Before we begin, I remind Members that they are expected to wear face coverings when not speaking in the debate, in line with current Government and House of Commons Commission guidance. I remind Members that they are asked by the Commission to have a covid lateral flow test twice a week if coming on to the parliamentary estate. This can be done either at the testing centre in the House or at home. Please also give each other and members of staff space when seated, and when entering and leaving the room. That is particularly important today—it is so cold in this room that I do not blame you for huddling together. If any of you wish to put extra clothing on or to use a coat as a blanket, please do so.
I beg to move,
That this House has considered the delivery of a new Tobacco Control Plan.
It is a pleasure to serve under your chairmanship, Mr Bone—I believe for the first time in this place. I speak as, and declare an interest as, the chairman of the all-party parliamentary group on smoking and health. We welcomed the Government’s announcement of the new tobacco control plan, and we welcomed that it would be published this year, to deliver the Government’s smoke-free by 2030 ambition. I do not want to put any pressure on my hon. Friend the Minister, but she does not have long to achieve the first ambition. The Government’s ambition to reduce smoking rates to 5% or below, making smoking obsolete, is one that all of us in the all-party parliamentary group share. I believe that will be endorsed on an all-party basis this morning, because it is clearly a great way to ensure the health of the nation.
For me, this is deeply personal. Both of my parents died of cancer caused by smoking. My late mother was only 47 when she died of lung and throat cancer, as she was a very heavy smoker for most of her life. I do not want to see families go through what my family had to go through during those terrible days. For me, it is a lifetime ambition to ensure that people understand the risks of smoking, the damage to their health and the damage to their families.
The all-party parliamentary group is keen to support the delivery of the ambition of a smoke-free Britain, which is why, in June this year, we published a report setting out our recommendations for the tobacco control plan for England. Those recommendations were endorsed by more than 50 organisations, including the Royal College of Physicians, Cancer Research UK and the British Heart Foundation. On behalf of the APPG, I am pleased to welcome my hon. Friend the Public Health Minister to her new post, and indeed to welcome her opposite number; to put our recommendations on the record; and to give the Minister the chance to respond to those views.
The APPG has a long-term track record of acting as a critical friend to the Government on the tobacco control agenda. I am confident that this collaborative and constructive relationship will continue. Although smoking rates in my constituency are lower than the English average, there is no room for complacency. In Harrow, more than one in 10 people still smoke and smoking kills around 250 people a year. That is obviously far too many. In 2018-19, there were 1,566 smoking-attributable hospital admissions and 370 emergency admissions for chronic respiratory disease, which is caused almost entirely by smoking. That is in one constituency, so imagine what smoking does to the national health service up and down the country.
Research presented to the all-party parliamentary group shows that, on average, smokers are likely to need social care a decade earlier than non-smokers, and particularly never-smokers. Smoking-related disease and disability make it hard to carry out normal daily activities such as getting dressed, walking across a room and making a meal. Most of us take these things for granted, but we should not.
The importance of the smoke-free 2030 ambition is clear. As the Minister herself stated recently,
“tobacco continues to account for the biggest share of avoidable premature death in this country. It contributes half the difference in life expectancy between richest and poorest.”—[Official Report, 1 November 2021; Vol. 702, c. 621.]
More than 70,000 people died from smoking last year in England alone. For every person killed by smoking, at least another 30 are living with serious smoking-related illnesses.
I warmly congratulate my hon. Friend on bringing forward this debate. On the point about the 70,000 deaths, is it not important to understand that that is year after year after year? Would he set that in contrast with the awful toll we have had from covid and the terrible restrictions that we have necessarily placed upon the population of this country, and agree with me that getting rid of this horrible substance would be far less of an intrusion on people’s liberties than the sort of things we have seen over the past 18 months? Over time, that would have a far greater impact on health, wellbeing and people’s ability to go about their daily lives. It would reduce the burden on the national health service very substantially indeed, and address the health inequalities that sadly mean the life expectancy of the richest and poorest in this country are currently separated by upwards of 10 years.
I could not have put it better myself. My right hon. Friend quite clearly makes the comparison between covid-19 and smoking. People cannot help catching covid, but when they smoke they make the choice as to whether they inflict life-changing circumstances on themselves.
Like my hon. Friend, I had a parent who died in their 40s from throat cancer. As we try to migrate 7 million people away from burnt tobacco, the challenge is to move them to less harmful forms of nicotine. Their addiction is to the nicotine; they crave nicotine, not the burning of tobacco. If we can make these transitions, we can reduce harm at a much quicker rate.
My hon. Friend is quite right. Nicotine is one of the most addictive drugs on the market, if not the most addictive, and perfectly legal to consume. The issue is whether someone, once addicted to nicotine, can quit. The damage is done not necessary by the nicotine, but by the delivery mechanism by which someone gets the nicotine.
Anything that reduces the risk of cancer or other related diseases has got to be good news. We can migrate people and encourage them to quit. Ideally, they give up completely. However, because it is so addictive they may need help and assistance to do that. Vaping and non-heated tobacco are ways of migrating people to safer means of delivering the nicotine they desire.
Taking up the point made by my right hon. Friend the Member for South West Wiltshire (Dr Murrison), ending smoking is essential if we are to level up the nation’s health after the pandemic. We need to reduce health inequalities between rich and poor, and increase healthy life expectancy by five years by 2035, in line with the Government’s manifesto commitments.
As well as being necessary, tobacco control measures are popular with voters for every main party, including the Conservative party, which both my hon. Friend the Minister and I represent. Results from the annual YouGov survey of over 10,000 adults in England, funded by Action on Smoking and Health, show that more than three quarters of the public support the Government’s smoke-free 2030 ambition, and eight out of 10 members of the public support Government intervention to limit smoking.
The Government have the full support of the APPG in delivering the smoke-free 2030 ambition. However, as the Government stated in the 2019 prevention Green Paper, achieving that ambition will require “bold action.” Inequalities in smoking rates have grown in recent years, not shrunk. In order to be smoke-free by 2030, we need to reduce smoking by two thirds in just a decade—we have only nine years left to achieve that—and by three quarters for smokers in routine and manual occupations. At current rates of decline, Cancer Research UK has estimated we will miss the target by seven years, and double that for the poorest in society.
There are still nearly 6 million smokers in England. We will only achieve a smoke-free 2030 by motivating more smokers to make quit attempts, using the most effective quitting aids, while also reducing the number of children and young adults who start smoking each year. With 1,500 people dying from smoking-related diseases every week and less than a decade to achieve a smoke-free 2030, there is no time to waste.
Disappointingly, with the end of the year in sight, there is still no sign of the tobacco control plan that was promised this year. My first question to my hon. Friend the Minister, therefore, is whether she can she set out a timeline for the publication of the next tobacco control plan. But the tobacco control plan is only as strong as the measures it includes. That is why the APPG was disappointed that the Government rejected the amendments to the Health and Care Bill tabled by my friend the hon. Member for City of Durham (Mary Kelly Foy), and supported by myself and other officers of the APPG, in Committee.
