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London Health Commission: Smoking

Volume 758: debated on Thursday 15 January 2015

Question for Short Debate

Asked by

To ask Her Majesty’s Government what plans they have to support the recommendations of the London Health Commission with regard to combatting the impact of smoking on health.

My Lords, in opening the debate, I declare my interests as in the register. Over the past year, I had the privilege to chair the London Health Commission at the request of the mayor, Boris Johnson. I express my thanks to the mayor for giving me the opportunity to do so. As a politician, the mayor took a brave step by establishing an independent commission, tasking it with examining the evidence and giving my fellow commissioners and I the freedom to make the right recommendations for London.

I also express my thanks to the thousands of health and care professionals and Londoners who contributed to the commission. They were generous with their time and their ideas. The work of the commission and the report, Better Health for London, are the expression of the passion and the ambition that Londoners have for better health. London can be the healthiest major global city. As our nation’s capital, London should be a leader and set an example for other cities in Britain. London should not be an exception, and the proposals set out by the commission could, and indeed should, apply to other cities in our country.

We all want to lead healthy lives. Our health is determined by all different parts of our lives—what we eat and drink, whether we choose to smoke or drink and how much, how we travel to school or work, and how we choose to spend our leisure time. Yet we can lead healthy lives only by working together to improve health—schools, employers, charities and voluntary groups, local and regional government, transport, the NHS and, above all, individuals and families. We each can choose to invest in our own health and we can help each other to choose better health.

At the heart of the commission’s vision of a healthy city lies a very simple idea: making healthy choices should be easier. Making those choices easier requires action from us all. The healthiest choice is not always easy or obvious. Every day, we make hundreds of choices that affect our health: how we get to and from school or work, what we choose to eat and how we spend our free time. The goal is to make each of those millions of individual choices that little bit easier, because in that difference is everything: making small changes individually will make a huge difference collectively.

Smoking is one of the worst choices for health. Every year, in London alone, about 8,000 people die prematurely due to smoking and more than 80,000 people die prematurely across the country as a whole. The consequences of smoking cost society as a whole at least £2.7 billion a year. Smoking does not simply cause an earlier death; it causes poorer quality of life. Tobacco does enormous harm to health and limits life’s possibilities. Tragically, about 45% of cigarettes that are smoked are consumed by people with mental illness, contributing to life expectancy that is 10 to 15 years shorter than in the population as a whole.

Hundreds of children take up smoking every week—two classrooms’ full a day. With advertising outlawed, they do so inspired by the adults they see. Once they start, they continue, as cigarettes are more powerfully addictive than narcotics. It is little surprise that in places where more adults smoke, more children begin to smoke as well.

Just as smokers’ lungs are polluted, the lungs of our city—our parks and green spaces—are polluted by smoking. London should lead the way for Britain, and the mayor should lead the way for London by acting to make our public spaces smoke-free. Our parks and green spaces account for nearly 40% of the capital, the equivalent of 20,000 football pitches—imagine that space completely smoke-free. I also believe that Trafalgar Square and Parliament Square should be rid of smoking. It would be a powerful message for the iconic centre of our city and the political heart of our country to become smoke-free. Indeed, such a measure would make our capital and our country an exemplar for the world.

Many noble Lords will have seen the launch of the commission’s report last October, when the mayor and I played a game of football with a classroom of schoolchildren. Of course, noble Lords may have seen it for all the wrong reasons, as it featured the rather entertaining sight of the mayor fouling a nine year-old boy. What was so striking was what the children had to say, not about the foul, but about making parks smoke-free. They were universally stridently in favour of the idea. They were far better advocates than I. One said, “It’s horrible when people come and smoke where we are playing football. I hate it”. Another said, “They leave all their cigarette ends on the floor”, and another young child said, “It’s really disgusting. I wish they wouldn’t do it”.

That is what London schoolchildren think. Making parks smoke-free will not only help smokers to make better choices by reducing the opportunities to smoke, it will help children to make the right choice to never start smoking. Yet this is more serious than childish debate. The question of making parks smoke-free exists precisely at the boundaries of the proper role of the state. I understand and I acknowledge that different people will hold different beliefs. Our parks are public. They are shared spaces that we should enjoy together. We already accept some limitations on our actions within them. There are restrictions on letting dogs foul, dropping litter or consuming alcohol. I believe that our parks should be spaces that promote healthy behaviour, such as exercise.

