Health: Cancer Nurses

Lord Forsyth of Drumlean Excerpts

Wednesday 2nd May 2018 Lords Chamber

[Lord O'Shaughnessy]

The noble Baroness will know that the NHS benefits from many of those visas issued under tier 2, which obviously has great benefits for our workforce. It is in the long-term interests of this country that we recruit more of our staff, wherever possible, from the domestic workforce. On that basis, Health Education England has committed to increase the number of cancer consultants by more than 20% between 2016 and 2021, as well as increasing the number of radiographers and others.

[Lord Forsyth of Drumlean (Con)]

My Lords, does my noble friend really think it necessary that specialist cancer nurses are educated to degree level? If he does think that, given that because of their levels of remuneration most of the student loan will not be paid back, would it not be a good idea to consider writing off those student loans for those nurses who stay for a period within the health service?

[Lord O'Shaughnessy]

What comes to life in the cancer workforce strategy and the Macmillan report is the complexity of the workload that these nurses carry out, so a very high level of qualification is required. One thing we do not have at the moment is a national competency framework, which is being designed. Funding for nurses is obviously a topic that we come to often in this House and it is worth noting that the income point at which repayment of the loan starts has been increased by this Government, to make sure that lower-paid nurses and other staff are alleviated from that burden.

General Practitioners: Workforce

Lord Forsyth of Drumlean Excerpts

Monday 5th March 2018 Lords Chamber

[Lord O’Shaughnessy]

That is an important issue. We know that workload is a problem. I point the noble Lord and other noble Lords to NHS England’s 10 high-impact actions. These are actions which all GP surgeries can take; for instance, using technology such as e-booking and e-prescribing to reduce the kind of workload he is talking about.

[Lord Forsyth of Drumlean (Con)]

My Lords, does my noble friend not acknowledge that one reason that GPs are retiring after the age of 55 is that their salaries are such that their pension exceeds the limit, which the previous Chancellor reduced from £1.8 million to £1 million, and they find themselves having to pay tax on their pension contributions at 55%? Would not the simple solution be to raise the threshold, thereby allowing GPs to continue in practice and not be taxed on their pension contributions unfairly?

Nurses: Tuition Fees

Lord Forsyth of Drumlean Excerpts

Wednesday 29th November 2017 Lords Chamber

[Lord Forsyth of Drumlean (Con)]

Can my noble friend indicate what percentage of the borrowing by student nurses under the student loans scheme will be paid back at the point when it is written off after 30 years? If so, would it not be better to do this earlier in their careers, rather than at the end of them?

[Lord O'Shaughnessy]

My noble friend is quite right to point out that student debt is forgiven after 30 years. The point of that is to ensure there is an equitable system, where those who earn more pay back more over the course of their working lives. It is important to point out that, with the new threshold moving up to £25,000, a nurse earning £26,000 in band 5 of the Agenda for Change pay scale would pay back £7.50 of that loan per calendar month.

Health and Social Care

Lord Forsyth of Drumlean Excerpts

Thursday 12th October 2017 Lords Chamber

[Lord O'Shaughnessy]

The Government have not dropped Dilnot. We will be consulting on both the cap and the floor in the proposals that come forward on social care funding, which build on the Dilnot proposals.

[Lord Forsyth of Drumlean (Con)]

Does my noble friend recognise that the importance of the cap on people’s contributions was that it made it an insurable element, and therefore it could be incorporated in people’s long-term pension and other plans? Will the Government please revisit the idea of abandoning the cap, which was a central part of Dilnot?

[Lord O'Shaughnessy]

I reassure my noble friend that he is quite right to point out the benefits that attend to a cap. The intention is to consult on both the floor and the cap.

Education (Student Fees, Awards and Support)(Amendment) Regulations 2017

Lord Forsyth of Drumlean Excerpts

Thursday 27th April 2017 Lords Chamber

[Lord Clark of Windermere (Lab)]

My Lords, it is particularly appropriate that the final debate of the Parliament in this House is on a matter of such concern to the British people: our National Health Service. If there is one group of people who always top the approval ratings among the British people, it is nurses. I will not say where we politicians are.

It is widely accepted that the National Health Service provides real value for money. In fact, we get health on the cheap in this country. We spend less on health than any other member bar one of the G7 nations, and I am not sure that that can continue for much longer. I think we will have to spend more on health, with our ageing population and the growth of what is technologically possible.

In a sense, we have been helped in this debate by the report of a Select Committee of this House on The Long-term Sustainability of the NHS and Adult Social Care. It draws to our attention how we have failed over the years to have long-term planning for organising staff. We must remember that approximately 150,000 people work for the health service. It is a fascinating organisation. It is a labour-intensive organisation—which applies in one way to nursing—married to and working alongside cutting-edge technology and science. It works, and we must continue to ensure that it works. The key is the staff at every level.