Those amendments would have closed the loopholes in the regulations that expose children to the insidious marketing tactics of the tobacco industry, provided funding for tobacco control and strengthened the regulation of tobacco. As it stands, the Bill fails to include a single mention of smoking or tobacco and represents a major missed opportunity to introduce key policies for achieving a smoke-free 2030. That is why we have retabled the amendments on Report. I hope the Government will look at them sympathetically, because the Bill is the ideal opportunity for them to deliver their 2019 commitment to finish the job and introduce the legislation that is needed if we are to achieve a smoke-free 2030. My second question is whether the Minister will commit to considering the adoption of tobacco amendments to the Health and Care Bill on Report.
My next area is the “polluter pays” levy. The bold action that the Government acknowledge is needed cannot be taken without investment. The Health Foundation estimates that a minimum £1 billion is needed to restore public health funding to its 2015 levels, with more needed to level up public health across the country. While there was some positive news on tobacco taxation in the recent spending review, which we welcomed, unfortunately the Government opted not to increase the public health grant to local authorities. As a consequence, we need to establish new sources of funding.
The Government promised to consider a US-style “polluter pays” levy on tobacco manufacturers in the 2019 prevention Green Paper. This scheme would mirror the approach taken in the United States, where user fee legislation raises $711 million annually from the tobacco manufacturers, with the funds then used to cover the cost of stop smoking campaigns, tobacco control policy development, implementation and enforcement.
I must say that I am opposed to punitive taxation policies, because I do not think they work. Does the hon. Member accept that tobacco companies already pay the Government £13 billion? An additional levy could lead—and most likely would lead, as the evidence shows—to a significant increase in criminality, because instead of paying for taxable product, people will buy smuggled product. Is that not a huge worry that he has about introducing a levy?
I will come to some of these issues in a few moments, if the hon. Gentleman will be patient and let me build the case. Obviously, it has been estimated by ASH that the funding needed for a comprehensive tobacco control plan to deliver a smoke-free 2030 would cost around £266 million for England and £315 million in total for the UK. A levy could raise around £700 million from the tobacco manufacturers, to be spent on tobacco control and other public health initiatives. The devolved Governments would also have the ability to opt into the scheme, should they so wish.
Such a scheme is more than justified in response to market failure that allows an industry, whose products kill consumers when used as intended, to make exorbitant profits. While net operating profits for most consumer staples, such as food, beverages and household goods, stands at 12% to 20%, Imperial Brands in the UK enjoyed net operating profits of 71% in 2019. That is £71 in profit for every £100 in sales. In 2018, it is estimated that tobacco manufacturers made over £900 million in profits in the UK alone.
The hon. Member for North Antrim (Ian Paisley) makes an interesting point about taxation. Would it be possible for politicians, with all their imagination, to use the taxation system to encourage cigarette and tobacco companies to transition their products away from combustible tobacco to less dangerous nicotine-delivery mechanisms?
My hon. Friend makes a good point; clearly, research could be undertaken to establish how we could use the taxation system to transition people in that way. I personally welcome the escalators that have been put on tobacco products and continued by the Chancellor.
Despite the enormous profitability for those companies, major tobacco manufacturers pay very little profit tax in the UK. That probably reflects their global engagement in diverse and elaborate tax avoidance strategies, which allowed Imperial Brands to lower its UK corporate tax bill by an estimated £1.8 billion over the past 10 years, and British American Tobacco to reduce its bill by an estimated £760 million over the same period. Public support is strong for such a measure, with 77% of the public supporting making tobacco manufacturers pay a levy or licence fee to the Government for measures to help smokers quit and to prevent young people from taking up smoking, and just 6% opposing it.
The covid-19 pandemic has put huge pressure on public finances, and there is a desperate need for bold, properly funded policies to level up public health after the pandemic. Our recommendations on the “polluter pays” approach are backed up by a much more detailed policy paper on how this would work, which we commend to the Minister and her officials. Will the Minister commit that the recommendations for a “polluter pays” mechanism will be included in any consideration of how the tobacco control plan should be funded?
My last major point is about raising the age of sale. If England is to be smoke-free by 2030, we need to prevent people from starting smoking at the most susceptible ages—when they are adolescents and young adults. Two thirds of those who try smoking go on to become regular smokers, only a third of whom succeed in quitting during their lifetime. Experimentation is rare after the age of 21. Therefore, the more we can do to prevent exposure and access to tobacco before that age, the more young people we can stop from becoming hooked into this deadly addiction.
Raising the age of sale from 16 to 18 was associated with a 30% reduction in smokers aged 16 and 17 in England, as was increasing the age of sale to 21 in the United States among 18 to 20-year-olds. University College London estimates that increasing the legal age of sale from 18 to 21 would immediately result in 95,000 fewer smokers aged 18 to 20 in 2022, and an additional 77,000 fewer smokers over the long term, to 2030. That would reduce smoking prevalence among 18 to 20-year-olds to 2%, compared to 9.6% without the intervention. It would be simple and inexpensive to introduce, as ongoing enforcement costs are already factored into the existing age regulations. This is the regulatory measure that would have the biggest impact on reducing smoking prevalence among young adults.
Compared to non-smokers aged 18 to 20, smokers in this age group are more likely to be from lower socioeconomic backgrounds. As such, the effect in increasing the age of sale would be particularly beneficial in poorer and more disadvantaged communities. It could also have knock-on benefits. Smoking during pregnancy, for example, is concentrated among young, disadvantaged mothers, and whether a woman smokes during pregnancy is significantly affected by her wider environment. Discouraging experimentation and the uptake of smoking among young, disadvantaged people would prevent smoking in young women who may go on to become pregnant, as well as their male partners, friends and family members. That then reduces the likelihood that young women and their children will be exposed to toxic second-hand smoke during, or indeed after, pregnancy.
In keeping with the current age of sale legislation, raising the age to 21 is not about criminalising those under that age, but about making it much more difficult for them to get hold of tobacco. Increasing the age of sale is supported by a majority of the adult population, with 63% in favour and just 15% opposed. The support is consistent among Conservative, Labour and Liberal Democrat voters—I do not have figures for the Democratic Unionist party. That is also true for those aged 18 to 24, among whom 54% support the measure and just 24% oppose, and for 11 to 18-year-olds, of whom 59% support and 14% oppose.
Given the strength of the evidence and the public consensus that this is the right thing to do, I and other members of the all-party parliamentary group urge the Government to launch a public consultation on raising the age of sale. It is particularly important to encourage children and young adults, who will be most affected by the policy, to participate.
Experience of smoke-free law implementation in England in 2007 showed that a public consultation can help raise awareness and bolster compliance with legislation. For example, 98% of all premises and vehicles inspected in the first nine months after the law was implemented complied fully with the legislation, and 81% of business decision makers thought the law was a good idea.
When the Government rejected the amendment to the Health and Care Bill that would have provided the power to raise the age of sale to 21 by regulation, they said that they would like to review the evidence base for increasing the age of sale to 21 in more detail. That seems to me and others a very good idea. The best way to do that would be by carrying out a consultation, which is what we are calling for in the revised amendment on Report. I urge the Minister not to wait for the debate but to give her support to the consultation now.
My final question for the Minister is this: will she give a commitment to conducting a consultation on raising the age of sale from 18 to 21 within three months of Royal Assent of the Health and Care Bill? That brings me to my conclusion, Mr Bone. I welcome the opportunity to have this debate and look forward to contributions from right hon. and hon Members and the replies from the Front Benchers.
It is a pleasure to serve under your chairmanship, Mr Bone. I pay tribute to the hon. Member for Harrow East (Bob Blackman) for securing the debate and for his work as chair of the all-party parliamentary group on smoking and health, of which I am vice-chair.
