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Smoke-free England

Volume 711: debated on Tuesday 29 March 2022

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

I beg to move,

That this House has considered progress towards a smoke-free England.

I will start by reading a couple of paragraphs from an excellent Government document published in July 2017, entitled “Towards a smoke-free generation”. I will not detain the Chair too long, but there are a few sentences that I want to read into the record. The document says:

“Over 200 deaths every day are still caused by smoking…Smoking rates have remained stubbornly higher amongst those in our society who already suffer from poorer health and other disadvantages. Smoking rates are almost three times higher amongst the lowest earners, compared to the highest earners…Smoking accounts for approximately half the difference in life expectancy between the richest and poorest in society. This injustice in the variation in smoking prevalence can be seen across England; from places where adult smoking is as low as 5% to others where smoking remains above 25%. The prevalence remains even higher in people with mental health conditions, where more than 40% of adults with a serious mental illness smoke. We want to address this. Our vision is nothing less than to create a smokefree generation…the government will provide leadership and guidance on the most effective interventions.”

There we have it: a bold statement of intent. So what does a smoke-free 2030 look like? First, it is not smoke-free. When we talk about a smoke-free 2030, we are actually talking about 5% or less of the adult population smoking—that is recognised by The Lancet. Currently, more than 14% of the adult population smoke, and it could actually be higher than 14%, because lockdown may have increased the prevalence of smoking as people turned to cigarettes as a way of releasing and relieving stress. Cancer Research UK is not optimistic about the 2030 date, which will not come as a surprise to anyone here. Its best guess is that 2037 is when we will achieve 5% or less, and I am afraid the general view is that 2037 now looks optimistic.

To put it in context, what is 200 deaths a day? That is 75,000 deaths a year and, on top of that, 500,000 admissions to hospital every year for smoking-related illnesses. Over 10 years, 750,000 people will die from smoking. That is approximately the population of Birmingham every 10 years, and 5 million people will be admitted to hospital.

The Government touch on the huge disparities in smoking between richer and less well-off areas. In some of the most deprived wards in seaside towns in the north-west, smoking rates are above 22%. In the leafy parts of Surrey, they are less than 5%—in essence, parts of Surrey have achieved smoke-free status. What does 22% versus 5% look like? That translates into about an eight-year differential in life expectancy. Of course, not all that eight-year differential will be linked to smoking but, as the Government identified in their report in 2017, about 50%—four years—of that differential will be linked to the fact that more people smoke in more deprived areas than wealthier ones.

Look, the Government have made great strides. I will not be churlish with the Minister—I would not be churlish with her, because she is a very nice woman and she is very committed to this cause, which is more important than being nice.

I understand that a pack of cigarettes now costs more than £10, although that is not something I have bought for 17 years. Some might be pushing £14, so this is becoming an expensive habit. Even at that price, 14% or more of the population are smoking. We are down to some really tough nuts to crack, if we want to reach that 5%. I remind the Government of the part of the report entitled, “Backing evidence-based innovation”:

“Despite the availability of effective medicines and treatments to support quit attempts, the majority of smokers choose to quit unassisted, by going ‘cold turkey’. This has proved to be the least effective method…The best thing a smoker can do for their health is to quit smoking. However, the evidence is increasingly clear that e-cigarettes are significantly less harmful to health than smoking tobacco. The Government will seek to support consumers in stopping smoking and adopting the use of less harmful nicotine products.”

I congratulate the hon. Member on this Adjournment debate. He may know that I have never smoked, but I am a strong advocate of vaping. Does he agree that, if the Government are serious about reducing smoking prevalence, they must ensure that medical professionals have access to the latest evidence on e-cigarettes and are encouraged to signpost patients to appropriate guidance about harm reduction, as well as information about how to switch successfully, if they cannot quit?

Of course, I agree with and endorse what the hon. Lady said—on this occasion, let me call her my hon. Friend—because what we are talking about today is harm reduction.

Let me read two more sentences, from page 15 of the report, which I am sure will be of interest to the hon. Lady:

“The Government will therefore continue to evaluate critically the evidence on nicotine-delivery products, providing clear communication about what is known and unknown about the short and long-term risks of using different products relative to smoking and the absolute risk to children, non-smokers and bystanders.”

Remember that that was written five years ago, so there has surely been time to do this.

What I do not understand is why the Government are so squeamish when it comes to looking at harm reduction. The hon. Member for North Tyneside talks about vaping, but there are nicotine pouches, “heat not burn” products and something called snus, which I understand is used in parts of the world. Before we cast these alternatives aside, let us remember that they reduce the harm caused to the user. There is nothing more harmful than smoking burnt, lit, combustible tobacco—nothing. Sweden has taken an enlightened approach. It has embraced science and looked at harm reduction. Smoking rates are now well below 10%, and some independent experts reckon they are nearer 7%. It looks like Sweden is going to be the first country in Europe to meet the magical 4.99% and be a smoke-free European country.

