Junior Doctors: Industrial Action

Kevin Barron Excerpts

Thursday 24th March 2016 Commons Chamber

[Ben Gummer]

We will do everything in our power to ensure that patients are protected. We have a very robust assurance programme, conducted by NHS Improvement and NHS Employers. We will do everything we can to ensure both that the number of elective operations cancelled is as low as possible, consistent with the needs of safety, and that emergency cover is provided. Withdrawing the number of doctors that the BMA will withdraw in this action means that there is an increased risk of patient harm, and I am afraid that the BMA and its members need to consider that very carefully in the weeks ahead.

[Kevin Barron (Rother Valley) (Lab)]

It is clear that the Government are in a very difficult position, hence the Minister’s attack on Opposition Front and Back Benchers. I have to say that, from my experience of nine years on the General Medical Council, I do not recognise the various descriptions of the doctors’ profession that the Government have given over the past few weeks, including as being radicalised. We all know that this dispute should and will be settled not by imposition but by negotiations around a table. It seems to me that instead of using, at the Dispatch Box and elsewhere, rhetoric that has fired this up, Ministers would do much better to react to what the BMA said yesterday, which is that it wants

“to end this dispute through talks”.

Why do the Government not get on with it, keep us out of it and just do what people expect them to do?

[Mr Speaker]

Before the Minister replies, may I remind the House that this is an urgent question, not a debate under Standing Order No. 24 or a series of speeches? There seems to be predilection among colleagues to preface whatever question they ultimately arrive at with an essay first. A number of Members say, “Oh, I have to say this.” No, Members do not have to say anything; they have to ask a question, preferably briefly. That is all we want to hear.

NHS: Learning from Mistakes

Kevin Barron Excerpts

Wednesday 9th March 2016 Commons Chamber

[Mr Hunt]

I thank my hon. Friend for his question. He and I have talked many times and thought very hard about how we can learn lessons from the air industry. He is one of the people who came to me first to say that if we want to set up an equivalent to the air accidents investigation branch, we need to give people in the healthcare world the same legal protections that others have when they are speaking to that branch, and that is at heart of the statement that I have made to the House today.

The point about safe space is very, very important. This is not about people getting off scot free if they make a terrible mistake. There is no extra protection here for anyone who breaks the law, commits gross negligence or does something utterly irresponsible. Patients still have those protections. What they gain is the comfort that we will get to the truth and learn from mistakes much more quickly. Every single patient and bereaved family says that the most important thing is not money, but making sure that the system learns from what went wrong. We will ensure that we construct the safe space concept, and I do not rule out extending that beyond the investigations of the healthcare safety investigation branch.

[Kevin Barron (Rother Valley) (Lab)]

In welcoming the statement, may I say that, in my experience on the General Medical Council and on the Health Committee, the biggest cloud that hangs over the culture of non-reporting in the national health service is litigation? Last year it cost the British taxpayer £1.1 billion, £395 million of which went on legal costs alone. Should we not be looking at a no-fault liability scheme inside the national health service so that we can really encourage cultural change?

[Mr Hunt]

The right hon. Gentleman is absolutely right that the fear of litigation has a very pernicious effect, which we see across the NHS. Litigation is a huge drag on costs and we are reforming how it works. We have looked at what happens in other countries. In Sweden, for example, the creation of a no-blame culture has had the dramatic impact of reducing maternity and neo-natal injury. I hope that today’s statement is a step towards that, but we will consider other reforms to the litigation process as well.

Community Pharmacies

Kevin Barron Excerpts

Tuesday 23rd February 2016 Westminster Hall

[Kevin Barron (Rother Valley) (Lab)]

I congratulate the hon. Member for St Ives (Derek Thomas) on securing this debate.

I am the chair of the all-party group on pharmacy in Parliament and I have been for more than five years. I have a keen interest in public health and lifestyle issues, and I have quite enjoyed chairing the group. After the letter of 17 December, the all-party group—three Members of this House and one from the other place—met the Minister, on 13 January. We had what I described afterwards as “straightforward talking” about the letter—a letter that posed more questions about the future of pharmacy than it gave answers. The Minister was straightforward, and he said that one issue was that, in October of this year—so just for the second half of the financial year—£170 million will be taken out of the community pharmacy budget. That leaves a number of questions to be answered, including that of what will happen in a full financial year.

The Government make great claims about putting an extra £8 billion into the national health service, but the truth is that that £170 million, which is part of the £22 billion of efficiency savings, is being taken out of the NHS, so it is hardly new money. It is not the £8 billion—that comes in a few years’ time. We are talking here about major cuts to vital services.

Since the publication of that letter, it has become clear that as many as 3,000 community pharmacies could close in England alone—a quarter of them. How would that happen? Would it be by stealth, which is suggested in the letter and in the consultation currently coming out of the Department, or is there some sort of plan? We have seen in the letter, and in others, that if there is a 10-minute walk between pharmacies, that might be looked into, but there seems to be no plan whatsoever.

What we have to accept—I put to this to the Minister in that meeting on 13 January—is that pharmacists do not work for the national health service, yet more than 90% of community pharmacies’ income comes from the NHS. The idea that we could change that mechanism and close community pharmacies is outrageous. The pharmacists may not work for the national health service, but their income depends massively on it—I wish it did not.

For many years I have been promoting lifestyle issues and the idea of pharmacists getting paid for doing things other than just turning scrips over, but that is how it works at the moment and there needs to be some serious talking. What happens if someone who has a 10-year lease on a property they took over to run the local pharmacy is forced out of business? All those questions remain unanswered, yet there is the threat of up to 3,000 pharmacies in England closing.

[Rachael Maskell]

I am following the argument that my right hon. Friend is putting forward. Does he agree that, instead of cutting services, we should be looking at opportunities for community pharmacies to extend healthcare further into their communities? It should be about investment at this time, particularly in prevention, which is all about saving money further down the line.

[Kevin Barron]

I agree with my hon. Friend. That is one of the reasons I took over as chair of the all-party group more than five years ago. I believe that our pharmaceutical services should be taking that route of travel.

It would help if the Government provided details of how they will ensure access to pharmacy services in remote or deprived communities. If the market will drive closures, there will be chaos, and something substantial needs to be in place.