As a cancer surgeon, I see the pain and suffering of people afflicted by smoking-related diseases, as well as that of their friends and families. True compassion for their experience lacks authenticity if it is not joined with resolute action. I have not come across a single patient who did not wish that they had never smoked. I contest the notion that it is a question of liberty. Cigarettes are more powerfully addictive than narcotics, as I said. There is no freedom in addiction. Indeed, addiction is the antithesis of freedom. I have always been struck by that great revolutionary rallying call, “Give me liberty or give me death”. The advocates of smokers’ rights are generous enough to give them both.

I have no doubt that parks will become smoke-free by the end of this decade. Thirty years ago, it would have been unthinkable that pubs and restaurants would be smoke-free. Today, it is unthinkable that we would ever return to smoking indoors. The 2007 smoking ban was a major achievement of the previous Government and the present Government have continued the good work with new measures to control advertising at the point of sale and to stop smoking in cars with children. These measures are very welcome and I applaud the Government for having taken them. None the less, it is vital that the work continues.

As part of the work of the commission, we examined cities around the world that have made progress in the fight against smoking. New York City has famously led the way. Noble Lords who have visited New York recently will know that Central Park and all the city’s parks are smoke-free. Today, significantly fewer New Yorkers smoke than Londoners. The lesson of two decades of pioneering tobacco control in New York is that the fight must be sustained with new measures and initiatives. When it is not, smoking rates creep back up again. For that reason, I urge the Government to progress their plans for plain packaging of cigarettes in a timely manner so that the regulations are made within this Parliament. If they do, they will surely be saving lives. With the election so uncertain a few months from now, Ministers, Members of the other place and noble Lords can proudly know that they will have saved lives. Other than the protection of corporate interests, I can see no earthly reason to protect the brand value of tobacco.

As I close, I encourage noble Lords to take a moment to read the findings of the commission. I am an advocate for smoke-free parks, yet the report presents a broader range of measures to make our capital the healthiest major global city. Progress for better health can be made only through bold aspirations. I thank noble Lords for their contributions today and for demonstrating their commitment to better health for all the people of this land.

The question before us this afternoon is contained in the report of the London Health Commission, chaired by the noble Lord, Lord Darzi, which says under the headline “Smoke free London”:

“Each year, more and more Londoners are choosing to quit smoking, improving and lengthening their lives”.

To my mind the question is: will the banning of smoking in parks and green spaces actually result in a reduction in smoking or not?

It will not surprise colleagues that I had a quick look at what has happened in Australia on plain packaging. The policy has been in existence for two years there. The targets were to reduce youth smoking, to reduce overall smoking rates and to increase the effectiveness of health warnings. Yet the evidence from the Australian Government after two years is that youth smoking has not declined; it has grown to reach a seven-year high. Plain packaging has had absolutely no effect on the sales of legal tobacco or on adult smoking and the imports of illegal tobacco have grown, which is perhaps a side issue. That shows that if we are influenced by modern policy which is not based on science, we are going to find that we are wasting our time.

First, as regards the situation here, we are not talking about the direct effect on people’s lungs from smoking; we are talking about second-hand smoke, otherwise known as environmental tobacco smoke or ETS. This is in two parts: it is a mixture of exhaled mainstream smoke and side-stream smoke released from a smouldering cigarette and diluted by the ambient air. It is not the same as smoke inhaled by a smoker. So what are the risks? Some scientific work has been done—one lot in Egypt, for which I am happy to provide noble Lords with the source, and the other one in Boston where Professor Michael Siegel of Boston University’s School of Public Health says:

“No evidence demonstrates that the duration of outdoor exposure in places where people can move freely about is long enough to cause substantial health damage. … In trying to convince people that even transient exposure to second-hand smoke is a potentially deadly hazard, smoking opponents risk losing scientific credibility”.

We must be very careful here in Parliament that we do not undermine the scientists.

Secondly, if this did happen, what effect would it have on London’s tourism? On the front page of today’s Evening Standard the figures are pretty stark. Tourism is vital to the success of London. A record £3.56 billion is spent by tourists over the three-month summer period and £8.9 billion over nine months, with tourism up by 6.6%. I suggest that what tourists like to do is go to the park, have a break, maybe have a drink because they usually have a backpack with them, and have a smoke. If that smoking is not going to undermine our smoking policy, tourists will not be allowed to smoke in green parks and that will put them off. Or, if this policy does come in, it will result in people smoking in doorways, which we know is a terrible nuisance for those people who are working and going in and out of these doorways.

