedly, the introduction of vaping products has dramatically improved people’s chances of quitting smoking, but the appeal of these products to children is concerning. We need action to ban children-centred advertising, branding and flavours, alongside strict legal penalties for those who sell to children.

Vaping works for many, and COP10 should not seek to make it harder for smokers to move into vaping. Any vaping rather than smoking is less harmful. Abstinence alone does not work. Not everyone who takes up vaping will give up smoking, and ASH estimates that 35% of vapers still smoke alongside vaping, so we need a solution to move those unsated by vaping.

Heat-not-burn products heat tobacco rather than burn it and are therefore a less harmful alternative to cigarettes. They mimic the experience of smoking much more closely than vapes, making the transition away from cigarettes easier for adult smokers. However, studies show that they are less attractive than vapes to younger people who have never smoked.

I want the UK to stand up at COP10 for a harm reduction approach that encourages every small step to help people move away from smoking, reducing prevalence at every level. It is in our diverse communities, such as my constituency, that the reduction has slowed the most, and the messaging and tools available are not working. When I was a councillor in the London Borough of Ealing, I chaired the scrutiny committee on ceasing smoking and bringing in related resources through the NHS and other services. That was in 2003 and 2004, and we are still talking about how the situation should be improved.

In Panama, I want to hear the Minister using their power and the UK’s authority to stand up for solutions that work. I want the Government to stand by these arguments. NHS policy papers, the Khan review and ASH show that allowing people to make smaller changes leads to longer-term change. If we use our position as one of the FCTC’s largest financial contributors, our voice should be heard. I urge the Government to lead, and the Minister for Primary Care and Public Health to join COP10 as part of our delegation.

Yes, we have made great steps towards our shared goals, but we risk it all as we approach the final hurdles. Now is not the time to diminish our resolve in the fight against smoking. To meet our bold commitments, we must use every weapon in our arsenal. Every less harmful product should be on the table. We must improve funding for specialist services, recognise the harm the industry does to our communities and tackle the illegal tobacco trade. We want COP10 to work, but it needs leadership based on evidence-led policy. Abstinence on its own does not work. A strategy is needed that can dispel smoking’s dark cloud, leaving a brighter, cleaner and healthier future for our children.

Hospice Services: South Devon

Virendra Sharma Excerpts

Wednesday 29th November 2023 Westminster Hall

[Kevin Foster]

The hon. Gentleman makes an important point in highlighting hospice at home. The service is growing because many people do not want to be in a hospice or a hospital, and if given the choice, they would rather pass away at home surrounded by their loved ones. My stepdaughter was supported to do that. It is quite an experience when it happens, but it was what she wanted.

The hon. Gentleman is right to say that there is a need for those groups to have the type of facilities they require and be supported in that. I accept that, given the sheer area that some hospices cover for that service, they may have to have some form of remote working arrangement for most of the day, but certainly, I see how Rowcroft provides that facility and it works well. There is that balance of the hospice for those who need it and are at that stage in their treatment and care, and the hospice at home to try to give people the choice they deserve at the end of their lives.

The plans have been developed in a way that allows residents to live in a caring, nurturing and vibrant home that supports as much independence, mobility and inclusion as possible. The Ella’s Gardens vision is not just one for patients and families, but one of being a hospice that is part of the community. Rowcroft’s large gardens are open to the public and are a popular community facility. There is never a sense of hiding away or being something that people only talk about when affected by it. The plans therefore include community facilities, a village hall and a day nursery. That creates opportunities for recreational activities and intergenerational connections, effectively making it a facility for the whole community with a unique side to it, and not just a hospice that people only attend if they need to be with a loved one.

Unsurprisingly, the plans have been widely acclaimed across our bay and have already received planning permission from Torbay Council. They could be under way in just over 18 months, providing support to our wider healthcare services, from a formal commission agreement with the integrated care service. The Minister will be pleased to hear that this is not a direct pitch for Government capital funding, although obviously if there were funding available, it would certainly help. That said, I would be delighted to welcome the Minister to Torquay so she can see at first hand the transformation the project will bring, not just to hospice and palliative care but to the future for that kind of care. A future that is about being not just part of the health and care system but at the heart of our community’s life, as well as being there when needed at a time when a loved one is passing away. I hope the Government will see it as a model for the future and one they want to get behind.

Given what I have already outlined, I would appreciate hearing the Minister’s responses to some specific points. As a matter of urgency, will she confirm how much of the £25 million children’s hospice grant each children’s hospice will receive in 2024-25, when they will receive it and how?

What assessment have Ministers made of the impact of integrated care board funding on children’s hospice care, and the risks of withdrawing the ringfenced grant? These services will work across regions; to ensure a more planned approach, will the Government direct ICBs to work with their neighbours on planning and funding children’s hospice and palliative care services?

More widely in the hospice sector, the variation in statutory funding between regions and hospices is stark. What thoughts have the Government had on ensuring a more consistent approach? Some hospice costs, including NHS pay rates, are decided by the Government. Would the Minister consider implementing a funding formula that would allow cost increases that are out of the hospice’s control to be reflected in local service contracts? Given the increase in costs this year, could the Government supply a simple fixed amount per hospice that forecasts a deficit? How do the Government see the future needs of palliative care being met? I am not requesting that hospices be publicly funded; the charity model offers many advantages and flexibilities. However, hospices must have predictability when planning for the future.

There is much more that I could say about the opportunities, challenges and pressures on hospices in South Devon, but I should draw my remarks to a close to allow the Minister adequate time to respond and perhaps take interventions. For families across South Devon, Rowcroft Hospice is a service that is not just valued, but treasured. It is a place where memories are made, conversations had that bring peace after a dispute that now seems petty, family events are held, news is shared and smiles may be raised, even as the end nears. In short, a hospice is a place where life is added to days, when days can no longer be added to life. We need to ensure that Rowcroft continues to be such a place for decades to come.

[Mr Virendra Sharma (in the Chair)]

Before I ask the Minister to respond, I point out that there might soon be votes in the Chamber. There will be multiple votes in the next debate.

Under-age Vaping

Virendra Sharma Excerpts

Wednesday 12th July 2023 Commons Chamber

[Mr Virendra Sharma (Ealing, Southall) (Lab)]

I am thankful that those on the Labour Front Bench chose this important topic for debate. We have a policy for and a commitment to a smoke-free future, but it is at risk. In a mere few years, we have paved the way for our children and grandchildren to live healthier, fitter and longer lives. The hard work of doctors, nurses, charities, researchers and activists mean that we are on the edge of creating a future free from the shackles of smoking. That hard work is in serious jeopardy. Smoking still claims the undesirable title of the leading cause of preventable death in the UK, and at current levels, more than half of Britain’s 6.6 million smokers will die prematurely. Those are horrifying figures, and when a number of people equivalent to the entire population of Wales will die from smoking, it is clear that we are not moving fast, hard or strongly enough on our smoke-free by 2030 commitment.

As many ex-smokers will know, there is no silver bullet in the fight against smoking. Our strategy must accommodate an integrated approach that understands that targeted social support works with Government regulation—an approach that combines powerful new tools to help current smokers quit, while preventing children from ever forming this terrible habit. Vaping has its place. It is a tool, but it is only one of them, in the fight to end smoking.