[Mr George Howarth (Knowsley) (Lab)]

My right hon. Friend makes a powerful case. He mentioned the market. Does he agree that one difficulty that smaller independent pharmacies, such as John Davey in my constituency, have is that unlike the big chains they are unable to negotiate favourable deals on the drugs they dispense and, therefore, they are already at a disadvantage in market terms? Before the Government go any further with the programme they need to address that important issue.

[Kevin Barron]

I do not disagree with my right hon. Friend. I will not use the name of the company, but I can go into the store of one of the major chains, which is not in my constituency but not far away, and it takes me a minute to walk to the prescription counter, whereas in most of the pharmacies in my constituency I can get there in two or three seconds. We must recognise that, at constituency level, we are not comparing like with like.

Another thing is that key payments for pharmacies will be phased out, and there might be a drive towards a commoditised medicine supply service with an increased focus on warehouse dispensing and online services. Again, the possibility of added value in a local pharmacy regarding lifestyle issues potentially goes out of the window, and we really need to look at that. I have no direct experience, but I am told that they have that in the United States.

As well as dispensing medicines, community pharmacy teams help people to stay well and out of GP surgeries, to get the most benefit from their medicines and to manage their health conditions. The NHS spends £2 billion a year on GP consultations for conditions that pharmacy teams could treat. Community pharmacy can and should do more. A national community pharmacy minor ailments service could save the national health service some £1 billion a year. In some of the pharmacies in my constituency, there is already a minor ailments service. I understand that the Government recently changed their mind about developing such a service at a national level, and I would like to know why. Such a service makes great sense to me. It keeps pressure off not only GP surgeries but the local A&E.

In 2014-15, pharmacies delivered more than 3.17 million medicines use reviews, to increase people’s understanding and help them to take their medicines correctly. We get a lot more from our pharmacies than their just turning scrips over. Our communities and our constituencies need that, and if there are to be any changes, they should be carried out in a sensible and planned way, and not in the chaotic way of some of the suggestions of recent weeks.

Junior Doctors Contracts

Kevin Barron Excerpts

Thursday 11th February 2016 Commons Chamber

[Mr Speaker]

Order. I must advise the House that, so far, we have got through eight questioners in 14 minutes, which, by the standards of the House operating at its best, is poor, so we need to do better. That means shorter questions and, frankly, rather pithier answers.

[Kevin Barron (Rother Valley) (Lab)]

I had a further email on this subject from a doctor in my constituency this morning. He thanked me for forwarding replies from the Department, although he did say that they were disappointing. He said that the BMA had proposed a contract that met the Government’s cost-neutral requirements, but that it had been rejected. Is that true?

[Mr Hunt]

I will be pithy, Mr Speaker. This is not just about cost-neutrality, but about dealing with weekend care, which is why that proposal was not accepted.

Oral Answers to Questions

Kevin Barron Excerpts

Tuesday 9th February 2016 Commons Chamber

[Mr Speaker]

I am sorry, but demand is so high. Last but not least, I call Kevin Barron.

[Kevin Barron (Rother Valley) (Lab)]

The 6% cut in the pharmacy budget will come in in October—halfway through the next financial year. Will the Minister tell us what the percentage cut will be in a full financial year?

[Alistair Burt]

Negotiations are ongoing with the Pharmaceutical Services Negotiating Committee. The amounts that have been set out cover this financial year and the settlements are moved on from year to year, so the discussion is ongoing. The future for pharmacy is very good, although it will be different, as the profession has wanted for some time. Not only is there a great future for high-street shops in areas where we need them, but there will be an improvement in and enlargement of pharmacy services in healthcare settings, primary care settings and care homes around the country.

Tobacco Control Strategy

Kevin Barron Excerpts

Thursday 17th December 2015 Westminster Hall

[Kevin Barron (Rother Valley) (Lab)]

I beg to move,

That this House has considered a new tobacco control strategy.

I am pleased to speak in this debate with you in the Chair, Mr Betts, because we are not talking about football today—our teams are doing different things in the league at the moment. I ought to declare that I am the vice-chair of the all-party group on smoking and health, and have been an officer of sorts for it for some 20 years. I am sure Members are aware that the group’s secretariat has been the Action on Smoking and Health charity for many years.

My commitment to tobacco control is well known in this House. For the more than 20 years that I have been involved in this issue, I have had great support from Action on Smoking and Health, as I know Governments have from time to time. My commitment was an individual one at one stage, going back a couple of decades, so I am pleased that in recent years we have seen a growth in cross-party support for tobacco control, as people recognise that it is a key area of public health.

The Minister has played a key leadership role in guiding through the House measures such as standard packaging and the prohibition on smoking in cars with children. She has been helped by the strong support for these measures across Parliament, both here and in the other place. We have moved on in leaps and bounds on this major public health issue in the past decade. Measures to tackle the harm caused by smoking are strongly supported by the public, three quarters of whom supported Government action to limit smoking in a YouGov poll conducted for ASH, and around half of whom think the Government could do more.

In recent years, a great deal has been achieved with the support of the public and all political parties, starting with the Labour Government introducing the first comprehensive tobacco control strategy in 1998; they subsequently introduced comprehensive smoke-free legislation with strong cross-party support. The coalition Government published as their first detailed public health strategy the tobacco control plan for England in 2011. Over the life of the current plan, a great deal has been achieved, and smoking prevalence rates in England have fallen significantly during the five years of the plan from some 20.2% in 2011 to 18% in 2014.

[Norman Lamb (North Norfolk) (LD)]

I am not sure whether the right hon. Gentleman will cover this, but I am particularly interested in smoking prevalence rates among those who suffer severe and enduring mental ill health. It appears to have been stubbornly more difficult to reduce smoking rates among that group. Given that people with mental ill health die earlier, and that smoking actually damages their mental health, does he agree that it is critical that the NHS ensures that those people get access to support services to help them give up smoking?

[Kevin Barron]

The right hon. Gentleman is absolutely right; there is a high incidence of smoking among people with mental health conditions, as there is among poorer households. I will go into that in more detail, but he is right to mention it.

Smoking rates have fallen among not only adults but, importantly, young people. Regular smoking among 15-year-olds has fallen even faster under the plan, from 11% in 2011 to just 6% in 2014. That is a great credit to the current plan, but it is about to come to an end, so we need a new strategy.

