Tobacco and Vapes Bill (Sixth sitting)

Andrea Leadsom Excerpts

Committee stage
Thursday 9th May 2024 Public Bill Committees

[The Chair]

With this it will be convenient to discuss clause 43 stand part.

[The Parliamentary Under-Secretary of State for Health and Social Care (Dame Andrea Leadsom)]

Welcome back, everyone.

Clause 10 provides regulation-making powers for the Secretary of State for Health and Social Care in England, and Welsh Ministers, to extend the offences relating to the sale, purchase and free distribution of vapes to other consumer nicotine products, such as nicotine pouches. Clause 43 gives Scottish Ministers the equivalent regulation-making powers. Part 3 of the Bill provides for similar measures for Northern Ireland, which will be discussed separately. The measures will ensure that we have a consistent approach across our nations to protecting children from accessing other nicotine products and being exposed to the health harms and addictive nature of nicotine. They also address a point that was raised earlier by hon. Members.

Nicotine is a highly addictive drug, and we must not replace one generation addicted to nicotine with another. Giving up nicotine is very difficult, because the body has to get used to functioning without it. Withdrawal symptoms can include cravings, irritability, anxiety, trouble concentrating, headaches and other mental symptoms. Evidence also suggests that the brain in adolescence is more sensitive to the effects of nicotine, so there could be additional risks for young people.

Under current legislation, there are no mandatory age restrictions on other consumer nicotine products. Although data suggests that the use of other nicotine products is low overall, there is a growing trend of use, particularly among adolescent boys, and there are indications that industry is beginning to encourage the uptake of other nicotine products. As we work to tackle youth vaping, it is important that there are not loopholes that can be exploited to put children at risk of nicotine addiction through the use of other nicotine products. That is why we are including powers to extend age of sale, proxy purchasing and age verification requirements to other nicotine products.

Clauses 10 and 43 are an important part of our work in ensuring that the collective package of measures in the Bill succeeds in protecting children from potential health harms. I therefore commend them to the Committee.

[Preet Kaur Gill (Birmingham, Edgbaston) (Lab/Co-op)]

We support clause 10 as a tidying provision that ensures that the additional restrictions on the sale and free distribution of vaping products to under-18s can be extended to other nicotine products in England that have the potential to cause similar harms. It provides that the measures in clauses 7 to 9 can be extended to emerging products such as nicotine pouches, and clause 43 makes similar provisions for Scotland.

It is clearly not right that addictive nicotine products can be sold and freely distributed to children. Awareness of the products is growing, and legislation needs to keep up. According to research by Action on Smoking and Health, awareness and usage of nicotine pouches is higher among younger adults, and just over 5% of 18 to 24-year-olds have tried one. As with vapes, the marketing of nicotine pouches is likely to be attractive to children and young people, with similar branding to sweets and soft drinks. At present, a loophole means that it is not illegal to sell them to children, so I support the measures to close it.

Will the Minister set out her intentions with regard to the use of the new powers, and what conversations she has had with devolved nations on the issue? Will she also explain the Government’s view on the potential harms from the use of nicotine pouches? Does she believe that these products could have value as a stop-smoking aid, like vaping? What merit does she see in including the products in regulations similar to the tobacco-related products regulations for vapes? If she intends to introduce regulations on nicotine pouches, can she set out her intended timescale for that?

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[Dame Andrea Leadsom]

I wholeheartedly endorse almost everything I have heard. I share hon. Members’ concerns and applaud them for their commitment to solving the issue of nicotine pouches. As my hon. Friend the Member for Harrow East rightly pointed out, should the industry find a way around something in the Bill, we would have to legislate again with primary legislation. The right thing to do, therefore, is to take powers to make secondary legislation that gets on top of the issue and future-proofs us, so that right across the United Kingdom we can tackle this appalling scourge: the tobacco industry’s determination to get our children addicted.

Extraordinarily, the tobacco industry dominates the UK nicotine pouches market, and it claims to self-regulate—that is, it claims not to sell to under-18s. That is absolutely extraordinary. A recent study suggests that although nicotine pouch use is low among adults, with roughly one in 400 adults in Great Britain using them, nicotine pouches are increasingly popular with younger, largely male audiences. The Committee on Toxicity of Chemicals in Food, Consumer Products and the Environment has identified gaps in research and flagged that the long-term health harms are not known, but use by non-smokers is likely to be associated with some adverse health effects due to the nicotine.

We all know that other nicotine products need to be clamped down on. We will not need to consult on age of sale restrictions on nicotine products; we will be able to use regulations, hopefully in this Parliament, with implementation from 2025. It is certainly our plan to consult on all of this regulation to get ahead of nicotine pouches and other nicotine products with a view to implementing the regulations in 2025.