Two years after the Government stated their ambition to make England smoke-free by 2030, projections show that they will miss that target by seven years, and double that for the poorest in society. Despite a promise of further action on tobacco, we are still waiting for the new tobacco control plan, which the Government pledged to publish this year. In the absence of that new plan, the Health and Care Bill is a timely opportunity to take the first step towards a smoke-free 2030.
Despite the urgency of the issue and my best efforts in Committee, the Health and Care Bill fails to make a single mention of tobacco or smoking. To correct that oversight, I tabled amendments to the Bill, based on recommendations made by the APPG on smoking and health, including proposals for a “polluter pays” levy, health warnings on cigarettes and inside packaging, and to close the loophole allowing e-cigarettes to be marketed at children. Those measures are all low-cost or revenue-generating, are popular with the public and could be implemented quickly and easily by the Government. Although the Government expressed support for the principle behind the proposals, they rejected every single one, saying that they wanted to wait and see the evidence.
The Government have cited the need to wait for the publication of the post-implementation reviews of the Standardised Packaging of Tobacco Products Regulations 2015 and the Tobacco and Related Products Regulations 2016. The Government were required by law to publish those by May 2021. That has now drifted to an aim to publish by the end of the year. Will the Minister say how much longer we will have to wait for the Government to start taking action to deliver the smoke-free 2030 ambition? She should know that if the APPG’s amendments are not adopted in the House of Commons, they will be retabled in the other place.
Today I want to briefly make the case for my proposals and address the Government’s arguments against them. The first proposal is to include health warnings on cigarettes and cigarette papers. Substantial research supports their implementation, and they are already under consideration in Canada, Australia and Scotland. Such warnings would be cheap and easy to implement through a simple amendment to the Standardised Packaging of Tobacco Products Regulations 2015. The Government said they were sympathetic to the aims of the measure, but they are not willing to adopt it, citing the need to conduct further research and for more evidence. Warnings such as “smoking kills” have been shown to be effective on billboards and tobacco packs, so why would they not be effective on cigarette sticks, too? Adding warnings to cigarette sticks is also important because young people in particular are likely to begin smoking with an individual cigarette rather than packs. There have also been at least eight peer-reviewed academic studies published since 2015 that specifically looked at warnings on sticks and found them to be effective, particularly in making cigarettes less attractive to younger adolescents and never-smokers.
Cigarette pack inserts that provide health information have been required in Canada since 2000. Substantial evidence shows that they are effective, and research supports their use in the UK, too. The Government have already acknowledged in the prevention Green Paper that there could be a positive role for inserts giving quitting advice in tobacco products. Pack inserts are easy and cheap to introduce and, as the Government have acknowledged, could be implemented by a simple revision of the Standardised Packaging of Tobacco Products Regulations 2015. Again, the Government refuse to adopt the amendment, citing the need for further research and public consultation and to wait for the recommendations of the post-implementation review of the SPOT regulations, yet there is no guarantee that the review will contain concrete recommendations. Indeed, the 2019 review failed to do that. My concern is that the measure needed will just get kicked into the long grass, putting the 2030 ambition at risk.
There are currently no controls on the use of branding to promote e-cigarette products, some of which, particularly e-liquids, are branded in a way that is clearly attractive to children through the use of bright colours, sweet names and cartoon characters. Research by YouGov for ASH found that in 2021, 3.3% of 11 to 17-year-old never-smokers have tried e-cigarettes once or twice; 0.5% use them less than weekly; and 0.2% use them more than once a week. Although those percentages seem low, it still amounts to 174,900 never-smokers trying e-cigarettes. Another 26,500 carried on using them, and 10,600 used them more than once a week. The ASH YouGov survey of adults and young people found that standardising the packaging of e-cigarettes and refills reduces the appeal of vaping to young people, particularly young children, while having little impact on adult smokers’ interest in using the products to quit smoking. Frustratingly, the amendment was voted down by the Government in Committee.
A further issue that must be addressed is that although it is illegal for e-cigarettes to be sold to children under 18, it is not illegal for them to be given out as free samples to under-18s. That loophole fails to deliver on the spirit of the legislation, which is designed to protect children from nicotine addiction. Clearly, the legislation needs amending to ban the sale and free distribution of any consumer nicotine product to under-18s. The Government inexplicably voted down that proposal in Committee. They said that they did not have a firm or robust evidence base at present to suggest that there was a widespread problem. As stated, around 174,900 never-smokers aged 11 to 17 have tried e-cigarettes and another 10,500 use them more than once a week. Does the Minister genuinely think that we should wait until their use of e-cigarettes becomes a significant problem before taking action to remove this loophole?
Finally, I want to talk about flavourings. The ban on flavourings in smoking tobacco was introduced because flavourings, particularly menthol, make it easier for young people to start smoking and increase the likelihood that they will become addicted smokers. However, the flavour ban only prohibits characterising flavours, which are subjective and difficult to measure, making the ban easy to circumvent and complex to oversee. Legislation in Canada bans all flavours, which is easier to implement and enforce. There is good reason to do that, as the tobacco industry has introduced several innovations that have exploited loopholes in the regulations to undermine the impact of the ban. For example, Japan Tobacco International launched a range of alternative products containing menthol, but which they claimed complied with the law. Figures in the Express revealed that 12 months after the ban came into force in 2020, the company had sold more than 100 million packs and made around £91.65 million in profits from menthol brands.
In addition, modified smoking accessories have been introduced, including cards, filter papers and filters, that are designed to add a menthol flavour to both hand-rolling tobacco and cigarette sticks. UCL’s smoking toolkit study found no decline in the proportion of smokers in England reporting menthol cigarette smoking following the introduction of the ban, and it suggested that smokers of menthol cigarettes were able to take advantage of the loophole. The flavour ban is clearly failing to prevent the sale of flavoured tobacco, which is why I propose extending the ban to all tobacco flavours, not just those described as characterising.
Again the Government oppose the measure, claiming that
“it is not clear how a ban on flavours would be enforced in practice”.––[Official Report, Health and Care Public Bill Committee, 28 October 2021; c. 815.]
That is not logical as it is much easier to enforce a complete ban on flavours than on only those defined as characterising, which is very subjective.
Does the Minister agree that the tobacco industry is making a mockery of the current flavour ban? Will she commit to closing the loophole by removing the limitation to only include flavours defined as characterising as soon as possible and extending the ban, which currently only applies to cigarettes, to all tobacco products and smoking accessories?
It is a pleasure to serve under your chairmanship, Mr Bone. I join the hon. Member for City of Durham (Mary Kelly Foy) in congratulating my hon. Friend the Member for Harrow East (Bob Blackman), as the chairman of the all-party parliamentary group on smoking and health, on securing an important debate, and I compliment his outstanding record in the subject area of smoking cessation. As he will know, I chair a separate APPG—the all-party parliamentary group for vaping—which I established in 2014. I do not vape, have never smoked and have no personal interest in vaping, but I set up the APPG after meeting with a proprietor of a small business in my Rugby constituency, who was concerned that impending legislation from the EU—the tobacco products directive—might mean that his customers would not have access to a product that had enabled many of them to finally stop smoking.