I am concerned that we are not going at this problem as hard as we should as a nation, but there is hope, which I am sure the Minister will refer to in her speech. There is the independent review of smoke-free 2030 policies, led by Mr Javed Khan OBE. The review offers reasons for optimism. In its objectives it states:

“The review will make a set of focused policy and regulatory recommendations in 2 areas, and will consider…the most impactful interventions to reduce the uptake of smoking, particularly among young people.”

It will also consider

“the top interventions to support smoking cessation, particularly in deprived areas of England where there are significant health disparities”.

That sounds like a call to arms. On outputs, the review says:

“The review will provide a far-reaching report focused on the key policy and regulatory recommendations that give the government the best chance of achieving the Smokefree 2030 ambition and addressing the health disparities associated with smoking.”

Can I make a plea to the Minister and her Department? This issue is harm reduction. It is about reducing the 75,000 deaths a year. It is about reducing the 500,000 people who go into hospital. It is not about banishing nicotine.

In a perfect world, nobody would even chew nicotine gum, but the fact is that they do. We do not live in a perfect world. People become addicted to nicotine, and it becomes part of their day. It is far better to consume it in a way that offers a much lesser chance of either shortening someone’s life or putting them in hospital. Let us use the regulatory and tax environments to differentiate harms, so that the highest harm is combustible tobacco and we can gradate the level of harm going down. We can use the tax system to signpost people to the least harmful nicotine product.

I would like to conclude by saying one thing. Levelling up has to mean reducing the disparities in people’s life expectancy. One of the greatest disparities is in those who suffer from a diagnosis of psychosis/schizophrenia. By the Government’s own reckoning, 40% of people with the diagnosis—possibly more—smoke. I know about this because I have been deeply involved in the issue of mental health since I entered Parliament 17 years ago. Smoking is often linked to the treatments used to help people with psychosis/schizophrenia—sadly often still called the chemical cosh. The treatments tend to enhance appetite, so people experience massive weight gain. They also tend to depress the person in receipt of the medications, which drives them to smoking. On average, if someone has a diagnosis of psychosis/schizophrenia, their life expectancy is reduced by 15 years—the Government say in their document that it is between 10 and 20 years. This is a real issue for so many people. This is not a “nice to have” harm reduction; it is an absolute necessity. I thank you, Ms Rees, and the Minister for allowing me to make the case for harm reduction today.

It is a pleasure to serve under your chairmanship for the first time, Ms Rees. I am not sure I can be as passionate as my hon. Friend the Member for Broxbourne (Sir Charles Walker), but I am convinced that we in the UK are standing on the brink of a huge opportunity to get this right in the very near future. Some 3 million people vape today, which is wonderful compared with 3 million people smoking, and approximately 6 million, maybe 7 million, continue to smoke. As my hon. Friend has pointed out, that leads to 75,000 deaths a year, or 200 people every single day. The number of people who have died from vaping is zero. So when we look at the plain stats on this, we can ask, “Do we want 200 people per day to continue to die through smoking rates continuing as they are, or do we want to have zero people dying per day?” My answer to that is pretty clear.

There is some good news, which I will come to in a moment. I have great respect for the Minister; I know she has heard these arguments many times before, and she always takes them with such grace, but I will go through a couple of negatives before I come to the positives—I am equal to my hon. Friend in my optimism for the future.

I chair the Parliamentary Office of Science and Technology, a fantastic, impartial organisation that produces science briefings for parliamentarians and their research staff. We produced a POSTnote on electronic cigarettes,. In 2013, only one in 20 people thought that vaping was as harmful as smoking. That was really encouraging, but in 2016 we observed that about one in four people thought vaping was as harmful as, if not more harmful than, smoking. We have been going backward, and today about 53% of people think that vaping is as harmful as smoking. Something is very wrong when the information flow has reversed in such a short space of time for something that was only introduced to the UK about 15 years ago, so we really need to get a handle on that problem.

There is a simple test when it comes to smoking. Lots of people say, “Oh, I like smoking. I wish we had the freedom to smoke,” and I agree entirely: you can kill yourself with your own poison, and that is fine by me. However, when a smoker is asked, “Would you like your children to smoke?” the answer is always, “Oh gosh, no. I would want them to have them the freedom to do it, but I would really rather they didn’t.” I have tried this, and it says an awful lot. It says that smokers—I was one—do not want to smoke; they stumbled into it in their youth or at a time when they thought they would be able to escape from its clutches. The truth of the matter is that nobody really wants to smoke.