There are some things that can positively be done. I used to be the leader of the London Borough of Islington. There are things that local government can do. A number of local authorities are doing some very good work, putting money into the provision of publicity targeted at encouraging people to cease smoking. If we could spend money on that, I am willing to bet that would be far more effective than banning smoking in parks. We can use the existing police community support officers’ legislation to make sure that any smokers aged under 16 are marched out or told to stop. We can improve the provision of public refuse facilities. We have moved on from that era where you could not hand in anything. There are facilities now, although they could be improved. And finally, we can amend the law to enable the provision of indoor ventilated smoking rooms in pubs, as in other parts of Europe. That will keep the smokers away from doorways and gardens. So I ask my noble friends to think again. This will not work and it will deter the tourists.

My Lords, I think that the noble Lord, Lord Naseby, will find that he is a lone voice in this debate. I will not attempt to counter all the points, but when he comes to reply, perhaps the Minister will have something to say about the so-called evidence adduced from Australia, which so far as I am aware has been produced only by the tobacco industry itself. It funded the research. Perhaps the Minister will be able to confirm that.

I shall start by congratulating my noble friend Lord Darzi on securing the debate and on contributing to a brilliant report which, if it is implemented, will help London set the lead for all of us to lead healthier lives in the future. I agree with absolutely everything he said in his speech.

As a direct result of the measures taken by Parliament, and particularly in this House, the UK is now a world leader in tobacco control legislation. Smoking by people aged 16 years and over has reduced over the past decade by more than a fifth, from 26% to under 20%. As a result, there are almost 2 million fewer smokers than a decade ago. Your Lordships will recall that all the tobacco control measures contained in the Children and Families Act 2014 began their lives not in the House of Commons but in this Committee Room, and were the subject of amendments proposed by Members from all parties. Three of them are here today, and I am delighted to see that the noble Baroness, Lady Finlay of Llandaff, is to speak and that the noble Baroness, Lady Tyler of Enfield, has joined the debate. It was to the Minister’s great credit that he accepted the principle for adopting standard packaging for tobacco products here, and he graciously responded to the defeat in the House on smoking in cars when children are present by ensuring that the House of Commons was given the opportunity to vote on it too. I understand that the regulations to give effect to that will be with us shortly.

However, like my noble friend Lord Darzi, I am concerned that there seems to be some doubt about the Government’s resolve on standard packs. My understanding is that to ensure that Parliament is allowed its say before the general election, the Government must ensure that regulations are laid this month so that they can go through parliamentary scrutiny by the Joint Committee on Statutory Instruments and the Secondary Legislation Scrutiny Committee in time. I really hope that the Minister will be able to confirm today that this is their intention. To delay a vote on standard packaging until after the election would be seen by the tobacco industry as a significant victory and would seriously damage the Government’s credibility on health issues.

The case for standard packs is simple. Cigarettes are the only legal products sold in the UK that kill their consumers when used exactly as the manufacturer intends. No company should be allowed to promote such a product through advertising and marketing. Thanks to our efforts here and those of the public health community, packaging is the tobacco industry’s last remaining avenue to lure vulnerable children into starting to smoke. It must therefore be made as unattractive as possible. Contrary to what the noble Lord, Lord Naseby, says, it is a policy that works. Recent evidence from Australia, which was the first country to introduce standardised packaging, shows that soon after standard packs began to appear in shops, smokers reported finding cigarettes in these packs less appealing or satisfying. Research has also shown that smokers consuming cigarettes from standard packs were 81% more likely to have thought about quitting at least once a day during the previous week.

Standardised packaging is intended to protect children and young people from starting to smoke. Young people are a vital market for the tobacco industry, particularly young women. The marketing message is this: smoking is cool, glamorous, and constitutes adult behaviour. Some two-thirds of smokers start before they are 18 and the vast majority while still teenagers. Every day, hundreds of children in the UK start smoking. Standardised packaging would remove the existing attractive promotional aspects and require the appearance of all tobacco packs to be uniform, including the colour of the pack. They are not going to be plain packs, as the noble Lord, Lord Naseby, says; they will allow for the promotion of strong anti-smoking and health messages. Studies from around the world show that plain, standardised packs are less appealing, make health warnings more effectively, and reduce the ability of the packaging to mislead customers about the harm caused by smoking. In April this year, Sir Cyril Chantler’s government-commissioned independent and comprehensive review of evidence reported that there is a strong public health case for the policy, concluding that,

“the body of evidence shows that standardised packaging … is very likely to lead to a modest but important reduction over time on the uptake and prevalence of smoking and thus have a positive impact on public health”.

If I had a little more time, I would widen the debate and talk about the tobacco control plan for England, which expires at the end of the year, and ask the Minister to give an assurance that it is his intention that it will be taken forward after it expires. I also hope that he will be able to say positive things about the measures contained in the London Health Commission’s report, including the licensing of retailers for tobacco.