Another reason for getting involved was that a member of staff in my office had tried every mechanism available to him—patches and other routes—to quit smoking, but the only thing that had worked was vaping. Since setting up the APPG for vaping, we have heard from many members of the public about the benefits of vaping in enabling them to stop smoking, and the support that has been given to that position by Public Health England’s assertion in 2015 that vaping was 95% safer than smoking combustible tobacco.
I believe that two points should be integral to the treatment of vaping in the forthcoming tobacco control plan. First, there is the recognition of relative risk and harm reduction products, which was mentioned by my hon. Friend the Member for Broxbourne (Sir Charles Walker). Secondly, there is the fundamental importance of distinguishing between combustible tobacco, which we all know and have heard in the debate already is extremely harmful, and the far less harmful non-combustible alternatives that are available. The new plan should continue on the progressive path that the UK has forged over the last few years by continuing to recognise the importance of reduced-risk products in reducing smoking prevalence in our country. It is absolutely essential that we do not conflate smoking combustible tobacco with vaping. That position is not helped by the fact that we regularly see in public places signs telling people that smoking is not permitted and nor is vaping. Signage and messages such as that are putting it in people’s minds that there is an equivalent harm between smoking and vaping, when we know that is not the case. They are entirely separate activities and should be treated as such.
It was concerning to read through some of the documents from the recently concluded framework convention on tobacco control COP9 meeting and see a concerted effort by some to treat vaping as smoking. The hon. Member for City of Durham mentioned that concern. We should push back against such messages at all costs. Earlier, and by contrast, it has been pleasing to see the Government acknowledge the importance of vaping. They did so in the 2017 tobacco control plan and I believe the case for vaping has increased since that time. Of the estimated 3.3 million vapers in the UK, 1.8 million are ex-smokers and the balance are smokers who also vape. We need to recognise that category of people, who reduce their exposure to tobacco by continuing to smoke from time to time but who also use vaping as an alternative device. If we assume that when they are vaping they might otherwise be smoking, their use of vaping products at that time helps their health.
Vaping has played a significant role in recent years in reducing smoking prevalence. If the Government are serious about their 2019 commitment to getting smoke-free by 2030, the role of vaping should be reinforced and supported through the new tobacco control plan. However, as we have heard, we know that approximately 7 million people continue to smoke in the UK and we need to do all that we can to help the many people who have tried to move from cigarettes to safer, reduced-risk products, as my hon. Friend the Member for Broxbourne said.
Over the past year the APPG for vaping has conducted two inquiries, with two reports, which I know the Minister has seen. The first focused on the UK’s position at the recent COP9 and the second analysed the opportunities available for tobacco harm reduction policies post Brexit. I thank the Minister for her receipt of our reports and for meeting the members of the APPG ahead of COP9 last week. I know that all Members, not just the members of APPGs, will be interested to hear from the Minister some of her thoughts on the outcome of COP9. She will, I know, acknowledge the delay in publishing the tobacco control plan that we expected this summer, as mentioned by my hon. Friend the Member for Harrow East. Can the Minister confirm that the post-implementation review into tobacco-related products will be published beforehand, as recommended by the APPG in its most recent report? I hope that she can also confirm that the new plan will not be published prior to the publication of Office for National Statistics data for 2021 on smoking prevalence. We understand that that was something that her predecessor intimated.
The APPG’s expert recommendations on how we can achieve a smoke-free 2030 can embrace the ideas to help eliminate smoking, tackle inequalities and help level up and strengthen consumer confidence in vaping by tackling some of the misinformation that is currently prevalent. Our report called for the tobacco control plan to ensure that we meet our 2030 smoke-free target by setting out a clear plan to achieve it, embracing the concept of tobacco harm reduction and, as mentioned previously, ensuring that the post-implementation review of the tobacco and related products regulations is published ahead of time. It is imperative that the evidence gathered through the process is properly considered, transparently disclosed and used to best effect before we set out our new policy direction under the new tobacco control plan. The new plan should be used as an opportunity to introduce a multi-category approach that, as we heard earlier, encourages switching to less harmful alternatives when a smoker is unable or unlikely to quit entirely. As we have heard, we know that it is the process of combustion that carries the harm in cigarettes, so we need to fully analyse all the non-combustible reduced-risk products available on the market and align our regulations for all of these products—as has been advocated for by the Royal College of Surgeons.
Finally, we should use the new tobacco control plan as an opportunity for the UK to cement its place as the world leader in tobacco harm reduction. I have been on calls with representatives of other countries; we have a lead in this area that other countries look to and it is important that we maintain that. I know the Minister will agree that that means allowing sensible communication on the benefit of vaping, rather than banning their promotion and looking at the transposed EU tobacco products directive. That way, we can make sure that they are fit for purpose for our more progressive approach to tobacco control and harm reduction. By making these changes we will give ourselves a real chance to reach our smoke-free 2030 target. Without bold leadership—which I know the Minister will provide us with—there is a danger that we will miss that target; as a consequence, we will miss the opportunity to help those 7 million people who still smoke get off tobacco for good.
I congratulate the hon. Member for Harrow East (Bob Blackman) on securing this important debate. He and I share many interests in common in this House, and this is one of them. I welcome the new Public Health Minister to her role. It is vital that smoking should be at the top of the Government’s list of priorities. Although Northern Ireland and the devolved nations are responsible for our own public health policies, the Government in Westminster retain responsibility for important UK-wide policies. Ensuring that the Minister understands the importance of urgent action on smoking is therefore vital for ensuring that we make the progress we need to make in Northern Ireland.
Last year, a review of Northern Ireland’s progress in the 10-year tobacco control survey, published in 2012, was released. Although we met our target in ensuring a minimum of 5% of the smoking population accesses smoking cessation services annually, that was the only target from the 2012 strategy that had been achieved, which is disappointing. Quite clearly, we are not hitting our targets at a population level. Results from Northern Ireland’s health survey show there has been no significant change in smoking rates from 2018-19, with 17% of the adult population still smoking—the highest rates in the UK. This is extremely disappointing and, as my party’s health spokesperson, I am concerned about what is happening.
Of most concern, however, is that we are failing the most disadvantaged smokers. The target was to reduce smoking rates among manual workers from 31% to 20% by 2020. We are far from this, with rates among manual workers still at a very stubborn 27%. Similarly, rates of smoking in pregnancy have barely declined over the years, despite that having been a priority in the strategy, as the hon. Member for Harrow East mentioned. We had hoped to reduce levels from 15% in 2010 to 9% by 2020. However, the proportion of pregnant women who smoke at the time of delivery is still a very disappointing 14%. We all know that that puts women and their babies at risk of serious and avoidable harm. We are, however, doing better with children and young people—another priority area. Smoking rates among 11 to 16-year-olds have been halved to 4% since 2010. We had set a target of 3%, which was missed. We are not there yet, but that is one area of improvement.
Although smoking rates have declined among children and young people, analysis by Cancer Research UK estimates that 10 children under 16 take up smoking every day across Northern Ireland. If that does not worry you, Mr Bone, it should. Children who live with smokers are almost three times more likely to take up smoking than children from non-smoking households, which creates a generational cycle of inequality, with smoking locked into disadvantaged communities. It is clear to me, in the statistics that are put forward, that disadvantaged communities are one of the areas that the Government and the strategy need to address.
