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Tobacco Control Plan

Volume 629: debated on Thursday 19 October 2017

I beg to move,

That this House has considered the Government’s publication of the new Tobacco control plan.

I begin by thanking the Backbench Business Committee for allocating time for this very important debate. I also welcome the Minister to his new post in the Department of Health, and I am sure he will hear much more about this issue in the months to come.

I have no financial interest, but I should mention that I am an honorary fellow of the Royal College of Physicians, as it is heavily involved in the debate on tobacco.

I have repeatedly called in this House for the publication of a comprehensive tobacco control plan to replace the Government’s previous plan, “Smoking Still Kills,” which expired in 2015. I welcome the Government’s publication of this new five-year strategy this summer, which seeks to achieve what they term a “smokefree generation”.

Despite a long-term reduction in smoking rates, tobacco use remains the leading cause of preventable premature deaths and ill health, accounting for about 100,000 deaths each year in the UK. In addition, 23% of all hospital admissions for respiratory problems in 2014-15 were directly attributable to smoking. I thoroughly welcome the falling adult smoking rates in England—down from 46% in 1974 to 15.5% in 2016—but I have to say to the Minister and to the House that we cannot take this work for granted. That is why we need the tough but achievable targets that the new current control plan contains.

Smoking and the harm it causes are not evenly distributed, as hon. Members will know. People in more deprived areas are more likely to smoke and less likely to quit. Smoking is increasingly concentrated in more disadvantaged groups and is the main contributor to health inequalities in England. Men and women from the most deprived groups have more than double the death rate from lung cancer of those from the least deprived areas of the UK. I am not saying there is exactly a north-south divide, but where money is divided in such a way that is likely to happen. Rates do vary between north and south on occasion, as we see if we examine smoking during pregnancy rates, which vary from 2% in the Central London clinical commissioning group area to 27% in the Blackpool CCG area.

Data produced by Public Health England show that in my local authority area 18.1% of women smoke at the time of delivery compared with the national average of 10.6%. The plan says that it will reduce the prevalence of smoking during pregnancy. Does my right hon. Friend agree that every CCG and local authority will have to have sufficient funds to carry this work forward?

Clearly that is the case. I agree with this publication and its intention, but there will be issues to address on different forms of funding. I will discuss that a little later in my speech. We can see from the two figures from central London and Blackpool that there is a challenge out there; this difference alone can have a dramatic impact on health inequalities, as maternal smoking causes up to 5,000 miscarriages, 300 perinatal deaths and 2,200 premature births in the UK each year.

In my area of Rotherham alone, the smoking rate among people in managerial and professional occupations is about 10.2%, but that leaps to 29.4% among those who have never worked or are long-term unemployed. Such facts clearly show that we are still struggling to get through to certain groups within society, and the Government must do more to identify ways of getting through to these difficult-to-reach groups.

The right hon. Gentleman is setting out the harm caused by tobacco. As a recent convert to the benefit of e-cigarettes in assisting people to stop smoking, I wonder whether he will be talking about the valuable role they play. Does he agree that it is a bit of a shame that the tobacco control plan does not go further in recognising the role that e-cigarettes can play?

I will comment on that, but I think the hon. Gentleman ought to be happy that this is the first time in any tobacco control plan that e-cigarettes have been mentioned and there is some intent to do things with them.

I welcome the acknowledgment of the seriousness of the issue for people with long-standing mental health problems, as the smoking rate is a staggering 40% among those with a serious mental illness. That is another area that needs to be targeted and worked on. The control plan rightly states that joined-up working and integrated commissioning between local government and the NHS are very important. This is not just the case in hospitals when people are admitted; we must focus on prevention and early diagnosis. For example, dentists are the only healthcare professionals who frequently see healthy patients and so are in an excellent position to identify possible oral health problems early on.

We welcome the tobacco plan and the reduction in the number of people who smoke from 20% to 16%, but there is one anomaly here, to which the right hon. Gentleman has referred. I refer to chewed tobacco, as it is not mentioned in this plan and there does not seem to be any plan to address this. Oral cancer is one of the major cancers across the UK, with some half a million people affected by it. Action on this was recommended 11 years ago. Does he feel, as many in this House feel, that chewed tobacco should be part of this tobacco plan and that there should be legislation to address this?

I am going to go on to discuss some of the issues relating to that situation. As I said, dentists are the only ones who normally see healthy people. I am aware that some GPs—we have one sat here in the Chamber—talk to healthy people even though these people do not think they are healthy at the time, but the situation is a little different for dentists. This early identification is crucial, as mouth cancer patients have a 90% chance of survival if the condition is detected early, but that plummets to just 50% if their diagnosis is delayed.

I say to the hon. Gentleman that I worked in an industry where people used to chew tobacco because we could not smoke at work. I tried it once at the age of about 16 and I am pleased to say that I never went near it again, although I used to smoke cigarettes when I came up from underground—that is a long, long time ago now. The general health implications of smoking are well known and documented, but mouth cancer often gets overlooked. This is the point: despite its killing more people in the UK than cervical and testicular cancers combined, there is still an alarming lack of public awareness towards oral cancer. There are thousands of chemicals contained in a single cigarette, and their point of entry is the mouth. Smoking helps to transform saliva into a deadly cocktail that damages cells in the mouth and can turn them cancerous.

Pharmacy teams also have an important role to play in promoting and encouraging attempts to stop smoking; as Members will know, in Healthy Living pharmacies and others, this is part of the job they do in advising people. These teams can be trained to be very effective in that. This often occurs in the community, but hospital and GP-based pharmacists are also well placed to offer this support. They are well placed to offer stop-smoking interventions with behavioural support and medication. In fact, the National Pharmacy Association is re-evaluating its position on e-cigarettes. As frontline healthcare professionals, pharmacists and dentists are exquisitely positioned to make a difference to health outcomes.

The Government must look to protect public health funding for stop-smoking services in particular if their aims are to be achieved. A growing number of local authorities have already stopped providing stop-smoking services for general smokers. The King’s Fund also highlighted that in 2017-18 local authority funding for tobacco control faces cuts of more than 30%. We have seen the transfer of commissioning responsibilities for public health services to local authorities, and subsequent cuts to the public health grant. A study by Cancer Research UK and ASH—Action on Smoking and Health, an organisation I have been involved in for more than two decades—found that 39% of local authorities reduced their smoking cessation budgets, despite the public health budget being ring-fenced by central Government. These are the issues that are happening down below, but we need to be aware of them.

All this has led to a reduction in mass media campaigns to motivate quitting, which are so vital to direct people towards the services that are on offer. Only this morning, I saw that the British Lung Foundation has published a report showing, yet again, that stop-smoking support is one of the most cost-effective treatments for people with COPD—chronic obstructive pulmonary disease.

Recently, in my role as vice-chair of the all-party group on smoking and health, I visited a smoking-cessation service—the one led by Louise Ross in Leicester. The team in Leicester have been trailblazers in the use of e-cigarettes for cessation purposes. They told me that Leicester’s stop-smoking service was the first in the country to go “e-cig-friendly” on No Smoking Day 2014. Since then, the team has built up a comprehensive bank of knowledge and insights, developed from many discussions with both vapers and smokers, that can be drawn on to help people get the best advice when they decide they have had enough of smoking. I had a discussion with a nurse who works in that service and who was using e-cigarettes in working with pregnant women to try to address our awful statistics on the effect of smoking in pregnancy. Most smoking-cessation services could do worse than talk to the people in Leicester about exactly what they are doing on that.

There has clearly been an increase in e-cigarette usage since the publication of the previous strategy in 2011: in 2012, there were some 700,000 e-cigarette users, and that had risen to 2.8 million by 2016. There is growing evidence to support the successful use of e-cigarettes as a smoking cessation aid. The Office for National Statistics found that in 2016, some 470,000 people were using e-cigarettes as an aid to stop smoking, while an estimated 2 million people had used the products and completely stopped smoking. I believe that e-cigarettes played a huge part in the beating of the target in the previous tobacco control plan. It is clear that e-cigarettes do not suit everyone, though, so there still needs to be a wide range of licensed stop-smoking medication to use alongside much-needed behavioural support.

Some 4,000 people in my Stockton North constituency use e-cigarettes and 14,000 people still smoke. Can my right hon. Friend envisage a day when e-cigarettes are available on prescription, like other products?

I actually had this conversation in Leicester, although I was not going to mention it in my speech. There is an issue—I think it was in a column in one of the national newspapers many months ago and I have tried to avoid it. If somebody avoids spending £20 or £25 a week on cigarettes, should they get free NHS prescriptions, if they are eligible, to help them to quit? There is a debate there, but I shall say no more than that at this stage.

I asked the team in Leicester what they thought about e-cigarettes on prescription for people who are eligible for free prescriptions, and they said that there might be a case for doing it for a month to break the person away from the cigarette-smoking habit and get them on to e-cigarettes. For the purposes of this debate, I shall leave that where it sits, but there might be a case for it. We clearly need more evidence on the use of e-cigarettes for smoking cessation so that we can make a better estimate.

I accept that the right hon. Gentleman wishes to park the issue of whether e-cigarettes should be available on prescription, but does he think that e-cigarette manufacturers should have a little more freedom—the tobacco products directive places restrictions on the advertising of e-cigarettes—to tell people about the nature of their products and how they can help people to switch from tobacco?

I shall address that briefly, because I know that other Members wish to get involved in the debate. The simple answer is that that is one of several issues that need to be addressed.

The best thing smokers can do for their health is of course to quit smoking altogether, but it is clear that e-cigarettes are significantly less harmful to health than smoking tobacco. Public Health England found that e-cigarettes are around 95% less harmful than smoking cigarettes. My instinct is that the remaining 5% is down to the fact that they have not yet been tested for long enough for it to be said that there is little or no danger at all. There is no evidence that e-cigarettes act as a smoking gateway for children or non-smokers, but research is still needed on their long-term use, and it should be carried out. Quitting smoking is always best, but there is clearly a hard core of smokers who have so far struggled to quit; they must be the people we focus on. It is worrying that an ASH survey found over a three-year period that the number of people who thought that e-cigs were “as or more dangerous” than cigarettes rose from 7% to 26%. That is why we need Government-funded research. I find it incredible that statistic is moving in that direction, rather than the opposite, although I must say that the debate on e-cigarettes, both in the Chamber and elsewhere, has not always been particularly clear.

