Care Workers: Professional Register

Lord Young of Cookham Excerpts

Monday 10th January 2022 Lords Chamber

Asked by

[Lord Young of Cookham]

To ask Her Majesty’s Government what plans they have to introduce a professional register for care workers.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Kamall) (Con)]

We will invest at least £500 million in the social care workforce over the next three years. The major investment includes the introduction of a digital care workforce hub. This hub will help identify people working in social care and provide them with access to resources to help them in their careers. It will also include a skills passport to provide staff with a permanent record of their training and development over their career.

[Lord Young of Cookham (Con)]

My Lords, I am grateful for that reply. In his letter to us today on NHS resilience, the Secretary of State says:

“Social care is vital for our success in managing Covid-19, working as part of a single system with the NHS.”


We all agree that we need to integrate the NHS and social care and provide a high-quality, seamless service to users, but as long as those in the social care profession are seen as the undervalued poor relations of those in the health sector, such integration is going to be very difficult. Scotland, Wales and Northern Ireland have already introduced a registration scheme, offering professional skills and better working conditions for those in social care and making it a more attractive career profession. When will England do the same?

[Lord Kamall (Con)]

As my noble friend rightly points out, the devolved Administrations have registers in place in Scotland, Wales and Northern Ireland and they have taken a phased approach over the years to registers of staff working in a variety of roles across social care, because of the complexity of the sector. This is why our first priority is to embed a knowledge and skills framework to clearly understand the current layout of the workforce and the skills required in their roles and to look at potential pathways before we consider mandatory regulation.

Cigarette Stick Health Warnings Bill [HL]

Lord Young of Cookham Excerpts

2nd reading
Friday 3rd December 2021 Lords Chamber

Moved by

[Lord Young of Cookham]

That the Bill be now read a second time.

[Lord Young of Cookham (Con)]

My Lords, I hope that we will now move to calmer waters.

I am sanguine about the prospects for this Bill reaching the statute book at this late stage of the Session. However, that is not fatal as its provisions could be implemented by a simple amendment to the Tobacco and Related Products Regulations 2016—easily done now that we have left the European Union. I have chosen this subject to keep up the pressure on the Government on public health and to help shape the agenda for the forthcoming tobacco plan; perhaps my noble friend the Minister can say when we might expect it. I do so also because the campaign against the harm done by tobacco has been one of my preoccupations since entering Parliament in 1974.

This Bill extends the logic of health warnings on cigarette packs to the cigarettes themselves. If implemented, it would require both cigarettes and cigarette papers to display health warnings such as “Smoking Kills” or “Smoking Causes Cancer”. I first proposed this measure as a Health Minister in 1979 in Margaret Thatcher’s Government. I was told by representatives from the tobacco industry that we could not add health warnings to cigarettes because the ink used to print the warnings could be hazardous to health. Thankfully, the debate around tobacco control has progressed significantly since then, and I am confident that noble Lords will see the compelling case for dissuasive cigarettes. From being an initiative that, I believe, I was one of the first to suggest, it now commands broad support from the Royal College of Physicians, Cancer Research UK, the Health Foundation and the Association of Directors of Public Health—in all, some 71 organisations concerned with reducing the harm done by tobacco.

Smoking remains a leading cause of premature death. The Chief Medical Officer, Chris Whitty, has said that it is likely to have killed more people last year than Covid-19. However, smoking kills on the same scale every year and will go on doing so for years without robust action. In 2019, one in seven of the UK population were smokers. In England alone, around 280 children under 16 start smoking for the first time every day. Smoking is highly addictive: only one in three smokers will be able to quit before they die.

There is evidence that, over time, the responsiveness of smokers to existing warnings declines. New techniques are therefore needed to refresh their interest. Cigarettes are cancer sticks and consumers should be warned on the product, not just on its packaging. There is a growing body of research evidence from around the world supporting the effectiveness of what are known as “dissuasive cigarettes”, particularly in making cigarettes less attractive to younger adolescents and those who have never smoked.

This measure is popular. In a poll conducted by YouGov for Action on Smoking and Health, 70% of those surveyed supported health warnings on cigarettes, two-thirds of them strongly. Only 8% opposed the proposal. This includes majority support from voters from every main political party, including 70% of those who voted for my party in 2019. Adding health warnings to cigarettes and cigarette papers is a simple measure with minimal cost that would help deliver the Government’s Smokefree 2030 ambition. Tobacco manufacturers already print on cigarette papers, so this would be cheap and easy to implement.