Anyone who follows the press or talks to doctors, nurses or the other health professionals knows that our National Health Service is in deep trouble and is functioning safely only due to the work level of the staff and their intense dedication to the service in which they work. That cannot continue indefinitely. Repeatedly, the royal colleges of nursing, midwifery and all the other medical disciplines tell us that we are getting towards breaking point. The strain is intense; the morale is low.

Let us take just nursing. Currently, we are about 24,000 nurses short—I think there is no disagreement with that. That affects not only our National Health Service but another big issue at the moment, the after-care service. A number of care providers, nursing providers and Care England have contacted me to say that they have had to close beds because they cannot get nurses to staff them. We tend to neglect that, and I mention it only in passing today because I want to concentrate on the health service.

I gather that the Government have had a report available to them in March which is not yet public which suggested, on a worst figure scenario—I emphasise that—that by the early 2020s we would be not 24,000 but 42,000 nurses short. Morale is not helped by the fact that nurses were not well paid to start with. They are highly qualified. All nurses are now graduates. They have to do professional work. Increasingly, they are doing work traditionally done by doctors. They are able and skilled do it, and we benefit greatly from that. The 1% annual pay increase which they have had to accept since 2010 is having a massive effect on morale, especially when people are having to work so hard.

We get by only because we import nurses from overseas. We have traditionally done that—I am not just blaming the Government in this case—but the problem is now acute. Of those nurses from overseas, 20,000 originate from European Union countries. Despite effort and pleading by me and others, we cannot get the Government to commit to those 20,000 people who work so hard in our National Health Service being allowed to stay in Britain. That will be easy to do: we need only to tweak the residency rules. That could be done without causing any problem, yet it would be of great benefit in retaining those nurses. I believe that we should offer them permanent residency in this country, as they have dedicated so much effort to providing healthcare for our population but, at the end of the day, we must train more home-grown nurses. The supply is there, because for every person who is accepted on to a nursing course at university, twice as many people apply. There is the quality and quantity of individuals who want to train nurses. The reason why they are not is because the Government have insisted on a cap on the numbers. Universities are not allowed to accept more nurses than has been agreed with the Government. By imposing this cap, we are exacerbating the problem.

I challenge the Minister that we are only really talking about saving money. That is what is dominating the Government’s approach to the training of nurses.

To recap a little, the bursary system that has been developed meant that nurses who went into training did not pay fees. The quid pro quo was that most of them went on to work in the care services or the National Health Service. That system worked well and was fully subscribed. Under the proposals we are debating today, those individuals will have to pay £9,000 per year in fees for three years which, with their living costs, will mean that nurses enter their profession not well paid and with £50,000 minimum hanging on their shoulders. I doubt that that is a sensible approach.

We must accept that nursing students’ courses at universities are very different from most courses. It is not just lectures and library work. At least half the time of nurses in training is spent on the job, on clinical training. In most hospitals, most patients could not determine who is a student nurse and who is a qualified nurse, because student nurses are doing the work of trained nurses, except in a few technical, specialist areas.

[Lord Forsyth of Drumlean (Con)]

I am most grateful to the noble Lord. On his point about the number of nurses who previously got bursaries and about financial controls on the bursaries, what proportion of those applying were unable to get bursaries and, therefore, unable to get training places?

[Lord Clark of Windermere]

As I understand the question, anyone accepted on to the course got a bursary—so they all got the bursary. I am pretty sure that I am right on that. But the point I was making about the course being different was not only that it is more intensive and about working on the job—the course is also longer. The average course length at universities for nursing, midwives and allied health professionals is 39 weeks a year, much longer than the average student course. So it is a different course; they have no opportunity, or little opportunity, to do any extra-curricular work, because of the nature of the job. Yet while they are working on wards, they work as a team.

In essence, the Government are insisting—for, I think, the first time in decades—that nurses pay for working in the health service. They are paying £9,000 a year to work as unpaid nurses. That is absolutely scandalous. Even before the new system came in, going back 50 years, you were accepted on a nursing course and went to the hospitals where you were trained. There was a mixture of blocks in the hospital and working on wards; that is how it traditionally went, but the nurses did not have to pay to perform those tasks. It is outrageous that this Government are insisting that nurses should pay for their own training.