Other innovations are continuing the “nicotine revolution”. Manufacturers are developing additional smoke-free products to persuade heavy smokers who would not otherwise quit smoking to switch to smoke-free alternatives, among which are the heated-tobacco products that have come on to the scene in the past year or so. Referred to in the “novel tobacco products” category of the tobacco control plan, such products could be the next step to reaching those hard-core smokers who, although they did not get on with e-cigarettes, are looking for another way out of smoking. I was pleased to see in the plan that Public Health England will continue to lead the investigation into the use of novel products as stop-smoking tools, with the evidence updated annually, and that PHE acknowledges that novel products are currently the most popular aid to stopping smoking in England.

Many people are wary of so-called novel products and the fact that many are produced or funded by tobacco companies. We must recognise that tobacco companies have in the past been extremely dishonest about the harms of smoking and the products they have sold, so we urgently need more research on these devices, and I hope the Government’s annual review will help to provide more information. I have been anti-tobacco for more than two decades in this House, but we should not ignore the potential benefits for people who have not been able to stop with more traditional smoking-cessation products just because some of these products have tobacco connections. It is vital that we all focus our minds on the reality of getting people off this habit that is still killing people and shortening the lives of more than 100,000 of our fellow citizens every year.

Many of the products I am talking about are covered by the EU tobacco product directive, which has resulted in many good things, including the establishment of reporting and notification requirements for tobacco products. Nevertheless, stakeholders have raised issues with some of the other requirements, and we may be able to use Brexit as a chance to look at the directive. I understand that we have been thrown into the TPD at the last minute. We have had the debate and I do not want to bore anyone with it further. We need to move on, because that is what happens in politics sometimes. We need to talk about what should be happening now and in future for the sake of our fellow citizens. Brexit is coming, so we should not be tied into a timetable for any changes to the TPD—although I do not even know the potential timetable for any further debate on Brexit. Nevertheless, if there is any discussion about changes to the TPD, we need to ensure that all stakeholders are involved in working groups to design a directive that works for the good of the United Kingdom, taking into account the issues I have mentioned.

For all its positives, there is a glaring problem with the tobacco control plan, and we all know what it is: money. Although not short on lofty ambitions, local authorities face huge strain and will not be able to deliver the kind of joined-up smoking-cessation services that the tobacco control plan deserves. Luckily, there are people who can help. Tobacco companies have made a fortune selling cigarettes. We might well argue that they got us into the mess we are now in, so it is only right they get should us out of it. They have the resources and customer base to help smoking cessation tools to get straight to the people who need them most. If the industry is willing to commit to a future based on e-cigarettes and other reduced-harm products, we should take them up on the offer and allow the Government and local authorities to partner with them to ensure we have the financial and technical assistance needed to help smokers to quit. I would not have said that five years ago, but five years ago we did not have these products that can clearly help a lot of our fellow citizens to get off cigarettes.

It was remiss of me earlier not to pay tribute to my right hon. Friend for all his work on this issue in recent years. Will he talk a little about people with mental health conditions and the fact that the tobacco control plan emphasises the need for parity of esteem in their treatment, in a similar way as there should be parity of esteem between the treatment of mental health conditions and the treatment of the general population? For that parity of esteem, the professionals who work with people with mental health conditions would need the necessary expertise and education. Will my right hon. Friend join me in encouraging the Minister to step up education for mental health professionals so that they, too, can be part of the campaign to help people to quit smoking?

I will indeed. The use of e-cigarettes in mental health institutions or in prisons could go a long way towards alleviating some of the problems in such institutions. When I was Chair of the Health Committee, we looked into smoking in public places in 2005-06, and we saw tobacco in effect being used as a form of control in some institutions, and everyone knew the damage it was doing to the people in those institutions. A lot of institutions have moved on now, though. It is a matter for the Prisons Minister, not the Minister who is present, but we need to consider the availability of e-cigarettes in such institutions so that we can get people away from this life-threatening habit.

In conclusion, the tobacco control plan offers the groundwork for a comprehensive strategy that is much broader than just cessation and that must include measures that reduce uptake as well as those that increase quitting. They should include reducing the affordability of tobacco by increasing taxation, which has been happening in this country for many years now. I will certainly have a close eye on the Budget in a few weeks’ time, as we need a renewed commitment from the Government to the tobacco tax escalator. Any money that is raised should be ring-fenced for use in smoking cessation and mass media campaigns to motivate quitting and enforcement of age of sale, which is also an issue. When the mass media campaigns ended after the 2010 general election—people were no longer seeing them on television or in other parts of their life—the demand for smoking cessation services reduced.

We all want a smoke-free society as soon as possible. We on the Labour Benches, and even some tobacco companies, are now saying that as well, so the Government could not ask for a better opportunity to take this further, to do it more comprehensively and with more success. The challenge now is to make sure that reality lives up to these ambitions. The tobacco control plan needs to be properly implemented and built on if we are to achieve those goals.

Order. Before I call the next person to speak, may I say that we have plenty of time for this debate and I hope that we will manage without a formal time limit? I much prefer to rely on the reasonableness and honour of hon. Members to have regard for others as well as themselves. If every speaker takes approximately eight minutes or so, then everybody who has indicated their wish to speak will have an equal chance to do so. If that does not happen, I will impose a time limit.

I am delighted to have the opportunity to speak in today’s debate on the Government’s tobacco control plan, which was unveiled in July 2017 and is supported by the British Heart Foundation. It is a co-ordinated effort to bring together the NHS, the Department of Health and local government to tackle smoking.

Although smoking in the UK is declining, the problem should not be underestimated. There are still 7.3 million adult smokers in the UK, and more than 200 smoking-related deaths a day in England, which costs the NHS millions every year. I welcome the plan and the £16 billion that has been ring-fenced by the Government for local public health services until 2021.

Those who use a local stop-smoking service are four times more likely to quit. The figures are astonishing. As the daughter of a smoker of more than 20 years, I have seen at first hand the journey that needs to be replicated to achieve the goal of a “smoke-free generation”.

The success of the 2011 to 2015 tobacco control plan reduced adult smoking rates from just over 20% to just over 15%. The aim now is to reduce rates to 12% and lower by 2022. That is not only right, but essential. We must work to save the 79,000 preventable deaths in England per year and the £11 billion that smoking is costing the economy.

Smoking is not a necessity. A cigarette is not a fashion accessory; it is the way towards lung and mouth cancer, strokes and heart disease and a host of other ailments and illnesses that kill. Let me be clear: I believe in choice and individual freedom, but I also believe that the Government have a role not only to guide, but to signpost and to promote the choices that will lead to healthier lifestyles. That is why I am so proud that the Government are prioritising the issue of smoking.

Some people have said to me: “Michelle if people want to smoke, let them.” I respond by saying that we must arm those people with all the information—the warnings and the facts. We must work together to deglamorise smoking. As has been pointed out, the smoking industry also has a responsibility to play its part. We must guide people and steer them to make informed choices. We must also discourage them, otherwise we will have to pay their NHS bills—money that could be spent in other sectors of the NHS. I often ask people, “If smoking were invented today and we knew all the risks and effects, would it be so freely available and popular?” Armed with the facts, we often make different choices in life.

My mother started smoking in an era when the health consequences were not known. I saw her struggle, desperately trying to give up. My Dad describes that time as a caricature, with my mother wearing anti-smoking patches and smoking cigarettes, while chewing anti-smoking gum and seeing a hypnotist, all at the same time. She simply tried everything. All the hypnotist did was to get her on to menthol cigarettes and give her a fear of hypnotists, so that did not go quite to plan. That taught me that, to break the cycle, it needs to be killed at the root, and people need to be prevented from smoking in the first place. I must add that my Mum has now not smoked a cigarette for seven years. [Hon. Members: “Hear, hear.”] Instead, she has e-cigarettes. Although that cannot be seen as the answer, it is very much part of the solution.

As part of the tobacco control plan, I want to touch on the support provided for pregnant workers, which aims significantly to reduce the likelihood of a person smoking while having a child. Currently, more than 10% of pregnant women smoke, and the plan is to get it down to 6%. Smoking during pregnancy increases the risk of stillbirth. Babies born to mothers who smoke are more likely to be born underdeveloped and in poor health. It is important that we give those mothers all the support and information available. For example, within the plan, NHS England will work to reduce smoking in pregnancy through carbon monoxide testing at antenatal care facilities and referrals to stop smoking services through the Saving Babies’ Lives care bundle.

Support, advice and information are crucial. We must make sure that all mothers are aware of the dangers of smoking. I urge us to be bold—bold with our information and bold with our warnings.

Information is key to this matter as well. ASH has told me that the Government no longer have the measure of the number of people with mental health conditions who smoke. Does the hon. Lady agree that the Government need to re-establish a national measure for smoking rates among people with mental health conditions, as that will aid planning and the provision of services?

Indeed, we have problems among many categories in the country. By 2018, the target is to ensure that all mental health facilities are smoke free. We need to identify why people with mental health problems are turning to smoking and then target those issues.

I urge us to be bold with our information and warnings. We should not be afraid to shock in our marketing material, because we in this House have a duty to those who have yet to have a voice and the ability to choose for themselves.

As I mentioned before, perhaps the section of the plan that will prove the most successful is the backing of evidence-based research into e-cigarettes. As the right hon. Member for Rother Valley (Sir Kevin Barron) said, it is the first plan to reference e-cigarettes. In 2016, it was estimated that 2 million people had used e-cigarettes and completely stopped smoking, while a further 470,000 were using them as an aid to quit.

