Tobacco Control Plan

Will Quince Excerpts

Thursday 19th October 2017 Commons Chamber

[Will Quince (Colchester) (Con)]

I rise to speak primarily as the co-chair of the all-party parliamentary group on baby loss. I apologise to some extent if I appear a little like a broken record on this subject, but in many respects I do not apologise because we have so much work to do in this area. I want to focus, if I may, on smoking in pregnancy. My hon. Friend the Member for Chippenham (Michelle Donelan) has eloquently put some of these points already, but I want to go into somewhat more detail.

The Prime Minister spoke of the burning injustice that sees the poorest in this country die on average nine years earlier than the richest. It is essential for the tobacco control plan significantly to reduce the health inequality between richest and poorest in Britain. Those who earn £10,000 a year are twice as likely to smoke as those who earn £40,000. As the Minister knows, we have massive issues with regard to smoking in pregnancy and regional variation: 2% in Richmond, 2.2% in Wokingham, and 2.4 % in Hammersmith; yet 26.6% in Blackpool, 24.4% in South Tyneside, and 24.1% in north-east Lincolnshire. Women in routine and manual jobs are almost three times more likely to smoke during pregnancy than those in managerial and professional roles. Teenage mothers are six times more likely than those over 35 to smoke throughout their pregnancy.

I applaud the success of the 2011 to 2015 tobacco control plan. As my hon. Friend the Member for Harrow East (Bob Blackman) pointed out, we exceeded the ambitions in the plan and reduced the adult smoking rate from 20.1% to 15.5%. I also applaud the Minister’s ambition to reduce the rate of adult smoking from 15.5% to 12% or less by 2022, and I further welcome the ambition to reduce the prevalence of smoking in pregnancy from 10.7% to 6% or less, notwithstanding my earlier point about regional variation.

To be clear, this is absolutely not about criticising or demonising women who smoke during pregnancy. Tobacco, as Members have already pointed out, is highly addictive and it can be incredibly difficult to stop smoking. In relation to stillbirth and neonatal death, the Government have set some really ambitious targets: to reduce the rate by 20% by 2020, and to cut it in half by 2030. In order to achieve that, we have to be clear about the fact that the biggest modifiable risk factor for those issues is smoking in pregnancy. I have raised these statistics in the House before, and I make no apology for reiterating them today. One in five stillbirths is associated with smoking, and women who smoke are 27% more likely to have a miscarriage. Their risk of having a stillbirth is a third higher than that of non-smokers. Mothers who smoke are more likely to have pre-term births and babies who are small for their gestational age.

Then we have second-hand smoke. Maternal exposure to second-hand smoke during pregnancy is an independent risk factor for premature birth and low birth weight, but only one in four men make any changes to their smoking habits when their partner is pregnant. The number of sudden infant deaths could be reduced by more than 30% if children were not exposed to second-hand smoke. The Royal College of Physicians has estimated that 20% of pregnant women are exposed to second-hand smoke throughout their pregnancy, increasing the risk of many poor birth outcomes. If every pregnancy were smoke-free tomorrow, there would be around 5,000 fewer miscarriages, 300 fewer perinatal deaths and 2,200 fewer premature births each year.

I want briefly to raise with Ministers the question of vaping and e-cigarettes. Although I appreciate, notwithstanding points already made by colleagues, that the jury is still out on these products to some extent, and although quitting outright is always the aim, these products must surely be better than smoking, especially for pregnant women. I encourage the Minister to work with the Treasury to investigate some kind of levy on the tobacco industry. Incidentally, the tobacco industry has huge investments in vaping and e-cigarettes; in fact, most of the biggest e-cigarette companies are owned by the major tobacco manufacturers.

[Vicky Foxcroft (Lewisham, Deptford) (Lab)]

Perhaps I should start by declaring an interest as an electronic cigarette smoker myself. I have seen at first hand the health benefits of moving from smoking to electronic cigarettes, including being able to run much further and feeling much healthier. A smoker who gives up for, say, six months will start to feel the same benefits. I encourage the hon. Gentleman to seek a lot more research in this area.