The Government’s justification for this change is to increase the number of nurses being trained, which we all welcome—we all want the number of nurses to be increased. It would help in so many ways. Virtually every hospital now survives by using agency nurses, paying far more by the hour than the NHS staff nurses get paid. We could save billions of pounds if we had sufficient nurses to staff our NHS and aftercare services. So what I am arguing for makes financial sense. The Government say that they are prepared, if nurses pay for their own education—and this is perhaps the point that the noble Lord was making—to lift the cap, so the universities could train as many students as they want. I hope that works; I want the system the Government are proposing to work. But then we come to the problem that it is easy enough for the universities to expand their lectures and provide library facilities; the difficulty comes when the National Health Service has to provide mentors, tutors and practical oversight of students when they work on wards and in clinical situations. There is no provision, as far as I can see, by the Government to provide extra money to hospital trusts to perform that critical part, which is at least half the cost of nurse training.

I want the proposal to work but it is highly risky. We are dependent on nurses from the European Union—and the latest figures are that there was a 90% fall in the registration of nurses from European Union countries since last December, which is an ominous sign. Then we have the figures from the Government, which show that the number of applicants to health courses was down by 23%. I accept the Government’s point that those were applicants, not people who had actually been accepted on to a course. What worries me is that, if it follows through, and if the Government do not get students prepared to enrol at universities, we will find that we make no inroads at all into the shortage of 24,000 nurses.

--- Later in debate ---

[Lord Forsyth of Drumlean]

My Lords, I rise briefly as I realise that Members opposite are anxious to get away to campaign for their leader in the forthcoming general election. Thirty years ago, as a junior Minister responsible for health in the Scottish Office, I was asked to support something called Project 2000 and the move that all nurses should be graduates. As a junior Minister, I thought it was a rather silly idea. I could see that there might be a case for having some health professionals with degrees, but getting rid of the old state registered nurse system seemed to me a huge mistake.

However, the chief nurse was a particularly formidable person and my Secretary of State did not agree with me. Over the last 30 years, some people have argued that we needed people who would do not the less important—these are some of the most important tasks—but the more menial tasks, such as emptying bedpans, spending time with patients and providing the general care that was so much a part of the health service, and that you did not have to have a university degree to achieve that. I very much hope that the Government will think about that again. The noble Baroness, Lady Watkins, has almost got there—I do not mean that in a rude sense—in terms of offering a path forward which might address this problem, but I do not believe that everyone needs to be a graduate.

The reason that I interrupted the noble Lord to ask him how many of the people who applied to become nurses ended up doing a degree and becoming a nurse was because I knew the answer to my own question, which is that it is a small proportion. The noble Lord’s speech contained a number of very important points with which I agreed. We will have to train more nurses as a result of leaving the European Union. That is clearly important. We will have to train more nurses because of the demands upon the health service. However, it seems to me that what the Government are proposing in these regulations, which is to remove the cap and to provide the funding through a loans scheme, will provide for that and address the problem.

Whether the Government are prepared to consider the admirable suggestion of the noble Baroness, Lady Watkins, that there may be a case at a stage in a nurse’s career when they have served the health service for a longer period for forgiving the loans is another question. The Economic Affairs Committee has looked at the representations we have received on student loans and I would not be surprised if that did not represent a better deal for the taxpayer than continuing with the repayment where people are not receiving substantial salaries. So, while I think that the noble Lord has identified some real issues, I very much hope that noble Lords will not vote for this Motion, which would set us backwards and not provide the opportunity for more nurses to be trained and brought into our health service. I also hope that the Government will consider whether it is absolutely necessary for people to have university degrees in order to perform nursing duties in our health service.

[Lord Willetts (Con)]

My Lords, in the absence of a voice from the Opposition Benches I will briefly intervene in the debate. I declare an interest as a visiting professor at King’s College London, which has a major role in medical education through Guy’s and St Thomas’.

The noble Lord, Lord Clark, is of course right about the importance of nurses and about the lack of a suitable supply of nurses in the old regime. We heard a very constructive intervention from the noble Baroness, Lady Watkins. I say to the noble Lord, Lord Clark, that nurses should not be worried about a model of fees and loans with graduate repayment. We went through all these concerns when we shifted mainstream higher education into fees and loans. In the first year, there was a decline in applications—but that stopped as soon as the students understood that they were not paying up front, and that it was a repayment scheme where they would pay back only if they started to earn more than £21,000 a year, and through PAYE. In other words, the so-called debt was nothing like a bank overdraft or a credit card debt; it was repayment through the income tax system if they were earning enough. That tackled their concerns, and since then we have seen an increase in the number of students applying to university.