There has been a great deal of discussion on e-cigarettes—the pros and the cons—so what is needed now is more evidence to support them and enable their use positively. They are not risk free and they are addictive—it would be wrong not to mention that—but I agree with Public Health England, which recommends that e-cigarettes are used in areas not covered by the smoke-free legislation and that organisations do not include them in their smoking policies. It is true that we do not know the full extent of the medical effects, but we do know that, for the majority of people, they are the only way to stop smoking and they are by far a better alternative.

In addition, statistics show that people rarely start on e-cigarettes. They use them as a way of breaking their cigarette addictions. It is important to remember that, to tackle smoking effectively, we need a prevention strategy as well as a strategy to help people quit smoking. Dr Andy McEwen, executive director of the National Centre for Smoking Cessation and Training, stated that switching from tobacco to e-cigarettes substantially reduces the major health risk. I urge the Minister to push the case for a review by the National Institute for Health and Care Excellence, which currently is at odds with Public Health England on this topic.

As I said, we have seen many worried headlines about e-cigarettes, particularly for young people. However, the latest and largest study, based on five separate surveys, gathered data from 2015 to 2017 and was from a collaboration including experts from Public Health England. It showed that a tenth to a fifth of 11 to 16-year-olds had tried an e-cigarette. However, only 3% or fewer used them regularly, and they were already smoking tobacco-based products. Among young people who have never smoked, the use of e-cigarettes was completely negligible, despite the media headlines. It is also important to remember that they are restricted in terms of the minimum age sale and the tight restriction on marketing. Let us be clear: the best thing that a smoker can do is to quit smoking. However, the evidence is increasingly clear that e-cigarettes are significantly less harmful to health than smoking tobacco.

Another area that I want to mention is inequality in smoking. By 2022, the Government expect to reduce the inequality gap in smoking prevalence between those in lower paid or manual occupations and those in higher paid or professional occupations. For example, the plan includes promoting links to “stop smoking” services across health and care systems in the UK. However, it is important that we look at the causes, not just the symptoms, when we examine why those in lower economic circumstances smoke more, and why they struggle more to quit. That is why support to councils is so vital, so that they can identify local trends and solutions. I would be interested to hear more about the Government’s plans to invest in research into the causes. We do need to pay more attention to the challenges that are faced by the disadvantaged and those from lower socio-economic groups.

As someone who believes in low tax in general, it would be remiss of me not to point out that on this subject I passionately argue that we should maintain a high duty rate for tobacco products. It is a disincentive for people to start smoking, especially the young, and I urge the Government to go further in the upcoming Budget. Of course, enforcement is nothing without encouragement to give up. So, to conclude, I echo the sentiments that tackling smoking requires a plan—a plan that seeks to prevent smoking, but also assists those who currently want to give up smoking. This plan does that. Treating smoking-related illnesses is estimated to cost the NHS £2.5 billion a year, while the wider cost to society is a staggering £12.7 billion. But the real cost is the human lives—those that are cut short, and the families that suffer: families in Wiltshire, in my constituency, and up and down the country. I am delighted that in Wiltshire there are now 25% fewer hospital deaths from smoking-related illnesses, but that is still too many, and that is why creating a smoke-free generation is essential.

I am concerned about the damage that smoking does to my constituents. Almost 15% of the population of Suffolk smoke. More than 7,500 admissions to Suffolk hospitals every year are attributable to smoking. Those who do not quit will have roughly a one in two chance of dying prematurely from smoking-related diseases.

The tobacco industry is deliberately producing products that it knows will kill its customers. While the market for cigarettes is mercifully in decline in the UK and other rich countries around the world, it is still growing in low-income countries, where the industry regularly uses tactics that would be illegal in this country, including the deliberate sale and marketing of cigarettes to young people and children. As a result, more than 7 million people die from the consequences of tobacco use each year. Almost four fifths of the world’s 1 billion smokers now live in low and middle-income countries. Money spent on tobacco is money not spent on other household needs. In Kenya and Bangladesh, tobacco cultivation has replaced food crops, leading to local food insecurity. In Malawi, at least 78,000 children are forced to work in tobacco fields, preventing most of them from attending school. Tobacco growing around the world is responsible for a loss of biodiversity, land pollution due to the use of pesticides, soil degradation, deforestation and water pollution. The result of all that deeply destructive and irresponsible activity is that the four major tobacco manufacturers are some of the most profitable businesses on earth.

It is impossible to hold an ethical investment in a tobacco company. To invest in tobacco is to seek to make money from environmental destruction, social exploitation, disease and premature death. That is increasingly understood by investors, because last year AXA, one of the world’s largest insurers and a major part of the Ipswich economy, divested more than $2 billion of tobacco industry assets. I welcome its decision. Tobacco-free investment policies have also been announced by AP4, one of the most influential pension funds in Sweden; Medibank, the largest health insurer in Australia; Fonds de Réserve pour les Retraites, France’s public pension fund; the Irish sovereign investment fund; and CalPERS, the largest public pension fund in the USA. So far in 2017, tobacco-free investment decisions have been made by AMP Capital, Bank of New Zealand, SCOR, PME, ACTIAM and Aviva, the largest insurer in the UK. In addition, ABN AMRO, the global bank, will cease lending to tobacco manufacturers. Those very welcome individual decisions now constitute a clear trend.

In that context, it is increasingly absurd that large investments in tobacco are still held by local authority pension funds across the United Kingdom. There is a fundamental contradiction between the local authorities’ public health responsibilities and their investments in tobacco, which actively promote the biggest public health problem confronting this country.

I understand that pension fund trustees have a duty to run their funds to secure strong returns for beneficiaries. Local authority workers depend on sound investments for their pensions. Case law has now made it clear that local authority pension fund trustees may consider non-financial factors when setting investment strategies, provided that any restrictions they place on investment as a result of such consideration do not significantly affect financial returns. But how immoral does an investment have to be before the financial returns no longer trump the moral question?

The hon. Gentleman is making a powerful argument, but will he consider the fact that many tobacco manufacturers are actively investing in non-tobacco products, which may change their whole future investment strategy? In the light of that fact, should not investors—pension funds and so on—look at that long-term development of such businesses rather than their current position?

I thank the hon. Gentleman for his intervention, but I do not agree with him. If a company is producing something that is detrimental to the whole world, the best approach is to disinvest from it.

How bad does an investment have to be before its financial returns no longer trump the moral question? Are there no factors that could lead a pension fund to divest on moral grounds alone? Such factors could—and in my view should—include the UK’s treaty obligations. For example, article 5.3 of the framework convention on tobacco control, to which the UK is of course a party, states:

“In setting and implementing their public health policies with respect to tobacco control, Parties shall act to protect these policies from commercial and other vested interests of the tobacco industry in accordance with national law.”

Guidelines for the implementation of article 5.3 were agreed back in November 2008 at the third conference of the parties to the convention. Recommendation 4.7 states:

“Government institutions and their bodies should not have any financial interest in the tobacco industry, unless they are responsible for managing a Party’s ownership interest in a State-owned tobacco industry.”

I am delighted that the UK has no state-owned tobacco industry, but the level of public investment in private tobacco firms in this country flies in the face of the convention.

As leader of the opposition at Suffolk County Council—before I was elected to this august House—I brought forward a motion proposing that the county’s pension fund should disinvest from tobacco funds. The motion was passed unanimously. The pension fund committee then commissioned legal opinion on how to divest, but the opinion was that the committee could not legally do so.

Does the Minister believe that our local authorities should also invest in, say, pornography—a very profitable business I am led to believe? Profit should not be the only consideration for pension fund investment. We can and must do better, and responsible disinvestment by local authority and public sector pension funds is the right place to start. This is an issue on which the public health Minister could usefully engage, and I hope he will make a commitment to do so when he replies to the debate.

It is a pleasure to follow that contribution by the new hon. Member for Ipswich (Sandy Martin). I agreed with almost all of what he had to say—except perhaps about pension funds investing in pornography, which I think stretched the point. I also congratulate the right hon. Member for Rother Valley (Sir Kevin Barron), who I have known since I was elected as a great champion of anti-tobacco and anti-smoking measures.

I should declare an interest as the chairman of the all-party group on smoking and health. For me, this is a personal issue: both my parents died of cancer, directly as a result of smoking, and I do not want anyone to go through what my family had to go through.

My hon. Friend the new Minister for public health is the third Minister I have berated about getting the tobacco control plan published, and I congratulate him on the fact that it was duly published almost in his first few days in his role. I thank him for that, and I look forward to many such measures, which we will be calling for, being given equal standing and impetus.

We should, of course, review the outcome of the previous plan, which expired at the end of 2015. The three ambitions of the old plan, which included reducing smoking rates among adults and children, were more than achieved, and I congratulate Governments of both political persuasions on that. We just about made the target of reducing the level of smoking among pregnant women to below 11%, although that happened somewhat later than envisaged in the plan. We now have the lowest prevalence of smoking ever recorded among adults and children.

We are still in the position where 80,000 people a year die from preventable smoking-related diseases, and the single cause of that is tobacco. It is the only product available legally that, if people use it as the manufacturer intends, will kill them. My hon. Friend the Member for Chippenham (Michelle Donelan) made the point that were tobacco to be discovered now, there is no chance that it would ever get to the stage it has.

Tobacco kills half of lifetime smokers. On average, smokers lose 10 years of their life expectancy. For every death that is caused, about 20 smokers suffer from a smoking-related disease, so the problem is not only death but smoking-related diseases and the cost to the health service.

Every year in Harrow, my local borough, about 1,500 hospital admissions and 200 premature deaths are caused by smoking-related diseases. If we extend the picture across the country, we see that there is a huge problem.

Tobacco control policy should have as its objective the end of smoking, which I absolutely support. The Minister states in the plan that the aim is

“to create a smokefree generation”,

which is a wonderful idea, but if we go further into the plan, we see that the aim is to cut smoking rates to no more than 12% by 2022. That is too weak a target—we should be looking to go much lower than 12% by 2022.