The reduction ambitions set out in the tobacco control plan for England have been achieved ahead of the end of the strategy. However, a great deal remains to be done. Smoking remains by far the single largest cause of preventable illness and premature deaths in the United Kingdom, causing about 100,000 premature deaths a year and killing more people than the next six causes put together, including obesity, alcohol and illegal drugs. The cost of smoking to the national health service in England is estimated to be about £2 billion a year.

My constituency, Rother Valley, sits in Rotherham borough. Just under one in five people smoke in Rotherham, which is about the same as the national average. That amounts to some 37,391 people. Nearly 500 people in Rotherham die from smoke-related diseases every year—primarily cancer, heart disease and respiratory diseases. An estimated 900 children in Rotherham start smoking every year, and it is important to remember that two thirds of smokers start before the age of 18. Of those who try smoking, between one third and one half will become regular smokers. The best way to prevent children taking up smoking is to encourage their parents to quit, because children are three times more likely to start smoking if their parents smoke.

Smoking rates are much higher among poor people. In 2014, 12% of adults in managerial and professional occupations smoked, compared with some 28% in routine and manual occupations. Almost all groups that experience disadvantage have higher smoking rates than the general population. For example, as the right hon. Member for North Norfolk (Norman Lamb) mentioned, people with mental health conditions are much more likely to smoke, and nearly eight out of 10 prisoners and people who are homeless smoke.

Poorer smokers also face financial hardship as a result of smoking. When their expenditure on smoking is taken into account, some 1.4 million households are below the poverty line—that is 27% of all households that include a smoker. In Rotherham alone, smoking is estimated to cost the national health service some £12.2 million. The current and ex-smokers who require social care in later life as a result of smoking-related diseases cost society in Rotherham an additional £5.7 million, £3.3 million of which is funded by the local authority through social care costs, and £2.4 million of which is self-funded.

Quitting smoking surveys show that about two thirds of smokers would like to stop smoking, but only around one third make a quit attempt in any given year. Continued Government and public sector action to cut smoking rates therefore remains necessary, and a new strategy is required to replace the expiring tobacco control plan.

The current Department of Health tobacco control plan will expire at the end of this month, as I understand it. I am delighted that the Minister with responsibility for public health has announced that there will be a new plan, and I look forward to her announcing when it will be published; we may hear something today. It is crucial that a new tobacco control plan be a public health priority, and it has to be comprehensive. The current strategy has been successful because it is comprehensive and, so far, properly funded.

The main elements of successful tobacco control, as implemented in the UK, are well understood and strongly backed by evidence. They are: price rises through taxation, intended to make tobacco less affordable and to help pay for tobacco control interventions; stopping the smuggling of tobacco, which allows children and young people easy access and reduces the incentives for adult smokers to quit; helping smokers to quit through evidence-based services, including support and, where appropriate, the prescription of nicotine replacement products; an end to tobacco advertising, marketing and promotion, including on the pack design; and mass-media campaigns and social marketing of anti-smoking messages. Legislating for smoke-free enclosed public places and vehicles to protect people from the harmful effects of second-hand smoke has been a great success. The new strategy will need to be comprehensive and ambitious, with tough new targets, and it has to be well funded.

I commend to the Minister the comprehensive set of measures set out in the ASH document, “Smoking Still Kills”, which has been endorsed by more than 120 public health-related organisations, including the British Heart Foundation, Cancer Research UK, medical royal colleges and the British Medical Association. The report calls on the Government to impose an annual levy on tobacco companies, proposes new targets for reducing smoking prevalence to make our country effectively tobacco-free by 2035, and makes a comprehensive set of recommendations for a renewed national strategy to accelerate the decline in smoking prevalence over the next decade.

Hon. Members will remember that at the launch of that report in June, the Minister committed the Government to publishing a new strategy to replace the current plan. Sustained funding is essential to the success of any new strategy, as it has been for Government strategies to date. Clear evidence from the UK and overseas shows that a reduction in spending on tobacco control, together with less emphasis on new policies and on enforcement of existing ones, is likely to slow, halt or even reverse the long-term reduction in the smoking prevalence rate.

Some measures, once implemented, either do not need funding—such as standardised packaging, and the ban on advertising, promotion and sponsorship—or are self-funded, such as tax increases and reductions in smuggling. Others continue to need to be properly funded, including mass-media campaigns, stop smoking services and enforcement to prevent children from being able to buy cigarettes.

I am deeply concerned that the cuts in funding to the Department of Health and local authority public health budgets, both in-year and announced in the spending review, threaten to undermine the ability of the planned new tobacco control plan for England, so that, unlike the current plan, it will not be effective. We are already seeing cuts to stop smoking services up and down the country, and to local authority investment in tobacco control, even before the spending review cuts are implemented. Will the Minister confirm that the new tobacco control plan will contain ambitious targets and be sustainably funded?

I want to focus on the importance of mass-media campaigns, which are highly cost-effective in encouraging smokers to quit and in discouraging young people from taking up smoking. When funding was cut to mass-media campaigning in 2010, when the coalition Government came in, there was a noticeable impact on quitting behaviour. There was a decrease of 98% in the amount of quit support packs. Quitline calls fell by 65% and hits on the website fell by 34%, but the evidence shows that such services are only effective if they are sufficiently well funded; in recent years, they have not been.

At the peak in 2009-10, nearly £25 million was spent by the Government on mass-media campaigns. However, last year, in monetary terms, not taking inflation into account, the amount had fallen to less than £7 million, and it is likely to fall again this year. Investment in mass-media campaigns is a crucial part of the mix of tobacco control interventions needed to drive down smoking rates, and the UK is seriously under-investing.

To give an international comparison, in the US, the Centres for Disease Control and Prevention’s best-practice recommendations for mass-reach health communications to reduce smoking is $1.69 per capita. Using 2014 population figures, that means that in England, we should be spending in the region of £57 million a year on mass-media campaigns for that to be evidence-based. We are spending eight times less than that.

The cut in spending is already having an impact. An early indicator of the effects of reductions in spending on tobacco control is given by the smoking toolkit study run by Professor Robert West, from University College London. Results for 2015 show that smoking prevalence has stopped declining and is beginning to go back up again for the first time in many years.