I will finish with the comment of the Chief Medical Officer, Professor Sally Davies, who supports the smoke-free park plan, saying that it will stop,

“role modelling in front of children”.

It is children and young people that this policy must be directed towards.

My Lords, I, too, congratulate the noble Lord, Lord Darzi, on initiating this opportunity to debate the important issue of the harm done by smoking, and the best ways for it to be eradicated.

In recent weeks, the world has been shocked by the loss of life in events such as the terrible murders in France, and in Nigeria, and by accident in the recent AirAsia plane crash. Approximately 2,200 human beings lost their lives in those events. People have rightly been outraged by the murders, and anxious to prevent such loss of life, whether caused by evil people or air accidents, in future.

Today we are discussing how we can prevent many avoidable deaths and much suffering resulting from a legal product, but one which we now know to be anything but safe. I have drawn attention to the approximate number of people who lost their lives in those terrible events because it is a comparable figure to the number of people who in the UK alone lose their lives each week as a result of smoking-related diseases. Despite many years of progress, smoking-related disease still claims 272 lives prematurely every day in the UK, causing approximately 100,000 deaths annually. This is something about which we can take action—to reduce the loss of life; to create substantial health benefits that will raise the quality of life for many people; and to reduce poverty and increase opportunity for many of the least well-off people in our country.

The tobacco industry works furiously hard to avoid erosion of its profits because its products result in the early death of one in two of its customers. It needs to continually recruit new smokers to maintain its profits. However, its new customers are nearly always children or young people. Two-thirds of regular smokers start before the age of 18 and two-fifths of them start before 16. I wholeheartedly welcome the recommendations made in the London Health Commission’s report. It is clear from the findings of the noble Lord, Lord Darzi, that London needs to do more to tackle smoking, which is the major cause of preventable premature death in the capital. Measures such as smoke-free parks and a strengthening of work on illicit tobacco are very welcome, but many other important measures must be implemented if we are to continue to drive down smoking prevalence in the future, as we have done so successfully in the recent past.

This House took important steps, tabling amendments to the Children and Families Bill, subsequently taken up by the Government, to prohibit smoking in cars with children and to require all cigarettes to be put in plain, standardised packaging. However, while the regulations on smoking in cars have been laid and, once voted on, will be implemented this year, there remains a silence from the Government about standardised packaging. I hope that the Minister will break that silence this afternoon.

The Tobacco Advertising and Promotion Act has been effective in reducing children’s exposure to promotional activity and has brought about a consequent reduction in awareness of tobacco marketing among young people. Between 2003 and 2013—very much contrary to the arguments put by the noble Lord, Lord Naseby, when he opposed restrictions on tobacco advertising—regular smoking among young people declined from 10% to 3% in the UK. However, we must do much more.

Tobacco packaging is now the most prevalent form of tobacco advertising. Smokers display the branding every time they take out their packs. In doing so they are making a statement about how they want to be seen by others as they display, and endorse, the brand that they have chosen. The arguments put forward by the tobacco industry to oppose plain paper packaging are completely undermined by the vehemence of their opposition to it. The industry’s credibility was undermined long ago by its denials about the link between smoking and lung cancer, the addictiveness of nicotine and the effects of passive smoking. The tobacco industry now claims that standardised packs will lead to an increase in tobacco smuggling.

The hypocrisy of the industry on this issue was well exposed by the disclosures about its own role in organising tobacco smuggling. I noted that the noble Lord, Lord Naseby, was reading from the brief of the Tobacco Manufacturers’ Association, which can hardly be considered to be objective in this matter. The association claims that there has been an increase in tobacco sales in Australia since the introduction of standardised packaging, but it ignores the increase in population in Australia in that time. Adjusted for population, tobacco sales per person in Australia have in fact fallen since the introduction of standard packs.

The strong cross-party support for the tobacco control measures contained in the Children and Families Act amply demonstrates the strength of feeling of parliamentarians on this issue. I know that my party wants to see that time is allocated for the required debate and a vote on the introduction of standardised packaging before Parliament rises for the general election.

There is a choice ahead of us between promoting public health or rewarding the tobacco lobbyists. It will be greatly to the discredit of this Government if they do not ensure that the necessary regulations for plain paper packaging are laid before Parliament, in time for the regulations to be voted on as soon as the notification to Europe process comes to an end on 2 March. It would be a public health disaster if the views of the tobacco industry and a small minority of parliamentarians sympathetic to it stopped the clearly expressed will of Parliament on this issue from being implemented.