[Rachael Maskell]

I do not know whether the Minister is aware that the strength of the nicotine in these products is excessively high—much higher than in other products—and so they rapidly bring about addiction. When the Government brought forward measures to try to educate the country about alcohol use, they did a comparison. Perhaps it would be helpful to do a comparison about the amount of nicotine that individuals are taking through a nicotine pouch, because the public would be alarmed to know that we are talking about their taking multiple factors of nicotine into their bodies.

[Dame Andrea Leadsom]

The hon. Lady is absolutely right; they vary from 2 mg to 150 mg per pouch. I imagine that that variation would make it hard to provide a complete comparison, but she is quite right that education will be a big part of the implementation.

[Dr Johnson]

I think that most parents in my constituency would be horrified to think that nicotine pouches are available for sale to children. I appreciate that the Bill takes the power to ban nicotine products other than vaping products at a later date, but I would grateful if the Minister could explain why we should not ban the sale of nicotine to under-18s full stop. I do not understand why and in what circumstances anyone would ever wish under-18s to have nicotine sold to them.

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[Dame Andrea Leadsom]

My hon. Friend makes a good point. The Bill takes powers to bring forward the age of sale restriction, and that in itself will not require further consultation. It is my expectation that, if possible, that will be brought forward in this Parliament. However, as has been explained, if we put something in the Bill, the industry will get around it by saying, for example, “This doesn’t contain nicotine”—except it does, as we have already seen.

The other thing I want to raise with hon. Members is that clauses 61 to 63, which will grant the ability to restrict flavours, packaging and location in store, will also apply to nicotine products. Those measures are clearly designed to reduce their attractiveness to children.

[Rachael Maskell]

In response to my questions and accepting the clause as it is written, can the Minister give the Committee an assurance about when the regulations will be brought forward to ensure that products such as nicotine pouches will come within scope of the Bill?

[Dame Andrea Leadsom]

All I can say to the hon. Lady is that she has heard me, and I am determined to bring that forward as soon as possible. There are good reasons for not putting the provision on the face of the Bill, which are to do with future-proofing. I can only give her my absolute assurance that, as soon as humanly possible, I will bring the regulations forward for consultation where necessary and for implementation where not.

[Dr Johnson]

I am grateful for the Minister’s answer, but I am still a bit confused. I can see the point she makes about the industry and the need to remain flexible; that is really important and why we support clause 10 —particularly in relation to sections 8 and 9, which are about the purchase of products on behalf of children. I welcome the fact that later in the Bill we will see restrictions on the appeal of the packaging of vaping and tobacco products, which will help to make them less attractive to children.

However, I still do not understand why any product containing nicotine would need to be available to children and why that would not be on the face of the Bill. If we were to specify nicotine pouches in the Bill, I see that that could be got around by calling them “nicotine gum” or something else, but if it said, “Nicotine—full stop—cannot be sold to under-18s,” that would be difficult to work around, because no nicotine product could be sold to under-18s. I expect that if I did a survey of parents in my constituency, most would presume that that was already the law.

[Dame Andrea Leadsom]

My hon. Friend makes a good point, which I will take away and reflect on. We have obviously already aired the discussion about the benefit of taking powers as opposed to putting something in primary legislation, but she makes a good point and I will come back to her.

[Bob Blackman]

One of the challenges we are talking about is not only nicotine itself—we had medical evidence last week to suggest the damage it does to the body, let alone its delivery mechanisms—but the mixture of different routes by which it gets into the body. At the moment, evidence is emerging about the damage from the use of different accelerants to get nicotine into the body. Will the Minister consider what may need to be done about those particular types of chemicals and other methods that may need regulation to outlaw them, because of the damage that they do particularly to children and to all other vapers?

[Dame Andrea Leadsom]

My hon. Friend makes a really good point. We have heard about some of the heavy metals and other carcinogens in vapes. The Bill is so comprehensive in banning things such as cigarette papers, herbal cigarettes and so on precisely because of other things that people put into their lungs. As the chief medical officer for England said, it is fine to drink a glass of water but have you ever tried inhaling one? It is not such a pleasant experience. He made the point that although it might be perfectly safe to eat a non-toxic flavour, it could be very different to inhale it.

As we heard last week, the fact of the matter is that there simply is not yet the evidence to say what some of these products do to human beings when inhaled. It is absolutely right that we protect children from those effects, hence this Bill. I hope that one of the outcomes of this legislation will be that we get far more evidence via independent research into the potential harms of first-hand vaping and other consumption of nicotine as well as second-hand consumption, which I know a number of hon. Members are interested in. I am sure we will come back to that in due course.