With vaping, snus, and non-combustible tobacco, which may be more harmful than vaping, but is nowhere near as harmful as smoking, we have a huge opportunity to embrace newer technologies and approaches, and I know the Minister is keen to do so however she can. I agree with my hon. Friend the Member for Broxbourne that harm reduction is the key here. Why have 200 people dying per day when we could have zero dying per day? Why hold on to the idea that anything we can do to move people from smoking to vaping, snus or one of those other products should be slowed down in any way?

On balance, I am quite optimistic for the future. I am optimistic because the Minister is in her post, but also because the Javed Khan review appears to be going in the right direction. It appears to recognise that we cannot let the perfect be the enemy of the very near perfect, which vaping appears to be at this stage. Also, whether we voted remain or leave, we are now outside the strictures of the European Union and its directives. We have full autonomy and full power to head in any direction we choose, and I ask for that direction to be informed by the evidence, the data, the science, Javed Khan’s review, and what is self-evident before our very eyes—that people do not die from vaping, full stop.

I am also optimistic because we have a couple of other opportunities. We have the opportunity as a Government—the UK Government—to direct a little bit of funding at research, because there are some unanswered questions about the long-term effects of vaping and these other products. We could direct or nudge a little bit of research funding in that direction. It would not cost a fortune. A small amount could be dedicated to a longitudinal study of the outcomes. I think that such a study would put the final few sceptical academics’ minds at rest—or not, as the case may be—when we got the results.

This morning I was at a meeting on this subject with Demos, which is producing a study of this issue and some recommendations for policy. One message that came through loud and clear from the healthcare professionals was, “Give us the opportunity to try this, at least in a limited way, maybe in a limited area or perhaps just with pregnant women, because it is very clear that vaping is far better than smoking during pregnancy. Give us an opportunity, maybe in a restricted location, a particular area or with a particular demographic, to try the approach of switching people to vaping, and let’s see if that works better than trying to get them to stop smoking during pregnancy or in any other circumstances that they are in.”

There is another wonderful opportunity here. This is bizarre—absolutely bizarre—but I love to say that, bizarrely, the tobacco industry in the west is behind switching to vaping. I say to the Minister that actually the industry is ready to put its hands in its pocket and pay for a lot of this work, which is absolutely extraordinary. I think the industry recognises that its business model will not continue to succeed in the west, including in the UK, and we should be mindful that it is prepared to put its hands in its pocket to help the transition—not for altruistic reasons, of course; it will be because the industry is switching its business model more towards non-combustible and vaping products. It may also be because some of the cigarette manufacturers would like to look in the longer term at these inhaling systems as a way to deliver medicine—not smoking or vaping, but delivering all sorts of other products. The tobacco industry has a profit motive, but this is the first time that I have known it to be potentially aligned with UK policy and we should certainly take advantage of that.

I could go on for ever, but I will not do so. What I would say in summary is this: do not let the perfect be the enemy of the good. It is a really good thing to do to push in this direction. There is very little pushback from anywhere. I plead with the Government to consider the information flow as part of the judgments that they will make in the near term, because if more people today than in 2016 think that vaping is more harmful than smoking, then clearly something is very seriously wrong with the information processes.

I have a last question, which basically is: how do we get to smokers? We might think, “Oh, we don’t want to advertise these things online and on television.” Well of course not; we have to keep children and advertising to children out of the mix when it comes to these products. There is a really simple way to get to smokers though: every single smoker has to open their box of cigarettes, so have something inside the box. It is really simple and it only targets those people who continue to smoke, so let us get on with it.

Minister, thank you very much for listening. Sir Charles, thanks for calling this debate, and thank you, Ms Rees, for calling me to speak.

First, I thank my hon. Friend the Member for Broxbourne (Sir Charles Walker) for calling this important debate. I am grateful to him for his contribution and I am grateful to other Members who share the Government’s ambition for Britain to be smoke-free by 2030. My hon. Friend is correct when he says that that means 5% of people smoking, but it would still be a great achievement to get from where we are now to just 5%. The UK is a world-leader on tobacco control and we now have one of the lowest smoking rates in the world. According to my records, only 13.5% of people in the UK smoke, but that percentage is still too high. As he stated so passionately, the Government know there is still so much more to do.

We know that there are still around 6 million smokers in England and that smoking remains the single biggest cause of preventable mortality; two out of three long-term smokers will die from smoking. We also know that smoking is one of the largest drivers of health disparities and that the burden of tobacco harms is not shared equally. Smoking rates are far higher in poorer areas of the country, as my hon. Friend said, and among lower socioeconomic groups. We can see smoking rates of 23% in more deprived areas, compared with rates of 8% in wealthier ones. In addition, one in 10 pregnant women still smoke, increasing the risk of health problems for their babies. Smoking prevalence among people with long-term mental health conditions is also far too high, at over 25%.