This measure was one of several tobacco amendments to the Health and Care Bill tabled in the other place by officers of the APPG on Smoking and Health, of which I am a vice-chairman. As it stands, the Bill fails to include a single mention of smoking or tobacco and represents a significant missed opportunity to introduce key policies for achieving Smokefree 2030. Disappointingly, the Government refused to adopt the recommendations in the Commons, saying that they needed to

“conduct some further research and build a more robust evidence base in support of such additional measures before introducing them.”—[Official Report, Commons, 28/10/21; col. 812.]

However, these warnings are already under consideration in Canada, Australia and Scotland. Here is an opportunity for the UK to be ahead of the curve instead of waiting for others to lead. The robust evidence will be available only if someone does it.

Health warnings such as “Smoking kills” have been shown to be effective on billboards and tobacco packs, so why would they not also be effective on cigarettes? Adding warnings to cigarettes is important, because young people in particular are likely to start with individual cigarettes rather than packs. In addition to all the existing research on the effectiveness of health warnings, there have been at least eight peer-reviewed academic studies published since 2015 which specifically looked at warnings on cigarettes and found them to be effective, particularly in making cigarettes less attractive to younger adolescents and never-smokers.

This is a simple measure with minimal cost that would help deliver the Government’s ambition to make England smoke-free by 2030. This worthy ambition was announced in 2019, yet we are still waiting to hear what steps the Government will take to make it a reality. At the current rate of decline in smoking prevalence, Cancer Research UK has estimated we will miss that ambition by seven years, and double that for the poorest in society.

We will achieve a smoke-free 2030 only by motivating more smokers to make a quit attempt, using the most effective quitting aids, while reducing the number of children and young adults who start smoking each year. Dissuasive cigarettes will contribute to both objectives and reinforce the impact of other measures which require significant investment, such as behaviour change campaigns and stop smoking services.

This measure, along with the other tobacco amendments proposed in the Commons, will be retabled in the Lords after Second Reading next week by myself and colleagues from the All-Party Group on Smoking and Health, some of whom I welcome in today’s debate. I am confident these amendments will have strong cross-party support.

I end by quoting my honourable friend Bob Blackman MP, chairman of the all-party group, speaking during a recent debate on the Health and Care Bill in the other place:

“if we look back over the years, the measures on smoking in public places, on smoking in vehicles, on smoking when children are present and on standardised packaging of tobacco products were all led from the Back Benches. Governments of all persuasions resisted them, for various reasons … but we on the Back Benches who are determined to improve the health of this country will continue to press on with them, and we will win eventually. It may not be tonight, but those measures will come soon.”—[Official Report, Commons, 22/11/21; col. 74.]

I can assure the Government that, when the Bill comes to the Lords, we in this Chamber will take up the challenge. I beg to move.

--- Later in debate ---

[Lord Young of Cookham (Con)]

My Lords, I thank everyone who has taken part in this debate, starting with the noble Lord, Lord Rennard, whose long-standing commitment to the campaign to reduce the harm done by smoking is well known; he also underlined the all-party commitment. He trailed the broader package of a suite of measures as part of the APPG manifesto published earlier this year, of which this is one component. We look forward to taking that agenda forward on the forthcoming Bill.

My noble friend Lord Naseby and I have been on opposite sides of this debate ever since we both joined the House of Commons on the same day in 1974. I was reading last night a contribution that he made in May 1980, much of which he repeated today, showing consistency. I say to my noble friend that much of his speech was not about the Bill but about raising the age limit, the licensing regime, a potential levy and a tax on profits. I understand that. He described the promoters of the Bill as misguided. I wonder whether he would like to reflect on that, given the wide range of health organisations that I mentioned—for example, the Royal College of Physicians and Cancer Research UK—and whether he also believes that they are misguided in supporting the Bill.

[Lord Naseby (Con)]

The misguided bit is that the promoters of the Bill have not taken any advice on communication. It is quite clear to me, as one who has been a professional in that world, that to place a communication, as my noble friend suggested, on a narrow cigarette that is burning away, in red on a white background, is not good communication.