I particularly welcome the targets to cut the number of 15-year-olds who smoke regularly to lower than 3%, and to cut the number of pregnant women who smoke to less than 6%. Those key targets will have long-term effects. The reality is that most people who smoke—two thirds—acquire the habit before the age of 18, so one of the key issues is to prevent young people from starting to smoke. If we can achieve that, we can make sure that we cut off the supply of smokers. We know that once people are addicted, it is much harder for them to give up smoking.

Funding for tobacco control is essential. We need to be clear that the headline figure for public health spending has increased since 2013, rising 25% each year, but that does not take into account the extra responsibilities that local authorities have. Analysis by the King’s Fund has shown that once we take those responsibilities into account, local authority spending on public health has fallen in real terms since 2013-14 by 5%. At the same time, the population has grown by 3%, so the reality is that we are seeing a reduction in spending.

In Harrow, spending on tobacco control has fallen from £364,000 a year in 2013-14 to £9,000 in the current year—a decline of 98%. If we analyse Department for Communities and Local Government returns, we see that spending on tobacco control across the country has fallen by 33%. That cannot be acceptable.

It is clear that one of the issues we have to address is stop smoking services, which are key to helping people to get off smoking in the first place. They are highly cost-effective and they would make sure that we reduced the number of deaths. Every smoker who goes to a GP or any doctor should be relayed to a stop smoking service immediately to help them to give up smoking. Clearly, that will cost money, and I share the view of my hon. Friend the Member for Chippenham that the tobacco industry should pay for the damage it does to our national health service and our health. Imperial and Japan Tobacco International make joint profits of about £1 billion a year, and they should be charged for cleaning up the damage that these products cause on the basis that the polluter pays. In the United States, the tobacco industry is required to pay an annual user fee, which means that the Food and Drug Administration collects more than $2 billion a year.

The Government introduced the annual tax escalator of 2% above inflation, but that is due to end in 2020. We should increase it and make sure that the money raised is ring-fenced so that it can be used to implement smoking-cessation measures. That would not only encourage the tobacco industry to look at what it does to prevent people from smoking, but discourage it from manipulating prices to subsidise cheaper brands and encourage people on low incomes, or young people, to start smoking—we know that the industry does precisely that. As we move in that direction, we should see an increase in tobacco tax.

A licensing system for tobacco should be introduced to make sure that we have complete control, from manufacturer to retailer. That would ensure that we could have proper enforcement all the way through the process and take action against the illicit trade.

One issue that is very prevalent, but is not mentioned in the tobacco control plan, is oral cancers. The British Dental Association estimates that between 91% and 93% of oral cancers are preventable and that two thirds are caused directly by smoking or by chewing tobacco. Large numbers of people who originate from the Indian subcontinent—between 40% and 50%—chew tobacco that is unregulated. There are no warnings on any of this tobacco and nor is there any estimate of how much damage it is doing, but large numbers of people from the Indian subcontinent who chew tobacco routinely present with oral cancer as a result. We should make sure that there are health warnings on these products, and that people are warned about the consequences of taking them. Tobacco does not have to be included within these products, but frequently it is included. If tobacco is involved, clearly there should be warnings and proper regulation should be in place. My hon. Friend the Minister has suggested that there are no plans to do anything about this, but I urge him to review the situation very closely, examine the evidence, and then act in the same way that he has done on the tobacco control plan.

I am grateful to my right hon. Friend the Member for Rother Valley (Sir Kevin Barron) for securing this important debate.

There used to be a time when cigarettes were perceived as cool—but people were being conned. Powerful tobacco companies were placing their products in movies and using careful branding to make us think that cigarettes would make us more attractive, more athletic, or even smarter. What they forgot to tell us was they also leave people unable to breathe, cause heart attacks, and kill half of those who use them. Some 15% of adults in the UK still smoke. In some parts of my constituency, half of all people still smoke. Not surprisingly, these are also the areas where people die youngest. I predict that in 50 years’ time nobody will smoke. We will look back on the 20th and early 21st centuries and shake our heads and laugh at the idea that people were poisoned with tobacco and paid for the privilege.

Like many Members in the Chamber, I would like to see England smoke-free. That means no young people starting to smoke because they know that it will make their breath smell and their teeth bad, no pregnant women smoking because they know that each time they smoke a cigarette their baby is also smoking a cigarette, and no young parents smoking because they know that their kids will copy them as soon as they are old enough. It means people in their 40s and 50s quitting, because lungs decline rapidly if people continue smoking beyond this age, and in time they struggle to breathe. It is never too late to stop. It is best never to start, because stopping smoking is one of the hardest things that someone will ever do—but one of the most worthwhile. As many Members have mentioned, half of all cigarette smokers will die of smoking-related conditions. There is a powerful case for continuing to take stronger action towards a smoke-free society, and I welcome much of the tobacco control plan for England.

It is important to recognise success. Smoking rates in the north-east of England have fallen to just over 17%—down by almost a half since 2005, and the largest regional fall in smoking rates in the country. Having 200,000 fewer smokers in the region could mean 100,000 fewer premature deaths. This is, in part, due to the work of successive Governments who have pushed the issue up the agenda.

I welcome all the ambitious targets that the tobacco control plan for England sets for future reductions, but I particularly welcome the focus on stopping smoking in disadvantaged social groups. The decline in smoking in our society has not been uniform and, as in many areas of society, many people have been left behind. However, it is wrong to think that just providing services to people living in poverty will be enough. My experience of working in areas of socioeconomic deprivation in England has taught me that health behaviours do not occur in isolation. It is genuinely hard for someone to stop smoking if they are worried about how they are going to pay their next bills; they are threatened with losing their benefits, perhaps even having to wait six weeks for universal credit; they have insecure work; they live in a community threatened by crime and antisocial behaviour; and they are struggling to look after their family. Smoking is often a symptom of other problems. Reducing smoking requires poverty reduction and true engagement at a community level to make life better and easier for people living in areas of deprivation.

I would now like to focus on those with mental health conditions. As has been mentioned, the smoking rate among people with mental health conditions has remained stubbornly high. In Stockton South, the rate is about 40%, even though smoking rates have fallen among the rest of the population. It is one of the single largest factors in the lower than average life expectancy among people with a mental health condition. For someone who has a mental health problem, stopping smoking is good not just for their physical health but for their mental health too. There is evidence that if someone with depression stops smoking, it can have an effect on improving their mental wellbeing similar to taking antidepressants.

Closing the gap in smoking rates is not a straightforward task. It is a challenge that requires a collaborative approach, including not just the NHS but communities, mental health charities, anti-smoking organisations and, not least, smokers themselves. I welcome the plan’s commitment to work with the Mental Health and Smoking Partnership to identify how we reduce rates of smoking in this population. However, while the ambition of the plan is welcome, it is not clear how the Government intend to assess progress within the population of those with mental health problems. I would be grateful if the Minister could tell us what he intends to do to make sure that there are reliable, national ways of measuring smoking rates among the whole population of those with mental health conditions, not just those with severe mental health problems. Government should know how they will assess whether targets are being achieved.

Like other Members, I am concerned about cuts that local authorities are making to public health funding, their hands often tied by huge Government cuts. I am particularly concerned about cuts in smoking cessation services. The evidence is quite clear: well-run services that combine behavioural therapy and prescription of nicotine replacement products offer smokers who want to quit the best chance of success. Community-based interventions to tackle inequalities are stressed in the plan, but that will be empty rhetoric unless the funds to do this work follow. The five year forward view and the sustainability and transformation partnerships place a significant emphasis on prevention. The pressure on NHS services in future can be significantly eased if we ensure that we make the necessary investments in prevention now. Government must finance the public health provision necessary to put effective tobacco control policies into action and to enforce tobacco control legislation where it is being broken. That Government commitment is threatened by austerity, and by cuts in local government funding in particular.

It would be a welcome boost if the political consensus that exists in this House—it spreads across all parties— on the need for tobacco control were supported by a commitment to fund local authorities in England to deliver the radical steps that we now need to make the next push towards a smoke-free society.

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.

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.

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.

It is an honour to follow my friend the hon. Member for Colchester (Will Quince). He highlighted, importantly, the dangers of pregnant women smoking, and he was very supportive of women who find themselves smoking during pregnancy. I congratulate my right hon. Friend the Member for Rother Valley (Sir Kevin Barron) on securing this Back-Bench debate. The knowledge he brought to his opening speech set the tone for the debate.

I am pleased to take part in the debate because I am a member of the all-party group on e-cigarettes, and I believe that vaping is a safe and popular alternative to smoking. I have never smoked or vaped. I am the oldest of five siblings, and none of us has ever been a smoker. I put that down to the fact that both my parents smoked all their lives, and smoking never held any charm or attraction for me or my brothers and sisters when we were young people.

Because my parents, other relatives and friends smoked, and I am married to someone who started smoking at the age of nine, I think I understand why people smoke and the impact it can have on their lives. When my parents started to smoke in the 1940s, people were not fully aware of the dangers of smoking. Now, we all know that smoking can kill or cause serious lifelong illness. It makes me so sad to see so many young people starting to smoke.

The hon. Member for Harrow East (Bob Blackman) mentioned mouth cancer. That reminded me that I lost a colleague, who was in her early 60s, to mouth cancer, and only a year before she had seen her son, aged in his 40s, die of the same horrible disease, so I know how awful it can be.

Vaping is important as a safe alternative to smoking for people of all ages. I am pleased that for the first time the tobacco control plan focuses on vaping as a viable alternative to cigarettes. As my right hon. Friend the Member for Rother Valley has said, independent studies by Public Health England and the Royal College of Physicians have recognised that vaping is at least 95% less harmful than smoking, and research by the University of St Andrews has found that the cancer risk from vaping is only 1% of that of smoking. Many other valid statistics from various bodies now support vaping as a safe alternative for smokers, as has been highlighted in the debate.