Smoking rates have increased from 18.5%—the lowest ever recorded—to 18.7% in recent months. There has also been a fall in the proportion of smokers who made an attempt to quit, from 37.3% in 2014 to 32.4% in 2015. There are lower success rates for quit attempts, from 19.1% in 2014 to 17.0% in 2015. That is going in the opposite way to how it should be going.

I want to move on to an area on which the public have contrasting views: the role of electronic cigarettes, which are perhaps badly named, and harm reduction. Over the last few decades, it has become increasingly clear that although population smoking rates had been declining, some groups—particularly the poor, the disadvantaged and those with mental health problems—were being left behind. Those are the groups with the highest levels of nicotine addiction, who find it hardest to quit.

At present, the most popular source of nicotine—the cigarette—is far and away the most hazardous and addictive. In response to that, tobacco harm reduction approaches have been developed in the UK to find ways of giving smokers who are unable to quit access to alternative, less harmful forms of nicotine. We are at the forefront in the world in developing such an approach. Current smoking cessation programmes use nicotine replacement therapy, but they also use non-nicotine approaches such as psychotherapy and other pharmaceutical products. Although there has clearly been success with those products, they predate the advent of electronic cigarettes as a major consumer product.

Electronic cigarettes are now widely on sale and have become the most popular tool used by smokers to help them quit. There is growing evidence that they are effective aids to quitting, and they are used by around 2.6 million smokers, primarily to help them quit or prevent them from relapsing back into smoking. Although concerns have been raised about their use by young people and never-smokers, this has not been found to be an issue. Indeed, use by adults who have never been regular smokers is very rare, and although a growing number of young people under 18 have experimented with electronic cigarettes, regular use is limited almost exclusively to young people who are current smokers or who have experimented with smoking in the past.

More worryingly, evidence from ASH indicates that the public increasingly have false perceptions of the harm from electronic cigarettes, and smokers who have not yet tried an electronic cigarette are much more likely than other smokers to believe they are as harmful as conventional cigarettes, or more harmful. That is certainly not the case. A recent groundbreaking review by Public Health England, which was published in August, found that they are 95% safer than smoking tobacco and recommended that health providers and stop smoking services take a more proactive approach in supporting smokers who want to use electronic cigarettes to quit smoking.

For 50 years we have known now that it is not the nicotine in cigarettes that does the damage to people, but the contaminants in the tobacco. However, some people, including in the medical field, are talking electronic cigarettes down as though they were as dangerous as cigarettes. That figure of 95% safer gives us 5% wriggle room, because I do not think that has been tested or proven at this stage. It could be far higher than that, but this product is a way of taking nicotine into the system that does not do the damage that tobacco does.

I believe a large part of the delay in the roll-out of electronic cigarettes has been due to the fact that they were not developed in the UK, or not through traditional methods in national health service labs. I just wish they had been, because then some medical practitioners in the NHS would have had a different attitude to them. The regulatory systems are not used to this sort of organic growth that comes in from outside. However, the Medicines and Healthcare Products Regulatory Agency’s new approach to licensing e-cigarettes is a welcome step. To my knowledge, the MHRA is the only medicines regulator in the world to licence an e-cigarette, as happened earlier this month. They will potentially become a major part of smoking cessation programmes.

Unfortunately, there are high costs to putting e-cigarettes through the MHRA, and from conversations with British suppliers it is clear that the licensing costs are prohibitive for smaller manufacturers if they want them to be a medicinal product. That is obviously a major block, and it is argued that only the tobacco companies are putting those products through the MHRA at the moment. That may be because they have the money to be able to put them through at this stage. I would prefer a tobacco company to spend money on putting these products through the MHRA, so that they can get into smoking cessation clinics, than to sell cigarettes, which prematurely kill 50% of the people who use them. We should take our head out of the sand and look at the potential of these products to get everyone off cigarettes, which are so damaging to their health.

I recently met someone who runs a small business in my constituency and has developed a product called E-Burn, which is an e-cigarette for use in prisons. It is currently used in the prison on Guernsey and is being adopted by the NHS for use in secure hospitals. That innovation is taking place out there. I have not tasted that product and I do not know it from any other, but when I was on the Select Committee on Health in 2005-06 and we did an inquiry on smoking in public places, one of the most difficult things was trying to convince people that those in prisons ought to have smoke-free workplaces as well.

[Norman Lamb]

It should also be mentioned that in mental health settings and in-patient wards, where no-smoking policies have been introduced and patients have been helped to escape from addiction to tobacco, a significant improvement in their mental wellbeing and mental health has been seen.

[Kevin Barron]

The product to which I referred comes from China, I understand, but is assembled in Rother Valley, and the person who runs that company wants to expand his business and create jobs. I want to encourage him on the basis that it creates better health if these products are used both in mental health institutions and in prison.

I mentioned the 2005-06 report. The Health Committee, which I chaired at the time, had great difficulty in convincing people who ran institutions that smoke-free workplaces should be as much for people inside prisons and secure hospitals as for anyone else. Various arguments were put to us at the time. The major issue was not just about taking people off cigarettes; it was about control in prisons. I now see that from 1 January we are banning smoking in all Welsh prisons and selected English prisons, which we could loosely call non-traditional environments. That has taken a long time. We were told when we were doing that inquiry in 2005-06 that the Prison Service would bring things forward within three months of our completing it. It has actually taken 10 years to get to this stage. I suspect that if e-cigarettes, no matter which ones they are, go into those institutions for people who are addicted to nicotine and cannot get off that addiction, it will help us get what some of us were arguing for 10 years ago.

Next year, the UK will implement the electronic cigarette provisions in the tobacco products directive, which will provide a regulatory framework for those products, giving users greater assurance about their safety and quality. However, e-cigarette users have raised concerns that the UK Government’s implementation of those provisions will force products that they use off the market and may cause them to revert to conventional smoking.

I accept entirely that it is essential that the directive be implemented proportionately. As I understand it, the MHRA will be responsible for that, although not for making all e-cigarettes medicinal product, which involves high expense. It will bring in a regime whereby it will look at the quality of e-cigarettes, and quite right too. We want to know, if people are buying e-cigarettes in shops on our high streets or wherever, that what the packet says is what is in the product. People should know exactly what they are using. I agree about that, but I hope the Government will ensure that the regulation of electronic cigarettes is proportionate and maximises the benefits to smokers while minimising the risks.