[Lord Young of Cookham (Con)]

I will come to that specific point, but he described the promoters of the Bill as misguided and I was making the point that he includes among those misguided people a very wide range of serious health opinion. As I said, I will come to his point.

The noble Baroness, Lady Uddin, put the Bill in personal terms. I am grateful for her contribution. She made the point that we need to move on from the health information on packs, which is now taken for granted, to a new means. On my noble friend’s point, he raised the question of whether it would be easy to read. A cigarette is right under your nose so it is probably easier to read what is on the cigarette than what is on the pack. Also, the pack is not seen by other people, whereas, if you put a message on the cigarette, those in the company of the smokers will also see it. I see that as an added advantage of this move.

I listened with some disbelief to my noble friend Lord Moylan. He started off by saying that he was surprised that I had introduced this Bill in the middle of a pandemic, implying that I should wait until the pandemic is over before introducing what I think would be a very useful health measure. Astonishingly, he described the message that I want to put on the cigarettes—“Smoking kills”—as propaganda. Even the tobacco manufacturers now admit that smoking is bad for your health. I just wonder whether my noble friend has ever read the 1962 report of the Royal College of Physicians—the whole weight of evidence. The health warning that smoking kills, and damages your health, is not propaganda but accepted health fact. He should move on.

My noble friend then described the 2030 target for a smoke-free England as ASH’s target, but it is not; it is a government target to which the Government have committed—I look to my noble friend on the Front Bench. Finally, my noble friend Lord Moylan described what I am doing as patronising. There is the libertarian wing within my party, of which he is clearly a member. I have listened to these arguments about things being patronising for the last 30 or 40 years. When there was a proposal to introduce compulsory crash helmets for motorcyclists, that was described as patronising. Parliament legislated and I do not think there is any question of repealing that. I heard exactly the same argument about seatbelts for drivers and then passengers; people said that was patronising legislation. I heard it about banning sponsorship for sporting events and banning smoking on public transport and then in public places. I am sure I will hear it again during the passage of the Health and Care Bill, which has a provision for adding fluoride to water.

Every single one of those measures has been adopted by Parliament, and I do not think anybody would seriously suggest that any of them should be repealed. In due course, measures such as the one I am promoting today will be accepted as conventional wisdom. I hope that, in a few years’ time, my noble friend will accept that this is the direction in which public opinion is moving. As I pointed out, this is a popular measure; it is popular within my party. I am glad I have got that off my chest.

I am very grateful to the noble Baroness, Lady Merron, for her support and her predicted support for the other measures that I and other noble Lords will introduce as amendments to the Health and Care Bill, which gets its Second Reading on Tuesday. That is much appreciated, as is her own record as a Minister in the Labour Government.

Finally, I am grateful to my noble friend the Minister, whose personal commitment to reducing the damage done by smoking shone through his speech. He put the Bill in the slightly broader context of government policy and recognised the imperative to drive down smoking. He said he had strong support for measures to stop people smoking. I will pick up one or two points from his speech for which I am very grateful. He said that the tobacco control plan would be published next year. “Next year” spans several months, so I wonder whether he could at some point be a little more specific about the timing of this plan, for which we have been waiting for some time, rather than referring just to 2022. He made the point that everyone is waiting for robust evidence. If everybody waits for robust evidence, no one will provide it, so at some point a country has to go first. I was grateful that he said that while he was unable to support this measure at the moment, he would consider it as part of the suite of measures to be looked at as part of the tobacco control plan. I accept what he says. That about sums up everything.

Bill read a second time and committed to a Committee of the Whole House.

Public Health Grant to Local Authorities

Lord Young of Cookham Excerpts

Tuesday 2nd November 2021 Lords Chamber

[Lord Kamall (Con)]

As noble Lords will know, the Chancellor has confirmed additional spend for public health, and the public health grant will be maintained in real terms over the spending review period, enabling local authorities to invest in prevention and front-line services such as child health visits. There will also be continued funding of £100 million per year over the period to tackle obesity in adults and children, as well as investment in a new start for life offer for families, with an additional £66 million in 2024-25. We know and recognise the importance of public health. At the same time, the NHS is committed to rebalancing between public health, prevention and therapeutics.

[Lord Young of Cookham (Con)]

Has my noble friend seen analysis by the University of York showing that expenditure on public health is three to four times more effective in terms of health outcomes than investment in the NHS? Will he take steps to ensure that we now invest in the resilience of the public health network to ensure that we are better placed for any future pandemics?