My second point very much follows on from the excellent intervention of my noble friend Lord Forsyth. The reason we are short of nurses is that successive Governments have rationed the number of nurses. They have done that because nursing places have been financed out of public expenditure and the way to control public spending was to control the number of nurses. Back in 2004-05, we funded 25,000 nurse places a year. That has been in steady decline under successive Governments for a decade and is now down to around 17,000.

If we look at the evidence of what has happened in the past decade, there is no prospect under any Government of having more nurse places under the old system. A crucial part of these reforms is to remove the cap on places so that we will have more nurse places under the new system. The new system delivers more cash to cover nurses’ living costs during their nursing education. It delivers more money per nurse through the fees and loans system for universities providing nurse education and it removes the cap, thus providing the NHS with more trained nurses in total. That is a constructive reform of the NHS. It is progress on tackling the long-standing problems in nursing to which the noble Lord, Lord Clark, drew attention—and it is why I fear that this Motion is misconceived.

Tobacco and Related Products Regulations 2016

Lord Forsyth of Drumlean Excerpts

Monday 4th July 2016 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, I welcome this debate and thank the noble Lord, Lord Callanan, for allowing us to have a further go, since we have already debated it in Grand Committee. I am sure the Minister is looking forward to winding up at the end of the debate.

I should declare an interest as president of the Royal Society for Public Health, which has pronounced on e-cigarettes. I would say to the noble Lord, Lord Callanan, who was a mite critical of the organisation, that as a Minister I established the MHRA, and I am glad to see that it is doing so well in relation to this matter. I liked his rousing endorsement of the record of Ministers in his Government on this matter. When he mentioned Edwina Currie, I thought he was going to talk about eggs—he will recall that she had a bit of a downer on egg production—but she did not quite take it to Europe in the way he suggested.

I have moved an amendment to the Motion because, although I share some of the noble Lord’s concerns about the regulations in relation to e-cigarettes, my problem with his Motion is that he calls on the Government to withdraw the entire set of regulations. The regulations cover e-cigarettes, but there are also a lot of useful measures that will discourage smoking in general. That is why I cannot support the noble Lord’s Motion, although I share some of his concerns.

It is pretty clear from the work of my own organisation, the Royal Society for Public Health, as well as from that of the Royal College of Physicians and other health bodies, that e-cigarettes can actually be an incredibly useful tool in encouraging smokers to give up smoking. The core of people who have already taken advantage of e-cigarettes are often those whom traditional public health measures have not touched. That is why I am particularly concerned about whether the regulations will have a negative impact on that group.

Equally, I know that noble Lords will quote the report of the Royal College of Physicians. It is worth reading because it says that there is a case for some regulatory provisions, and the Minister will no doubt refer to that. However, my main concern is the point, which was made by the noble Lord, Lord Callanan, that RSPH research has revealed that 90% of the public have the impression that e-cigarettes are at least as harmful as tobacco. That is not helped by the fact that some organisations have notices prohibiting not just smoking, but vaping. Because some elements in the public health field—how can I put this kindly?—perhaps got the wrong end of the stick when e-cigarettes were first produced, they have given the impression that e-cigarettes are much more harmful than they are. The problem with the regulations is that they colour the context, and the public may be confused about the positive effect that e-cigarettes can have. Therefore my amendment to the Motion—I do not intend to delay the House very long—seeks to draw attention to some of the concerns that we have about the regulations on e-cigarettes, although we wish to see the regulations introduced as a package.

However, I also draw attention to the other problem that we have with the Government’s current policies on smoking cessation, which is that budgets, particularly those which go to local authorities, have been drastically reduced, and we have seen a drastic reduction in smoking cessation services. As an example, the amount of money that has been spent on smoking cessation media campaigns has been drastically reduced. Some £24.91 million was spent in 2009-10, which has become £5.3 million in 2016. Of course, I understand budgetary constraints, but I would also say that because of the risk of confusion by the public over e-cigarettes, some Department of Health-sponsored public campaigning is necessary to get the right facts across to the public.

[Lord Forsyth of Drumlean (Con)]

The noble Lord said that he could not support my noble friend’s Motion because it referred to all the regulations. Why, then, does his amendment not seek simply to delete Parts 6, 7 and 8 of the regulations? Which parts of the regulations as they stand does he not agree with?

[Lord Hunt of Kings Heath]

I thought that my amendment elegantly dealt with the broad principles rather than going into technical details such as which paragraph I do not like. I am disappointed by the noble Lord’s intervention on that matter. No doubt he is stunned by his noble friend’s remarks that in fact the EU came to the rescue of the UK. We know that if the EU had not legislated in this area, the Government would certainly have brought in legislation much earlier which would have been much more draconian than the regulations that are before the House tonight.

[Lord Forsyth of Drumlean]

We can change that.