Too much focus on vaping as the answer to cutting smoking risks raising its profile too high, and ultimately attracting more young people. Helping current smokers to quit can be only one aspect of our approach. Without further action to encourage people never to start smoking in the first place, Britain will miss its smoke-free 2030 target by seven years, with the poorest areas missing that target by at least 14 years. When tobacco kills someone in the UK every five minutes, we do not have 14 years to act, never mind 21. I therefore welcome updates on the important work of cracking down on the illicit tobacco trade, and congratulate enforcement agencies on seizing £7 million-worth of illegal tobacco products.

We know there is a strong link between illegal sales and under-age smoking, so tackling the problem at its source is by far the best approach. I am disappointed by the lack of Government plans to tackle the alarming growth in vaping among children. The introduction of vaping products has undoubtedly dramatically improved people’s chance of quitting smoking, but the appeal of these products to children is a serious concern. Communities such as mine in Ealing, Southall want and need strengthened trading standards. They want to see regulators able to impose the fines that His Majesty’s Revenue and Customs can use. That was a missed opportunity earlier this year; trading standards can only pass evidence to HMRC. By not bringing through that important reform, the Government are providing safe harbour for criminal gangs and organised crime to generate cash.

This illegal and unregulated trade is of serious concern to me, but when the situation demands immediate action, the Government announce a slow consultation. We already have comparable evidence from tobacco products about packaging, flavouring and price points. We know that the branding, flavours and price are targeted at children. When the uptake of vaping among non-smokers is so high, it is baffling that the Government have not acted to make vaping products follow the same trading standards and rules as tobacco. If we are serious about tackling the uptake of vaping by non-smokers, we have to act to regulate and police vaping as we do other tobacco products.

I will briefly go a little off-topic, although the issue is relevant. In communities such as mine, it is not just vaping that is targeted at children. Paan is a serious issue. It is a chewing tobacco product, often sold in corner shops, with nuts, seeds and sweets mixed in for flavour, and it can be picked up for pennies a portion. Because of that and betel, there are terrible statistics on the rates of oral cancers in Asian communities, and anything that reduces those rates will save lives. Yes, we need vaping to help people quit, but only as part of a risk-reduction strategy; making vapes for children, marketing them at children and selling them to children—no.

Thornbury Health Centre

Virendra Sharma Excerpts

Wednesday 5th July 2023 Westminster Hall

[Mr Virendra Sharma (in the Chair)]

I will call Luke Hall to move the motion and then the Minister to respond. As is the convention for 30-minute debates, there will not be an opportunity for the Member in charge to wind up.

[Luke Hall (Thornbury and Yate) (Con)]

I beg to move,

That this House has considered Thornbury Health Centre.

It is a pleasure to serve under your chairmanship this afternoon, Mr Sharma. It is a genuine privilege to have the chance to debate the important matter of how we deliver good local health services on such a symbolic and important national day: the 75th birthday and anniversary of our national health service. Today, it is quite natural that politicians from all political parties will be discussing the NHS—whether it needs to reform or innovate more, and how it can improve—but I take this opportunity to thank everybody who works in the NHS for all that they do and achieve every single day. Like so many others, my family has relied on their dedication, expertise and, at times, compassion in some of the most difficult times in our family’s life. I will never stop saying a huge thank you to the team at Southmead Hospital for all that it did for my family, and of course for so many others in the region.

People access healthcare in a variety of ways: through their GPs, through local hospitals and, increasingly, in their own homes. South Gloucestershire, where my constituency is based, is a growing community. We have new developments all the time, and there are more residents to support. If we are to meet the growing demand for local health services in the years ahead, it is vital that capacity in our local health service is extended, that pressure on the main hospitals is reduced and that our community receives the financial investment in local health services that it requires. That is why I called for this debate—to highlight some of the challenges that we face, but also some of the opportunities ahead of us in the west of England, in building a state-of-the-art Thornbury health centre to provide health services to people right across South Gloucestershire.

Smokefree 2030 Target

Virendra Sharma Excerpts

Tuesday 20th June 2023 Westminster Hall

[Several hon. Members rose—]

[Mr Virendra Sharma (in the Chair)]

Order. I have two announcements to make before I call the next speaker. This debate will still finish at 11 am. I intend to start calling Opposition Front Benchers at 10.30 am. Rather than setting a time limit now, I make this request of all Members: try to be brief, so that everybody can contribute. I hope that, in that way, we can deal with the situation. I call Mary Kelly Foy.

[Mary Kelly Foy (City of Durham) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Sharma, and to follow my co-sponsor of this debate, the hon. Member for Harrow East (Bob Blackman). He is also the chairman of the all-party parliamentary group on smoking and health, of which I am a vice-chair. I declare that interest.

As we have heard, the measures announced by the Minister in April were a step in the right direction. However, they fell very short of the comprehensive strategy outlined by the APPG and the Khan review, and it has taken far too long—almost four years—for the Government to get going on this. In the meantime, tobacco continues to kill an estimated one person every five minutes in Britain. The deaths are disproportionately concentrated in regions such as the north-east—regions that have some of the highest rates of poverty and, in turn, the highest rates of smoking in England. In the north-east, nearly 13,000 people died prematurely from smoking between 2017 and 2019. This has an economic cost for our communities of over £100 million in healthcare costs and £64 million in social care costs. All the while, tobacco companies make record profits, leaving the taxpayer and families to pick up the pieces.

We are fortunate in the north-east to have a highly effective regional tobacco control programme—Fresh—funded by all the local authorities in the region and the local integrated care board, and it has proven successful over the years. Just yesterday, it launched a new behavioural change campaign called “Smoking Survivors”, which features two women from the north-east who have quit smoking and survived cancer. However, national funding for behavioural change campaigns such as that fell by around 90% between 2008 and 2018. Although regional activity is vital, we need strong leadership from the Government if we are to see every region be smoke free by 2030.

Like the hon. Member for Harrow East, I welcome the Minister’s recent announcement on tackling youth vaping, but why did it take so long for the Government to act? When the Health and Care Act 2022 was going through Parliament in 2021, I tabled amendments that would have given the Government powers to prohibit child-friendly branding on e-cigarette packaging and to ban the free distribution of vapes to under-18s, which, as we know, has strong cross-party support. To my amazement, not only did the Government fail to adopt my amendments, but they voted them down.

As the Minister will remember, one of Dr Khan’s must-do recommendations was raising the age of sale for tobacco beyond 18, so I was disappointed not to see that included in the April announcement. The all-party group has already urged the Government to launch a public consultation on raising the age of sale, and I urge them to do that too.

I will end with a few questions for the Minister, which probably echo what the hon. Member for Harrow East asked. Will the Minister commit to consulting on a “polluter pays” levy to raise funding for a comprehensive tobacco control strategy?

Will the Government consider measures to address the affordability, accessibility, appeal and advertising of vapes, which were recommended by ASH in its response to the Government’s call for evidence on youth vaping? Once again, I highlight the fact that big tobacco companies rigorously lobby against vaping regulations, so I would like the Minister to take note of that.