I want to finish by discussing our role in global tobacco policy. As reported by Public Health England, money has been found in the spending review for the Department of Health to support the international implementation of tobacco control. The UK, as a world leader in tobacco control and in supporting development internationally, has a key role to play in that area. I am pleased to see the Minister nodding. The UK is the first G7 country to meet the long-standing commitment to spend 0.7% of gross national income on official development assistance—a commitment that is enshrined in law, I am very pleased to say as a Member of the House. Building economic growth and creating jobs helps developing countries to lift themselves out of poverty, and we can justly be proud of our work in that area.

Key to effective development work going forward will be helping to deliver on the new sustainable development goals. One of those is to accelerate the implementation of the World Health Organisation framework convention on tobacco control. I hope, therefore, that our new tobacco control plan will be cross-Government and will include an ambitious international strategy to help countries with FCTC implementation.

The Addis Ababa declaration on financing for development, which backs up the sustainable development goals, says that parties, such as the UK, should strengthen implementation of the WHO FCTC and support mechanisms to raise awareness and mobilise resources for the convention. The UK, as a world leader both in development and in tobacco control, has a key role to play in helping to support FCTC implementation, particularly in low and middle-income countries.

The financing for development declaration goes further and states that

“price and tax measures on tobacco can be an effective and important means to reduce tobacco consumption and health-care costs, and represent a revenue stream for financing for development in many countries.”

Clearly the UK has expertise in tobacco taxation: we have some of the highest taxes in the world, combined with a comprehensive and effective strategy to tackle illicit trade. A 2014 study found that tripling tobacco taxes around the world could reduce the number of smokers by 433 million and prevent 200 million premature deaths from lung cancer and other smoking-related diseases. That would benefit UK plc, because increased tobacco taxes of necessity go hand in hand with enhanced anti-smuggling strategies, which we now have to deal with daily. Her Majesty’s Treasury, in collaboration with Her Majesty’s Revenue and Customs, is in the process of setting up a cross-departmental ministerial working group to tackle the illicit trade in tobacco and help HMRC to achieve its aims, which include:

“Creating a hostile global environment for tobacco fraud through intelligence sharing and policy change”.

If other Governments increase tobacco taxes and enhance their anti-smuggling strategies, that will help to create precisely that hostile global environment for tobacco fraud. HMRC is working on that at the moment.

Our international strategy also needs to include work to help countries protect their tobacco control public health policies from the commercial and vested interests of the tobacco industry, and to ensure that UK diplomatic posts do not help tobacco companies promote their deadly products around the world. It was rightly considered a scandal earlier this year when the British high commissioner to Pakistan was revealed to have attended a British American Tobacco meeting with the Government of Pakistan, at which BAT lobbied the Government not to implement tougher health warnings on cigarette packs—a campaign that was successful, sadly. In a recent BBC “Panorama” programme, it was alleged that BAT employees and contractors had been involved in making payments to officials and politicians in Africa in return for access to draft tobacco control legislation. Given the UK’s strong domestic record on tobacco control and our leading international role in promoting successful tobacco control policies, we need to remain vigilant and ensure that we all do everything we can to promote successful tobacco control around the world.

I had personal experience of what the tobacco companies do more than 20 years ago, when I was promoting a private Member’s Bill to ban tobacco advertising and promotion. A lot came out years later through the tobacco files about exactly what had taken place and the influence that those companies exerted to try to stop us doing what this country has now done. They tried to stop us putting this country on the map as a major force in tobacco control, as it is now. Will the Minister confirm that the international work to support the implementation of the WHO FCTC will be a key part of the new tobacco control plan, and that it will include supporting Governments in protecting their public health policies from the commercial and vested interests of the tobacco companies, in line with article 5.3 of the FCTC?

I thank you for your indulgence, Mr Betts—you will be pleased to know that I am about to sit down. The tobacco control strategies have been published, in recent history, about once every five years. They have been crucial to this country in saving the lives of many of our fellow citizens and in our getting a good evidence base for the same thing to happen throughout the world. The last thing I want is for this country to stop doing what it has been doing well. I have asked questions about funding and other things, but there is much that we can do that requires not money but good will and determination.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

It is a pleasure to serve under your chairmanship, Mr Betts. What an excellent and extremely well-informed debate we have had. I thank the right hon. Member for Rother Valley (Kevin Barron) for raising this important issue for debate. In a way, the timing is more helpful for me than for right hon. and hon. Members, inasmuch as this is a piece of work to which we in the Department of Health are turning our minds, so it has been enormously helpful to hear the views of colleagues from across the House on how we go forward. There are some areas of the topic on which I can respond, but some on which Members might have to wait until a little way into the new year.

The Government have a very clear position on tobacco control, recognising that smoking is and remains one of the most significant challenges for public health, with all the devastating social and personal consequences that Members have outlined. The Government have been proactive and, I think, ambitious in their approach to tobacco control. That was reflected in the comments made by both Government and Opposition Members, for which I thank them. It is also reflected by the fact that many other countries approach us for advice on tobacco control matters. Over the time I have been in this post, it has been a pleasure to attend a number of international events at which we were asked to provide a leadership role. I will say a little more about international matters before I finish.

Our efforts are paying off, and have paid off. As the shadow Minister said, they build on the good work done by previous Governments in previous Parliaments, and we continue to see year on year reductions in smoking. Since 2010, its prevalence has decreased by almost 3%, saving thousands of lives and, of course, countless families from the pain and harm caused by smoking. At various events in the past I have been open about discussing my experience of that harm in my own family. I know that I speak for other Members who have seen that as well.

Before I talk about the new strategy, it is worth reflecting on progress against the current tobacco control plan. We have met, or are on track to meet, the three national ambitions. Adult smoking prevalence is now at 18%, which is the lowest rate since records began; only 8% of 15-year-olds smoke, which is also an all-time low; and rates of smoking in pregnancy are falling, with the most recent figures showing a rate of 10.5%, so we have a high degree of confidence that we will meet that national target as well. On 1 October, it became an offence to smoke in a car carrying children and for adults to buy tobacco for those aged under 18. Making the latter—also known as proxy purchasing—an offence has been called for a great deal in the past. As has been noted, we have also passed legislation to introduce standardised packaging and consulted on how we intend to transpose the revised EU tobacco products directive into UK law.