[Lord Hunt of Kings Heath]

No doubt we will of course be able to see in the future what a Government would do in the event of Brexit. However, to be fair, at the moment we are debating these regulations, which have come into force. I have attempted to signal some of my concerns that this would have a negative impact on the use of e-cigarettes without detracting from the overall regulations. I beg to move.

--- Later in debate ---

[Baroness Hollins (CB)]

My Lords, I refer to my interests in the register, perhaps particularly that until last month I was chair of the board of science for the British Medical Association.

The Motion from the noble Lord, Lord Callanan, states that the regulations,

“run counter to advice from the Royal College of Physicians to promote vaping and … that they could force vapers back to smoking”.

Noble Lords should be aware that the Royal College of Physicians does not support the Motion. The Royal College of Physicians, together with ASH, the BMA, Cancer UK, the Royal Society for Public Health and the UK Centre for Tobacco and Alcohol Studies all support the TRPR, including the regulation of e-cigarettes. Yes, medical organisations such as the RCP and the BMA recognise the substantial harm reduction offered by e-cigarettes, but they also conclude that they are not harmless—both identify the need for regulation of e-cigarettes to protect the public.

Noble Lords may have received some very inaccurate briefings, making some assertions that are just not substantiated by the evidence. For example, “nicotine itself is not dangerous”. It is just not true. It is both toxic and addictive. Although vaping using electronic cigarettes is much less harmful than smoking, nicotine is toxic. It is also not helpful if you are going to have surgery. It is not helpful when it is swallowed. It is harmful when it is in contact with the skin, and its addictive properties, for me as a psychiatrist, are particularly of concern.

It is just not true that the limits of 20 milligrams per millilitre will force many vapers to return to smoking. Use of high-strength nicotine is not the norm, and vapers who need more nicotine can get it by vaping more frequently.

It is not true that the regulations mean no advertising. Substantial forms of advertising would still be permitted under the regulations—at point of sale, on billboards, on buses, as inserts in printed media and as product information on websites. Furthermore, the ASH/YouGov results show that more than 90% of smokers are now aware of e-cigarettes, so existing smokers already know about vaping. It is the non-smokers, whom we do not want to become addicted to nicotine, who are not so aware.

[Lord Forsyth of Drumlean]

Can the noble Baroness explain why it is okay to advertise on the side of a bus but not in a newspaper?

[Baroness Hollins]

I do not have an explanation for the kinds of advertising that have been approved, but some advertising is still permitted. The information that is being put out is that no advertising is allowed.

There are particular concerns for people with serious mental illness, given that about one-third of all tobacco consumption is by people with current mental health problems. I could go into some of the complications of smoking and the relationship between nicotine and some of the psychotropic medications that are used. The Royal College of Psychiatrists states that e-cigarettes,

“seem to be fairly effective in helping smokers stop or control their smoking”,

but it goes on to say:

“Although they seem to be safe, we aren’t yet clear about longer-term health risks”.

Any benefits or disadvantages to public health are not yet well established. This reflects concerns over e-cigarettes’ effectiveness as a smoking cessation aid, the variability of the components of e-cigarette vapour and the absence of the significant health benefit associated with the dual use of e-cigarettes and tobacco cigarettes. The BMA strongly believes that a regulatory framework is essential. I hope that noble Lords will agree with the medical experts who have supported these regulations.

--- Later in debate ---

These regulations directly affect me, my health and my well-being. I could not understand why Brussels wanted to penalise the vaping industry and vaping users but after hearing my noble friend Lord Callanan’s contribution on the pharmaceutical and tobacco industry having got at Brussels, all is now clear. I am sorry that we are considering only a regret Motion. If I could vote against these regulations, I would.

[Lord Forsyth of Drumlean]

My Lords, first I congratulate my noble friend Lord Callanan on the very excellent case that he put. I shall not proceed by repeating any of the arguments. I have looked at the regulations, but some people who have spoken in the debate clearly have not.

If someone wanted to sabotage a product, add to the costs of producing that product, limit the scope for competition with that product, and drive out of business small producers, it is hard to see how a more effective job could be done than in respect of the regulations that apply to electronic cigarettes. As far as noble Lords who argued that this is all a plot by the tobacco companies are concerned, one way of ensuring that all of this ends up in the hands of large businesses will be by pursuing exactly these regulations—by limiting choice and, of course, by creating a black market, which will be accessed through the internet, as we have seen occur over and over again in respect of medicinal products.