[Lord Kamall (Con)]

I thank my noble friend for that very important question. We continually assess our preparedness plans for infectious disease outbreaks and pandemics to ensure that they remain as robust as possible. This assessment includes, as appropriate, incorporating lessons learned from exercises that test the readiness of our plans and from our experience in responding to pandemics, disease outbreaks and other types of incident in the UK. The UK Health Security Agency will be dedicated to ensuring that we are protected from all future threats, including pandemics.

Social Care

Lord Young of Cookham Excerpts

Wednesday 27th October 2021 Lords Chamber

[Lord Kamall (Con)]

I thank the right reverend Prelate for that question. I am not able to answer it directly now, but I will send an answer.

[Lord Young of Cookham (Con)]

My Lords, further to the question from the right reverend Prelate, I understand the concern that the proceeds from the ring-fenced levy may not be enough to relieve all the pressure on social care. So will the Minister encourage the NHS trusts, which are receiving the bulk of the extra funds, to use Section 75 of the National Health Service Act 2006 to commission social care, thereby taking some of the pressure off local authorities?

[Lord Kamall (Con)]

I thank my noble friend for that suggestion, and I will take it back. What we have to remember about the way social care is funded is that, in reality, it is mostly private providers that provide social care, and these are funded by private and state-funded patients. Quite often, we find it is private patients who cross-subsidise state-funded patients. I will take the question from my noble friend back and send an answer.

Social Care Funding (EAC Report)

Lord Young of Cookham Excerpts

Thursday 28th January 2021 Grand Committee

[Lord Young of Cookham (Con) [V]]

My Lords, at a time when your Lordships’ House is under fire, there can be no better example of its value than the document we are debating. The committee achieved in a matter of weeks what has eluded Governments for over 20 years.

In December 2000, the Queen’s Speech said:

“The legislation will also take forward my Government's response to the Royal Commission on Long Term Care for the Elderly.”—[Official Report, 6/12/00; col. 2.]


That was the Sutherland commission. Nothing happened. At the end of the Labour Government’s time, they were back where they started with the 2009 Green Paper Shaping the Future of Care Together. The coalition agreement echoed what Labour said in 1997:

“We will establish a commission on long-term care, to report within a year.”


But Dilnot suffered the same fate as Sutherland.

In 2017, the Queen’s Speech said:

“My Ministers will work to improve social care and will bring forward proposals for consultation.”—[Official Report, 21/6/17; col. 6.]


Nothing happened. The last Queen’s Speech said:

“My Ministers will seek cross-party consensus on proposals for long term reform of social care.”—[Official Report, 19/12/19; col. 7.]


Again, nothing happened, as the noble Lords, Lord Razzall and Lord Campbell, said. That is the background to the substantial achievement of my noble friend and his committee.

Some critics may say that this consensus has been achieved at an unaffordable price—not so. The chairman of the committee, my noble friend Lord Forsyth, is a notable hawk when it comes to public expenditure. I put “Lord Forsyth, control of public expenditure” into Google and got 860,000 hits. On his committee are two former Chancellors and two former Treasury Permanent Secretaries, with the imperative of public expenditure restraint in their very DNA—I do not imply that the other noble Lords on the committee are a soft touch. This is not a body of men and women who will come up with something unaffordable. The next step should be a White Paper and legislation.

I have two comments to make in the time available. I do not agree with paragraph 8:

“We share the concerns of many witnesses about the Government’s plans to make local authorities more fiscally self-reliant.”


I think local authorities should become less dependent on central government, not more, and I hope the forthcoming Green Paper will give them more powers and a broader income base. I understand the committee’s concern that some local authorities are less able to spend on social care than others, but that should be rectified through the revenue support grant, not by making all local authorities more dependent on the Government.

My other comment is about the moral hazard from free personal care, touched on in paragraph 106:

“There may be a deadweight cost to the introduction of free personal care.”


It is a dead weight as some will no longer have to pay and others may opt out of caring to benefit from the free package.

This raises the broader issue of responsibility between the family on one hand and the state on the other, touched on by the noble Lord, Lord Hunt, and my noble friend Lord Lansley. Dilnot’s view is straightforward:

“For those who can afford [social care] it should not be free”.