Will the Minister confirm that a consultation on raising the age of sale will be considered? Finally, will he reassure the House that a comprehensive strategy to address smoking and vaping will be delivered—if not through the tobacco control plan, as promised by his predecessors, then in the forthcoming major conditions strategy?

[Mr Virendra Sharma (in the Chair)]

I urge Members to stick to about five minutes.

--- Later in debate ---

[Hywel Williams (Arfon) (PC)]

I congratulate the hon. Member for Harrow East (Bob Blackman) on securing the debate. I must confess to some trepidation about taking part, because it is on an England-only topic: health is devolved, as the hon. Member for Strangford (Jim Shannon) pointed out. However, smoking is of specific and acute importance to young people, and many young people from Arfon work, live, love and play in England, so it has relevance.

I am a former smoker. I smoked until my 30s, when a friend pointed out the folly of rolling dried leaves up in paper and setting fire to them in my mouth—that eventually persuaded me. More relevantly, as long ago as 2005 I was a supporter of the Smoking in Public Places (Wales) Bill, a private Member’s Bill promoted by Julie Morgan, the then Labour MP for Cardiff North, that would have devolved power to the Welsh Assembly to ban smoking in public places. Unfortunately, the then UK Labour Government did not provide time for that Bill, and by the time an England and Wales Bill had become law, more people employed in bars, hotels and restaurants in Wales had contracted fatal smoking-related diseases. I am not being too dramatic about this: the lack of devolution in that instance actually cost lives.

In Wales, as in England, smoking is the largest single cause of preventable and premature death. Poverty is an issue. Wales is a poor country: when we were in the European Union, parts of Wales qualified for regional aid on the same basis as the most poverty-stricken parts of the former Soviet bloc in eastern Europe. That is how bad it was and, tragically, that is how bad it remains.

Smoking is responsible for half the difference in life expectancy between rich and poor. Smoking hits us hard in Wales: our smoking rates are some of the highest among vulnerable populations. The Welsh Government’s tobacco control plan, published in July 2022, sets a target for Wales to become smoke free by 2030. Meanwhile, England’s tobacco control plan has expired, and the promised updates have been delayed time and again.

As I said, this is an England-only matter because health is devolved. Health policy has diverged between Wales and England, not least in that the wellbeing approach adopted in Wales is markedly different from the illness policy introduced elsewhere. Reducing smoking is an urgent element of that wellbeing approach. However, many of the key policy interventions in Wales that require legislation are reserved and must be voted through in this Parliament. The Welsh Government do not have the power to put warnings on individual cigarettes, put inserts in tobacco packs or strengthen the regulation of e-cigarettes—by the way, if they did, I suspect that those warnings would be in both our languages, but that is a matter for another day. The Welsh Government have even been told that they do not have the power to raise the age of sale for tobacco to 21.

Those were all key measures that were recommended in the Khan review and are supported by the people of Wales, but they cannot be taken forward because of a lack of devolution and powers. By being so slow, the UK Government are undermining the ability of the Welsh Government to achieve their Smokefree 2030 ambition. That ambition is supported by seven out of 10 people in Wales, a figure that rises to eight out of 10 among those who voted for my party, Plaid Cymru, at the last election.

The “polluter pays” levy is vital for Wales, as it is for England. I was pleased to put my name, on behalf of Plaid, to the amendments to the Health and Care Bill that the hon. Member for City of Durham (Mary Kelly Foy) tabled on Report, and particularly to the amendment that called for a consultation on a levy on tobacco manufacturers to pay for measures needed to deliver a smoke-free future. If the Government had adopted that amendment, we would now be much closer to achieving the target. A UK-wide levy would have raised as much as £700 million per year, which would have been sufficient to fund the programme both in England and Wales.

There are many other regulations that would benefit Wales but that need action from Westminster. Because of the time available, let me just say that those measures include: warnings on cigarettes; a ban on all tobacco flavours; prohibition of free distribution of vapes to children; a ban on sweet names, bright colours and cartoon characters on vapes, which are all so appealing to children; and a requirement that tobacco packs have inserts. These are all measures that the Government have refused to adopt in the past and are still slow to adopt today. Announcements on pack inserts and free vape distribution are urgent, so that both Parliaments have clarity. Will the Minister confirm the dates for the launch of the consultation on the pack insert regulations that was announced in April, and at the very least to reassure us that it will take place before the summer recess?

[Mr Virendra Sharma (in the Chair)]

I hope that the Front Benchers and the Minister will spare about a minute or two for Bob Blackman to wind up at the end of the debate.

Obesity and Fatty Liver Disease

Virendra Sharma Excerpts

Thursday 8th June 2023 Westminster Hall

[Mr Virendra Sharma (Ealing, Southall) (Lab)]

Thank you, Mr Hollobone, for giving me the opportunity to speak for the second time in two days.

I congratulate my hon. Friend the Member for Caerphilly (Wayne David), the chair of the all-party parliamentary group on liver disease and liver cancer, on securing this debate. As vice-chair of the APPG, I am concerned that the UK Government lack a coherent strategy for tackling the worsening liver disease public health crisis, which disproportionately affects our most disadvantaged and marginalised communities. Ealing’s mortality rate for men under 75 is among the worst in the country.

Despite being a leading cause of premature death in the UK, liver disease has not been appropriately prioritised by the Government and was overlooked in the major conditions strategy. Fatty liver disease is a public health emergency. Liver disease mortality rates are outpacing those for other major conditions, such as diabetes or respiratory conditions, which have stabilised or improved over the past 40 years. I am not complaining that those conditions have improved, but it is a fact that liver disease has not been taken seriously. Liver disease deaths are four times higher in the most deprived areas, where risk factors such as obesity, alcohol misuse and viral hepatitis are more prevalent. Poverty and deprivation are key drivers of both obesity and fatty liver disease in the UK.

Ethnic minorities have higher obesity rates than the national average, and south Asian populations are particularly vulnerable to developing fatty liver diseases due to a combination of genetic and societal risk factors, but limited action is being taken to accelerate earlier diagnoses of liver disease within primary care and community settings to reach the communities most at risk. Will the Minister commit to an urgently needed review of adult liver services to tackle the huge inequalities in liver disease outcomes and care across the country? Early detection and diagnosis is key, as all previous contributors have indicated clearly and eloquently. Four in five people with NASH, the most severe form of fatty liver disease, are undiagnosed. The prognosis of NASH is often poor with patients at high risk of liver failure and liver cancer, which has a five-year survival rate of just 13%.

My local integrated care system—North West London ICS—is currently categorised as green, which indicates there is now a fully effective pathway in place for the early detection and management of liver disease. Sadly, due to societal, ethnic and deprivation reasons, my constituency and Ealing lag behind other areas. I urge the Minister to look at the positive examples of ICSs, such as North West London ICS, and see how the great work they are doing can be replicated more widely across the country. I also ask the Minister to expand the work needed to ensure equitable access for all to those improved pathways.

