Tobacco and Vapes Bill (First sitting)

Zubir Ahmed Excerpts

Committee stage
Tuesday 7th January 2025 Public Bill Committees

[Euan Stainbank (Falkirk) (Lab)]

I am an officer of the responsible vaping all-party parliamentary group.

[Dr Zubir Ahmed (Glasgow South West) (Lab)]

I declare an interest as an NHS transplant and vascular surgeon. My wife is a lung cancer doctor.

[Dr Beccy Cooper (Worthing West) (Lab)]

I declare an interest as a public health consultant and a member of the British Medical Association.

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[Euan Stainbank]

Q It is clear, from the comments made about display and advertising, that child vaping is an issue that needs to be tackled; I think it is an issue that many of our constituents and many people in the country recognise. Especially for adult smokers, do you believe that there will be any impact from the display and packaging restrictions on the effectiveness of vapes as a tobacco cessation tool?

Professor Sir Chris Whitty: Our view is that the benefits of preventing people who are not currently vaping, particularly children, from vaping through what is proposed in this Bill significantly exceed that risk. However, that risk exists; we all accept that. To go back to a previous point I made, that is why having these powers gives us the advantage that if, as a result of where we get to—remembering that this change will come after consultation and there will be secondary legislation going through Parliament—it looks as though we have gone too far, it will be possible to ease back. Our view, though, is that at this point in time, and subject to what the consultation shows, the net benefit in public health terms is positive for the prevention of children starting smoking, over any risk for adults.

The area of greatest uncertainty is on flavours. There is some genuine debate around that, with a range of different views from people who are quite seriously trying to wrestle with this problem—rather than doing marketing masquerading as wrestling with this problem—but in all other areas, most people think that the benefit outweighs the risk.

[Dr Ahmed]

Q Thank you, Sir Chris—your anecdote about the vascular war resonates strongly with me as a practising vascular surgeon; many of my patients leave hospital with fewer legs than when they entered. The comment I want to make is on the chronic disease burden. As you all know, there is a rising epidemic of chronic disease in our country, and it will probably require various public health measures to get back under control. I wonder if I could ask you to comment on how you feel this legislation might impact on the chronic disease burden on the NHS going forward, not only in the short term but in the long term?

Professor Sir Chris Whitty: I will give a view, and I think Sir Gregor will want to add to it. It will make a very substantial difference. The thing to understand is that not only does cigarette smoking cause individual diseases, but many people as they go through life have multiple diseases from smoking. They will start off with heart disease, for example, as a result of smoking, and will go on to have a variety of possible cancers, and they might have chronic obstructive airway disease, and they will end up potentially with dementia. All of these would have not happened at all or would have been substantially delayed had they not smoked. Of course, this is heavily weighted towards areas of deprivation, people living with mental health conditions, and other areas where I think most people would consider it really unjust in society. All of us, and anybody who has looked at this in public health terms, would say that if you could remove smoking from the equation, the chronic disease burden would go down very substantially, and be delayed, and the inequalities of that burden of disease would also be eroded. The arguments for this are really clear.

To give some indication of the numbers involved, we have thousands of people every year—millions over time—going into hospitals and general practices only because they are smoking. Had they not smoked, they would not have to use the NHS, and they would not have the chronic disease burden that disbenefits themselves, disbenefits their families and, of course, because of the impact on wider society, disbenefits everyone else as well. Undoubtedly this Bill—if it is passed by Parliament—will reduce that burden and have an enormous impact.

Professor Sir Gregor Ian Smith: Thank you for raising this as a question, because it is a very important point to understand. I will speak to the experience in Scotland. The Scottish burden of disease study published by Public Health Scotland suggests that from now to 2043 we are going to see a rise of 21% in overall burden of disease across our society in Scotland. That burden of disease is very much weighted towards a number of conditions such as cancer, dementia including vascular dementia, cardiovascular disease, and others. There is no doubt in my mind that smoking contributes to those.

Chris’s point about the multimorbidity that people experience is really important in this context. There are more people in Scotland who experience multimorbidity under the age of 50 than those who do over the age of 50, and much of that is related to smoking. Anything that we can do to reduce that burden of disease on people will not only make their own lives so much better, but make them more productive—they will be able to spend more time with their families, they will be economically active for longer, and they will also use health services less. So there is both a compelling health argument and an economic argument here on the preventive nature of stopping smoking and stopping people from beginning to smoke, which is really important to understand in the context of that projected increase in the burden of disease.

The last thing to remember is that our experience of disease can sometimes be cumulative. As Sir Chris alluded to, people who have developed diabetes for other reasons but who smoke as well, will have accelerated disease as a consequence. Removing as much as we can, step by step, the risks that are associated with the development of that accelerated disease—you will have seen it very clearly in your role as a vascular surgeon—has to be a step that we take to maintain both the health and the economic prosperity of our nation.

Professor Sir Chris Whitty: The numbers that I was looking for—

[The Chair]

I am sorry, Sir Chris. Just for the purposes of timekeeping, which is my job, we have about 20 minutes left and five people wish to ask questions, so can we keep the questions as tight as possible, and within reason the answers as well?

Professor Sir Chris Whitty: I wanted to give the exact numbers, which I just found in my notes. Some 75,000 GP appointments a month are caused by smoking—just think of that when you phone up the GP—and 448,000 admissions to the NHS: again, think of that when you look at these areas. So the impact of this is really very substantial.

