King’s College Hospital Foundation Trust

Bob Blackman Excerpts

Tuesday 12th December 2017 Commons Chamber

[Mr Dunne]

I am afraid that the hon. Gentleman was not referring to the urgent question. We are talking about what has happened at King’s over the past few days, rather than what is happening in Scotland.

[Bob Blackman (Harrow East) (Con)]

My local hospital trust, based on Northwick Park Hospital, has had to make some very difficult decisions to make itself more efficient and to reduce its deficit, and it has done so under excellent leadership. Does my hon. Friend know whether decisions were taken at King’s to keep to the deficit target? Were efficiencies made, and how effective were they?

[Mr Dunne]

What is particularly disappointing about King’s is that it does have a cost improvement programme, but regrettably, it has not been able to keep to it. It is particularly surprising that, as recently as October, the senior leadership team indicated that they were on track to meet their deficit, which palpably, as we now realise, was not the case.

Hormone Pregnancy Tests

Bob Blackman Excerpts

Thursday 16th November 2017 Commons Chamber

[Steve Brine]

First, may I correct myself? I might have said that the expert working group met “companies”, not “families”. If I said “companies”, I wish to correct the record.

I agree with the hon. Lady that the notice the families were given was not good enough. I and my colleague in the other place have made that crystal clear. Some notice was given to Mrs Lyon on Friday last week that there was likely to be an event on Wednesday, but that was not confirmed until Monday, so that was the notice the family got, and I do not think that is good enough; I have made that very clear.

On the hon. Lady and the hon. Member for Bolton South East (Yasmin Qureshi), who chairs the all-party group, being locked out of the press conference, I cannot imagine how that happened, and again I have sympathy on that. I expect the MHRA to look into that and explain that to me, because, while we may disagree, I can see how that merely feeds the conspiracy theory that some have around this subject.

[Bob Blackman (Harrow East) (Con)]

My hon. Friend is clearly struggling to defend this position. I urge him to look at the scope of this review and all the evidence that was presented to it, as all the evidence that was available should be looked at and looked at again. Without that, many people across this country will not be satisfied that justice has been done.

[Steve Brine]

With respect, I do not think I am struggling at all; I am just setting out a very clear position. Ministers are confident in the report and the review process. I say again that this was a comprehensive independent scientific review of all available evidence by experts across the expert working group who have a broad range of specialisms.

Oral Answers to Questions

Bob Blackman Excerpts

Tuesday 14th November 2017 Commons Chamber

[Mr Dunne]

As the hon. Lady will be aware, we are looking for a relationship with the EU to ensure that we have tariff-free access to the single market, including for drugs and medicines, because the life sciences industry is such a critical element of our economy. Contingency plans are being put in place for a no deal. She will have to wait, as will the rest of us, to see whether or not that eventuality happens. Of course we do not want it to occur—it is not our intent.

[Bob Blackman (Harrow East) (Con)]

8. What steps he is taking to reduce smoking rates.

[The Parliamentary Under-Secretary of State for Health (Steve Brine)]

Adult smoking prevalence is now 15.5%, the lowest ever. As the House will be aware, in July we published a tobacco control plan for England, which sets out stretching ambitions to reduce smoking prevalence still further and commits us to a series of actions to deliver those ambitions. Our end goal, as we have made clear, is a smoke-free generation.

[Bob Blackman]

I thank my hon. Friend for that answer. Does he agree that one of the most effective ways of helping people to give up smoking is the provision of smoking cessation services? In Harrow, the local unit managed to help 4,000 people attempt to give up smoking, with more than 50% doing so, but the answer from the local council has been to close the unit—that is very ineffective. Will he take action to make sure that this does not happen across the country?

[Steve Brine]

My hon. Friend is right to raise the issue. Local authorities, not Ministers in Whitehall, are best placed to take local spending decisions, but they must be accountable for their decisions. That is why we publish information at local authority level on smoking prevalence and quit numbers, so that local decision makers can be held to account. We also offer them expert support from Public Health England. I have a strong feeling that he will continue to hold those in Harrow to account.

Tobacco Control Plan

Bob Blackman Excerpts

Thursday 19th October 2017 Commons Chamber

[Bob Blackman (Harrow East) (Con)]

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

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

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

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

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

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

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

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

“to create a smokefree generation”,

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

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

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

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

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

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

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

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

--- Later in debate ---

[Stephen Kerr]

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

[Bob Blackman]

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

[Stephen Kerr]

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

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

[Martyn Day (Linlithgow and East Falkirk) (SNP)]

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

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

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

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

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

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

[Bob Blackman]

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

[Martyn Day]

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

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

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

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

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

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

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

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

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

Oral Answers to Questions

Bob Blackman Excerpts

Tuesday 4th July 2017 Commons Chamber

[Steve Brine]

I will have to look into the exact point that the hon. Gentleman raises, but I should like to welcome him to his place. I worked closely with his predecessor, and the hon. Gentleman has a tough act to follow. When we publish the tobacco control plan, there will be clear local tobacco plans as part of it. We in the Government can give the best evidence of what works, but we need to recognise what is needed in each local area. I know that he has specific needs in his local area in relation to tackling this issue.

[Bob Blackman (Harrow East) (Con)]

I welcome the Minister to his place. Does he agree that it is vital that anyone who approaches the national health service with a smoking-related disease should be pointed towards smoking cessation services? Does he also agree that it is vital that local authorities continue to run those services?

[Steve Brine]

Yes, absolutely. Local authorities have an obligation to do that, but as I said to the new hon. Member for Ipswich (Sandy Martin), it is important that local plans come forward alongside the new national plan. Local solutions are needed for different areas, and that will be the case in my hon. Friend’s borough just as it is in my area of Hampshire.

NHS Shared Business Services

Bob Blackman Excerpts

Tuesday 27th June 2017 Commons Chamber

[Bob Blackman (Harrow East) (Con)]

My right hon. Friend has confirmed that the contract has now been taken in-house. Can he also confirm that it is a totally different operation and that none of the people who were involved in making the decisions is now involved in making the decisions on the current service?

[Mr Hunt]

I can absolutely confirm that.