But that does not address the fundamental problem that the noble Lord, Lord Forsyth, identified in his powerful speech—the unfairness of the present regime for people with, for example, dementia. A possible way to minimise both the moral hazard of people opting out and the initial cost is to look again at activities that might qualify for free personal care—for example, cooking and dressing. These activities could be performed by family members without imposing huge burdens on them. Therefore, to bring the costs down initially, they might be excluded from the free package where there is an alternative. But this is a detail that we can iron out when, as I very much hope, legislation based on this high-quality report is introduced in the next Session of Parliament.

Covid-19: Vaccination Prioritisation

Lord Young of Cookham Excerpts

Wednesday 25th November 2020 Lords Chamber

[Lord Bethell (Con)]

It will not be possible to publish any results until we have the clear data on the vaccines. Individual vaccines may behave quite differently with different groups of people. There may be some vaccines that work well with the elderly, some that work well with those with clinical conditions and some that work well with children. It is only when we know that data that the final prioritisation can be published.

[Lord Young of Cookham (Con)]

My Lords, on 12 November I asked my noble friend’s ministerial colleague, my noble friend Lord Greenhalgh, if he would recommend to the JCVI that rough sleepers and those who work with them should be a priority for vaccination. He said he would. Does that remain the case, and will they indeed get priority?

[Lord Bethell (Con)]

My noble friend has made the case for rough sleepers extremely well. It is one that we are deeply concerned about. When it comes to the prioritisation list, what has been published so far is an interim and indicative list. It will be reviewed, and a more detailed list will be published in time.

Social Care

Lord Young of Cookham Excerpts

Wednesday 28th October 2020 Lords Chamber

Asked by

[Lord Young of Cookham]

To ask Her Majesty’s Government when they will publish their proposals for the reform of social care.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)]

My Lords, the Government’s current priority for adult social care is for all recipients of care to receive the support they need throughout the Covid pandemic. While we published a winter plan that looked ahead through winter 2021, we are acutely aware of the long-term challenges to the social care system in England and the importance of reform. Putting social care on a sustainable footing, where everyone is treated with dignity and respect, is one of the biggest challenges our society faces.

[Lord Young of Cookham (Con)]

I am grateful to my noble friend for that reply, but this is not a happy story. Last year, the Prime Minister said:

“We will fix the crisis in social care once and for all with a clear plan we have prepared to give every older person the dignity and security they deserve.”


A few weeks ago, however, that reply was diluted in a Written Answer that said:

“There are complex questions to address to which we want to give our full considerations in the light of current circumstances.”


That is straight out of “Yes, Minister”. When will we see the clear plan announced 15 months ago, together with a commitment to the necessary funds to redress the imbalance between health and social care, so tragically revealed by the current pandemic?

[Lord Bethell (Con)]

My Lords, I reassure my noble friend that there is absolutely no dilution in the commitment to a long-term solution. No one in the Chamber would deny that the challenges in this question are extremely complex. The Government are also committed to cross-party talks and everyone in the Chamber recognises that we need a generational solution, not a political fix. In terms of finance, it is undoubtedly the case that the social care system has been under pressure during Covid. That why we have put an enormous number of funds—I could list them—into social care in the past six months. The refinancing of the social care system is one of the items that will undoubtedly be on the agenda.

Queen’s Speech

Lord Young of Cookham Excerpts

Tuesday 22nd October 2019 Lords Chamber

[Lord Young of Cookham (Con)]

My Lords, it is a pleasure to follow the noble Lord, Lord Patel. We enjoyed his deferential tribute to the noble Baroness, Lady Emerton, and I shall pick up in a moment what he and other noble Lords have said about social care. My noble friend who is replying to this debate has a long frontier to patrol, so perhaps I can make her task easier by saying that I want no mention in her wind-up speech.

I want to make three brief points on health. First, the Department of Health has set a great example to every other government department in that, since 2010, it has had only three Secretaries of State. Contrast that with the eight Secretaries of State at DCMS, seven Secretaries of State at both DWP and Justice over the same period, or indeed the nine Housing Ministers over nine years.