Branded Medicines Voluntary Scheme and the Life Sciences Vision

Virendra Sharma Excerpts

Wednesday 3rd May 2023 Westminster Hall

[Mr Virendra Sharma (in the Chair)]

Before we start, I remind hon. Members that the debate can last until 6.13 pm. There will be five minutes for the SNP to wind up, five minutes for the official Opposition and 10 minutes for the Minister.

[Anne Marie Morris (Newton Abbot) (Con)]

I beg to move,

That this House has considered the voluntary scheme for branded medicines and the Life Sciences Vision.

It is an honour to serve under your chairmanship, Mr Sharma. The “Life Sciences Vision”, which was agreed and published in 2021, was a very ambitious document of which the Government should be rightly proud. It looks at further investment and development in neurodegenerative disease, kick-starting diagnostics, treatments and novel vaccines, more investment in cardiovascular disease and obesity, morbidity or mortality from respiratory disease, the biology of ageing and mental health conditions. That is an ambitious and worthwhile list. However, its delivery can only be a joint endeavour; it has to be a partnership between Government and industry. Both parts need to do what they can to drive this forward.

If industry is to play its part, it needs from Government good research facilities, first-class universities and academics who are attracted to this country. It needs efficient an effective systems for clinical trials, phases 1 to 3. I am aware that the Government are currently looking at how that might be improved and that James O’Shaughnessy is spearheading a report that will hopefully be out shortly. I sincerely hope that its findings will be implemented.

Industry also needs a regulatory regime that is fit for purpose across both the Medicines and Healthcare products Regulatory Agency, which evaluates whether a medicine is fit for purpose and safe, and the National Institute for Health and Care Excellence, which looks at whether a medicine is value for money. Industry also needs to ensure that whatever medicines finally come through the regulatory system are used—that there is an uptake among patients and that they are prescribed. There is clearly a moral imperative for that, but there is also clearly a financial one.

From the Government’s perspective, if they are to invest in ensuring that we are most attractive and efficient place to launch a medicine, they need to ensure that UK patients have quick access to both old and new innovative medicines. They need to ensure that industry is there, ready and waiting, with the new initiatives and ideas absolutely raring to go. That said, the Government need to manage the overall cost of the medicines budget, and they need a commitment from industry to invest. Fundamentally, it is a contract—an agreement—and both benefit if the deal is right.

One of the mechanisms that sets out the terms of that arrangement in practice is the voluntary scheme for branded medicines pricing and access. Most of us refer to it in shorthand as VPAS, as I shall for the purposes of this debate. So what is VPAS? Effectively, in this agreement the Government set out what they will do for the industry. In the last iteration of VPAS, commitments were made about reforms to NICE, some of which have been met and some of which have not. At the same time, industry agrees that it will cap the growth of Government medicine spending. The consequence is that all over-prescribing beyond the agreed and expected rate of growth is at the risk of the pharmaceutical industry. It is a very complicated formula.

The current scheme was devised in 2019. It replaced the PPRS—the pharmaceutical price regulation scheme—and was originally conceived such that the medicines budget could grow by 1.7%. That figure is now 2%. Any prescribing over that figure would effectively be paid for by the pharmaceutical companies by way of a reimbursement to Government of a percentage of their turnover, but it is a very complex and uncertain calculation.

One of the reasons for that is that the figure is anchored at a 2013 growth point, and it is not re-based each year. The consequence is that there is great uncertainty for any investing company about what the rebate will be year on year, which makes it difficult to budget. The compounding effect of the lack of re-basing is that the effective rebate is currently 26%, and left unaltered it would go to 30% for the next iteration, which is currently being negotiated to start in 2024.

We need to get that pricing in context. Effectively, when pharmaceutical companies go to NHS England and the regulators, there is a process of price-gouging. The first gouge, effectively, is by NICE. It looks at the market price and discounts it by an average of 55% to 65% under the patient access scheme. After that, NHS England may require a further cut to meet the affordability criterion of £20 million. The VPAS slice is after that, and, as a consequence, many pharmaceutical companies are saying, “Frankly, the pips are being squeezed too hard, and we simply cannot afford to invest in the research and launch our medicines here.” The current rate is uncompetitive internationally, and unless we change our approach to rebasing and to the growth cap, I fear we will lose much-needed investment here.

Pharmaceutical companies have a choice, and they can research and launch anywhere in the world. We are now a single-country regulator, rather than part of a European system, and that makes us, from the start, much less attractive. Industry is already voting with its feet. Indeed, in this morning’s Science, Innovation and Technology questions, a number of questions were about disinvestment decisions by pharmaceutical giants in this country. It is clear that many are simply no longer investing in research here or in UK regulatory approvals. That is a loss not just to the economy but to patients, because every drug prescribed to patients has to go through that regulatory approval process. Indeed, the Association of the British Pharmaceutical Industry has done some analysis and believes, based on the evidence, that our global share of research and development declined from 4.9% in 2012 to 3.3% in 2020. It advises that the number of initiated industry clinical trials fell by 41% between 2017 and 2021. Across leading European countries, the UK saw the largest decline in new medicine launches between 2010 and 2021.

However, it does not have to be like that. The ABPI and PricewaterhouseCoopers confirmed in a report that the life sciences sector is one of the most valuable for the UK: it creates £36.9 billion in gross value added, 584,000 jobs and 18% of all the UK’s R&D. They say that if the life sciences strategy was implemented in full, there would be £68 billion of additional GDP over 30 years from R&D investment, 85,000 additional jobs and a 40% decrease in disease burden. So VPAS could and should be part of a solution, not a problem.

The approach needs fundamentally to change; it cannot continue to be a question of who blinks first on what the pricing figure and the size of the reimbursement will be. This has to be looked at holistically in the context of what is in the best interests of UK plc and our health outcomes. The approach needs to be a collaborative one in which risk is shared. The solution proposed by the ABPI is a cut in the rebate to 6.88% and the creation of a two-pot system under which one pot continues to go the Treasury while the other—a separate 1.5% premium, if you like—goes specifically towards clinical research, genomics and so on.

The challenge with the second pot is, first, that it is quite small in terms of making significant changes; secondly, that it is a bidding pot, so there will be winners and losers; and thirdly, that although the ambition is to use it to level up, that will create all sorts of problems in relation to the Barnett formula. So although the system is well intentioned, I am not sure it would actually work in practice. It has had much support from patient groups and others, and I understand why, because delivering a fairer relationship is the direction of travel.

However, we have to bear in mind the political and economic reality of where we are, and we must not lose the prize of providing a much stronger link to, and a driver of, the life sciences vision, which seems largely to have been orphaned. That agreement needs some tangible benefits and obligations. There need to be key performance indicators for both sides—industry and Government—and there need to be deliverables for both sides.

The all-party parliamentary group on access to medicines and medical devices, which I chair, set out an alternative proposal to try to find a more collaborative approach. I believe in the free market and that, ideally, there should be no cap; sheer market growth through investment would result in our growing the economy and the Government tax take funding new medicines and producing money for the NHS. However, I am clear that I have to be grounded in reality, and if we are to find a way forward, there needs to be a risk-sharing solution, because no cap is the inverse of where we are now—it puts all the risk on Government rather than on industry.