My Lords, like other noble Lords, I welcome this debate and congratulate the noble Lord, Lord Darzi, both on securing the debate and of course on his work on the important report from the London Health Commission. I, also, have had many conversations with patients dying from tobacco-related diseases. I have never had a patient who is glad that they smoked and that their life has been shortened by it, but I have had enormous numbers of patients who regret that they are leaving children orphaned early, because their lives are coming to an end prematurely and there is no way that that can be stopped.

I strongly support the findings of the London Health Commission report and, as has already been said, the Royal Parks becoming smoke-free sets a very clear example and message that these are open spaces—we are fortunate enough to have fresh air in London. I question the assertion from the noble Lord, Lord Naseby, as regards New York, because I have not seen any evidence that the tourist industry there has suffered at all. In fact, anecdotally, I have heard people say it is welcome that in Central Park there is smoke-free and a sporting open area.

The advantage of Parliament setting an example to the rest of us by having Parliament Square Garden smoke-free is of course clear. The city-wide working against illicit tobacco certainly needs to be strengthened, but that is a secondary part of tackling the issue of tobacco overall. As the report states, there are still 1.2 million smokers in London and smoking-related disease causes 8,400 premature deaths in the city and more than 51,000 hospital admissions. We have heard in recent weeks how the whole NHS is creaking under the strain—in London as much as anywhere, though it is widespread. Boroughs with a high prevalence of smoking are also among the poorest, and smoking remains a cause of health inequalities.

The NHS needs a radical upgrade in prevention and public health, as was stated in the NHS Five Year Forward View. The cause of preventable deaths through tobacco is the same as the next six causes put together, including alcohol, obesity and illegal drugs. I hope that the Government will undertake to renew their very successful coalition Government’s Tobacco Control Plan when it expires.

We do, indeed, have the necessary measures to tackle this in the Children and Families Act 2014. There is evidence that two-thirds of smokers start before the age of 18. In 2011, it was estimated that more than 200,000 children aged 11 to 15 started smoking. I warmly welcome the regulations to prohibit smoking in cars that were laid before Parliament in December last year and are due to come into effect this October. I urge the Government to set a date for the regulations to be voted on at the earliest opportunity.

I shall take a moment to address e-cigarettes because I am concerned that they contain nicotine, which is a highly addictive element in cigarettes. That risk certainly needs to be assessed and tackled. There is evidence that e-cigarettes are helping people who are smokers to quit smoking, but I was worried by the Trading Standards Institute’s finding that 40% of retailers are willing to sell these products to young people under 18, despite the fact that the vast majority—about 80%—of the products carry warnings that they should not be sold to people under 18. The consultation on the regulations to bring forward the primary legislation in the Children and Families Act enabling regulations to prohibit the sale of e-cigarettes to under-18s was launched before Christmas. I hope that that will proceed without delay.

Perhaps I may turn to the issue of standardised packs. More than half a million children have taken up smoking since the Government first announced in 2011 that they would consult on this measure. A vote on the necessary regulations has to happen before the general election. If the Government table them immediately this can happen. I am concerned that we have been told that we cannot have them laid before the end of the period of notification to Europe on 2 March this year. That is, in fact, a red herring. I do not understand why they cannot be laid now, so that as soon as 2 March is past a vote can be held. In the extremely unlikely event of an amendment being required, a short timeframe could be used to review whatever recommendation comes out from the relevant committees. I was interested to hear on the “Today” programme this morning that Labour now plans to incorporate this in its manifesto, if I have understood correctly. Perhaps other noble Lords will clarify that.

The security markings on the proposed packs would be no easier to counterfeit than the current security markings. The evidence from Australia has been overwhelmingly positive. Over the last few weeks, more than 4,000 doctors and allied medical professionals have called on the Government to stop dragging their feet on regulations. Section 94 of the Children and Families Act allows the Secretary of State to introduce regulations for these packs and was overwhelmingly passed in both the House of Lords—nem con—and the House of Commons, where only 24 MPs voted against the move. A poll on support for standard packs conducted for ASH found that 64% of adults in Britain were in favour; but what I found interesting is that in Australia the number of smokers supporting the measure has risen from 28.2% before its introduction to 49% after implementation. Therefore, I hope that, in answering today’s debate, the Minister will have some good news for us about the progress on standardised packs.

My Lords, I rise to speak briefly in the gap. The UK is a world leader in tobacco control, of which I feel very proud. I have worked and lived in London for virtually all my life, and I would love to see London set a real lead and a real example by becoming a smoke-free city in the way described by the noble Lord, Lord Darzi. I congratulate the noble Lord on securing this debate, on all his work and on the recommendations of the London Health Commission, which were very far-reaching.