Why is this important? It takes time for a Secretary of State to build an effective team of Ministers; to understand and, at times, change the culture of a department; to build relationships with the external stakeholders, often crucial to the success of the department; to build a relationship with the parliamentarians and Select Committees who are holding that department to account; and to build a political base for support for reform. You simply cannot do that if there is a constant churn at the top of a department. No other organisation— commercial or voluntary—would tolerate that instability, and nor should a government department which spends billions of pounds, employs thousands of people and provides key services to the country. So, if Ministers cannot match the excellent continuity of service of Her Majesty the Queen, perhaps Prime Ministers should strive for greater stability, such as we have seen in health.

My second point concerns the balance between curative medicine on the one hand and preventive medicine on the other. Like other noble Lords, I welcome the commitment to extra funding for the NHS. The CQC report last week, State of Care, underlines the pressure on A&E and the staff shortages—the justification for the extra resources—and I welcome the Bills in the Queen’s Speech.

However, we are now reaching the point of diminishing returns from investment in curative medicine. The major improvements that we all want to see in the nation’s health will come from lifestyle changes and public health measures. My noble friend the Minister, in the department in a previous capacity, was responsible for public health and took some commendable decisions, which I applaud. I hope that she escapes my fate when I was Public Health Minister in 1981 and Dennis Thatcher persuaded his wife to transfer me to another department because of my aggressive stance towards the tobacco companies.

Against that imperative of focusing on public health to achieve real improvements, noble Lords will understand my alarm at reading in the Telegraph on 3 July during the leadership contest for my party:

“Boris Johnson will end the ‘continuing creep of the nanny state’ if he becomes prime minister, starting with a review of so-called ‘sin taxes’ on sugary, salty and fatty foods”.


It went on to say:

“The former foreign secretary wants to reverse the interventionist policies pursued by Theresa May and David Cameron in favour of a more liberal agenda”.


I assume that he has subsequently relented, as he now refers to himself as a one-nation Tory leading a one-nation Government. As a former chairman of One Nation in another place, I am delighted that he is now one of us. However, one-nation Conservatism embraces a benign paternalism that is prepared to take public health measures in the national interest. We are suspicious of neoliberalism, with its overreliance on the free market with minimum state intervention, as implied in the quotation to which I referred.

Noble Lords may recall the cries of “nanny state” whenever people make this speech. I remember hearing it when we debated the compulsory wearing of seat belts—which was introduced by a Conservative Government—with crash helmets for motorcyclists, with health warnings on cigarettes and with the banning of smoking in public places. No one would now go back on those reforms, which have saved countless lives and reduced demands on the NHS.

However, we need to build on them, giving adequate resources to Public Health England and to local authorities for their public health responsibilities. Making England smoke free by 2030, which is the objective of the prevention Green Paper, will require introducing measures so far turned down, some of them based on the polluter pays principle.

Tackling tooth decay will involve revisiting the regime for introducing fluoride. Tackling obesity, which was mentioned by the noble Baroness, Lady Massey, will involve more radical measures than those so far introduced, such as a sugar tax. We should look again at minimum prices for alcohol, where the initial response in Scotland has been positive. So, although it is controversial, I want to see more emphasis on preventive medicine and a willingness to take decisions that may initially be unpopular with the right-wing press but that are right for the nation.

My final point is about social care for the elderly, and this is not a happy story. The Queen’s Speech says:

“My Government will bring forward proposals to reform adult social care in England to ensure dignity in old age”.


Noble Lords may ask where they have heard those words before. In 1997, the then Health Secretary, Frank Dobson, said that the arrangements for long-term care of older people were so unsatisfactory that they,

“cannot be allowed to continue for much longer”.—[Official Report, Commons, 4/12/1997; col. 496.]

The Queen’s Speech in December 2000 said:

“The legislation will also take forward my Government’s response to the Royal Commission on Long Term Care for the Elderly”.


That was the Sutherland commission. Nothing happened. At the end of their time in office, the Labour Government were back where they started with the July 2009 Green Paper Shaping the Future of Care Together. The coalition agreement echoed what Labour said in 1997:

“We will establish a commission on long-term care, to report within a year”.


The Dilnot commission, which was mentioned by the noble Baroness, Lady Bakewell, suffered the same fate as Sutherland. The Queen’s Speech in 2017 said:

“My Ministers will work to improve social care and will bring forward proposals for consultation”.


They are still awaited.