How can we find this risk-sharing solution? First, we can increase the cap. It is currently at 2%; 4% would allow quite a lot of headroom. We could ensure that, each year, the system is rebased, so that we do not end up with a complex way of compounding what the rebate figure will be year on year.

One of industry’s real concerns is that a big chunk of money goes straight into Treasury coffers, and there is no evidence of how it is recycled to benefit pharma or health. In its paper, the APPG suggests that we ringfence a large part of that rebate, though probably not all. Part of it would probably still have to go back to the Treasury, but a significant enough amount would enable those seven life science missions to be driven forward, and industry, academia and clinicians could look at what we can do to drive this vision forward with a sensible amount of money.

The current scheme could also be simplified by excluding some of the six categories of medicines included in the VPAS scheme. Biosimilars and branded generics, where the branding is mandated by the regulator rather than choice, could sensibly be excluded. I appreciate that that increases the cost, but given that those products represent such a large chunk of medicines used in the NHS, that must be a no-brainer. Some of those are older products that are of great benefit to the NHS.

There has also been concern that the negotiation needs to be across all Government Departments, whether the Department of Health and Social Care, NHS England, the Treasury, the Department for Business and Trade or the new Department for Science, Innovation and Technology. Similarly, although the Association of the British Pharmaceutical Industry represents all the sectors, some very specific interests groups, such as the Ethical Medicines Industry Group and the British Generic Manufacturers Association, believe they need the opportunity to put their case forward. What is the downside of listening? Surely, think-tanks, academia and those groups all have something to say. If we want the right answer, that is the right way forward. We need a two-way commitment and two-way investment.

What could the Government do to help themselves manage their medicine budget cost? First, they could streamline regulatory activity. Currently, we have the Medicines and Healthcare products Regulatory Agency and the National Institute for Health and Care Excellence. That is a sequential system, which means we have to go through different sets of appraisal to satisfy both regulators. Much of the data and many of the questions, while not the same, are similar. Other jurisdictions are looking at running the two processes in parallel. Why do we not steal a march on others and integrate them? We could do that and have a state-of-the-art regulatory body. To do that, we would need to take out the budget impact test and put it back into NHS England, where it started. That strikes me as the right place for it to sit.

How could we monetise that regulator? First, as the Government already recognised in the last Budget, we should look at mutual recognition of approvals in the USA, Japan and the EU. That will not be easy, and I suspect it will be possible only in some limited areas of medicine. None the less, that is the way to go. Many developing countries would be delighted to have a quality regulator such as the MHRA and NICE. Why can we not charge to be their regulator?

The real call from industry, however, is to make uptake real. Although the theory is that any drug approved by NICE will automatically be taken up in the integrated care system budgeting system, the reality is that that is not the case, because there is no enforcement mechanism. That is very important for financial and moral reasons, and uptake is an issue that the Government could sensibly agree to look at. It is about implementing many of the new suggestions coming forward and, hopefully, the clinical trials and recommendations from James O’Shaughnessy. Because we would have a large pot for life sciences, we could create a long-term working partnership through the VPAS to deliver the life sciences vision.

If this is going to work, the industry needs to identify, in principle, investments that it would make in the UK. I know that such discussions take place, but what can the industry bring to the table to generate growth in the economy, increase skilled jobs and attract research academics and practising physicians? How can it identify ways in which it can support the Government in other parts of the life sciences vision delivery pipeline? Ultimately, much of this is going to be based on trust and good will. Sadly, that is not there at the moment, so the most important thing is to get it back.

For the VPAS 2024 to work, we need something that is fair to the industry and the Government and that will deliver what we absolutely need: the most innovative medicines for individuals living in this country, which they want and deserve. It can be done, and I am absolutely confident the Minister and his team will do their level best to try to achieve that. I am conscious that he is limited in what he can say, because of ongoing consultations, but I would welcome some reassurance that he agrees we should move to something that is more of a partnership—where there is true commitment and collaboration, and where there is a true link between the VPAS payment by industry and its use for life sciences development—so that we can actually see the life sciences vision live.

National No Smoking Day

Virendra Sharma Excerpts

Thursday 9th March 2023 Westminster Hall

[Bob Blackman (Harrow East) (Con)]

I beg to move,

That this House has considered national no smoking day.

It is a pleasure to serve under your chairmanship, Mr Efford. Many of us will be well aware that yesterday was No Smoking Day, an annual awareness day in the UK that aims to help people who wish to quit smoking. This year, No Smoking Day is raising awareness of the greatly increased risk of developing dementia that results from tobacco use. Through this debate, I hope that we can raise awareness of the considerable health risks associated with tobacco products.

It shocks me that, despite two out of three smokers dying from smoking-related illness, there are still 6.6 million people in the UK who smoke regularly. I firmly believe that if people were more aware of the self-inflicted harms that they are causing by using tobacco products regularly, that figure would drop considerably, and those people would be less inclined to continue smoking. It is therefore crucial that we reverse the withdrawal of Government funding for the no smoking public awareness campaign, which effectively highlighted the dangers associated with smoking and the support that is available to help people quit.

The wider health implications of smoking are truly frightening. Every single day in England, 150 new cases of cancer are diagnosed as a direct consequence of smoking. Additionally, a person is admitted to hospital with a smoking-related illness every single minute. Tobacco products are the biggest cause of death in the UK, killing on average 78,000 people a year through cancers, respiratory diseases, coronary heart disease, heart attacks and stroke, vascular disease, asthma and chronic obstructive pulmonary disease, or COPD. To be clear, that is 78,000 avoidable deaths caused by self-inflicted harm.

Smoking affects some socioeconomic groups more harshly than others. In areas around the city of Kingston upon Hull, 22% of residents engage in tobacco use, and in Blackpool the figure is as high as 20.6%. That encourages children and other members of the household to take up smoking, because they follow the example of others and have much easier access to such products in the home. When a parent smokes, their offspring are four times more likely to share the habit. I was horrified to learn that 90,000 children between 11 and 15 in this country regularly smoke, despite the fact that it is illegal for premises to supply tobacco to those children. The younger a person starts smoking, the harder it is for them to give up, and the more likely they are to continue the habit into their adult life. Some 80% of regular smokers started smoking before the age of 20.

Smoking in pregnancy is far too common, and it is an area that I have constantly campaigned on. If a mother is happy to smoke, being fully aware of the health implications, she is risking not only her health but the life of her unborn child. As soon as an innocent child, not even born, is subjected to heightened health risks because of smoking, it becomes a far more selfish and cruel act. Smoking during pregnancy is the leading modifiable risk factor in poor birth outcomes, including stillbirth, miscarriage and pre-term birth. Further, it considerably heightens the risk of the child contracting respiratory conditions; attention and hyperactivity difficulties; learning difficulties; problems of the ear, nose and throat; obesity; and diabetes. Unfortunately, there are over 51,000 babies subjected to such experiences each year. I am sure we all agree that that is 51,000 innocent babies too many. 

As I mentioned, the theme of No Smoking Day this year was the increased risk of dementia, so it would be remiss of me not to touch on the strong links between smoking and dementia. A recent study ranked smoking third out of nine modifiable risk factors leading to dementia. The World Health Organisation estimates that 14% of cases of Alzheimer’s disease worldwide are potentially attributable to smoking, and states that smoking increases the risk of vascular dementia and Alzheimer’s. Studies also show that people who smoke heavily—more than two packs a day—in mid-life have more than double the risk of developing Alzheimer’s disease or other forms of dementia two decades later.