I also pay tribute to the Government for all their work on tobacco control and, indeed, to the Minister personally for everything that he has done. I remember very clearly the strength of feeling in this House when we debated the Children and Families Act 2014 around the standardised packaging of tobacco and about banning smoking in cars carrying children. The way the Government responded to that strength of feeling, looked at the evidence and then came back and accepted those things was an example of Parliament at its very best. The fact that the work was done very much on a cross-party basis really showed what can be done in this House when people come together and work together very sensibly.

I had the great privilege during that period of briefly meeting with the Minister in Australia, who was personally involved in steering this measure through in her country. It was wonderful to hear from her how they had got that through and the impact that it was starting to have. I want to add my voice to others in this afternoon’s debate to say how important it is that the standardised packaging regulations are laid in sufficient time for them to be considered, and for a vote to take place before the election. I also hope that the Minister will be able to give us some comfort on that because so much has been achieved in this Parliament that it would be a real travesty if we fell at the final hurdle.

My Lords, I start by reminding the Committee of my presidency of the Royal Society of Public Health. Of course I very much welcome my noble friend’s debate and, indeed, the excellent report. I like the aspirations and ambitions contained in it. Coming from Birmingham, I rather wish that we could have a similar report, and I will try to persuade my noble friend to come and write one. It strikes me that the traditional joint strategic needs assessments produced by directors of public health are often dry documents that do not really capture, in their very succinct message, the challenges and what needs to be done about them. I would love to see other parts of the country follow this model.

In Birmingham, 22% of young people are obese, and we know that that is going to store up huge problems for the future. Yet, looking at my noble friend’s paper, the figures are even worse for London. He mentions that:

“London has the highest rate of childhood obesity of any peer global city, and the highest proportion of obese children in all the regions of England. In London almost 1 in 4 children in Reception and more than1 in 3 children in Year 6 are overweight or obese”.

If you think about the scale of that problem, it is imperative that we start to do something about it. On smoking, my noble friend points out that:

“London boroughs with high smoking prevalence are also some of the poorest boroughs. Although there is a downward trend across most of London, there is a difference of 10% between the best and worst performing boroughs, and stark health inequalities are caused by smoking rates being much higher amongst people who work in manual or routine occupations”.

That is matched by the inequality experienced by children born today in different parts of London, who can have very wide differences indeed in their life expectancy.

The aspirations and ambitions seem to me to be excellent. I like many of the proposals. The idea of boosting the number of active Londoners to 80% is quite a goal. Gaining 1.5 million working days a year by improving employees’ health and well-being offers a very apt illustration of the link between health, well-being and the general economy. It is something that we need to really work on. I like the ambition to have the lowest death rates in the world for the top three killers. I agree that GP practices in London should be open from 8 am to 8 pm and that services should be delivered in modern, purpose-built and designed facilities. My noble friend told us how to do that quite a few years ago and it is to my eternal regret that we did not make enough progress on it. Anyone looking at the problems we are now facing in primary care and wanting to see the solution need not look much further than my noble friend’s report.

It is coincidental, though I would like to think that we planned it together, that the Labour Party today announced the public health programme that we wish to take forward post-election. It is very much dual-pronged in the sense that we see a really positive role in, rather than finger-wagging at adults, actually helping them to be empowered with information to make healthier choices and supported to get active, along with all the other things needed to improve their health. However, in the case of children, we wish to see statutory action and we particularly emphasise maximum limits to be set on levels of fat, salt and sugar in food marketed substantially to children. That would have a very big impact on obesity issues, alongside many more programmes around lifestyle in schools, particularly in physical activity.

On smoking, we wish to reduce smoking prevalence to 10% by 2025. We will have a goal that children born in 2015 will become the first smoke-free generation in hundreds of years. I was very proud to move the amendment to ban smoking in cars with children and I received support from almost every noble Lord present in the debate today. It was very good to see. I was struck by the overwhelming public support for that measure: it shows that the public will support these kinds of measures. We are also keen to introduce a levy on tobacco companies to be used to ensure that they make a greater contribution to the cost of tackling tobacco-related harm.

There is nothing further I could say about standardised packaging that has not been said already. I simply remind noble Lords that this was done on the basis of the report undertaken by Sir Cyril Chantler, who concluded that the body of evidence shows that standardised packaging is very likely to lead to a modest but important reduction over time. I stand behind Sir Cyril Chantler’s report.