I am pleased to say that many of my family and friends, including my husband, have all stopped smoking and now use vape products, and although many people so dear to me tried to give up smoking and always returned to tobacco, I am sure many others across the country are as happy as I am that relatives and friends have made this choice on vaping.

The commitment to support stop-smoking services is commendable, but in my experience—I undertook training to run smoking cessation sessions some years ago—it is very difficult for people diagnosed with diseases that might be smoke related to give up smoking. We all know that ill health can increase stress levels, so reliance on the habit at such a time can increase and it can be really tough to give up. Being able to switch to vaping for people in such situations is very welcome. I wish I had been able to recommend people, such as those who had had a heart attack, to switch to vaping when I was trying to help them to stop smoking, because those were difficult times for them.

I believe that the promotion of vaping and e-cigarettes is key to the Government achieving their vision of a smoke-free generation as part of the tobacco control plan. I support the view of the UK Vaping Industry Association that article 20 of the tobacco products directive, which conflates vaping products with tobacco products, should be reviewed, and that restrictions on advertising, packaging and product size should be lifted.

I do, however, have a warning for the Government. Much of the attraction of vaping is that, after the initial outlay for equipment, it proves a much cheaper way to enjoy the habit than smoking. I seek an assurance from the Government that they will ensure vaping always remains affordable, and that they will not be tempted to impose an excise tax that would force up prices and give smokers less reason to switch. Finally, I agree with colleagues that the Government must put their money where their mouth is if the tobacco control plan is to succeed.

May I say what a pleasure it is to follow the hon. Member for North Tyneside (Mary Glindon)? I am glad that vaping has been of assistance to her family, and that things are on the up from that point of view. May I also thank the right hon. Member for Rother Valley (Sir Kevin Barron) for securing the debate? We have had a really important debate this afternoon. He raised some critical points, and I thank him for doing so.

May I also take this opportunity—I have not yet had such a chance—to welcome the Minister to his place? I know he is absolutely passionate about healthcare, and that he will bring to his role all the dedication and enthusiasm of someone who is in the lucky position of having a job that is also his passion. It is good that he will be responding to the debate.

I gave a lot of thought to how I would approach the debate. For a Conservative who generally takes the approach of pursuing individual liberty, there is perhaps some tension in favouring a control mechanism that takes away people’s individual choice. Some excellent points have been made, and two speeches in particular really nailed it. The first was by my hon. Friend the Member for Chippenham (Michelle Donelan), who made the point that were tobacco discovered today, it is inconceivable that it would be freely available on the high street in the way that it is. It seems to me that that is an historical anomaly. The second was by my hon. Friend the Member for Harrow East (Bob Blackman), who spoke movingly about his parents’ deaths from cancer. I am very sorry to hear of that, but it really emphasises everything we are saying in the debate. Of course, we always have to balance the libertarian desire for freedom with the public health interest, and I hope that those two important points have really hit home with hon. Members.

I have spoken at length this week about healthcare in Oxfordshire, its future and my concerns about the way it has been managed. While we must always look at treatment—ensuring that we will one day find a cure for cancer, and in the meantime that we care for those who have cancer with every means at our disposal—we really must continue to fight. What I mean is that we must continue to decrease as much as possible the number of people who suffer cancer in the first place.

We are in the presence of some particularly cold and hard facts. The cost of having 7.3 million smokers is that smoking is the biggest killer. It is clearly identified and open to view as the biggest cause of cancer. It leads to more than 200 smoking-related deaths a day, or 16% of those who die. There are 79,000 deaths per annum —79,000 preventable deaths, 79,000 personal tragedies—to say nothing of the 20 times the number of people who, for every death, are suffering from preventable smoking-related conditions. It seems to me that there is an enormous emotional imperative: we must tackle smoking and the damage it causes.

If I have not persuaded hon. Members on an emotional level, let us just look at the hard economic facts. Smoking costs the economy £11 billion. There is a £2.5 billion cost to the NHS, with 474,000 hospital admissions. Let us just think what we could do for the NHS if we could divert that funding towards the care of conditions that are not avoidable or preventable. There is a £4.3 billion cost to employers, and a £4.1 billion cost to wider society, including the £760 million going to social care. Let us just think about how we could treat dementia or Alzheimer’s if we could divert the money from conditions that are preventable towards those that are not.

Moreover, not only is smoking a cost to the economy and a personal tragedy for those affected, but it is overwhelmingly targeted on the poorest. This health condition is actively feeding inequality. Children of smokers are two to three times more likely to be smokers themselves. The Prime Minister has spoken—very powerfully, in my view—of how the poorest are dying up to nine years earlier than the richest, and half those deaths are smoking related. This condition affects the poorest in society the most.

Surely the economic, moral and health arguments are overwhelming when it comes to the Government’s ambition of creating a smoke-free Britain. It is into that arena that the Government step with this plan.

The good news is, of course, that stopping smoking produces health benefits in months and it is easier, relatively speaking—I appreciate that it is not easy—to give up now than it ever has been. There is the technology. We have heard about the help given by vaping or e-cigarettes; last Stoptober, 53% of those who gave up did so with the assistance of e-cigarettes.

Happily, yes, the prevalence of smoking is declining more sharply than for many years, and this is where the tobacco control plan stands. The last one hugely exceeded expectations: the percentage of people smoking declined from more than 20% to 15%. I applaud the Government for taking forward bold, imaginative and forward-thinking measures as we tackle this public health crisis. The Government wish to reduce the inequality gap that I mentioned, get adult smoking rates down from 15.5% to about 12% and reduce the percentage of 15-year-olds who regularly smoke from 8% to 3%. That is so important, given that the early years govern people’s health choices for the rest of their lives.

My hon. Friend the Member for Colchester (Will Quince) and I spoke in the baby loss debate earlier this week; I mentioned that smoking was one cause of problems during pregnancy. I am glad that my hon. Friend brought that issue up again today. He is right to say that it is difficult to give up smoking. We are not being censorious in talking about pregnant women who smoke, but it would be much better for everybody if we reduced the proportion who do from 10% to 6%.

The Government are providing £16 billion for public health funding to local councils, which are best placed to marshal resources and help people in their areas. Perhaps most effective has been the mass media campaign. Many years ago now—it is a distant memory—the campaign against drink-driving started, and it has had an incredible effect in shaping public expectations. I am not suggesting that smoking is on the same level—there is a recklessness in drink-driving that is not so stark in smoking—but as my hon. Friend the Member for Chippenham said, the issue is education and making it clear that someone is much more likely to hurt themselves and others if they continue to smoke.

I will not speak for much longer, but I want to make one or two brief further points. The first is that the Government propose a joined-up approach between local authorities and NHS England, which I encourage as it produces results. I am also encouraged by the “smokefree NHS” section of the plan—the NHS leading by example. I have discussed the impact on employers; the NHS is a large employer, so it is important that it should lead the way.

Lastly, I want to comment briefly on mental health. The NHS is leading the way as far as those using, working in or visiting the NHS are concerned, and the practice of escorting people from mental health hospitals on and off premises is due to end now that the health problems have been identified. Let us be clear: although 40.5% of people with serious mental health difficulties do smoke, they want to stop smoking just as everybody else does. I hugely encourage that. This is an example of the Government’s taking an approach to mental health in the round. Yesterday, I asked the Prime Minister about help given to military personnel, but this is another example of how to ensure that the issue is not just addressed in only one silo of society.

Thank you for letting me speak for a little while, Madam Deputy Speaker. Like the British Heart Foundation and Action on Smoking and Health, I welcome the plan enormously. It builds on recent Government work on tackling smoking. The proposals are ambitious and bold, and I ask everyone to support the Government’s plan to create a smoke-free generation.

It is a pleasure to follow my hon. Friend the Member for Witney (Robert Courts). I also congratulate the right hon. Member for Rother Valley (Sir Kevin Barron) on bringing this debate to the main Chamber, on enabling an important conversation about the coming of smoke-free Britain, and on the long-term work he has done on this issue. I welcome my neighbour, the public health Minister, my hon. Friend the Member for Winchester (Steve Brine); I applaud his progress and focus on this issue and encourage him to be as ambitious as possible.

Many colleagues will be aware that I am passionate about trying to keep fit and healthy, although serving in the House precludes much of that, and about working to reduce heart conditions among people of all ages. It should come as no surprise that I very much welcome the Government’s new tobacco control plan. I chair the all-party parliamentary group on running—please join. I also actively support Cardiac Risk in the Young and belong to the all-party parliamentary group on arrhythmias. I could not be more passionate about these issues. Smoking claims more than 200 lives per day in England. Think of how many lives we are losing from preventable causes. We have also heard about the £11 billion cost to the economy.

Last November, I held the parliamentary reception for carers’ rights day and I shall do the same next week; the long-term impact of this issue really concerns me. Like many Members, I am not here to lecture; we are all sympathetic and we have been measured in our comments. I believe in choice, but more importantly in education and understanding the real impact on families and our NHS. We simply know that smoke-free is best.

I know first hand what the addiction can do to long-term health and quality of life. As we have heard today, we simply would not allow a smoking culture to start growing today so we cannot ignore the challenge it has left us. Smoking has blighted my life—sadly, it can blight relationships and families all too often. Like many, my mum became a smoker in the late ’50s to stay slim and attractive and avoid putting on weight. It was fashionable, and the reality of its impact on health was simply never understood. She could never, ever give up: it was the first, the last, the everything—an addiction and a habit. She always said, “I wouldn’t know what to do with my hands; I’ve tried knitting!”

E-cigarettes did help, but we were unclear at the time whether they were better or worse. There was great help from GPs, including hypnosis, gum, tablets, lozenges, wands—you name it; it did not work. My dad smoked heavily throughout his life, although to be honest he enjoyed all the so-called good stuff as well. But it all resulted in my being a sandwich carer, with young children and older parents on whose health smoking had taken its toll. Both my parents died in their early 70s from smoking-related heart issues—both before my 40th birthday, and both before I came to this place. They did not have a chance to see their grandchildren grow up, as happens in many families as a result of smoking.