My hon. Friend the Member for Windsor (Adam Afriyie) raised the issue of smoking during pregnancy. The decline there has not fallen in line with other groups, so we know that more needs to be done. We continue to explore options to support smoking cessation in pregnant women; those options will be set out in our tobacco control plan and they are also part of our NHS long-term plan. We know that it is not just the woman who needs support; it is her partner as well. We must continue to help those groups in all the ways we can.

What are we doing? In 2019 the Government set the bold ambition for England to be smoke-free by 2030. To support that, we have been building on the successes of our current tobacco control plan, and later this year we will publish a new plan with an even sharper focus on tackling health disparities. The new plan will set out a comprehensive package of new policy proposals and regulatory change. To help push those ambitions forward, the Government have commissioned an independent review of our tobacco control policies, led by Javed Khan, the former CEO of Barnado’s. The review will assess the most impactful interventions to help us achieve our goal of being smoke-free by 2030. I know that Javed Khan has some really ambitious ideas that I am sure my hon. Friend the Member for Broxbourne will welcome.

More needs to be done to prevent young people from taking up smoking and to protect our future generations from its devastating harms. More also needs to be done to support current smokers to quit, especially in deprived communities and among the priority groups. Smoking, and the grip it has on our society, must become a thing of the past. I am confident that the Khan review will give us the focus and political support to do so. I encourage all hon. Members to contribute to the review so that we can hear as wide a range of views as possible. We are open to bold new ideas about how to reach our smoke-free ambitions. Hon. Members have talked about the role of reduced-risk products. The Government are supportive of smokers using less harmful nicotine delivery systems to quit or switch away from the most harmful form—combustible tobacco.

This week is the beginning of VApril, which is a campaign run by the industry to support smokers who are looking to quit. Would the Minister support efforts to encourage adult smokers to quit by speaking with local authority stop smoking services, this month in particular, and highlight the role of e-cigarettes in reducing harm?

The hon. Lady—I will call her my hon. Friend—speaks passionately about vaping, and we have had those conversations before. We know and acknowledge that reduced-risk products are not risk-free, but vaping is a way to help people stop smoking and it has been proven to be effective. We must continue to ensure that the products do not appeal to young people and non-smokers—that is really important. However, we need to get the message out that vaping is an effective way to stop smoking. Balanced and proportionate regulation is required as we shift to different products. We have an innovative and varied nicotine market in the UK, as has been mentioned; vapes are by far the most popular alternative source of nicotine, but there are also patches, gums and, more recently, nicotine pouches.

We want to see more smokers using vapes to quit, which I know is in line with the wishes of the hon. Member for North Tyneside (Mary Glindon). She mentioned earlier the possibility of vaping and e-cigarettes being available on prescription, and the Secretary of State has spoken of his desire to see those products routinely prescribed by the NHS. That is something that we need to move forward with. My hon. Friend the Member for Windsor raised the important issue of the perception of vaping and how it has changed. That is something I will take away and consider.

The Minister talks about the range of alternative products, such as vapes, “heat not burn” and other things that already exist, and about the statistics on people’s perceptions of the health impacts of those products. We know that those products are less harmful, so does she agree with what my hon. Friend the Member for Windsor (Adam Afriyie) said about the importance of getting that information our to people—even if it is as simple as a slip of paper in a cigarette packet? I like to think that a Conservative Government, rather than seeking to ban things, could empower people to make that choice through information. We could certainly do more to get that information out there.

My hon. Friend is quite right. It is important that we communicate the other ways people can stop smoking and, as the hon. Member for North Tyneside said, do so in such a powerful way. As Members of Parliament, we all have a role in getting those messages out, and I am sure that everybody in this room will be doing their bit in VApril to get that message through to the public. It is about messaging and about people understanding the impact smoking has, not just on their lives but on other people’s lives as well.

I am also aware of the desire to bring snus to the UK market to give smokers further choice of less harmful alternatives. Considering the range of alternative nicotine products that can be accessed by smokers, the Government are not currently minded to introduce a new tobacco product to the UK market. Current alternative products such as nicotine pouches deliver nicotine in an identical way to snus but do not contain any tobacco. We will continue to consider the evidence around snus and we welcome additional non-tobacco reduced-risk products to the UK market.

I thank my hon. Friend the Member for Broxbourne again for calling this important debate and for hon. Members’ interesting contributions to the discussion. We have packed a lot into 30 minutes. I hope to be able to tell the House more in the coming months about the specific policies that will deliver our ambitious agenda for a smoke-free England. The end is in sight through a sustained and multi-pronged approach. I hope we can look forward to a future for our children without the death and misery that is caused by smoking.

Question put and agreed to.

Sitting suspended.