Tobacco and Vapes Bill (Second sitting)

Zubir Ahmed Excerpts

Committee stage
Tuesday 7th January 2025 Public Bill Committees

[Liz Jarvis (Eastleigh) (LD)]

Q Do you think the Bill goes far enough to protect children and young people from the harmful effects of tobacco and vaping?

Professor Linda Bauld: It is very ambitious on tobacco. We will be the first in the world—after unfortunate events in New Zealand, from my personal perspective—to introduce the smoke-free generation policy, and the world is looking at us. That is good. In terms of protecting people from vaping, the Bill has a proportionate set of measures, but if I come back to the answer that I gave to the shadow Minister, we really need to keep our eye on the regulations and—going back to the Minister’s questions—make sure that we are striking a balance. Given the evidence that we have for much stronger regulations on vaping, I think this strikes the right balance, but we need to make sure that we do that in a proportionate way. Finally, to go back to the comments from the previous set of witnesses, we also need to make sure that local areas have the flexibility around some of the measures to adapt them for their local circumstances.

[Dr Zubir Ahmed (Glasgow South West) (Lab)]

Q Thank you, Professor Bauld, for sharing your extensive expertise with us today. I want to explore the intersection between poverty and health, and where you think the Bill will have an impact. We know that health outcomes are poorer where there are pockets of high deprivation, as in many areas of Scotland, including my constituency of Glasgow South West. What are your thoughts, both quantifiable and general, as to the impact of this legislation on those children and on those particularly deprived communities?

Professor Linda Bauld: Dr Ahmed, you know—as Sir Gregor Smith said earlier—that smoking rates in our most deprived communities in Scotland are about 26%, compared with 6% in the least deprived. That is a very big number, and we see that pattern across the UK.

The Bill will make a difference in several respects. First, on preventing smoking uptake by gradually raising the age of sale, the evidence that we have from studies done by my colleagues at University College London and elsewhere is that previous rises in the age of sale have not exacerbated inequalities but have had a benefit in terms of preventing uptake. We know from the evidence that we have that those measures should be useful and helpful, and should not exacerbate that. The other thing is that, to go back to my earlier answer to the shadow Minister, by preventing smoking uptake in the groups that are likely to be future parents who are already likely to smoke, which are highly concentrated in our most deprived communities, we are going to have an impact there.

I do not see any signs in the Bill, when I look across the measures, that we will be exacerbating inequalities with it. I think that we will probably have the biggest impact in the areas where we have the most smokers which, unfortunately, are our most deprived communities.

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[Sadik Al-Hassan]

Q I thought you said that there are no licensed products on the market?

Dr Laura Squire: There are not, which is why that is the way we would prefer to do it. Again, if we licensed these consumer products as a medicine, there are very strict requirements on labelling and on what needs to be given to the patient to explain what the product is and its risks. That is not there with these consumer cigarettes. It is going to get stricter under the new rules, but my preference would be that we give people more information.

[Dr Ahmed]

Q Thank you, Dr Squire, for being with us. The Royal College of Physicians has called for manufacturers to limit the production of toxic substances and for the MHRA to independently verify some of the contents of e-cigarettes. Do you think that that can be achieved through the measures in the Bill as it stands?

Dr Laura Squire: It depends on what happens with the actual regulations. At the moment, we do not have powers to test consumer e-cigarettes—that power sits with trading standards. Again, if we license something as a medicine, we go into absolute detail about what is in it. At the moment, it depends on what is in the regulations that come round. We do not do testing at the moment, and it would be important to think about the point at which any testing is done. If it is done at the point where something goes on to the register, that is fine and it tells you that the sample we saw at that point was compliant. But what happens later down the track? I think the role that trading standards has in doing that testing is really important, because it can do it post-market at any point. The question really is about the role of the MHRA—a medicines and healthcare products agency. Is it getting deeper into these consumer products where the risk is not outweighed by the benefits? That is an uncomfortable position for a medicines regulator.

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[Liz Jarvis]

Q Lord Bichard mentioned Border Force. Will ensuring that it has enough resources to implement this Bill successfully be a consideration? In response to my question, Matthew Shanks mentioned a public health campaign. Are there any plans to have a public health campaign to back that up?

Andrew Gwynne: The short answer to both those questions is yes. We have committed to an investment across HMRC, trading standards and Border Force of £100 billion over the next five years to enforce these measures—sorry, it is £100 million. The Treasury will be having a fit; I am getting my billions and millions wrong. I wish it was £100 billion.

As far as public health campaigns are concerned, just this week we committed £70 million for smoking cessation. For this new year, I have signed off a concerted public health campaign for smoking cessation on social and broadcast media. As this Bill progresses and becomes law, there will be a huge public health publicity campaign so that everybody is aware of our Smokefree 2030 target ambitions.

[Dr Ahmed]

Q I have a couple of points, Minister. The first is to do with poverty and how the Bill will affect those who are disproportionately impacted not only by smoking but by second-hand smoke. We heard from our CMOs and Professor Bauld about the impact that smoking-related diseases have on those populations. It is not often in our lives that we get an opportunity to use an instrument that has the potential to change the trajectory of the lives of people who are at the lower end of the economic spectrum in society. What do you think will be the impact of the Bill on them?

Secondly, could you make a wider comment on the historical context of the Bill? In 2006, it was a Scottish Labour Government in the Scottish Parliament who set in train some of the processes that we are trying to finish today. Over those 14 to 15 years, we have seen many positive short-term and long-term public health outcomes. What do you think will be history’s judgment on this portion of that journey?