A third of smokers in Northern Ireland still report smoking inside their home, which demonstrates that there is much further to go in creating smoke-free communities and protecting children and others in the household, but progress is being made. I trust that hon. Members saw the recent announcement that, not before time, Northern Ireland will join the other UK nations in banning smoking in cars carrying children. That overdue but welcome measure will help to protect our young people and prevent the creation of a new generation of smokers.
Smoking is a significant challenge in Northern Ireland, particularly in our most disadvantaged communities, which have faced so much adversity in the last 18 months. Those problems are not specific to Northern Ireland, however, as smoking and the inequality that it causes are challenges for the whole UK. Our job is not over yet. Northern Ireland and the whole UK have much further to go on smoking, and there is no time to lose.
I trust that the Minister agrees with all hon. Members and will be even more steadfast in her conviction by the end of the debate. The recent Budget and spending review was an opportunity to go much further in achieving the smoke-free society that we need. Regrettably, that was not realised. Tax increases are one of the most effective interventions that we have to reduce smoking rates and uptake, although that may not be all hon. Members’ opinion. Vitally, they are also the only intervention proven to reduce inequality.
I am convinced, like the hon. Member for Harrow East, that increasing the cost of tobacco products through taxes drives down smoking rates, increases tax revenues and reduces the cost to public finances and society. I hope that the Minister will give us some reassurance. It is an intervention that we should make the most of. The Chancellor’s announcement that the duty escalator rate on all tobacco products would increase by 2% above inflation, and by 6% above inflation on hand-rolling tobacco was welcome, but we could and should have gone further.
There is still a major gap in excise tax rates between factory made cigarettes and hand-rolling tobacco, which makes the latter more affordable and encourages smokers to trade down to it rather than quitting. That disparity has made hand-rolling tobacco increasingly popular over the years, which should have been addressed by the Chancellor. It is not the Minister’s responsibility, but I am keen to hear her thoughts on it and what discussions she may have had with the Chancellor. In 1998, fewer than one in five smokers mainly rolled their own cigarettes, but that number is about one in three in Northern Ireland today. I would welcome that issue being addressed through tax revenue. Tobacco taxes are a reserved issue, so I hope that the new tobacco control plan will commit to maintaining high duty rates on tobacco products, as the last one did. I also hope that the Chancellor will seize future opportunities to increase duty rates for tobacco products.
I have repeatedly raised the issue of licensing for tobacco retailers in this House and I will do so again. In Northern Ireland, since 6 April 2016, retailers have been obliged to register with the tobacco register of Northern Ireland; the final deadline for doing so was 1 July 2016. That built on a similar scheme already in place in Scotland, and a scheme is due for implementation in Wales. Since 2018, we have implemented a track-and-trace scheme that requires every retailer to have an economic operator identifier code registered to their business and a facility identifier code for each store or premises that stores tobacco.
Since leaving the EU, the UK has established and launched its own system, with Northern Ireland operating in the UK and EU systems. That makes it easy for all nations in the UK, including England, to not just implement a retail register scheme, but go further and implement a comprehensive retail licensing scheme. Retail licensing is the obvious back-up to the tracking and tracing of cigarettes and would help to tackle the illicit trade that gives smokers access to cheap tobacco.
In Northern Ireland, there has been a serious issue with paramilitaries using illegal tobacco as one of their revenue streams. Those who sell it have no compunction about selling it to children too. The illegal trade makes it not just less likely that smokers will quit, but more likely that children will start. That double whammy greatly concerns me. The Police Service of Northern Ireland is aware of that and is taking steps to address the issue.
I urged the Minister’s predecessors to ensure that their officials were in contact with the devolved nations on retail licensing and I do so again. Will the Minister ensure that her colleagues at Her Majesty’s Revenue and Customs talk to their equivalents in Northern Ireland, Scotland and Wales about their experiences with tobacco retail licensing and the lessons that they have learned regionally from the experiences of the devolved nations?
I am conscious that other hon. Members want to speak. England remains an outlier on this important measure that could help to tackle illicit trade and protect children from tobacco. My absolute priority is stopping children’s access to tobacco. We can and should address those issues collectively, bringing knowledge from the nations that we represent—the four regions of the great United Kingdom of Great Britain and Northern Ireland. If we do so, I am confident that we can and will deliver policy that helps not only us but the constituents that we serve. That is our duty.
I thank my hon. Friend the Member for Harrow East (Bob Blackman) for securing the debate. I recently joined the all-party parliamentary group for vaping, but I have taken an interest in that area ever since it became a matter of not infrequent discussion when I was a Member of the European Parliament, especially in relation to the EU tobacco products directive and some of the flaws therein. We need a serious debate about advertising practices related to vaping and misinformation about the use of e-cigarettes and vaping products. That is especially significant for me as the Member of Parliament for Northampton South, which has a nationally high smoking rate of 18.8%.
The Government’s tobacco control plan must be based on the significant and growing body of evidence that vaping is an effective alternative for smokers. I thank the Secretary of State for Health and Social Care and his team for announcing that the Medicines and Healthcare products Regulatory Agency has updated its guidance on medical licensing for e-cigarettes, allowing them to be prescribed to those trying to quit smoking. However, there is still a public perception that vaping is as harmful, or more harmful, than smoking. The rate of smokers switching to vaping has slowed over the last 18 months, largely because of misleading media articles and junk science causing concerns over the quality of e-cigarettes. Some 53% of smokers believe that vaping is as harmful or more harmful than smoking, according to a 2021 Government updated evidence summary. There needs to be concrete and clear information on passive vaping to counter the public misconception that it is harmful.
It is clear that the Government and industry must push back against those misconceptions, and the forthcoming tobacco control plan must set out to tackle them. I encourage the Government to look at some of the proposals put forward in Canada and New Zealand, which hon. Members have mentioned. These countries are introducing approved health claims and messaging about switching from smoking to vaping, alongside some nicotine health warnings.
We must make a clearer distinction between smoking and vaping. There must be clear standards that differentiate smoking from vaping in public spaces—and importantly in work spaces. The last thing that someone attempting to quit smoking wants is to stand around in the same vicinity as smokers. Employers should have specific workplace vaping policies that balance the needs of vapers and smokers. The parliamentary estate could lead the way in adopting and implementing this policy.
Finally, I ask the Minister to support online vape retailers. Retailers and manufacturers must be able to responsibly promote their products online, and to highlight the health and cost benefits of switching to e-cigarettes. At this point, I suppose that my wife would say, “Il meglio è nemico del bene”—the best is the enemy of the good. I am not unaware that there are drawbacks and problems with nicotine intake. However, given the damage that smoking does to people’s health and the sad personal experiences that we have heard today, that expression must be borne very much in mind.
Vape retailers are unable to use their own websites and social media platforms to communicate the benefits of vaping to customers. The barriers faced by online vape retailers are disproportionate and should be removed to allow effective communication with those attempting to stop smoking, which is critical, by switching to vaping. Compared with methods such as patches, which were used when as a county council leader I took part in the return of public health to local government in 2009 to 2013, vaping’s effectiveness is clear. We are in all seriousness talking about saving lives.
I declare an interest as the chair of The Gallaher Trust, which was set up half a dozen years ago in the wake of the closure of tobacco production in Northern Ireland. It was named after Tom Gallaher, a huge industrialist in Northern Ireland who created tens of thousands of jobs. Although the charity has absolutely nothing to do with the promotion, sale or development of tobacco—it is a skills development charity, of which I am an honorary and unremunerated chairman—I think it is important to put my interest on record, because of the association that people may draw from that.