There seems to be no logic in the regulations. We have already touched on why some advertising is allowed but not others. I find it extraordinary that a Government should want to ban advertising when the evidence that we had from ASH—the noble Lord referred to that—states:

“Perceptions of harm from electronic cigarettes have grown with only 15% of the public accurately believing in 2016 that electronic cigarettes are a lot less harmful than smoking”.

If most people do not realise the benefits of it, what on earth is the logic of preventing people advertising it? How does the noble Baroness, Lady Walmsley, explain that she wants a public information campaign? How can we have a public information campaign without advertising the benefits of electronic cigarettes? Therefore, why is she against the advertising of electronic cigarettes? There is no logic in that.

I hope that noble Lords do not mind me mentioning the fact that my son is 37 years old. He has smoked cigarettes since he was 16, to the best of my knowledge, and probably earlier. He smoked very heavily, but three Christmases ago—I should declare an interest—I bought him an electronic cigarette. As a result, he has reduced the levels of nicotine and of all the things that we have tried—blackmail, bullying, nicotine patches, and everything under the sun—it has worked. The figures show that one-third of the 2.8 million adults who are vaping in this country are ex-smokers. The arguments being put for the public health benefits are overwhelming.

It pains me to say this, but this is a classic example of gold-plating of European regulations by the UK health department. The point is that, because the regulations are gold-plated, there is nothing we can do about them. They are EU regulations and we are required to implement them. I wonder what on earth was going on in the Department of Health that made it do this.

When we see something absurd happening, we should ask, “Cui bono?”. Who benefits from this? Certainly the Government benefit from it because people who are continuing to smoke cigarettes will pay a very considerable amount in tax to the Exchequer. I do not know how much a packet of cigarettes costs, as I have never smoked my life, but I am told it is about £9 for 20 cigarettes. People who start vaping will not spend that in a week. Families on low incomes—and many of the people who smoke heavily are among the lowest- income families—will benefit from something which enables them to deal with the addiction that they have to nicotine and remove themselves from it. Who benefits from this? Certainly not the people who are among the poorest in our country who are smokers. The Exchequer benefits—the Treasury benefits—if people are still smoking cigarettes because it gets its tax on the cigarettes, which is very considerable. Of course, the pharmaceutical companies, which sell the nicotine patches, benefit. The tobacco companies benefit because people are not switching away.

So what on earth are the Government doing, promoting the interests of the tobacco companies and the large pharmaceuticals—because that is the effect of this? The detail in the regulations is unbelievable. They even spell out which typeface—Helvetica—appears on the warnings, and whether it should be bold or italic. That is North Korean stuff: it is utterly absurd regulation. We may laugh at it, but, as the noble Lord, Lord Campbell-Savours, pointed out, it means that small businesses up and down the country will have to comply with these regulations, work out what they mean, change all their literature and everything else, and, as a result, be driven out of business.

We are in a bit of a quandary here, because there is much in these regulations that is quite desirable. When we have left the European Union, we will be in a position where we can hold our Ministers to account, hold votes and actually make these things happen. I had not realised that this is a very clever operation by the Department of Health. This is what you do: you have some absurd regulations, which you know you are not going to get through the House of Commons. So you persuade Brussels to include them in an EU directive; and heigh-ho, they have to sail through both Houses, because there is nothing we can do. We all take part in this pantomime, where we explain all the reasons why they should be changed, knowing full well that there is very little we can do about it until we leave the European Union.

So I congratulate my noble friend on his efforts and hope that, when the Government are free to do so, they will rethink these absurd regulations, which will undoubtedly cost lives. They are a classic example of how big business is able to use Brussels, together with lobbying organisations, to the disadvantage—and, in this case, life-threatening disadvantage—of the citizens of this country.

[Baroness Walmsley]

May I correct something that the noble Lord, Lord Forsyth, said? He suggested that there was an inconsistency in my remarks. I point out to him that my regret Motion regrets the advertising ban. If there were no advertising ban, it would be perfectly possible to have a public information campaign.

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[The Parliamentary Under-Secretary of State, Department of Health (Lord Prior of Brampton) (Con)]

My Lords, before this debate started I had feared that it would be a bit like Groundhog Day in relation to what happened in the Grand Committee Room earlier. However, it has been a fascinating and excellent debate. I thank the noble Lords, Lord Callanan and Lord Hunt, and the noble Baroness, Lady Walmsley, for tabling their various Motions and amendments. This has been a very good debate.

I start from the premise that all my instincts are always against regulation. In my view, there is normally a presumption against regulation. I should also make it absolutely clear that there is no doubt that vaping is far better for you than smoking. If, as a result of these regulations, more people were to carry on smoking, we would indeed have shot ourselves in the foot. To pick up the analogy that my noble friend Lord Ridley used about needle exchanges, the point is that they should at least be clean needles. I agree with his argument but we need some regulation to ensure that vaping is not abused, if I can put it that way.