I hope that the noble Earl is going to give us good news today. He will understand that there is a mite of scepticism about the Government’s approach to these matters. There is a suspicion that the Government are rather too close to some of the tobacco companies and rather too much under their influence. He could, at a stroke, put that right by telling noble Lords that these regulations are going to be laid within the next few days. I hope that he will do so.

My Lords, I thank the noble Lord, Lord Darzi, for securing this important debate. As we have heard, the Mayor of London set up the London Health Commission in September 2013, with the noble Lord, Lord Darzi, as chairman, to review the health of the capital, from the provision of services to what Londoners themselves can do to help make London the healthiest major global city. In October, the London Health Commission published its report, Better Health for London, with a range of recommendations for the Mayor of London to consider. I congratulate the noble Lord, Lord Darzi, and the members of the London Health Commission on their well considered and thought-provoking report.

Local government has responsibility for improving health and well-being in its communities, including reducing rates of tobacco use. Noble Lords will understand that it is not for me as Health Minister to respond to the London Health Commission’s report. That is for the Mayor of London, for whom the London Health Commission prepared its report. I will, however, be very interested to see how the mayor progresses the recommendations that have been made.

Nevertheless, given the Government’s commitment to tobacco control, I particularly welcome this opportunity to tell your Lordships more about the work we are doing to tackle tobacco use. Tobacco remains one of our most significant public health challenges. Smoking is a leading cause of cancer, cardiovascular and respiratory disease; smoking is the primary preventable cause of morbidity and premature death; smoking is a significant driver of health inequalities and remains the biggest cause of inequalities in death rates between the richest and poorest in our communities; and smoking places an enormous strain on the NHS, while the overall economic burden of tobacco use to society is estimated at more than £13 billion a year. We must also remember that tobacco use is harmful not only to individual smokers, but to others around them.

Reducing smoking rates is a public health priority for this Government. In early 2011, we published the Tobacco Control Plan for England, which set out a comprehensive package of evidence-based action to be implemented at national level to support local areas in driving down rates of tobacco use. We also set out in the plan the importance of our efforts to reshape social norms around tobacco use to promote health and well-being. The noble Lord, Lord Faulkner, and the noble Baroness, Lady Finlay, asked what our plans were for refreshing the tobacco control plan. As they said, the plan sets out action until the end of this year. Like both noble Lords, I, too, hope that whoever are in government after the election continue to take comprehensive and effective action on smoking. However, it will be, essentially, for the next Government to take that decision.

From the outset, we ought to reflect the enormous amount of progress that we have made over the past decade. Smoking rates in England are at their lowest since records began. Today, around 18 per cent of adults are smokers, down from around half of adults smoking in the 1970s. Almost 2 million fewer people in England are smokers compared to a decade ago, and London has some of the lowest smoking rates in the country. We know that the majority of smokers take up smoking when they are teenagers. Most smokers were regularly smoking before turning 18 years of age—before they were able to make informed, adult decisions about tobacco use.

The good news is that rates of regular smoking by children in England between the ages of 11 and 15 years have declined by some 70 per cent since 2000. However, I want to be clear that continuing to reduce the uptake of smoking by children is essential. Research published in 2013 shows that every day around 600 children aged between 11 and 15 years start smoking in the United Kingdom.

The Government have taken action to protect young people from tobacco and nicotine addiction and a range of new powers relating to smoking were introduced through the Children and Families Act 2014. We have laid regulations to end smoking in private vehicles carrying children in England, which shortly will be considered in your Lordships’ House and in the other place. New legislation will stop adults buying tobacco on behalf of children.

The Department of Health is currently consulting on proposed regulations to bring the same age-of-sale requirements into place for electronic cigarettes that exist for tobacco. I would just say, on electronic cigarettes—mentioned by the noble Baroness, Lady Finlay—that while there is emerging evidence that e-cigarettes may be helpful to some people wishing to quit smoking, the quality of products on the market remains highly variable. We continue to work towards a regulatory framework that ensures for those smokers who want to use e-cigarettes to cut down or quit that they meet quality standards and are accompanied by sufficient information to enable informed choices. However, e-cigarettes are not risk free. We do not know enough about the long-term health effects of adults, let alone children, using e-cigarettes. Furthermore, as there have been no long-term studies to examine whether e-cigarettes serve as a gateway to tobacco use, we cannot be certain at this stage about whether there is a gateway effect from the use of e-cigarettes into tobacco smoking, so further research is needed to answer that question definitively.

The display of tobacco products in shops can promote smoking by young people and undermine the resolve of adult smokers trying to quit. Legislation to end tobacco displays has already been implemented for large shops such as supermarkets. All other shops selling tobacco, including corner shops, will need to end their displays of tobacco on 6 April.