[Will Quince]

I thank my hon. Friend—I use that description intentionally—for that intervention, and I think she is absolutely right. Without wanting in any way to sound patronising, I applaud her for making the move from smoking cigarettes to using e-cigarettes. The evidence is out there to suggest that it is a great way to transition off smoking and off nicotine entirely. Far more research needs to be done in this area, and I hope that the Chancellor is looking at how we could, in the Budget, encourage tobacco manufacturers to provide these products for free to women who are struggling to give up smoking during pregnancy, in particular.

I would also like to touch on the important issue of carbon monoxide monitoring. Challenges remain for staff in implementing the NICE guidance, particularly in relation to carbon monoxide screening. NICE has recommended since 2010 that pregnant women be screened for exposure to carbon monoxide. The current tobacco control plan reiterates the importance of that and further commits to recording women’s carbon monoxide levels in the maternity services dataset. However, front-line staff do not universally have access to carbon monoxide monitors.

We know already that babies who are exposed to carbon monoxide are more likely to suffer birth defects, to be born prematurely and to have a low birth weight, so it is incredibly important that we look at this area. Carbon monoxide screening is one of the key elements in supporting women who smoke to access quit services. Properly embedded into services, screening can transform outcomes. The evidence from the north-east shows that following a comprehensive programme to train midwives, provide them with monitors and set up referral routes to local quit smoking services, smoking in pregnancy rates fell by nearly a third. We know that this absolutely works.

I stress to the Minister that carbon monoxide monitors are not an optional extra; they are an essential tool for midwives. We would never ask midwives to do their jobs without, for example, blood pressure monitors. In the same way, all midwives should have access to CO monitors. Part of the problem is that there is no consistent national approach to the provision of these vital pieces of equipment. Local decisions determine whether midwives and health visitors have access to them, so there is local variation.

I would also like to touch on training for health professionals. The smoking in pregnancy challenge group, a coalition of health and baby charities, produced a report in July examining the training needs of midwives and obstetricians in England. That report was launched at a joint event of the all-party group on baby loss and the all-party group on smoking and health. I co-chaired the event, and the Minister kindly attended and addressed the meeting. I do not need to remind the Minister of this, but the report found that although health professionals have generally received training about the harms of smoking in pregnancy, a majority have had no training in how to communicate those harms to women and support them effectively to access the treatment that is available. Health professionals say that, in the absence of training, they lack the confidence to engage in such conversations.

The report recommends that such training form a regular part of mandatory midwifery training and be embedded into obstetricians’ continuing professional development. Can the Minister outline the steps that are being taken to review and implement the findings of this report? Will consideration be given to extending the analysis undertaken by the smoking in pregnancy challenge group to look at training needs, involving key stakeholders such as other health professionals?

To conclude, I very much welcome the new tobacco control plan and the commitments that the Minister and the Government have made in this area. Is there more that we can do? Yes, of course, there is much more that we can do. I know that the Minister, the Secretary of State and the Minister of State, my hon. Friend the Member for Ludlow (Mr Dunne) are as passionate as I am about reducing our miscarriage, stillbirth and neonatal death rates.

I repeat, because it is really important, that this debate is not about demonising or criticising women who smoke during pregnancy. I fully appreciate how addictive smoking is; it is really hard to stop. Like my hon. Friends the Members for Chippenham and for Harrow East, I have seen my parents struggle. They have both been smoke-free for many years, and I am very proud of them, but it is incredibly difficult.

When it comes to pregnancy, we know that all parents want to give their baby the best possible start in life, so I thank the Minister for all the work that he and the Department have done so far. I ask him to keep a watchful eye on this issue and to be pragmatic in ensuring that the Government give anyone who is struggling to quit smoking the tools and the support that they need to help them to achieve that goal.

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[The Parliamentary Under-Secretary of State for Health (Steve Brine)]

I thank the hon. Member for Washington and Sunderland West (Mrs Hodgson), my ministerial shadow and my friend—she certainly is that.

I congratulate the right hon. Member for Rother Valley (Sir Kevin Barron) on securing this important debate. The Backbench Business Committee was an excellent innovation that arrived in this House at the same time as me—there is no correlation between those two things, I should point out—and debates such as this would not necessarily have happened without it. So well done to the right hon. Gentleman, and to all the Members who have participated. As the shadow Minister said, it is Stoptober, which is an excellent time to have this debate, but of course our passion to cut back on smoking rates is not confined to October.