Alongside our transformative success on smoking in public places is further good news: back in October 2015, smoking in cars with children was banned and that was also transformative. But there is also bad news—how often do we see people in work vehicles flouting smoking rules? Air pollution is having a growing impact on our mindset. We need to make sure that people are doing what is safe at work. Earlier this week, I was at a British Lung Foundation event highlighting its Breathe Easy campaign, which I applaud.

The 2011 and 2015 tobacco control plans had those successes and should be applauded—adult smoking rates are down almost 5% over that period—but we must continue to be bold. I am so pleased about the Government’s new plan. As we heard from my hon. Friend the Member for Chippenham (Michelle Donelan), action is essential: just saying that we have made some progress is not good enough.

By 2022, the Government expect to reduce the smoking rate to 12% or less, reduce the prevalence of smoking in pregnancy by almost half, and permit innovative technologies. We all know about vape shops and the prevalence of vaping on our high streets. It cannot be ignored and we must research it. I do not want, 20 or 30 years down the road, to have on our hands the results of thinking it was the new messiah when it was not. However, it may be, so let us do the research.

As a strong supporter of and believer in the excellent work of the British Heart Foundation, including in my constituency, I thank it for all it does. Public Health England tells me that since 2014 there are still about 20,000 smokers in Eastleigh. I welcome the previous Chancellor’s announcement of £2 million for the British Heart Foundation for the replacement of local defibrillators. I would like the Government to help with work on an app, so we know where those defibrillators are. The former Chancellor made the announcement because his constituent, Fabrice Muamba, survived only because of a defibrillator. Let us legislate to have them on planes as well—they cost about £700. My constituents Graham and Anne Hunter have seen the benefits of defibrillators. After losing their daughter, Claire Reed, they would absolutely welcome both the app and the defibrillators. It was as a result of them talking to the Chancellor that the £2 million was provided.

I welcome the Government’s plans to seek to reduce smoking among those with mental health conditions. We know that the most deprived and challenged will always be the most dependent. Those in a lower paid job are, sadly, still more likely to smoke or, more importantly, to stay a smoker. I stress to the Minister the importance of tackling the health inequality of this particular group in driving the next phase forward.

I congratulate the Government on their bold vision for a smoke-free generation and I look forward to further progress. All the lives we can save, and all the resources we can save, are absolutely worth it.

With your kind permission, Madam Deputy Speaker, as a Scottish MP I hope to make a short contribution to the debate on a tobacco control plan for England. I shall make some reference to the situation in Scotland, to highlight the cost of smoking in human suffering and death, as well as the cost impact on public health budgets and the overall economy. I welcome the debate on this vitally important matter and congratulate the right hon. Member for Rother Valley (Sir Kevin Barron) on securing it. I also applaud the Backbench Business Committee for granting the time.

The tobacco control plan builds on the successes of the previous control plan, established by the coalition Government, and aims to herald a smoke-free generation—I say that while recognising that much yet needs to be done. I wholeheartedly support the principle of preventative spending on early intervention, which can prevent negative health outcomes later in life. I also welcome the investment in tackling ill health and recognise that it has the potential to save a significant amount of public spending in the long term and can help to reduce health inequalities. I do not underestimate the power of addiction. For that reason, I feel that where there is a will to stop smoking we should do everything possible to help people to help themselves.

I welcome recent falls in the number of adults who smoke in England and Scotland, and the number of children exposed to second-hand smoke. However, smoking rates in Scotland are still higher than in England, and we must be prepared to do much more to reduce this figure. Currently in Scotland, tobacco use is linked to 10,000 deaths a year.

On e-cigarettes, I am a firm supporter of having a robust regulatory framework, which ensures all devices are safe and acknowledges their potential use in smoking-cessation programmes. I welcome the fact that earlier this year the Scottish Parliament voted to ban the sale of e-cigarettes to under-18s and to limit advertising, moves I fully support because they will protect the health of our young people.

On the tobacco control plan for England, I acknowledge that the previous plan reduced adult smoking rates in England from 20.1% to 15.5%. That is indeed progress. I also applaud the ambition in the plan to reduce adult smoking rates from 15.5% to 12% or less by 2022. It is welcome that the plan is supported by the British Heart Foundation, which recognises it as an important tool in reducing the rate of strokes and heart disease. I compliment the Government on the fact that the World Health Organisation has designated England as one of the best places in the world to give up smoking. The strategy is based on a joined-up approach between the NHS, the Department of Health and local government. That can only be good, too.

I welcome the ambition of the plan to reduce the number of 15-year-olds who regularly smoke from 8% to 3% or less; reduce the smoking rates among adults in England to 12% or less; reduce the inequality gap in smoking prevalence between those in lower paid, routine and manual occupations, and those in higher paid professional and managerial occupations; and reduce the prevalence of smoking in pregnancy from 10.7% to 6% or less. I also applaud making all mental health in-patient service sites smoke-free by 2018, as was mentioned by my hon. Friend the Member for Witney (Robert Courts). It has been a source of frustration for me for many years, as I am sure it has been for other Members, to visit hospitals for various reasons and find people congregated around the entrances, often having been escorted there by health workers who I am sure would prefer to be doing more productive things. I also welcome the ambition of permitting innovative technologies than minimise the risk of harm and maximise the availability of safer alternatives to smoking.

I hope we all support the idea of creating a smoke-free generation without any reservation. Effectively enforcing existing legislation on proxy purchasing and standardised packaging to reduce the uptake of smoking among young people is a very noble objective. Supporting pregnant smokers to quit, which will undoubtedly increase the life prospects of children yet unborn, and reviewing the sanctions for retailers who consistently break the law designated to protect young people from smoking, is welcome. As the right hon. Member for Rother Valley mentioned in his opening speech, in 2016 it was estimated that 2 million people had used e-cigarettes and had completely stopped smoking—that must be very good news—while at the time a further 470,000 were using them as an aid to quit.

In 2013, the Scottish Government introduced a five-year tobacco control strategy entitled “Creating a Tobacco-free Generation”. It set the target to reduce smoking prevalence in Scotland to 5% or less by 2034—again, a very ambitious and welcome target. The strategy set out a range of measures to support young people to choose not to smoke, to protect children and all people from second-hand smoke, and to continue to support those who do smoke to quit. Actions taken by the Scottish Parliament in recent years to control tobacco, and to limit and tackle the harm caused by tobacco, include legislation to prohibit smoking in public places, which came into effect in March 2006; raising the age of sale for tobacco from 16 to 18 in 2007; implementation of a tobacco retail register in 2011; a ban on self-service sales from vending machines in 2013; and the introduction of a tobacco display ban in shops from 2013.

I turn now to the impact of smoking. According to Scottish Government statistics, tobacco use in Scotland is associated with more than 10,000 deaths and about 128,000 hospital admissions every year. According to the Office for National Statistics, smoking prevalence in Scotland among over-16s was 17.7% in 2016—an estimated 942,644 smokers—compared with the UK-wide smoking prevalence of 15.8%. Smoking prevalence in Scotland fell between 2003 and 2013 but has remained fairly static since. Some 35% of adults in the most-deprived quintile of the Scottish index of multiple deprivation smoke compared with 11% in the least-deprived quintile.

According to ASH Scotland, on average lifelong smokers die about 10 years sooner than non-smokers. The estimated cost to the NHS in Scotland alone is £323 million. According to the Scottish Public Health Observatory, for every 1 percentage point by which smoking prevalence is reduced, the NHS could save £13.4 million. One last set of numbers underlines the cost of smoking: ASH Scotland estimates that smoking costs Scotland around £1.1 billion annually, including £271 million in healthcare costs, £692 million in productivity losses due to active smoking, £60 million in productivity losses due to passive smoking, £34 million in clearing smoking-related litter and £12 million in fires caused by smoking in commercial properties.

As an ex-smoker who went cold turkey many years ago, I agree with most of what has been said. Like many others, however, I come from a family where parents and grandparents smoked. I welcome all measures to help people to stop smoking. Does the hon. Gentleman agree that we need more investment in prevention, not least through public health budgets, but that those are now in the hands of local authorities, the cuts to which have been abominable over the years? Does he agree that more money needs to be invested in public health?

I note in the plan the £16 billion commitment to funding public health programmes, in conjunction with local authorities in England, which is surely welcome news.

Just to reiterate, although it is local authorities that spend the money to help people give up smoking, which is warmly welcome, the savings go directly to the health service, and so the money is not recycled back to those helping people to stop smoking to meet the considerable expense incurred.

I thank my hon. Friend for his intervention and his moving and impactful contribution earlier.

Behind the numbers on lives and costs, there is above all else the human suffering and the suffering of the families who lose family members to this terrible disease. I welcome any and all efforts to help people across the UK stop smoking.

I am grateful to the right hon. Member for Rother Valley (Sir Kevin Barron) for securing this important debate on the tobacco control plan for England. I congratulate him on his work over the years and, as a testament to that, on the general consensus today.

Scotland has its own strong tobacco control strategy. The Scottish Government have implemented and overseen a number of progressive actions on smoking, and I am grateful to the hon. Member for Stirling (Stephen Kerr) for listing many of them, which shows the strength of the consensus in the Chamber to which I referred. Record investment in NHS Scotland on smoking cessation services has helped hundreds of thousands of people to quit smoking, and our aim is to create a tobacco-free generation by 2034. Last year, the Scottish Parliament celebrated the 10-year anniversary of the smoking ban and welcomed comments from the World Health Organisation praising our excellent example of global public health leadership.

Not everything that we want to achieve can be done in isolation, however. A good example of something that required UK-wide co-operation was the introduction of standardised packaging for tobacco products. However, I want to focus on another area that requires co-ordination across the jurisdictions of the UK, and indeed of Europe and the world: the illicit tobacco trade. I press the Minister to report on progress to secure a Europe-wide traceability system, which is still being discussed at the European Commission, and to confirm that the UK Government will rapidly ratify the illicit trade protocol, the first subsidiary treaty under the WHO framework convention on tobacco control.