The issue of standardised packaging for tobacco has been raised by almost every Peer who has spoken. I want to be clear that the Government have not made a final decision on whether to introduce legislation for standardised packaging. We held a final, short consultation that closed in August and the results are informing decision-making. It is important that the Government have time to carefully consider all issues relevant to the policy. I assure noble Lords that a decision will be made in due course. However, in saying that, I reassure your Lordships that we in the Department of Health are, as I speak, very actively working towards a decision. The draft regulations for standardised packaging were notified to the European Commission under the technical standards directive on 29 August. We have received detailed opinions from 11 member states, which extends the “standstill” period to six months. This will expire on 2 March 2015 and until then we are unable to make regulations, although I hear what the noble Baroness, Lady Finlay, says about laying regulations.

As regards evidence from Australia—

Before the noble Earl moves on, will he confirm that Sir Cyril Chantler’s report, which he commissioned, is helpful to him in coming to a view as to whether or not standardised packaging should be introduced? Does he accept the report and its conclusions?

Undoubtedly it is extremely helpful although I am sure that the noble Lord would be the first to acknowledge that there are considerations that Sir Cyril did not address, which we obviously have to do across government before taking a final decision.

Can my noble friend assure those of us who take a detailed interest in this that the decision will be based on the independent evidence from Australia after two years of implementation against the yardsticks that that Government set?

I am grateful to my noble friend. I was about to answer the question posed by the noble Lord, Lord Faulkner, on exactly that point. Evidence and experience continue to emerge from Australia, as my noble friend rightly said. I can reassure noble Lords that my department is looking very carefully at the evidence as it emerges. We will introduce standardised tobacco packaging if, having considered the evidence both here and around the world and other relevant information, we are satisfied—I emphasise “satisfied”—that there are sufficient grounds to do so.

The UK leads the world in supporting smokers to quit, and local authorities are now responsible for providing “stop smoking” services in their communities. The Government have continued to invest in tobacco marketing campaigns to encourage smokers to quit. Your Lordships may have seen Public Health England’s latest campaign that is currently running. Our “Stoptober” campaign has become hugely successful, encouraging smokers to quit for a whole month, giving them a significantly better chance of remaining smoke-free for good. Today, we offer smokers information and support through a range of media, including through the internet and mobile telephone applications.

A new European tobacco products directive has been agreed and will come into force in 2016. The new measures cover labelling, ingredients, tracking and tracing, e-cigarettes, cross-border distance sales and herbal products for smoking.

Making tobacco less affordable is proven to be an effective way of reducing smoking prevalence. The Government continue to follow a policy of using tax to maintain the high price of tobacco at levels that have an impact on smoking prevalence. In the Autumn Statement, my right honourable friend the Chancellor of the Exchequer announced that the Government will consult on whether to introduce a levy on tobacco manufacturers and importers. That consultation is now under way.

The Government have taken sustained action to reduce levels of illicit tobacco, and over the past decade, the illicit market has declined significantly. In the past two years, nearly 3.6 billion illicit cigarettes and 1,050 tonnes of rolling tobacco have been seized. Local authorities continue to take their own action against illicit tobacco, which is to be welcomed.

Smoke-free legislation, implemented in 2007, has had beneficial impacts on health. I would say to my noble friend Lord Naseby, who mentioned this, that the legislation has been highly successful in terms of public health and it continues to be popular and well complied-with, on the whole. The Government have no intention of amending this important legislation along the lines suggested by my noble friend. As I said, levels of compliance and public support for the law are high. While smoke-free legislation covers enclosed work and public places, local authorities may wish to take action to limit smoking in open-area environments. That is a recommendation in the London Health Commission’s report. However, I do not believe that changes to smoke-free legislation would be needed to achieve this. I commend local authorities across England for the commitment they have shown to reducing tobacco use; for example, more than 80 councils have signed the Smokefree Action Coalition’s Local Government Declaration on Tobacco Control.

My time is up. I will finish by saying that the Department of Health has worked actively to support the implementation of the World Health Organization’s Framework Convention on Tobacco Control, including protecting tobacco control from vested interests, and is today regarded as a global leader in the implementation of effective tobacco control policies. The UK deserves that reputation and I am proud to be able to share with your Lordships the news that the Department of Health has just been named as the winner of the American Cancer Society’s prestigious Luther L Terry Award for exemplary leadership by a government ministry in the field of tobacco control.

With that, my Lords, I end by thanking the noble Lord, Lord Darzi, once again for this debate.

Committee adjourned at 5.57 pm.