Let me say a bit about the tobacco control plan and try to respond, as far as I can, to the points raised in the debate. My ministerial brief covers a wide area: public health, primary care, and cancer. That might appear to be a disparate agenda, but there is a plan. For me, all of my responsibilities come back to prevention and in particular how we prevent some of the major diseases; cancer is, of course, still the biggest preventable killer in our country, and the link to smoking is obvious and has been given by many Members. To give some obvious examples, our work to tackle the harmful use of alcohol, our strategy to tackle obesity and specifically childhood obesity, and our tobacco control plan are all about doing more to prevent ill health in our country, and above all cancer.

The TCP is not an end in itself; it is part of a plan. The shadow Minister kindly said that publishing it was down to me. At our very first health orals, she asked when it would be published, and I gave the answer that it would be published by the summer recess. She then shouted out, “Which summer recess?”, but the plan had been started and I wanted to get it right and to get it out. It is amazing what announcing things at oral questions will do to our officials. Anyway, we got it out, and I am very pleased with it.

The last TCP ran from 2011 to 2015 and was considered highly successful; I am grateful to the many Members from all parties for saying that. All the ambitions we set out in that plan were exceeded. We introduced a significant amount of legislation over the course of the plan, as did the Labour Government before then. There was the ban itself, then the ban on smoking in cars containing children, and then, last year, the introduction of standardised packaging, which is a first for Europe. The UK remains a world leader in tobacco control, and Governments of both parties have a proven track record in reducing harm caused by tobacco. The country has made a significant reduction in the prevalence of smoking over the past 25 years, from 27% in 1993 to just over 15% today. That is some achievement.

[Will Quince]

At the moment we have symbols on every bottle of alcohol sold in the UK. I appreciate that this is under EU rules, so other Government Departments would need to look at this, but could we consider having “no smoking while pregnant” symbols on all smoking products, rather than just one in six, as is the case at present?

[Steve Brine]

I will look at that point; as ever, my hon. Friend makes a pertinent point from the Back Benches—where I do not think he will be forever, I might add. [Interruption.] It is evidently not my decision.

I have given the relevant figures, and we are now considered by independent experts to have the best tobacco control measures in Europe. We published the new plan this year to build on that success, but there is no room for patting ourselves on the back in this game, and we still have a huge amount to do.

We still have 7.3 million smokers. That exerts a huge impact on our communities and our NHS. Tobacco use is the biggest contributor to cancer, accounting for more than one in four UK cancer deaths, and nearly a fifth of all cancer cases in this country. Research by the Independent Cancer Taskforce reported that up to two thirds of long-term smokers will die as a result of smoking if they do not quit. We have heard from a number of Members across the House about people whom they have loved and lost, and they are not statistics; they are people’s mothers and fathers, and sons and daughters, who have been lost to cancer. Cancer is not contracted through smoking alone, of course, although it accounts for a huge part of the cancer rate. We must remember that 200 people die every day due to smoking; I think every Member will join me in saying I want us to do better than that.

The plan sets our interim ambitions en route to that goal. Over the next five years we want to reduce the prevalence of adult smokers to 12%. In answer to my hon. Friend the Member for Harrow East (Bob Blackman), I would like to go lower than that, but that is the current figure in the plan. It is not necessarily an end-point, however, and it is not an end in itself. We should also remember the prevalence of 15-year-olds who regularly smoke. We want to get that down to 3%, and the prevalence of pregnant smokers—which so many Members have mentioned today—down to 6%. We want to reduce the burning injustice—a number of Members have used that term today— that sees some of the poorest in our society die on average nine years earlier than the richest, so we will focus, as the plan says, on people in routine and manual occupations.

We want to focus on other groups particularly affected by smoking, such as people with mental health conditions and those in prisons. The hon. Member for Stockton South (Dr Williams) rightly spoke about that being part of a wider poverty reduction programme. That has to be central to the plan, which is not just owned by the Department of Health and me. It is a cross-governmental plan and everything that we do should be part of that aim to reduce poverty. That is why the Prime Minister said what she did. I guess that the hon. Gentleman does not agree with everything she said, but surely he must agree with her words on the steps of Downing Street about poverty reduction.