This makes the negotiations with the EU positively streamlined—and in this case we are negotiating with ourselves. I recognise that in the fag end of this Parliament we are unlikely to make progress, but at least let us have the promised Green Paper, narrowing the range of options and building a consensus, so that when we next debate the Queen’s Speech we can welcome measures, rather than proposals, to ensure dignity in old age.

Smoking-Related Diseases

Lord Young of Cookham Excerpts

Wednesday 14th September 2016 Lords Chamber

[Lord Young of Cookham (Con)]

My Lords, I remind the House that this is a popular time-limited debate in which speeches should conclude as three minutes appears on the clock.

Standardised Packaging (Tobacco Products)

Lord Young of Cookham Excerpts

Wednesday 21st January 2015 Commons Chamber

[Ann McKechin (Glasgow North) (Lab)]

There are now only a few weeks until Parliament dissolves, but tonight I want to urge the Government, even at this eleventh hour, to do something that can save hundreds, if not thousands, of people across the country from a premature death. They still just have the time to undertake one major reform that they promised long ago: the introduction of plain packaging for cigarettes. However, despite almost three years of consultations and reviews and clear evidence both at home and abroad to support regulation there has been a deafening silence for over eight months. Why is the Prime Minister prevaricating? I hope the Minister can answer that question this evening and show her resolve to be serious about this nation’s public health.

We have debated this issue many times but the need for tonight’s debate is simple: plain packaging works. Too many people suffer from diseases brought on by smoking and too many young people are still picking up the habit for the issue to be ignored until after the election.

Sadly, my own city, Glasgow, has one of the worst records for smoking-related premature deaths in the country. Of those who take up smoking, only about half will manage to stop before they die, and two thirds of current smokers started before they were 18 years old, so the early teenage years are the key period to hook people into the habit.

The cost to patients, their families and our NHS is still too high despite the considerable improvements in treatments and drugs over recent years. In Glasgow, according to the latest Scottish Public Health Observatory’s tobacco control profile there were over 1,900 deaths from lung cancer in 2012 alone and almost 47,000 smoking-attributable hospital admissions over that year. Almost 28% of the city’s population smokes against the Scottish national average of 23%. Even a small percentage drop in those figures would make a really big difference to a lot of people, save lives and alleviate the pressure on our health services.

Successive Governments over recent years have put in place a range of measures to assist public health. Duty on cigarettes has been routinely increased in Budgets above the prevailing rate of inflation and this has undoubtedly made a significant difference. However, the impact is clearly plateauing and there is evidence that in the poorest communities in particular the rise of the black market in cigarettes could be acting as a block on further smoking reduction.

Increasingly, non-economic measures need to be introduced to further limit the habit, the most obvious being the ban on smoking in public places. It was not without controversy when introduced, but with Scotland taking the lead it has transformed our communities, reducing overall smoking levels. It has been of benefit to workers and non-smokers alike, but if we are honest the smoking ban has also led to more people switching their drinking, and in turn smoking, habits to a domestic setting, rather than necessarily quitting.

Cessation services via GPs and local councils have become better organised and more comprehensive. The Local Government Association in England is producing a new report this weekend on cessation services, but has informed me that councils are committed to spending over £140 million in England on cessation services this year, and this is undoubtedly a sound investment.

The Government are to be commended for taking forward the legislation introduced by the previous Labour Government to prohibit the display of tobacco products at the point of sale, with all shops being subject to the ban by April this year. This, along with the ban on public advertising, has helped to change perspectives about the normality of smoking.

We know that children and young teenagers can be influenced by a complex range of factors and we must do more to protect them against the harm that smoking brings. Attractive colours and packaging have a strong influence on young people, and tobacco companies have not been slow to find other, indirect ways of promoting their products. In a presentation to an industry conference back in 2006, Imperial Tobacco’s then global brand director, Geoff Good, acknowledged that the tobacco advertising ban had

“effectively banned us from promoting all tobacco products”,

but noted that

“the marketing team have to become more creative…We therefore decided to look at pack design.”

In fact, the industry was even happy to admit this in its response to the Government’s consultation on the future of tobacco controls. Philip Morris stated in its response that

“packaging is an important means…of communicating to consumers about what brands are on sale and in particular the goodwill associated with our trademarks, indicating brand value and quality…placing trademarks on packaged goods is thus at the heart of commercial expression”.

I struggle to imagine what the good will of a cigarette might actually amount to, but there is no doubt that the industry has exerted enormous pressure to stop this move.