I congratulate the hon. Member for Harrow East (Bob Blackman) on securing the debate. He has presented the arguments in the way that he always does, very persuasively. It is important that we have had a very good, healthy debate. It has showed that we are probably all on the same page. We want to get to the same finish line, but there are differences in nuance and in how we get there. I think it is important that we explore those differences and we try to get there in the best, most efficient and effective way.
Any tobacco control plan must be evidence-based, not based on emotions. Evidence is key. Innovations to support quitting smoking are crucial to the plan. We have heard something of the detail from the hon. Member for Rugby (Mark Pawsey) and others who are very keen that we develop innovation to ensure a systematic quitting of smoking. The evidence shows that high punitive taxation policies simply do not work. For someone growing up in a deprived society, whose parents have low wages, and where cigarettes—a lawful product in the local shops—are nearly £15 a pack, the temptation to purchase a pack for a fiver from someone round the local pub is huge and significant. The real thrust of any tobacco control plan must go hand in hand with a plan that addresses criminality. Aside from one or two vague mentions of criminality, that is what is absent from the plan.
We have to focus on criminality. We can tax this product until it squeaks even more, but unless we address the criminality that lies behind illegal product and illegal product sales across the United Kingdom, I am afraid that consumption rates will stay at a very high, stubborn level. I do not believe that there are fewer than 10 million smokers in the United Kingdom. I think that anyone who believes that is in cloud cuckoo land. Walk down any street in this city and count the first 100 people. I would say that in excess of 20 people on average are smoking. That is a rudimentary calculation. In other places it is considerably higher—in night culture, for instance. Let us face the fact that smoking consumption is probably at a much higher rate than the figures suggest. Therefore, all the punitive taxation policies that have been adopted by the United Kingdom—and they are the highest in the world—are not addressing the stubborn fact that people are continuing to smoke.
Let us pivot and get on to other counteracting measures. Where do those other measures rest? I believe there is a role for partnership with experts. Three things need to be done. We need to explore, develop and ensure that new products are brought to the market expeditiously. We need to engage a huge amount of effort in education, especially for young people and women. We need to make sure there is adequate, sensible and robust enforcement against criminality.
As has been mentioned today, there is a full range of new products already on the market to ensure that less harmful products are available to smokers, helping them to reduce their habit and get away from smoking. I applaud companies that have created e-cigarettes, nicotine patches, heated products and vaping, to encourage people away from the very harmful addiction to tobacco and nicotine. Those less harmful alternatives must be pursued and we must encourage their use, not discourage it. Indeed, the points that were made earlier regarding misinformation about those products should be addressed sensibly by central Government. There must be co-operation with responsible companies that want to make their lawful product and pay tax on it. That co-operation should allow research and development to happen, to enable them to get away from manufacturing the single product that they currently produce.
Some mention has been made today of the levy, and it was suggested that there should be a new levy on tobacco manufacturing companies. As I said earlier, we in the United Kingdom pay the highest taxes in the world on a pack of cigarettes—I think that 90% of what we pay for cigarettes goes to the Government—but that high tax has not solved the problem by reducing consumption. What happens is that people are driven towards buying unlawful products, thinking that that is a harmless activity. Many people who purchase cheap cigarettes think that they come over from mainland Europe in a white van and do no one any harm, but of course most of those products are illegally made. They are not made by the tobacco companies. What is inside those products is beyond tobacco and therefore, incredibly, they are even more harmful than cigarettes. People do not necessarily realise it, but selling those products is a huge and significant crime in our kingdom.
In the last number of years, over £1 billion-worth of illicit cigarettes have been sold in the United Kingdom. This is not a problem exclusive to Northern Ireland; in fact, we are the minority. This is a multi-million pound problem across the whole United Kingdom, and we have to get to grips with it as soon as we can. That multi-million pound crime syndicate needs to be broken up and destroyed.
Regarding taxation, in 2019-20 tobacco alone accounted for £11.25 billion of the Government’s revenues. However, if we set against that the criminal sales of tobacco, we see that the Government lost almost £3 billion in tobacco revenue. There is a huge gap that could be made up. On the point about a levy, if there was proper enforcement against the criminals, an extra £3 billion would be available—legitimately raised from legitimate sales—for things such as the promotion of education, research and development. Imposing another levy on the tobacco companies is lazy and would not address the problem of crime; indeed, that problem would continue to grow. Until we face up to that, we will keep coming back to this House—year in and year out, decade in and decade out—and inflating taxation but seeing consumption remain stubbornly high.
Let us address the real issue of properly attacking the criminals. In 2020, HMRC gathered an additional £1.4 billion through its border control activities. That was an untapped source of new revenue, which came about largely as a result of Brexit and having more control of our borders, but also because of the pandemic and the inability to travel to and from the continent to bring illegal products in. The Government were able to raise revenue under those circumstances. With a little bit of ingenuity, they could continue to raise that additional £1.4 billion in previously untapped sources by clamping down on gangs and gathering the revenue that the public are entitled to have gathered on their behalf; that is something that HMRC should do proudly.
As Members know, there is a £10,000 on-the-spot fine for criminals engaged in evasion of tax on tobacco. People might say that that is a very high fine, but it is not. A case of illicit cigarettes is worth hundreds of thousands of pounds in illicit sales to a criminal, and a van full is worth over £1 million. Why is the on-the-spot fine not something like £50,000 or £100,000, in view of the sums that the criminals make? For every van that HMRC captures, at least 20 or 30 get through, so let us make sure that we have proper enforcement. The high price of a pack of cigarettes simply encourages people, especially those with less disposable income, to purchase illicit products.
I understand the point that was made about the age limit, but if we are going to change the age limit for smoking, we have to look at the whole panoply of age limits across the United Kingdom—for alcohol consumption, driving, betting and smoking. It would be incredibly difficult to enforce different age limits rather than having a standardised one. If a 20-year-old tells a shopkeeper that they are 21 and they want to buy a pack of cigarettes, that would be incredibly difficult to enforce. Shopkeepers already find it hard to tell an 18-year-old from a 14-year-old in some circumstances.
Let us make sure that we have a standardised age for sales rather than different ages for different products. I do not think the Government are looking at that point, but it will no doubt gather momentum, because it seems to be an easy solution. None of these easy solutions work. Hard attacks against criminal enterprises are where we will make a significant difference.
We need to avoid the danger of virtue signalling—I am not saying any of that has gone on today; we have had a good, positive and practical debate—and move towards evidence-based solutions, including by encouraging companies to make less harmful product available to the public, by enforcing and controlling the legitimate enterprises of business and by ensuring that criminals are not allowed to get away with their multibillion-pound criminal enterprise. Otherwise, we should really go the whole hog and ban tobacco altogether in the United Kingdom. To achieve some of the goals that have been set out, that is where this debate has to be taken. It is not being taken there at present, but we need to get real on this.
It is a pleasure to serve with you in the chair, Mr Bone. I add to colleagues’ congratulations to the hon. Member for Harrow East (Bob Blackman) on securing the debate, and on his leadership on this issue in Parliament through the all-party group and beyond. He made an outstanding case in his opening speech and set the tone for a debate that will, I hope, be practical and impactful.