It is important to recognise that there is probably an even stronger connection between smoking and dementia than the figures suggest. That is because a higher proportion of smokers die prematurely, so it is possible that the association between smoking and dementia has been obscured through a selection bias. Given that dementia is now the most feared health condition for all adults over the age of 55, I am sure the Minister will help to ensure that the data is shared with smokers whenever possible.

Smoking is not only hugely damaging to the health and wellbeing of individuals; it also puts a gigantic strain on the public purse and wider society. In 2021-22, the tax revenue from sales of tobacco reached £10.3 billion. That may seem a generous return to the Treasury, but it is tiny compared with the £20.6 billion that smoking actually costs the public finances. Let me break those figures down: £2.2 billion fell on the NHS, £1.3 billion fell on the social care system, and a staggering £17 billion was lost as a result of the reduction in taxes and increased benefit payments that arose from losses to productivity, including from tobacco-related lost earnings, unemployment and premature death.

The addictive nature of smoking products pushes many households into significant financial hardship. On average, those who smoke regularly spend more than £2,400 a year on tobacco. In 2022, that figure was enough to cover the average household energy bill—granted, perhaps it does not anymore, thanks to inflationary pressures. Research looking into the income and expenditure of households containing smokers found that 31% fell below the poverty line.

The socioeconomic inequality of smoking is huge. Those from poorer backgrounds and on lower incomes are considerably more likely to smoke, and in turn experience heightened health risks. Consequently, people born today in England’s more affluent areas are expected to live up to a decade longer on average than those in the least affluent areas. In Kingston upon Hull, 22% of households contain smokers, and the average income is £31,000. Comparatively, in west Oxfordshire, where the average salary is £40,000, the smoking rate drastically decreased to only 3.2%. Some £21.4 million in earnings is lost each year to smoking-related causes, and a further £20.2 million is lost due to smoking-related unemployment.

As I said, smokers are far more likely to contract cancer. I was unfortunate enough to witness that at first hand. When I was only 23, both my parents died as a direct result of smoking-related cancers. They died within a month of each other, which was a tragedy for my family and something that I remember every single day. It was a devastating period for my family, and the prospect of suddenly having to raise three younger sisters at a very young age was frightening—an experience I do not wish on any other individual.

Cancer treatments are not cheap. The average cost of treating a patient for lung cancer is more than £9,000 a year. That is a huge burden on already strained NHS budgets, and in many cases it is self-inflicted through smoking. Further, 75,000 GP appointments a year are a result of smoking-related illness. At approximately £30 an appointment, that could save the UK Government £2,250,000 annually and—very importantly in this day and age—would shorten waiting times for patients with other ailments. As I am sure my hon. Friend the Minister will agree, it is clear that we need to take urgent action to tackle this damaging practice.

[Mr Virendra Sharma (Ealing, Southall) (Lab)]

It is a pleasure to speak under your chairmanship, Mr Efford. On No Smoking Day, I am delighted to welcome the progress we have made as a country, and I am grateful to the hon. Member for securing the debate. I must declare that I am a non-smoker. In only a few years, smoking policy has worked. It has massively reduced prevalence, and people are healthier, fitter and living longer. Given how few Members are present, Mr Efford, I understand that I can talk a little longer, rather than having to intervene two or three times.

[Clive Efford (in the Chair)]

Order. Interventions should be short. Why not just make a short contribution?

[Mr Sharma]

I accept that. Working-class and black and minority ethnic communities are struggling to quit, and need more complex solutions. Does the hon. Member agree that vaping represents a less harmful alternative?

[Bob Blackman]

I thank the hon. Member for that brief intervention. From my perspective, I would encourage anyone who smokes and who wants to give up to try vaping. If vaping is considered by that individual to be a safer alternative, I would encourage them to try it. However, I am one of those people who say that we have to be very careful about vaping, because we do not know the long-term effects. It is certainly healthier to choose vaping as a way to give up smoking. However, I am concerned about the number of young people who are taking up vaping directly, and who may then go on to smoke, or to other ways of getting nicotine into their system. That is a really serious problem for the long term that the Government have to address.

As I was saying, the Government have set out a vision for England to be smoke-free by 2030, which I strongly welcome—I hope we can do it even more quickly than that —but Cancer Research UK, which has supplied me with information on this issue, has modelled the Government’s plan and suggests that they will not achieve the target until 2039 if recent trends continue. That is not good enough. The delay will cause around 1 million smoking-related cancer cases in the UK alone, so can my hon. Friend the Minister confirm how we will get back on track to reaching a smoke-free 2030?

Nothing would have a bigger impact on the number of preventable deaths in the UK than ending smoking. Smoking rates have thankfully come down, as indicated by the hon. Member for Ealing, Southall (Mr Sharma), and I want further action, so that the downward trend continues. Back in 2021, the Government committed to publishing a tobacco control plan, which we have yet to see. Smoking causes around 150 cases of cancer a day in the UK, meaning that since the last tobacco control plan expired in 2022, around 10,000 people’s lives have been changed forever with a smoking-attributable cancer diagnosis. Can the Minister confirm when the tobacco control plan for England will eventually be published? “Soon” is not good enough.

In June 2022, Javed Khan published his hugely anticipated independent review of tobacco control, which was commissioned by the UK Government. Like many others, I was pleased to contribute to the review, and we welcomed its pronouncements. It set out policy recommendations that would see England become smoke-free by 2030. However, despite being given clear recommendations and a road map of how to achieve the target months ago, the Government have yet to respond. I understand that Ministers have changed over the last year, particularly as a result of the changes in Government, but it is not good enough that we have not had a response to the long-awaited review.

It was stated that a response would be available in the spring. I am not sure if that is spring 2022, spring 2023 or, worse still, spring 2024, but the reality is that in ministerial terms, “spring” can be flexible—hence why we call it spring. Spring is almost upon us, so we await the response to the report. We need to know which recommendations the Government will choose to adopt, and which they will not, and why. Will my hon. Friend the Minister confirm when specifically the response to the Khan review will finally be published?

Next week’s Budget is a critical moment at which the Government must take the urgent action we are calling for. Without additional, sustainable funding, it will not be possible to deliver all the measures we need to make England smoke-free. Severe funding reductions have undermined our ability to deliver such measures. We need to encourage and help people to quit smoking. The reductions have been greatest in the most deprived areas of the country, where smoking is most likely to occur. Sadly, in 2022, only 67% of local authorities in England commissioned a specialist service open to all local people who smoke. That is largely due to financial pressure, following reductions to the public health grant. National spending in England on public education campaigns has dropped from a peak of 23,380,000 in 2008-09 to a mere 2.2 million in 2019-20. That is a 91% reduction. I am disappointed that funding for the No Smoking Day public awareness campaign has been completely scrapped, despite a mass of evidence suggesting that it was a highly effective campaign that had a direct effect on people who continue to smoke.