I wish to make a small number of important points which have been raised by noble Lords. First, we have fought long and hard to denormalise smoking behaviours, and Members of this House have been at the forefront of that. It is right to take a precautionary approach to managing any risk that e-cigarettes renormalise smoking behaviours, particularly by restricting children’s exposure to e-cigarette marketing and imagery. Glamorising these products, with adverts reminiscent of those from the tobacco industry many years ago, can only make them more attractive to children. Recent research by the Cambridge behaviour research unit also suggests that exposure to e-cigarette adverts influences children’s perception of smoking tobacco. It reduces their belief in the harm of occasional smoking. This has the potential to undermine some of the great progress we have made over the last six decades in controlling the smoking of tobacco.

I know that there are calls for a return to self-regulation, but just last week we saw the Advertising Standards Authority rule on a glamorous advert. I do not think that props are allowed in this House, but this is a four-page advert on the front and back of the Evening Standard. On the front, there is a very attractive young woman looking out over London while smoking a cigarette. On the back, there is a James Bond lookalike jumping out of a helicopter. That is not aimed at people who are smoking but at young people who might then think about smoking. Figures have been put about showing that there is no evidence that young people are influenced by this kind of advertising. However, that is not the case everywhere. The US is seeing an upward trend in children who have never smoked cigarettes using e-cigarettes, and data from Poland show that 30% of children surveyed use e-cigarettes. The Government have therefore taken a precautionary approach to any possible risk of the renormalisation of smoking behaviours.

Some 96% of smokers are already aware of e-cigarettes, so I am clear that promotion is not about raising consumer awareness, which already accounts for 96% of that market. While businesses’ ability to communicate about their products may have been curtailed in the interests of protecting children, they have not been banned outright. The regulations will not prohibit information being provided to customers either online or in physical retail outlets. Nor will they ban independent reviews of these products or discussion in e-forums. Some advertising will be allowed, such as point-of-sale, billboards and leaflets. Essentially, these are the information routes that were used when e-cigarette sales and use were growing the fastest. My noble friend made a point about billboards, buses and the like. The reason for the distinction between outlets is to try to minimise the impact on young people. That is what lies behind the differentiation between advertising media.

Secondly, the regulations provide minimum product standards and reporting of ingredients and emissions. This should reassure smokers who are looking to quit that e-cigarettes are safe and high quality, and give the Government and health professionals such as GPs confidence in recommending them to smokers. The product standards in the regulations are a result of balancing user needs and risk of accidental exposure to children. Of the reported poisoning incidents, running at some 250 a year, one-third relate to young children under the age of four. The regulations require child-resistant packaging, and the 20 milligrams per millilitre limit for nicotine, combined with the size restrictions on tanks, ensures a maximum exposure of 40 milligrams of nicotine, which is below the level of 50 milligrams that the European Chemical Agency assesses would cause acute toxic effects for toddlers. ASH recently published data indicating that only 9% of vapers report using e-liquid containing 19 milligrams per millilitre or more of nicotine. I know that my noble friend Lord Cathcart is a heavy user of this particular substance, but he is among only 9%. Moreover, the changes in technology will make it increasingly possible for users to get high levels of nicotine uptake for any given strength. Producers can of course get a higher strength approved by the MHRA.

My third main argument in favour of these regulations is that the UK’s approach to the regulation of e-cigarettes has, and will remain, pragmatic and evidence-based. We have one of the most liberal approaches to e-cigarette regulation in the world. We have implemented domestic age-of-sale legislation, preventing sale to under-18s, but we have not banned flavours in e-liquids or cross-border distance sales, nor have we restricted vaping in public places. I remind noble Lords that the latter two measures have been introduced in around two-thirds of all other EU member states and are also common in other parts of the world. I am not sure whether the noble Lord, Lord Forsyth, is right when he talks about gold-plating in this context.

[Lord Forsyth of Drumlean]

I am contemplating the Minister’s argument about children being exposed to dangerous quantities of nicotine—which obviously one wants to avoid—and how there is therefore a need to reduce the packaging. Is he planning to do the same for other household products such as domestic bleach and dishwasher liquid? We cannot approach that kind of problem through regulation: surely it is about encouraging parents to behave responsibly.

[Lord Prior of Brampton]

There are of course many products which do have tamper-proof packaging and we cannot debate all the ones the noble Lord mentioned. It seems to me entirely reasonable that this particular product should be tamper-proof. If a child were to swallow nicotine in these kinds of volumes it would have a very serious impact. It is entirely reasonable to have tamper-proof packaging.