The hon. Gentleman characterised his all-party group as a critical friend. That is very much the case, and in that sense it is the best example of a parliamentary group. It has been very impactful, especially through its most recent reports, which I will borrow from liberally. I hope to continue in the spirit of cross-party support that he and my hon. Friend the Member for City of Durham (Mary Kelly Foy) have established. There is not much politics in this area, and I think the less politics, the better. This is a big prize for the nation’s health, and together we can find a lot of the solutions. The hon. Gentleman led the debate in that spirt.
My hon. Friend the Member for City of Durham is the leading Labour figure on this issue, as she showed during our very long proceedings in the Health and Care Bill Committee—you shared in a significant portion of those, Mr Bone. I thought her amendments were excellent and I was proud to support them. I had hoped that the Government would be minded to accept them, and the ideas are still good ones. The hon. Member for Harrow East has kindly offered the Minister another opportunity to do so during the next stage of proceedings on the Bill, and I dare say the noble Lords may offer similar opportunities. The Government need to pick up these ideas, the vast majority of which are very basic things on which I think there is complete consensus. I hope to hear from the Minister about some progress.
The hon. Members for Rugby (Mark Pawsey) and Northampton South (Andrew Lewer) made points about vaping. It is important to keep talking about vaping in debates such as this—if nothing else, about some of the misinformation that the hon. Member for Northampton South mentioned. Vaping does work as a quit aid. Of course, we do not want people to start, and we always need to say that. I am unable to recall by rote the phrase that the hon. Gentleman’s wife used, but I will sometimes take 95%, certainly when it comes to health. With the things that my constituents disproportionately lose their lives to, 95% seems like pretty good progress. I hope that that is part of the tobacco control plan, and that the Government focus on improving quality and standardisation in the market. From looking in shops, I know how difficult it is to find the same product twice. That tells us about the vagaries in that market, which could be greatly improved.
When the hon. Member for Strangford (Jim Shannon) was speaking, I was struck by the fact that much of what he said about Strangford could equally be said about Nottingham North. He could have said “Nottingham North” instead of “Strangford”, and we would have heard the same thing. Health is a devolved matter, and it is important to respect that, but I hope we can move forward, by consent, as four nations on this matter. That would resolve some of the issues around illicit tobacco mentioned by the hon. Member for North Antrim (Ian Paisley), as well as building public support and understanding. We would not want massive variances on this issue, so I hope we can reach a consensus.
I agree with the hon. Member for North Antrim that we need to be evidence-based and to promote innovation. In my view, the evidence strongly shows that tax works as a driver for reducing smoking, and it has done for consecutive decades. I am not blind to the increased risk of illicit tobacco and I am aware of it in my community, but I do not see this as an either/or situation. We can have a higher tax regime and be very serious about organised crime, and I would support that approach.
This is a really big prize for our country. As we have heard, 7 million people, or about 15% of adults, smoke, which has devastating consequences for illness and death. In 2019-20, more than half a million UK hospital admissions were attributed to smoking. We have made great progress over recent decades—that should be a point of great pride for all parties—and we have the lowest rates of smoking since records began. However, there must be a recognition that these gains are not equal, and I hope the Minister will say that that will be a focus for the next tobacco control plan.
Poor communities, such as mine, have benefitted less. In 2019, fewer than one in 10 professional and managerial workers smoked—that is well on the way to the smoke-free 2030 target of less than 5%—compared with nearly one in four workers in routine and manual occupations. That is a serious variance, and it is a big part of the reason why the life expectancy gap between the richest and the poorest has widened in recent years.
A child born in Nottingham today is expected to live for seven years fewer than one born in Westminster today. Looking at healthy life expectancy, rather than pure life expectancy, the gap is probably double that. If we were to tot up all the environmental factors involved, half of the difference is attributable to smoking. “Levelling up” is the phrase of the day, and this is a real levelling-up issue that I hope we can all coalesce around. That is reflected in the fact that three quarters of the public support the smoke-free 2030 ambition. As politicians we can see that, for once, the right thing is also the popular thing, which is rarely the case. We should take that opportunity.
In Health and Care Bill Committee debates, we explored these issues at length. I hope the Government will revisit the amendments that were proposed, and we will certainly be doing so. I hope the Minister will tell me that I am wrong and being uncharacteristically cynical, but I am anxious that we will not see a new tobacco control plan in the next six weeks. If that is the case, why not use the Health and Care Bill in front of us as a vehicle?
As the Minister is pulling together a tobacco control plan, I hope she will actively consider some of Opposition Members’ suggestions for that plan. First, there must be a resumption of the promotion of stopping smoking. Over the past 11 years, this Government have stopped evidence-based behaviour change campaigns, which have virtually disappeared. It is no surprise that quit attempts have reduced by a quarter. Such campaigns are good investments, and we have lost them from the public health grant. We need them to be returned.
I mentioned vaping, and that point has been well explored. We need access to stop smoking services, which have really good evidence bases on their impact. We know that they are most likely to be used by people in occupations where smoking remains stubbornly high, but we have lost them as the public health grant has been clobbered over the past decade. I know for an absolute certainty that any savings we have made there have been hoovered up by losses in the health service, and I hope we can do a bit better there. Three weeks ago, in the Budget, we did not hear about a reversal of those cuts in funding to public health, and that is really disappointing. However, if there is a financial issue here—as I say, I do not think there should be, because this should be seen as an investment rather than a cost—we can, as colleagues have said, help the Minister to pay for those services and still have some change left over for an uplift in the poorest communities through a levy based on the “polluter pays” principle. I hope that the Minister will mention that.
The hon. Member for Broxbourne (Sir Charles Walker) asked the hon. Member for Harrow East whether the tax system could be a way of promoting changes within the tobacco industry. I think that is exactly right. When I meet representatives of the tobacco industry—I know it is out of fashion these days, but I meet anybody who asks me to meet them—they all tell me that they want to stop selling tobacco products to people. The tax system is a really good way of making good on that, and of taking the eye-watering profits that come through the system and investing them in effective ways of stopping people smoking. That would be a very good thing for everybody.
In the meantime, however, let us close the loopholes in tobacco control. The first, as my hon. Friend the Member for City of Durham says, is that the packaging of e-cigarettes clearly shows they are being pushed to children. Secondly, hon. Members were shocked—although they should not be—that companies can give out vaping products to under-18s for nothing. That loophole is clearly outside of the spirit of the law, so let us do better there. The final point is about characterising flavours in tobacco, such as menthol. That should be a real problem for the Government, and indeed for Members of this House. The regulations that we passed had a clear intent, but they are being routinely circumvented to the point where, if hon. Members had their phones in front of them, they could find menthol products in seconds. This will not do, and it behoves the Government to come back to those regulations and make good on them, either by making them more effective or by promoting greater enforcement.
I know that colleagues are keen to hear the fullest response possible from the Minister, so I finish by reiterating Opposition Members’ support. I think we can do something really impactful here, and we should use this tobacco control plan to do so. The sooner we see a draft, the better, so we can begin that work.
It is a pleasure to serve under your chairmanship, Mr Bone. First, I thank my hon. Friend the Member for Harrow East (Bob Blackman) for securing this important debate and for sharing his personal story with us. I also thank members of the all-party parliamentary group on smoking and health for their tireless work on tobacco control, as well as the APPG on vaping for their work.