Despite those achievements, smoking is still the leading cause of premature death and health inequality, and Members have rightly focused on that throughout the debate. About 8 million people still smoke, and the resulting number of premature deaths has been recorded. There continues to be enormous regional variation, which weighs heavily on me—I know that the right hon. Member for Rother Valley is very conscious of that as well. In some areas the prevalence rate is as high as 29%. With that backdrop, we can by no means think that the battle is won.

There is similar variation in ill health and death rates associated with smoking, as the hon. Member for Central Ayrshire (Dr Whitford) eloquently outlined. That variation means that there can be 472 deaths per 100,000 people in one area and fewer than 200 deaths in the same population in others. Throughout the country, we see variation in rates of smoking by pregnant women from more than 25% to about 2%. I know that some areas are working really hard to address that variation. I pay tribute to the people working in places that, despite the high rates that they battle, have seen encouraging results, such as the public health and NHS teams in Blackpool. They are bearing down on their high rates with some success and have done very well.

While we are discussing the ill health caused by smoking, perhaps this is a useful moment to give the shadow Minister a little reassurance in two regards. He made a good point about oral cancer, and I can confirm that one of the pictures in the new library of photographs being introduced with the tobacco products directive will feature throat cancer, so that will draw attention to it. Also, we received welcome information today from the British Dental Association setting out how dentists can help with smoking reduction and the identification of oral cancer. We will consider that further as we develop the strategy. That is welcome and timely news.

As we are talking about the work that people have done in different areas, such as the efforts to bear down on smoking in pregnancy, which have seen some welcome drops, I want to mention the role of health professionals. Their role has run as a thread through the debate, and I suppose it will be ever more relevant as some services look to integrate more with health professionals in the NHS and elsewhere. The movement of health visiting into local government in October—it is now commissioned through local government, as are public health services—offers a welcome opportunity to get some really close working between those two functions in local government right across the board.

As we look at the new tobacco strategy, we are working with Health Education England to identify how NHS health professionals can be further supported to act on smoking. Nevertheless, progress has been made, and I congratulate the midwives and health visitors who have done such good work to identify women who smoke during pregnancy. We have seen their work reflected in the ongoing reductions in the level of smoking during pregnancy, but there is more to do, so we are looking to build on that success.

As I have said, the Government remain committed to tobacco control, and our goal is to drive down the prevalence of smoking in England. At this point, I should say that we are working very closely and constructively with colleagues in the devolved Administrations on that shared objective. Our officials speak to each other regularly, and we are always interested to look at what measures are introduced. As always, it was good to hear the contribution from the hon. Member for Central Ayrshire. Tobacco-related deaths are avoidable, so we want to do more to avoid them.

Although I have said this in an event in the Palace of Westminster, I have not yet confirmed it in the Chamber, but I can confirm that the Government will publish a new tobacco control strategy for England next summer, which I think is a sensible timetable. I hope Members agree that, given the significant measures coming into force in the spring and the fact that we want a little time to reflect on the current strategy, that strikes the right balance. The work is under way already, which is why this debate is a timely opportunity to hear Members’ thoughts. I will ensure, throughout the timetable for developing and producing a new strategy, that there are ample opportunities for Members on both sides of the House to contribute to the strategy development. Important stakeholders, such as those who contributed through Members’ speeches today and supplied useful briefing materials ahead of the debate, will have important and regular opportunities to influence the strategy and have input into it.

In developing the strategy, we will review the current national ambitions, and we will further empower local areas and support action within them, particularly where tobacco control strategies can be tailored to the unique needs of local populations. We cannot ignore the stark differences in the results of different areas across our country, so the new strategy has to focus on those discrepancies. Robust activity at that level is vital if we are to tackle the impact of health inequalities in England and ensure that smoking prevalence continues to decline in all communities. We will, of course, need to support local authorities in pursuing collaborative partnerships and securing a high return on investment as they prioritise and streamline their budgets.

A number of questions were asked about funding, and we will give careful attention to it. I am not in a position to comment in detail on the funding of the strategy itself, about which hon. Members made a number of points and expressed concerns. It was made clear in the spending review that the public health budgets are to be ring-fenced for the next couple of years and protected, with conditions stipulating that the whole budget must be spent on public health duties.

If any right hon. or hon. Members are concerned about what is happening in a particular area, I ask them to please speak to me. The chief executive of Public Health England remains the accounting officer for how the ring-fenced public health grant is spent, and I am always extremely happy to ask him to speak to Members about their concerns about what is happening in their own areas. Manchester was mentioned specifically. I can confirm that we are aware of Manchester City Council’s decision, and Public Health England is currently working with it to identify how it can provide cost-effective support to local people who want to stop smoking. The new control strategy has not been finalised, so we cannot commit to the level of funding that will be needed, but Members have made their views on that extremely clear.

I gently say to my hon. Friend the Member for Harrow East (Bob Blackman) in particular that we have championed the way in which, over the past five years, local government has done extremely well in providing excellent services for less cost. It has focused far more on outcomes than on the money spent. It is relevant to bear that in mind, given that Members have expressed reasonable concerns about the local government spending landscape.

[Kevin Barron]

rose—

[Jane Ellison]

I sense an intervention coming.

--- Later in debate ---

[Kevin Barron]

I entirely accept that there are regional variations. We must all accept that, but the mass media—the news and the national media—cut across all regions. Will an evidence-based mass media campaign be part of the strategy that will be published in the summer?

[Jane Ellison]

I can give the right hon. Gentleman a broader assurance than that. Our approach to the subject has at all times been evidence-led, so the new tobacco strategy will clearly encompass a range of evidence-led activities. I hope that reassures him more broadly than just on that point. We must at all times be led by the evidence, as those who contributed today highlighted.

The new strategy is an opportunity to shine a spotlight on what local councils are doing locally, and to learn from innovative work. We cannot stand still in that regard. We must be open to evolving the way we do things, and that is already happening. The new devolution deals are an opportunity to focus on the exciting new ways in which local areas are reimagining the way they do things, and we have seen councils of all colours doing that. We must be optimistic in that regard and pay tribute to the innovation of local government across a range of areas. I have seen that in a host of different public health areas in the two-plus years that I have been doing this job.