Illicit tobacco undermines public health policy because it makes tobacco products available at a low price and often in branded packaging. It damages public revenue because it reduces the take from tobacco taxation. Figures from Her Majesty’s Revenue and Customs for 2015-16 estimated that the illicit market share in the UK for cigarettes was 13%, with the figure for hand-rolling tobacco 32%. The tobacco tax gap in that period was estimated at £2.4 billion, so clearly the illicit trade undermines our tobacco control strategy.

The involvement of the major tobacco manufacturers in the illicit trade is a major concern. Their involvement is evidenced by the fact that their genuine products—not counterfeit ones, or so-called cheap whites—form the largest share of the illicit market. The Scottish Government have committed to continue to support strong national and local alliances to tackle illicit tobacco. In 2009, the enhanced tobacco sales enforcement programme was introduced to enable the Scottish Government and trading standards officers throughout Scotland to work with Her Majesty’s Revenue and Customs to tackle the availability of illicit cigarettes and their sale to people under 18.

As we all know, there is an open border between England and Scotland, and if the amount of illicit tobacco rises in England, it will affect Scotland, as well as Wales and Northern Ireland. Scotland needs a commitment from the UK Government that they will ensure that local authorities in England are adequately resourced to conduct the fight against the illicit trade. At present, that is absolutely not what we appear to have.

The hon. Gentleman makes a powerful point. Does he concede that the tobacco companies themselves deliberately overproduce products for certain countries, knowing that they will be brought into the UK by illicit means and sold as illicit products? The tobacco companies themselves have a key role in this.

The hon. Gentleman makes a good point. The tobacco companies are indeed the villains in this scenario.

For the last 20 years, the UK has had an effective and well-resourced anti-smuggling strategy, and HMRC’s tax gap estimates have fallen by about a half since the peak in 2000, but there is every reason to fear that that success is under serious threat and that the progressive reductions in the market share of illicit tobacco may soon go into reverse. That is already suggested by recent small upticks in HMRC’s figures.

There is a specific problem for local authorities. Figures from the Chartered Trading Standards Institute published at the end of last year showed that the total budget for trading standards across Great Britain had fallen from £213 million in 2009 to only £124 million in 2016, and that the number of trading standards staff had fallen by more than half. That means that the chance of catching someone selling illicit tobacco or supplying it to an unscrupulous retailer or local consumers is significantly reduced. Information from local enforcement action can be used to help to track the supply chain, and less information means less tracking and intelligence, which cannot be in the interests of either public health or the public finances.

I urge the UK Government to make rapid further progress at the European and international level. The EU’s revised tobacco products directive establishes a new traceability system for all tobacco packaging, and that requires a coding system that can be accessed by enforcement officers to give information about the movement of products through the supply chain from manufacturer to retailer—this addresses the point made by the hon. Member for Harrow East (Bob Blackman). The system also requires security features to prevent tampering and ensure that products are genuine.

The European Commission has been carrying out consultations and research on the system’s specifications. While I consider its current proposals to be largely constructive and sensible, there are tobacco industry systems that the manufacturers are desperate to see states adopt to implement the directive requirements. The coding system developed by the four major manufacturers is known as Codentify, although it has now been hived off to a nominally independent company. In my opinion, it does not fulfil the requirement for independence in the protocol to eliminate illicit trade in tobacco products. That protocol explicitly requires Governments to take responsibility for control measures, rather than relying on industry self-regulation, which has clearly failed to deliver in the past. I therefore ask the Minister to confirm that the UK Government intend to participate in the European traceability system, and also to state clearly that they will work to ensure that its specifications include robust requirements for independence from the tobacco industry. The industry must not control the traceability system, either directly or indirectly through proxies.

A global tracking and tracing system is offered by the World Health Organisation’s illicit trade protocol, which was rightly negotiated as the first subsidiary treaty under the framework convention on tobacco control. The EU system will have to be consistent with the protocol, but it is obvious that a working global system would be even more effective than one that is confined to the EU. The protocol also contains other important provisions on control of the tobacco supply chain, including the requirement for manufacturers to conduct due diligence with their customers and to keep proper records of their transactions.

The UK Government have stated that they will become a party to the protocol on numerous occasions, including in their new tobacco control plan, and I welcome those statements, but they are yet to do so. I ask the Minister to give a clear commitment that the UK Government will move rapidly to ratify the protocol. A date for ratification would be excellent. It certainly needs to happen before 10 July 2018, which is the deadline if the UK is to be able to participate in the first meeting of the parties in October 2018 in Geneva.

Like others who have spoken, I welcome the tobacco control plan for England. It is not perfect, but it does represent a real commitment to tackling the smoking epidemic. I trust that it will also strengthen continuing co-operation with the Scottish Government, as well as the Welsh and Northern Ireland Governments, in addressing this No. 1 public health priority. However, the approach still needs to be strengthened and supplemented, and action against illicit trade is at the top of my “to do” list.

I very much hope that the Minister will be able to make the commitments that I have called for today, along with other Members on both sides of the House, and I look forward to the arrival of the first truly smoke-free generation throughout the United Kingdom.

I thank my right hon. Friend the Member for Rother Valley (Sir Kevin Barron) for securing the debate. He is a long-standing campaigner on the issue of tobacco and its effects on society, and it is good to see that he is continuing his campaign. He made an insightful and thought-provoking contribution.

I also thank other Members who have made excellent speeches on this important issue, including the hon. Member for Chippenham (Michelle Donelan), my hon. Friend the Member for Ipswich (Sandy Martin), the hon. Member for Harrow East (Bob Blackman), my hon. Friend the Member for Stockton South (Dr Williams), the hon. Member for Colchester (Will Quince), my hon. Friend the Member for North Tyneside (Mary Glindon), and the hon. Members for Witney (Robert Courts), for Eastleigh (Mims Davies) and for Stirling (Stephen Kerr).

I welcome the fact that the debate is taking place during Stoptober. It is nearly a year since our last debate on the tobacco control plan, which—this may interest some Members—marked my first outing as shadow Minister for public health. While the Minister I shadow has now changed—it is now the hon. Member for Winchester (Steve Brine)—the most significant change since our last debate is that, thanks to him, we finally have a new, updated tobacco control plan, which we were all very pleased to see. It is welcome that, after a long-drawn-out 18-month delay, we now have a plan that will take us a step further towards creating a smoke-free society.

Labour Members have welcomed the plan and its ambitious and noble goals, but we remain concerned about how it will be effectively implemented and achieved, especially given the short-sighted cuts in public health budgets, which my hon. Friend the Member for Stockton South highlighted knowledgeably in his excellent speech. As we know, the previous plan was extremely successful and reduced smoking rates from 20.2% to 15.5% but, as we have heard from every speaker today, it remains the case that smoking is still a serious issue in our society in terms of both its financial and human cost. Smoking and its related health problems cost our already financially strapped NHS more than £2.5 billion each year. If we were to seriously address smoking in society, we could reduce that financial cost and direct the money towards improving our NHS and ensuring that we have a healthy society.

It is estimated that 200 people a day die from smoking-related illnesses. In 2015, 79,100 people aged just 35 or over died because of smoking. It is not just adults who are affected, but babies and children. In 2010, as a result of pregnant women smoking, 19,000 babies were born with a low birth weight and an increased chance of taking up smoking later in their lives. As we heard in the excellent speech made by the hon. Member for Colchester, last week was Baby Loss Awareness Week. The hon. Gentleman is co-chair of the all-party parliamentary group on baby loss, of which I am proud to be an officer. It is estimated that up to 5,000 miscarriages, 300 perinatal deaths and around 2,200 premature births each year are attributed to smoking during pregnancy. Those saddening and distressing figures show exactly why we are here today to debate this issue and to ensure that the tobacco control plan is as effective as possible so that we can achieve a smoke-free society, and, in particular, support women during pregnancy.

We also know that smoking rates remain persistently high, especially among people with mental health issues, as my right hon. Friend the Member for Rother Valley mentioned. The plan sets out various recommendations relating to mental health, including improving support for smokers with mental health conditions and training for mental health staff to help to reduce smoking among that group, but I should like to hear from the Minister exactly what measures have been taken on the basis of those recommendations.

It is equally worrying that, as a number of Members have pointed out, the level of smoking remains high among those who are unemployed or members of lower socioeconomic groups, especially given the estimate that tobacco was 27% less affordable in 2016 than it was in 2006. There are a host of reasons for that, including the tax on tobacco products. I agree with the hon. Member for Chippenham that we should never seek to reduce that tax, for all the reasons that she gave, but it is deeply worrying that those groups, for whom poverty is rife, are not being sufficiently helped to quit smoking. During last year’s debate, I cited figures that showed that if smoking were reduced among those living in poverty and the costs of smoking to them were reinvested, we could make serious progress towards the eradication of poverty. Will the Minister give us an idea of what consideration he has given to the idea that reducing smoking could be a vehicle for ending poverty in society?

There is a clear drive in the plan for action on smoking cessation to be taken at a more local level. We do not disagree with that; in fact, we welcome it. We all agree that a “one size fits all” approach does not work, because of the geographical variations when it comes to smoking in our society. In my own region of the north-east of England, smoking rates are 25% higher than those in the south-west, and it is therefore unsurprising that the prevalence of lung cancer in the north-east is close to double that in the south-west. This is why it is important for us to do more at a local level to reduce smoking. However, I must urge the Minister—I know that he takes these matters very seriously—to bear in mind that “localising” action does not mean abdicating responsibility at a national level.