The UK is rightly recognised as a world leader on tobacco control. That is because it has invested in a range of interventions over the past two decades, including a strong regulatory framework that has led to, among other things, the introduction of standardised packaging, the end of tobacco displays, and protection from the harms caused by second-hand smoke. Thanks to those interventions, smoking rates in England are down to a record low of just under 14%. However, although we celebrate that success, there are still around 6 million smokers in England, and therefore there is more to be done.
I could not agree more with my hon. Friend. The burden of tobacco harms is not shared equally: smoking rates are far higher in poorer areas of the country, and among the lowest socioeconomic groups. Alongside the tragedy created by illness and early deaths, the NHS bears the heavy financial burden of £2.5 billion every year from smoking. In 2019-20, smoking was responsible for nearly half a million hospital admissions and around 64,000 deaths.
The Government have set the bold ambition for England to be smoke free by 2030. To support that ambition, we have been building on the successes of our current tobacco control plan. We will soon publish a new plan with an even sharper focus on tackling health disparities. That new plan will form a vital part of the Government’s levelling-up agenda and will set out a comprehensive package of new policy proposals and regulatory changes, to enable us to meet our smoke-free 2030 ambition.
We are, of course, carefully considering the recommendations of the all-party parliamentary group on smoking and health. Our new tobacco control plan will look to further strengthen our regulatory framework. We are exploring various regulatory proposals, including those put forward as amendments to the Health and Care Bill. We will conduct further research and build a robust evidence base in support of such measures, and will include the strongest proposals in the new plan.
One continuing concern is that one in 10 pregnant women are still smokers at the time of delivery, which is something that the Government are determined to tackle. The maternity transformation programme contains some important measures, and we have made a commitment under our NHS long-term plan that pregnant mothers and their partners will be offered NHS-funded treatment to help them to quit. I know that issue is close to the heart of my hon. Friend the Member for Harrow East. Our new plan will continue to have a strong focus on pregnancy and will encourage more innovation and new approaches to help mothers to quit.
The evidence is clear that e-cigarettes are less harmful to health than smoking. It remains the goal of the Government to maximise the opportunities presented by e-cigarettes to reduce smoking while managing any risks. Our regulatory framework enables smokers to use e-cigarettes to help them to quit, but we do not want to encourage non-smokers and young people to take up those products. In the current tobacco control plan we have actioned the MHRA to help bring medicinal e-cigarettes to the UK market. On 29 October, the MHRA published updated guidance to encourage manufacturers to do so.
Stop-smoking services remain at the heart of our tobacco control strategy, producing high quit rates of 59% after four weeks. Since 2000, they have helped nearly 5 million people to quit. We have protected the public health grant over the course of the spending review, to ensure that local authorities can continue to invest in stop-smoking services and campaigns specific to their areas. We will continue to support local authorities to prioritise those services.
The UK has been recognised as a global leader in tobacco control. We are proud to be a member of the World Health Organisation framework convention on tobacco control. My officials played an active role in the ninth conference of the parties—COP9—last week, and reaffirmed our commitment to deal with the global tobacco pandemic. It was a robust meeting, with more people attending than ever. In my video statement to COP9, I set out the UK commitment to having comprehensive tobacco control policies, including a strong regulatory framework for e-cigarettes. Our commitment to the WHO FCTC is further demonstrated through the overseas development funding we contribute to the FCTC 2030 project, which is now entering its sixth year. That project directly supports the implementation of the WHO FCTC in 31 low and middle-income countries, helping to reduce the burden of death and disease from tobacco.
I will now address some of the issues raised by right hon. and hon. Members. My right hon. Friend the Member for South West Wiltshire (Dr Murrison) talked about restrictions imposed during covid. Covid has highlighted the health disparities across the country. Our ambition to be smoke free by 2030 will play a major role in tackling those disparities. I would like to reassure my hon. Friend the Member for Harrow East that I am conscious of the urgency of the publication of the tobacco control plan. However, I am determined that the plan will have robust and effective measures. He also highlighted measures that the APPG would like to see included. Along with my officials, I am looking carefully at each measure put forward.
Tobacco taxation was raised by my hon. Friends the Members for Harrow East and for Broxbourne (Sir Charles Walker), as well as the hon. Member for North Antrim (Ian Paisley). That is a matter for Her Majesty’s Treasury. However, the Department continues to work with HMT to assess the most effective regulatory means to support the Government’s smoke-free 2030 ambition, which includes exploring a potential future levy.
I am a bit short of time.
On raising the age from 18 to 21, we know how important the period between the ages of 18 and 21 is for those who may experiment with tobacco. We will include a focus on protecting young people and adults from the harms of tobacco within our tobacco control plan. As I have already indicated, I am ambitious for our new plan.
On the Health and Care Bill, at this stage we do not feel that it is the right Bill for the suggested measures without a full assessment. Members should rest assured that they will be fully considered as the tobacco control plan is finalised.
The hon. Member for City of Durham (Mary Kelly Foy) and my hon. Friend the Member for Rugby (Mark Pawsey) asked about the post-implementation reviews. The Department will publish its response in the coming months. I make no excuse for the delay. We had more than 5,000 responses to that review, and that was coupled with the pressures that my Department has experienced on covid-19. I reassure colleagues that it is on our agenda and we will publish in due course.
The hon. Member for City of Durham also asked about the investigations into menthol. The Office for Health Improvement and Disparities is investigating a range of cigarettes to determine if the flavour of menthol is noticeable. Once that study is complete, we will explore whether further action is needed against companies that have breached regulations.
My hon. Friend the Member for Rugby asked a number of questions. I understand that the ONS will publish smoking prevalence data for 2020 next month.
As I have already said, COP9 was one of the best attended conferences of the parties so far. I understand that there was a real buzz and an appetite to address the harms from tobacco and implement the framework convention on tobacco control, which I am sure will be welcomed by everybody in the room.
My hon. Friends the Members for Rugby and for Northampton South (Andrew Lewer) spoke about e-cigarettes. The Government are clear that we only support the use of e-cigarettes as a tool for smokers who are trying to quit, not as a route for people to take up smoking by another means. Our approach to e-cigarettes has been and will remain pragmatic and evidence-based.
My hon. Friend the Member for Northampton South talked about the environment that those who are attempting to quit find themselves in. Vaping is not covered by the smoke-free legislation. It is down to individual businesses to determine how they consider the guidelines.
I extend my thanks to hon. Members for their participation in today’s debate. It has been very constructive and there is clearly cross-party support. I reiterate the Government’s commitment to a smoke-free 2030. As we build back better from the pandemic, our aim is to make smoking truly a thing of the past and level up society.
I thank my hon. Friend the Minister for her reply. I also thank the Opposition Front-Bench spokesperson for his strong support. I thank every colleague who has participated in the debate. We all share the same view: smoking must be eliminated and we must get to a smoke-free 2030. All the advancements in legislation on this subject have come from the Back Benches, and they will continue to come from the Back Benches. If the Government refuse to act, we will continue to press further.
In answer to the hon. Member for North Antrim (Ian Paisley), the “polluter pays” principle is key. When we raise tobacco tax at the point of delivery, the individual who smokes pays, but if we continue to tax the profits, we can pass the benefits on in terms of prevention. I thank colleagues for their contributions today. We have had a very good debate. No doubt the debate will continue, on both the Health and Care Bill and other measures.
Question put and agreed to.
That this House has considered the delivery of the Tobacco Control Plan.