The four largest tobacco manufacturers make around £900 million of profits in the UK each year. Profit margins on cigarette sales are significantly higher—as much as 71%—than on other typical consumer products. Consequently, the all-party parliamentary group on smoking and health, which I have the privilege of chairing, has called on the Government to introduce a “polluter pays”-style charge on the tobacco industry. That would finally make the tobacco industry pay for the damage its products cause to our nation’s health, and for the strain on the NHS. Remember: this is the only product that people can legally buy that will kill them if they use it properly. It is an outrage that smokers are preyed on by these big tobacco companies. I accept that I may not get the answer I would like, but will the Minister confirm that the Government will introduce a “polluter pays” charge on the tobacco industry in the upcoming Budget?

I have a ten-minute rule Bill going through Parliament that would require people who sell tobacco products to be properly licensed. If the Minister cannot endorse the Bill, I would welcome a commitment from him and his Department to dealing with this issue once and for all, so that we have a proper licensing regime for the sale of tobacco products in this country.

As I come to the end of my speech, I remind colleagues that making Britain smoke-free by 2030 is a well backed public initiative. Recent polling showed that 70% of people supported the Government’s investing more money in helping England to reach the target. Of those people, 74% would prefer the money to come from the tobacco industry, so that it pays for the pollution it causes.

I thank hon. Members for attending the debate. I look forward to hearing the contributions from the Labour and SNP spokespersons, and the Minister’s response, as well as contributions from colleagues from across the House. I commend the debate to the House, and urge the Minister to take urgent action on tobacco today; that would improve the health of the nation, reduce pressure on the NHS, and put money back in the pockets of those who need it most.

--- Later in debate ---

[Mary Glindon (North Tyneside) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Efford. I congratulate the hon. Member for Harrow East (Bob Blackman) on securing this debate. I hold him in high regard as a stalwart champion of the no smoking campaign. It is so sad to hear what made him into that champion. I am sure that what happened in his family has happened in many families in recent years.

I am not a smoker, but, as I have said in past debates on this subject, I was brought up in a household where both parents smoked. My mother died of breast cancer at the age of 72 and my father had a bad chest all his life. She was a Woodbine smoker, I might add. My late husband was a smoker for most of his life, from 1957—the year I was born—when he was only nine years old, and he gave up the habit on a number of occasions. Eventually, like so many smokers, he turned to vaping instead, which was a great relief to him and his pocket. How expensive smoking is for those on low incomes has already been referred to. It will come as no surprise to colleagues that I will talk about vaping as a safe alternative for those who already smoke.

One recommendation in last year’s Khan report on making smoking obsolete was about promoting vaping. Khan stated:

“The government must embrace the promotion of vaping as an effective tool to help people to quit smoking tobacco. We know vapes are not a ‘silver bullet’ nor are they totally risk-free, but the alternative”,

as has already been said, “is far worse.”

Dr Debbie Robson, a senior lecturer in tobacco harm reduction at King’s Institute of Psychiatry, Psychology and Neuroscience has said:

“The levels of exposure to cancer causing and other toxicants are drastically lower in people who vape compared with those who smoke.”

And Professor Ann McNeil, a professor of tobacco addiction at the institute, has said:

“Smoking is uniquely deadly and will kill one in two regular sustained smokers, yet around two-thirds of adult smokers, who would really benefit from switching to vaping, don’t know that vaping is less harmful”,

although evidence shows that vaping is

“unlikely to be risk-free.”

[Mr Sharma]

I will be brief. Does the hon. Lady agree that vaping represents a less harmful alternative, and that vaping products need to be safely regulated and trading standards empowered to strictly enforce their safety?

[Mary Glindon]

I thank my hon. Friend for that intervention. I will raise the issues he has just mentioned in my speech to reinforce what he has said.

In the past, Public Health England has stated that vaping was 95% safer than smoking tobacco, but anyone who does not already smoke should not be encouraged to take up vaping. I think we would all share that message, including those of us who champion vaping over smoking.

As a member of the all-party parliamentary group for vaping and given my interest in smoking cessation, I have worked with tobacco companies such as British American Tobacco UK and Japan Tobacco International as well as the UK Vaping Industry Association. Both the tobacco companies and the UKVIA are united in their efforts to make vaping products as safe as possible through regulation and to help prevent young people taking up vaping. I emphasise that because the companies are very conscious of the problems.

Although we acknowledge the importance of vaping in contributing to the fall in smoking since it entered the mainstream, one of the biggest concerns is products targeted to attract children and young people to start vaping. The industry is extremely concerned about rogue retailers selling e-cigarettes to minors, and are calling to increase fines for offenders to a massive amount. The UK Vaping Industry Association adheres to section 22 of the Advertising Standards Authority guide, which prevents the marketing of e-cigarettes to children. It calls for a licensing or approved retailer and distributor scheme to filter out retailers who are not applying the law, so that consumers and lawful retailers can feel confident that the vape products they purchase adhere to strict safety standards.

Given the rise of rogue traders selling vaping products to children—as well as illicit products—due to the lack of sufficient deterrents and enforcement, the industry sent an open letter to the Health Secretary with a number of recommendations, including increased penalties of at least £10,000 per instance of traders flouting the law. The Minister may be well aware of that, so I will not go into any more detail. Colleagues can look at that if they wish.

A recent press investigation into the increasing number of vaping products entering the UK market that do not comply with the tobacco and related product regulations, particularly in relation to the company ElfBar, prompted the British American Tobacco to conduct its own research. An independent, accredited laboratory carried out an analysis of ElfBar’s 600 products, which can be purchased from major UK supermarkets, including Asda, Tesco and Sainsbury’s. Shockingly, all the products tested contained significantly more than the permitted 2% of nicotine-containing e-liquid—often up to 50% or 60% more.

Following the publication of that information, a meeting was convened between the Medicines and Healthcare Products Regulatory Agency, the Office for Health Improvement and Disparities, and ElfBar last month. However, to date, no action has been taken by MHRA or Trading Standards to remove those non-compliant products from the market. The problem reinforces the industry’s call for tighter controls and fines, which I hope the Minister is considering in full.

The industry is also aware of the concerns about single-use vapes, which offer a cost-effective and easy way for those on low incomes to quit smoking, and thus help to address health inequalities. A recent report from the Office for National Statistics showed that smoking is at an all-time low, and acknowledged the important role played by vaping in reducing those figures. A proposed ban on single-use products could put doubt into the minds of smokers and vapers about the use of e-cigarettes, and that could lead them back on to the smoking trail. It is important to point out that the UKVIA is working to ensure compliance with the waste electrical and electronic equipment directive, and is working with the industry and other bodies, including the Department for Environment, Food and Rural Affairs, to proactively look at ways to maximise the recycling and reuse of vaping products.

It has been said before that vaping is not a panacea. However, it is a way out for people who have smoked for years and cannot give up the habit. It releases them from the dangers of smoking and moves them on to something we hope is less dangerous, and a lot more risk free. I hope the Minister will look at all the considerations that need to go into the tobacco control plan, and will work with those industries so that vaping can be an effective and safe tool as an alternative to smoking in the future.