The Prime Minister’s driving mission on the steps of Downing Street in the summer of 2016 was to call out the burning injustices of inequality in our society, but we have yet to see that come to fruition—as we know, the Prime Minister has been a bit busy with Brexit. I know that the Minister is also passionate about the burning injustice of health inequality, because we have worked together on many health issues over the years. I know that he understands the importance of improving public health as a mechanism of prevention, and reducing the burden on our NHS by addressing the issues at source. However, the Department in which he is now a Minister has overseen some of the deepest cuts in public health services in recent years. I am sure the Minister knows the figures for these significant cuts, but for the benefit of the House, I will quote statistics used by the Royal Society for Public Health, meaning that I know they are accurate. It says that the total cuts mean that there will be £800 million less in public health budgets between now and 2020-21, which must have a significant impact on smoking cessation rates.

A study conducted by Action on Smoking and Health and funded by Cancer Research UK found serious budget cuts to smoking cessation services, with a growing number of authorities admitting they no longer have a specialist stop smoking service that is accessible to all smokers. This must be paired with the damaging analysis of Department for Communities and Local Government figures on local government spending by the King’s Fund, which found that wider tobacco control faced cuts of more than 30%. If the tobacco control plan is to be truly successful, as I know the Minister wishes, it cannot be pushed for in isolation from the cuts to public health budgets. The two are inextricably linked and cannot be dealt with in silos.

The Minister must go away and look into this matter and the effect it will have on the outcome set out in the TCP. Now that we have a blueprint in front of us, which we are all grateful for, it is time to ensure it is achieved completely—not partially and not just in bits, but completely.

The Minister has been given much to think about during this excellent debate, and I hope that, in his relatively new role, he will be the champion needed to improve smoking cessation and reduce the prevalence of smoking in our society. Now is the time not for simple, warm words, but rather for concrete, defining action that drives forward this agenda.

There are many actions to take, but I know the Minister has a true passion for health improvement and prevention. He cannot allow the power he now has at his fingertips to be squandered when it comes to implementing this plan. I say again that the plan, as good as it is, cannot be seen in isolation from other Government actions and policies. Ensuring that the right funding is in place to fulfil the plan’s vision and ending the disastrous cuts to public health budgets is the only way we can truly see the plan’s vision realised.

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.

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?

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.

The statistics in some of our cities are much higher than in others. In my city of Bradford, the Minister will know that the figure for smoking prevalence is about 22%. Public health is so important; does he recognise the importance of giving more resources to public health and councils, which have experienced significant cuts in recent years?

I simply say to the hon. Gentleman, who has not been present for the debate, that that point has been made. I also point out that we are giving £16 billion of ring-fenced public health spending to councils in England, which is significant. However, I shall come back to his point if he will bear with me.

To achieve the ambitions in the plan, we need to recognise that smoking is increasingly prevalent in particular groups in society and in particular areas. That is why we need to shift the emphasis from national to local action, and support smokers, particularly in disadvantaged groups, to quit. Now is not the time for more legislation—we have done that bit. I do not rule it out forever, but successive Governments have done that part. Now is the time to redouble our efforts to focus on our top priority groups such as pregnant women, young people and people with mental illnesses. We must focus on the people and areas with the greatest need.

Let me give an example. Yesterday, we published the two-years-on plan from the national cancer taskforce, which looks at the cancer strategy. It is full of good case studies. One that especially struck me was the Manchester lung cancer project, whereby we screen people arriving at supermarkets in certain parts of Manchester. That has led to improved cancer detection and outcomes for the local community that are quite staggering. Why do that in Manchester and not in Hampshire—in Winchester in my constituency? That is because there is a high prevalence of lung cancer driven by smoking in the Greater Manchester area. I visited Macmillan’s headquarters in London and sat and listened to some callers on their support line. I asked about regional disparities and they said that when they got calls from that part of England, they were about lung cancer, and that is no coincidence.

The example I gave is a policy response from the Greater Manchester authority, led by Andy Burnham, formerly of this parish, who has already put in place a plan that will mean 115,000 fewer smokers by 2021. I pay tribute to Andy, with whom I worked a lot in the House through my chairmanship of the all-party parliamentary group on breast cancer. I know that he has been greatly affected by that, and he is great partner for us on this matter. That is exactly the kind of thing we meant when we said in the tobacco control plan that we wanted local areas to develop their own local strategies.

There are many other good schemes locally—for example, the Fresh programme operates in a dozen local authorities in the north-east. I wonder whether the hon. Member for North Tyneside (Mary Glindon) is aware of it. She made an excellent personal speech, and I congratulate her on managing not to turn into a smoker, given the family background that she described. All the evidence suggests that children who grow up in families where the parents smoke go on to do so. The hon. Lady clearly knows something that we do not.

Leicester provides great examples of innovative stop smoking services, and the right hon. Member for Rother Valley mentioned Leicester and namechecked the council officer, who I suspect will keep that Hansard report. Well done to Leicester.

I recognise that hon. Members are concerned about local stop smoking services, but as I said in response to an intervention, we have a £16 billion ring-fenced public health budget. The Government believe that local authorities are best placed to make decisions on how the services should be prioritised to meet the needs of their populations. That is why I gave the example from Manchester. I am many things, but I am not best placed to decide what works in Leicester or Manchester; locally elected politicians are best placed.

The Government will continue to publish data that help local people hold those locally elected leaders to account. That is a crucial part of the plan. Public Health England, for which I am responsible, will continue to offer support to local authorities to help them develop their local approaches in the most cost-effective and evidence-based way. As Minister, I will continue to be a passionate advocate for evidence-based tobacco control plan policy making. It is an integral part of my mission to reduce the toll of preventable cancers.

I want to say something about the Government’s approach to e-cigarettes, which almost every Member who spoke mentioned. The new control plan commits to monitoring the safety, uptake, impact and effectiveness of e-cigarettes and so-called novel tobacco products. We must find a better term than that. The plan charges Public Health England with the responsibility of including messages about the relative safety of e-cigarettes in their quit smoking campaigns. I am pleased to say that that is already under way and that PHE’s current Stoptober campaign, for the first time, highlights e-cigarettes among the array of tools that smokers can use to improve their chances of quitting successfully.

As we like to say during Stoptober, there has never been a better time to quit. I will leave to my right hon. Friend the Chancellor the several Budget submissions around e-cigarettes. The suggestion of my hon. Friend the Member for Colchester (Will Quince) of providing free e-cigarettes to pregnant women who are smokers is certainly worthy of consideration. I noted that the hon. Member for North Tyneside is not necessarily a fan of changes to e-cigarette levies, so it is fair to say that we so not have unanimity across the House on that. PHE is already preparing its new year quitting campaign, which is rolled out in January each year, and it will reprise the hard-hitting messages that we have seen on our televisions. It is through consistent messaging that we can hope to reverse the harmful, mistaken and increasingly widespread belief that vaping is no safer than smoking. It clearly is.

The right hon. Member for Rother Valley made an excellent speech, touching on health inequalities and how smoking disproportionately hits the poorest in society. There is huge variation in the figures for pregnant women, with smoking rates of between 2.3% in London and—to correct the record—28.1% in Blackpool. He also made an excellent point about dentists and oral health. PHE-commissioned training will continue to ensure that local authorities have access to the training they need to provide effective help to quit and the information they need to work with patients. He chairs the all-party parliamentary group on pharmacy—I think we will be meeting soon—so he would say this, but he spoke about pharmacists and healthy living pharmacies, which have been particularly good. He referred to Government research, and PHE is committed to reviewing the evidence on e-cigarettes on an annual basis, and is working closely with Cancer Research UK and the UK Centre for Tobacco and Alcohol Studies to deliver a forum to ensure that we continue to have that strong evidence base.

I think I need to wind up by 3 o’clock, Madam Deputy Speaker. Is that right? [Interruption.] “Well by,” she says. Okay, let me conclude by thanking everyone who has spoken today. I particularly enjoyed the speech of my hon. Friend the Member for Chippenham (Michelle Donelan). It was hypnotic in many ways but very good, and I noted her Budget submission. As usual, I thank my hon. Friend the Member for Harrow, although I suspect that his berating me on this subject will not have started and ended today. The hon. Member for Ipswich (Sandy Martin) made a consistent point about local authority pension schemes, and it must be for local authorities to make such decisions and then answer to members of the scheme, their elected members and, of course, the residents who elect them and get to make such decisions every day.

In closing, I appreciate the many challenges and I appreciate the support that the House has given to tobacco control legislation over many years. It is now up to us to provide a national lead and to support our local authorities and ensure that they carry through what is in the plan. I thank my friend the right hon. Member for Rother Valley for introducing today’s debate and ensuring that tobacco control is no longer a partisan issue; this is now about the tobacco control plan.

I just have a few reflections. Several people mentioned my involvement in anti-tobacco measures in this Chamber over many years, but it was never just me. Whether sat on the Opposition or Government Benches, I had allies on the other side who forced different Governments to take different positions all the time. Listening to the debate, we have now reached a consensus. We started off by banning tobacco advertising and promotion, then smoking in public places, then point of sale advertising and now we have standardised packaging. It has been just wonderful to sit here and recognise the fact that we now know what is in our midst, shortening the lives of many tens of thousands of our fellow citizens, and we are now seriously doing something about it. I say to the Minister—if I was on the Government Benches, I would say the same—that I do not see any need for further legislation. We need to implement what we have already done on smoking cessation to help people break this habit. I am thankful for what was said about me, but it is was not just me; there have been teams of people at different times.

It has been really good today that we have recognised the new products on the market, such as e-cigarettes and other novel products—I think “novel” is a European term that has come in from the tobacco product directive. No matter who owns them and no matter who is promoting them, people now recognise that such products can potentially be very useful in getting citizens off this killer—tobacco shortens the life of 50% of those who use it. We need the research, and we need to be determined.

I enjoyed all the Front-Bench speeches, and I say to my hon. Friend the Member for Washington and Sunderland West (Mrs Hodgson) that I loved the parliamentary Labour party brief I received last night—I cannot always say that when I talk about tobacco products or tobacco policy in this House. We now need to make sure that we improve things for our fellow citizens as soon as possible.

Question put and agreed to.


That this House has considered the Government's publication of the new Tobacco control plan.