But the picture in some communities and areas is not positive. Smoking rates vary across social groups—those from poorer communities and backgrounds experience higher tobacco use and much greater health burdens, as the right hon. Member for Rother Valley and others said in their speeches. Although the right hon. Member for North Norfolk (Norman Lamb) has left, I want to put it on the record—I am sure he will follow this up after the debate—that a particular focus of the new strategy will be on reducing health inequalities and their impact on people who suffer from a mental health condition. We are conscious of the great differences in smoking rates, so that will be a focus of what we do. A quarter of cigarettes are smoked by people with mental health conditions, so I can confirm that that group will be a key priority for the new strategy. We seek to embed the importance of tackling health inequalities both in the new strategy and locally, to cement the national gains that we have made.

We have introduced a significant tranche of legislation, some of which is still to come into force, so we are unlikely to commit in the strategy to a package of legislative interventions. I think colleagues appreciate the reasons for that. Rather, we will set out what we must do to identify and develop new and more effective measures for reducing smoking and smoking harm.

It might be useful to update the House on prisons, which hon. Members mentioned. We are conscious of the great differences in the rates for prisoners and non-prisoners. The Ministry of Justice has announced a programme to make prisons smoke-free, which will be implemented in stages, and prisoners will be given support to stop smoking. Public Health England continues to improve the support that it offers to prisoners who quit in prison to stay smoke-free when they leave.

Of course, tobacco control is not a matter just for legislation or for the Department for Health. There are a range of measures that can choke off the supply of new smokers and help those already addicted to quit. We will work with Her Majesty’s Treasury on tax, as Members would expect; with Her Majesty’s Revenue and Customs on the illicit trade; with local authorities, as I have already said; and, of course, with the NHS on smoking cessation services. I am conscious, as we look at the preventive landscape, that there has rightly been a focus on the five-year forward view. I am looking at several strands of that key piece of work, and this strategy is part of it. Our colleagues in trading standards, who do so much great work on enforcement, are also part of the solution. We will work with academia, the royal colleges and the wider tobacco control community to look at what works and how the Government can play their part.

Next year, in addition to publishing the new tobacco control strategy, we will introduce the stricter packaging requirements, and the revised EU tobacco products directive will come into force. The directive sets out harmonised rules on the composition and labelling of tobacco products that will apply from May 2016, and it will strengthen the functioning of the EU internal market. We look forward to its helping to improve public health. Examples of the impact of the directive are that the minimum pack size for cigarettes will increase to 20, and all flavours, including menthol, will be banned by 2020.

I will come to e-cigarettes in a moment, as I want to respond to the right hon. Member for Rother Valley and others and hopefully give them some helpful updates. First, on the international element, which was rightly raised, I can confirm that the UK has a significant role to play. The UK Government have signed the framework convention on tobacco control, and are now working in the UK and with the Commission to ensure that everything is in place to ratify that protocol. That is something we are committed to doing. The Department for Health has been awarded an overseas development assistance fund to assist other countries with developing their tobacco control policies. That funding will be used to protect people from the harms of tobacco internationally and to tackle the problem of health inequalities globally. A dedicated team will be established to deliver that work. I look forward to updating the House on that in due course.

I turn to e-cigarettes. Of course, the best thing a smoker can do for their health is to quit smoking, and to quit for good. There are now more than 1 million ex-smokers who have used e-cigarettes to help them to quit smoking completely. The evidence indicates that e-cigarettes are significantly less harmful to health than smoking tobacco. I thank Public Health England for the important piece of work it provided to advise us in the summer.

However, the quality of products on the market remains variable. It is therefore important that we have regulation that is proportionate—that is exactly the right word, and I echo that view—to ensure that we have minimum safety requirements and that the information provided to consumers allows them to make informed choices. That is exactly the aim of the regulatory framework set out in the revised directive.

In implementing the new EU rules, we intend to work towards regulation that will permit a range of products, which people want to use, to remain on the market, but with those products positioned as alternatives to smoking, not as products that introduce children to vaping or smoking.

I join the right hon. Member for Rother Valley in welcoming the arrival of licensed products that can be prescribed alongside existing nicotine replacement therapies. The Government had full support from both sides of the House when we took through precautionary legislative measures on the issue of children and e-cigarettes; indeed, most parts of the industry welcomed and supported the uncontentious approach of adopting the precautionary principle with regard to children.

We will continue to take a pragmatic approach to e-cigarettes, and we will be guided by the evidence. The right hon. Gentleman was right that, in a fast-evolving marketplace, we must be guided by the evidence. To that end, we have commissioned a comprehensive review of the impact of e-cigarettes to ensure that future policy decisions continue to be supported by a robust and published evidence base. That will build on the PHE review of evidence on e-cigarettes, which was published in August.

It might be helpful if I update right hon. and hon. Members on some relevant research projects. The National Institute for Health Research is funding a randomised controlled trial to examine the efficacy of e-cigarettes, compared with that of nicotine replacement therapy, when they are used in the UK stop smoking service. I spoke earlier of the evolving world of smoking cessation services and of understanding what works, and that will be an important piece of research. The report of the trial is expected to be published in 2018.

The Department—I hope this speaks to the watching brief that the shadow Minister asked that we keep—is commissioning work through the Public Health Research Consortium to identify whether there are any early signals of e-cigarettes having the potential to renormalise use of tobacco products. That work is expected to report in summer 2016. Again, we will look to update the House when we have the results—I know there will be interest in them on both sides.

I congratulate the right hon. Gentleman on securing a debate on this important issue. As I said, it comes at a really timely moment. When I come back in the new year, I and my officials will certainly turn considerable attention to this important strategy. As I hope I have made clear, none of us can rest on our laurels. We have made some good progress, but the Government will continue to develop support and new measures to reduce the prevalence of smoking further and faster in England. We will, I hope, continue to work constructively with colleagues in the devolved Administrations, with the objective of preventing more people—more of our constituents—from dying prematurely as a result of smoking.

I am acutely conscious of the fact that the burden of disease and harm associated with smoking falls most heavily on the most disadvantaged. Addressing that will be right at the heart of our new strategy. Like all those who have contributed to this excellent debate, I look forward to our first smoke-free generation.