It is no coincidence that the colours and graphics used on these packs are designed to attract new and younger users, and research shows that this increased emphasis has had an effect. Between 2002 and 2006, there was an increase in the proportion of young people aware of new pack design from 11% in 2002 to 18% in 2006. As the Minister is well aware, the systematic review commissioned by her own Government of 37 different studies provided evidence of the impacts of plain packaging. Each of the 19 studies that examined perceptions of attractiveness found that standard plain packets were rated as less attractive than branded packs. The studies also showed that the awareness of health risks was higher with standard packaging. Younger respondents were more likely to perceive that standard packs would discourage the take-up of smoking. All those findings back up the case that such a change would have an impact on young teenagers who were tempted to smoke.

In Australia, where plain packaging legislation was introduced in 2012, smoking rates have fallen dramatically. Daily smoking levels are at an historic low of 12.8%, and the average number of cigarettes smoked is now just 96 per week, compared with 111 in 2010. Fewer young people in Australia are trying cigarettes, and those who do so start at a higher age than in the past. Opposition to plain packaging among the public has also fallen steeply since the legislation came into force.

Some have argued that such a move will open the doors to a massive black market, and I note that that allegation has been reported in The Daily Telegraph in the past week. However, the main driver of black markets is economic: the difference between the actual value of the good and the price set for the consumer. It should not be beyond the wit of the authorities to devise a form of unique marking to stem counterfeit products. As the Minister will be aware, Sir Cyril Chantler stated in his report last year that he had found

“no convincing evidence to suggest that standardised packaging would increase the illicit market”.

The Trading Standards Institute has helpfully advised me today that, having reviewed the proposed regulations, it understands that standardised packs will retain the same security features as those found on existing tobacco packaging. It is the institute’s professional view that standardised packs would provide no new challenges in terms of detecting illicit products.

We know from what has occurred in Australia that tobacco companies have been forceful in pursuing their opposition at every step of the way. On the day that the Australian Government passed their legislation, Philip Morris and a number of other producers immediately launched a lawsuit to challenge the law. That challenge was rejected by the Australian domestic courts in 2012, but Philip Morris was not prepared to give up. In addition to taking the domestic action, it rearranged its assets in order to become a Hong Kong investor and use the 1993 bilateral trade agreement between the two countries to initiate an investor dispute arbitration. That case is due to be heard next month in Singapore, behind closed doors.

In addition, the company helped to finance a separate World Trade Organisation action brought against Australia by five tobacco-producing states. Australia refused each of those countries’ first requests, as allowed under WTO rules, but Ukraine made a second request in September 2012, which led to the establishment and composition of a dispute panel. The panel was composed in May 2014, but no report has been adopted and this matter is still outstanding. Similar industry pressure in New Zealand led by British American Tobacco has led to a long postponement, despite the fact that the legislation was introduced in its Parliament more than a year ago.

Using the same ISDS dispute procedure that the UK Government are so keen to support in the current EU-US negotiations on the Transatlantic Trade and Investment Partnership—TTIP—Philip Morris is suing tiny Uruguay over its decision to increase the size of health warnings on cigarette packets from 50% of the cover to 80%. We now await the outcome of this David and Goliath struggle, but it does raise the question as to why our Government are not more questioning of the possible impact of investor-state dispute settlement clauses on our public health policy, given the lengths that the tobacco industry is clearly prepared to take.

We need the UK to be brave—to face up to the industry giants and act in the interests of the public we serve. The Minister will be aware that the Scottish Government have sensibly agreed that legislation should be brought in throughout the UK at the same time and have given their assent to regulations being brought in by this Government covering Scotland, too. I want her assurance tonight that she will act on this agreement to give the boost to public health that is so needed in my city.

Over the past few years there have been several well-supported public campaigns calling on MPs to act, and recent polling has shown that a majority of the public are in favour of this proposal.

[Sir George Young (North West Hampshire) (Con)]

The hon. Lady will be aware that a range of views may be held among Government Members, but may I assure her that within my party there is a strong body of opinion supporting what she is saying and joining her in urging the Government to take action?

[Ann McKechin]

I am grateful to the right hon. Gentleman for his support tonight. This matter should, I hope, elicit cross-party support, because the health of our young people is a key issue that all of us should be deeply concerned about.