--- Later in debate ---

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

It is a pleasure to serve under your chairmanship, Mr Efford. I congratulate the hon. Member for Harrow East (Bob Blackman) on securing today’s debate. I was really sorry to learn about the circumstances that have brought him here; they really do account for why he is such a passionate advocate for non-smoking.

For decades, tobacco companies have used every manipulative means possible to recruit the next generation of smokers. For them, it is about big profits—£900 million at last count. With around 75,000 victims of their exploits dying every year, those companies have to market their products to new generations to replace those who die. I am angry because they are deliberately causing harm and taking advantage of marketeering, peer pressure and a pack of lies around a pack of cigarettes to make their victims feel good about succumbing to the powers of their addictive means. Once people are hooked, companies draw their prey into a lifetime of handing over precious savings to deposit in their bank accounts.

Those companies are using their resources wisely. British American Tobacco has bankrolled the Institute of Economic Affairs, a Tory think-tank that wants to privatise the NHS. One of its trustees has reported funding a former Health Secretary with £32,000 between 2010 and 2018—the less said about him, the better. With 30 Tory MPs benefiting in all, what could their motivation be? What could BAT’s motivation be? We will never forget Margaret Thatcher taking $1 million from Philip Morris as a consultant.

It is children that these despicable companies are targeting. I have been following the vaping debate, and child vaping is the latest fad. British American Tobacco and others are at it again, addicting children to their products, using different products at different times, with different flavours and colours and cheap devices. They are once again addicting a generation. Among young people, vaping is now seen as cool, as smoking once was, but the harms of these stimulants are unknown, and a lifetime of expense lies ahead, costing users physically, mentally and financially. These wolves in sheep’s clothing need calling out, and today’s debate is a good place to start.

Tobacco is still the biggest killer, luring people into horrible diseases such as cancers—including lung cancer—stroke and heart disease, as well as dementia, which, as we have heard, is the focus of national No Smoking Day. Given that that costs the NHS £2.2 billion a year and social care £1.3 billion, I have to ask why the Government are content not to set out an ambitious plan that is ruthless with the tobacco giants yet compassionate with their victims, taking every step to draw people out of their addictions and recover their health. Why are Government paralysed when the evidence is screaming at them?

This is the difference between the Tory party and the Labour party: Labour knows that health inequality is unjust. We want to take people to a safer, healthier place. That will be our priority. Thirty years ago, I did my dissertation on this very issue for my degree, and my conclusions were simple: money buys silence. Labour must never touch dirty money, and nor will it. That money kills, whether directly or indirectly. Instead, we must invest in health.

According to Action on Smoking and Health, 9.2% of the community in my city of York smoke. While that is lower than the national average of 13%, it costs our city £46.9 million. In my ICB area of Humber and North Yorkshire, 2,500 people, sadly, die each year. The healthcare costs are £8.2 million, adding to economic costs of £19.9 million due to lost earnings and £10.9 million due to smoking-related unemployment. What a lot of money. Let us reflect: 6.6 million people smoke across the UK. There are 150 new cancer cases a day, and 54,300 a year. Every minute, another victim is admitted to hospital, with 506,100 hospital admissions attributed to smoking. Last year, the cost to the public finances was £2.6 billion.

These wretched companies are fleecing their victims of their hard-earned living, with an average smoker spending £2,500 a year. Some 70% of smokers want to quit, so we need to ensure they have the means to achieve that. Let us remember that these multimillion-pound companies prey on the poorest, with 31% of households with somebody who smokes falling below the poverty line—if ever there was exploitation, this is it. Many new communities of people coming into the UK from challenging places across the world also have a high prevalence of smoking, presenting a new challenge for public health teams, and it is important to get on top of that too.

The UK Government aim to reduce the level of smoking to just 5% by 2030, but there is no tobacco control plan. In York, the local authority’s public health grant has been cut by 40% over the term of this Government, yet we do not know what is to come in 22 days’ time, when the public health grant runs out. On top of that, we have not seen the health disparities White Paper. We understand that it has been scrapped, so what on earth is going on? Tobacco companies make an annual profit of £900 million, yet only £2.2 million is spent on prevention. We need funding, we need professionals, we need education and we urgently need to move people to a space where their lungs and bodies can start to recover.

Despite Javed Khan’s independent review of tobacco control, published nearly a year ago, the Minister has been silent. Mr Khan recommends spending £125 million each year to enable the UK to hit its target, which will be missed without the investment that we absolutely need to see; increasing the age at which people can buy tobacco products; and ensuring that every public health intervention is made. I take the point made by my hon. Friend the Member for Blaydon (Liz Twist) about the illicit trade in tobacco, which we also need to crack down on. There are 15 strong recommendations in Mr Khan’s review, and I want to see the Government taking action, responding to that report and publishing their plan.

Unlike the Minister, Humber and North Yorkshire ICB is not sitting back. Its outstanding public health team are engaging in driving down smoking levels, with a new centre of excellence to co-ordinate population-level interventions, and investing in programmes of activity targeted at those who most need them. With stop smoking support and lung health check screening, work is under way to screen and divert. Like many colleagues across the House, I am asking the Government to publish the tobacco control plan; to publish a strategy to tackle the rise in vaping, particularly among our young people; to give local authorities the means and tools to safeguard a generation; and to introduce an annual public health windfall tax on these companies in the Budget next week. It is all about profit for them, and that profit should be used for public health.

[Mr Sharma]

Does my hon. Friend agree that the Government’s strategy and plan should include special provision for black, Asian and minority ethnic communities, so that they can be targeted and helped to give up this dirty habit?

[Rachael Maskell]

I thank my hon. Friend for making that really important intervention. We must help communities that are finding it hard to quit, including new communities. We really welcome the large number of asylum seekers who have come to York, but we know that there is a higher prevalence of smoking in that community. We must ensure that proper interventions are targeted at BAME communities too.

The figures speak for themselves, and the Minister cannot afford to sit back any longer. Labour will not. We want to save lives, and we want to save the health of our NHS too.

Oral Answers to Questions

Virendra Sharma Excerpts

Tuesday 19th April 2022 Commons Chamber

[The Parliamentary Under-Secretary of State for Health and Social Care (Maggie Throup)]

The Department of Health and Social Care commissioned research through the National Institute for Health and Care Research, co-funded with UK Research and Innovation, for an Imperial College London study, worth £580,000, looking specifically at the safety and effectiveness of two covid-19 vaccines administered by respiratory tract. The study is ongoing, but it is in the later stages of the phase one clinical trial, and the results will be made public in due course, following peer review.

[Mr Virendra Sharma (Ealing, Southall) (Lab)]

Those providing social care often work long hours and are a real lifeline for the most vulnerable. Will the Minister act to ensure that those in social care are paid properly with a real living wage, as Citizens UK is campaigning for?

[Gillian Keegan]

Actually, according to Skills for Care data from 2020-21, the majority of care workers were paid above the national living wage in that year. Most care workers are employed by private sector providers who set their terms and conditions. However, we have committed £1.36 billion to the market sustainability and fair cost fund, which will support local authorities to move towards paying providers a fair cost of care. We hope that will lead to better sustainability and better staff.