In closing, I echo the words of the shadow Public Health Minister. I wish colleagues and the staff of the House a very happy Christmas, and I thank all those who have contributed to this excellent debate.

[Kevin Barron]

May I also echo those comments? I wish everybody a happy Christmas and a peaceful new year as well.

The debate shows just how far the House, as a legislative body, has travelled over the past two decades, taking on these major issues on the basis of their effect on people, as opposed to their potential effect on political parties. That is greatly to the House’s credit, and I thank everybody who has spoken this afternoon.

I thank the Minister for leaving the door open in terms of what will be in the strategy next summer. Things may come forward that test us—such as what happens in the e-cigarette market and how we deal with that—and I am sure we will watch the issue with great interest. I thank everybody who has contributed.

[Mr Clive Betts (in the Chair)]

May I also take this opportunity to wish everyone here a very happy Christmas? I look forward to seeing you all again in the new year.

Question put and agreed to.

Resolved,

That this House has considered a new tobacco control strategy.

Oral Answers to Questions

Kevin Barron Excerpts

Tuesday 2nd June 2015 Commons Chamber

[Alistair Burt]

Notwithstanding the importance of recording information collected during a consultation, my hon. and learned Friend’s constituent is absolutely right that it should not get in the way of the relationship between doctor and patient. We have already removed some of the administrative burdens by cutting a third of the quality and outcomes framework indicators that need to be recorded, but plainly more needs to be done. He is right to say that I am looking forward to seeing quite a lot of GP surgeries in the forthcoming months.

[Kevin Barron (Rother Valley) (Lab)]

I welcome the Minister to the Dispatch Box. Does he think that the community pharmacy could help in great ways with the proper integrated care of patients so that the burden on GP surgeries is shared with other health professionals?

[Alistair Burt]

Yes, the whole concept of out-of-hospital care involves an expansion of what is considered to be direct primary care, and it also involves other support services. I am aware of projects in which pharmacies are already connected directly to GP surgeries. We will be expanding some of the pilot work that has already been done. If my Twitter account is anything to go by, pharmacies are very keen to promote themselves and say what they can do for patients, and we will certainly be responding.

Health and Social Care

Kevin Barron Excerpts

Tuesday 2nd June 2015 Commons Chamber

[Kevin Barron (Rother Valley) (Lab)]

I have to say to the hon. Member for North West Norfolk (Mr Bellingham) that I thought his speech was going well until the last few seconds, when he decided to weaponise it and attack the Opposition Front Bench. I will try to keep my remarks brief.

Looking forward, rather than back, the picture looks quite gloomy for healthcare in this country. The NHS’s “Five Year Forward View” stated that there would be a £30 billion annual hole in the NHS budget by 2020, so the £8 billion that the Government have promised will still leave a gap of £22 billion a year. Yet all we talk about here is ambulance waiting times and things like that.

We are going to have to look quite radically at healthcare in this country. All the experts say that the funding gap can be filled only if there is a radical upgrade in prevention and in public health. There should be much greater emphasis on prevention, with local authorities using their responsibility for public health and leading the way locally. Priorities include tackling obesity, reducing alcohol-related health problems and smoking, and increasing levels of physical activity. Otherwise, the Government will have to find even more money for the NHS. The “Five Year Forward View” stated that,

“the future health of millions of children, the sustainability of the NHS, and the economic prosperity of Britain all now depend on a radical upgrade in prevention and public health.”

I have to say that was lacking in the speeches we heard this afternoon.

I believe that key to that is the continuing need to drive down the prevalence of smoking in this country. Smoking currently costs the NHS at least £2 billion a year, and more than £1 billion in social care costs. Nationally, the total cost of smoking to society is currently nearly £13 billion a year. We have been more effective in reducing smoking than in any other prevention measure, and we know what works. Over the past decade smoking rates have declined from one in four to one in five of adults, and the rate has been even faster among young children. Between 2003 and 2013 there was a 70% reduction in smoking by young children—a phenomenal figure. However, more clearly needs to be done, because there are still 100,000 people dying of smoking-related diseases in the UK, and 20 times more smokers than that are suffering from smoking-related diseases: not just cancer and heart and lung disease; smoking can also cause infertility, diabetes and dementia. There are over 450,000 admissions to hospital every year due to smoking.

The clock is ticking on the tobacco control plan that was put in place, which expires at the end of this year. A new, more ambitious strategy for the next five years is needed to help fill the hole in national health expenditure. For a new strategy to work, it needs proper funding. The “stop smoking” services cost less than £100 million a year and, according to the National Institute for Health and Care Excellence, they are one of the most cost-effective treatments there is. Spending on mass media campaigns to help motivate smokers to quit and prevent young people from taking up smoking was only £25 million at its peak, and highly cost-effective. We are talking about spending millions of pounds to save billions.

Funding is the key. At a time when Government funding is being cut at national and local level, new sources need to be found. According to the Institute for Fiscal Studies, local authority spending per head has been cut by nearly 25% between 2010 and 2015, with the sharpest cuts to the poorest communities. We all know that smoking rates are highest among the most disadvantaged in society, so these are precisely the communities needing the greatest level of investment, yet it is being removed. Let me remind people of a speech I made a few months ago in this House, in February or thereabouts, when following cuts in local authorities the then coalition Government had had to put an extra £26 million of emergency payments into some local authorities because of the bed-blocking situation. They did not have money for social care, and our hospitals had beds full of people who had no clinical or medical reason to be in hospital but were there because the cuts in local authorities had caused problems in those areas.

The tobacco industry, of course, still continues to do quite well. In this country alone, it makes profits of over £1 billion a year. Its deadly product may be legal but is also lethal to 50% of people who use it. In last year’s autumn statement, the Chancellor said:

“Smoking imposes costs on society and the Government believe that it is therefore fair to ask the tobacco industry to make a greater contribution.”

However, it has all gone ominously quiet since then. In the March 2015 Budget, all the Chancellor said on the tobacco levy was that he was continuing to consult. That is not good enough. If the Government are to succeed in the radical upgrade in prevention and public health necessary to save the NHS, it is essential that we have a new and even more ambitious tobacco control plan for England launched by the end of this year, and it should be paid for by a levy on the tobacco industries’ profits.