The Government have asked the MHRA, local authorities and others involved in the enforcement of these regulations to develop a compliance regime together with the businesses which are currently in this industry. We will take a pragmatic approach to implementing the new notification system. Notification fees are low—£150 per product and £60 annually as a top-up—and are set to recover costs only. The MHRA has also developed guidance that minimises the burden on business.

E-cigarettes are not harmless. Nicotine is both toxic and addictive and there are unanswered questions about the effects of longer-term use. It is better to vape than to smoke but it is far better to do neither. These regulations reduce the risk of harm to children and protect against the renormalisation of tobacco use. They provide assurance on relative safety for users and legal certainty for businesses that wish to sell these products across the EU. I also underline that the regulations have the full support of the four nations of the UK, as well as many of those in the health community that have been involved in tobacco reduction, including ASH, Cancer Research UK and the British Medical Association. The Royal College of Physicians agrees in its report on the need for regulation of e-cigarettes to protect the public, and states that although e-cigarettes are estimated to be in the order of 95% less harmful than smoked tobacco, they are not harmless.

Moving forward, the Government are committed to a full review of the functioning of the regulations, including—

NHS: Diabetes

Lord Forsyth of Drumlean Excerpts

Thursday 26th May 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, I will certainly endeavour to do that. If the noble and learned Lord has a keen interest in research into type 1 diabetes, I am happy to meet with him outside and with anyone else who would like to join us.

[Lord Forsyth of Drumlean (Con)]

My Lords, does my noble friend agree that the considerable pressure on the National Health Service would be relieved if we were able to control levels of immigration into this country—we have shocking levels today—and if we did not have to make a net contribution of £10 billion to the European Union?

[Lord Prior of Brampton]

My Lords, I am not sure that that question has much to do with the original Question on the Order Paper. However, without the levels of immigration that we have had in the past, the NHS simply could not operate.

E-cigarettes: Regulation

Lord Forsyth of Drumlean Excerpts

Monday 7th March 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, we are capable of looking after vaping devices on our own, but if we ever want to sell into the European market, we will have to abide by those regulations.

[Lord Forsyth of Drumlean (Con)]

My Lords, is it not perfectly obvious that big business is lobbying Brussels to shut out competition, that e-cigarettes cost less, which limits the impact of highly regressive taxes on tobacco, and that they enable people to save their health? Will my noble friend admit that the Government are powerless to do anything about this?

[Lord Prior of Brampton]

No, I do not admit that the Government are powerless to do anything about this. I do not believe that the origins of this directive have anything to do with limiting competition; they are based in trying to have a regulated market where safety and quality are guaranteed.

NHS: Preventive Medicine

Lord Forsyth of Drumlean Excerpts

Wednesday 20th January 2016 Lords Chamber

[Lord Prior of Brampton]

Successive Governments have had a huge impact on reducing smoking levels, which are now down to 18%—the lowest they have ever been.

[Lord Forsyth of Drumlean (Con)]

My Lords, would this not be a suitable subject to be considered by a royal commission on the health service, which my noble friend Lord Fowler has advocated and for which he has considerable support in all parts of the House?

[Lord Prior of Brampton]

My Lords, the issue to which my noble friend refers was fairly fully discussed in a debate in this House initiated by the noble Lord, Lord Crisp, only some two months ago. If Members of this House wish to discuss it further, they are, of course, very welcome to do so. However, I am not sure that a royal commission is necessarily the right way to proceed.

NHS: General Practitioners

Lord Forsyth of Drumlean Excerpts

Wednesday 26th February 2014 Lords Chamber

[Earl Howe]

I do agree with the noble Lord’s final comment in particular. We know that GPs are hard pressed. GP consultation rates have risen by 40% since 1995. We therefore need to take several steps to address that. One is in the medium to longer term: we need more GPs, and we have tasked Health Education England to ensure that at least 50% of medical students move to the GP specialty. In the immediate term, there are the measures that I mentioned relating to the GP contract and the £50 million fund, both of which are designed to make the use of GPs’ time a lot more productive than it is at present.

[Lord Forsyth of Drumlean (Con)]

Can my noble friend tell me whether the previous Labour Government’s negotiation of the GP contract, which resulted in GPs being less available but being considerably better paid, may have something to do with the difficulties that we are now experiencing?

[Earl Howe]

My Lords, the resources that have been devoted to GP practice and primary care have gone up by a third in real terms since 2002. A lot of that was due to the revised GP contract. Unfortunately, that contract also allowed GP practices to opt out of out-of-hours care which, over time, has meant that patients have found it more difficult to access their GPs at evenings and weekends.