Question put and agreed to.

Clause 10 accordingly ordered to stand part of the Bill.

Clause 11

Displays of vaping and nicotine products

Question proposed, That the clause stand part of the Bill.

[The Chair]

With this it will be convenient to discuss the following:

Clause 45 stand part.

Clause 54 stand part.

[Dame Andrea Leadsom]

Clause 11 provides a regulation-making power to allow the Secretary of State for Health and Social Care in England and the Welsh Ministers in Wales to introduce future restrictions or requirements on the display of vaping and nicotine products, and their packaging and pricing where they are offered for sale. Clause 45 provides the same regulation-making power to Scottish Ministers, and clause 54 provides the power to Northern Ireland.

At this point, I would like to reiterate our plans for future vaping regulations, including on vape displays. I have made a commitment to consult on future regulations. Any regulations made will be accompanied by clear impact assessments. We will introduce new regulations as soon as possible following the passage of the Bill.

We simply cannot replace one generation addicted to nicotine with another, and we know that giving up nicotine is so difficult because the body must get used to functioning without it. Withdrawal symptoms can include cravings, irritability, anxiety, trouble concentrating, headaches and other mental symptoms. Despite this very clear health advice, there has been a significant and alarming rise in the number of children vaping in this country. Data shows that the number of young people vaping has tripled in just the last three years, and now one in five children has used a vape. That is alarming and unacceptable.

Evidence shows us that vapes are currently far too easily accessible to children within shops. Vapes are sometimes displayed alongside sweets and confectionery in retail environments, and often promoted in shopfront windows. These products are too easily seen and too readily available to children, and we have a duty to protect our children from harm. These clauses therefore provide regulation-making powers for new restrictions on where and how vapes and nicotine products can be displayed within a retail setting, and ensure that we are aligned right across the United Kingdom. The display restrictions will include both packaging and pricing. Future regulations on point-of-sale displays will help to reduce the ease of access to vapes to children, and the degree to which vapes can be targeted at children. These are important clauses to help us tackle youth vaping and to protect children from addiction and future health harms.

[Preet Kaur Gill]

We welcome the inclusion of these powers to regulate the display of nicotine and vaping products in retail settings. All of us have seen what has been happening in some shops: as the Minister said, colourful products that look like confectionery kept next to the pick ’n’ mix at pocket money prices. I appreciate that some in the sector have concerns that regulations on point-of-sale displays need to be balanced in respect of their impact on retailers, given existing restrictions on products like tobacco and some of the associated costs. In my view, however, there is no argument against the inclusion of the powers themselves.

I heard from a retail worker at a major supermarket chain that they are paid by the vaping companies to put displays of vapes in prominent locations in their stores. These are often far away from the tills, where there is little to no oversight by staff. I was told that where children once shoplifted sweets, they are now going straight for these products. One worries that the vape companies are almost happy to lose them, if they can get a new customer addicted who they know will come back for more.

None the less, I want to highlight that there appears to be broad support for some restrictions on the display of vapes among retailers. I note that in the Action on Smoking and Health survey of retailers in England and Wales, 80% of tobacco retailers supported prohibiting advertising and promotion of vapes or vaping products in store, and requiring them to be put behind the counter; only 12% were opposed. I would be grateful if the Minister outlined whether it is her firm view—she has alluded to it—that vapes should be kept behind the counter, or whether display should be prohibited entirely, which seems to be what the Government have looked at in their impact assessment. Alternatively, does she feel that further consultation is necessary?

I would also like to raise other questions about the potential for such regulations to be undermined. Clause 34 of the Bill provides an interpretation of terms used in part 1 of the Bill, but it does not define “retailer”. I therefore wonder whether other forms of display for sale would be caught under the powers as drafted here. I am thinking of vape vending machines, which are not in widespread use now but could be in the future.

Have her officials looked at that issue? Given the introduction of some vending machines with automated age verification features, has the Minister considered prohibiting vape vending machines, as has happened in Scotland? We can easily see how this situation could undermine the consistency of regulations on displays.

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[Dr Johnson]

I rise in support of clause 11 on restricting the display of vaping and nicotine products. I have been horrified to see that after the Government, with good intentions, made it difficult for children to see sweets at the counter, to reduce pester power and help protect them from obesity, the sweets were in many cases replaced by vapes. The Government are doing exactly the right thing in taking the powers to look at displays. As has been mentioned, the ability and flexibility of doing so through regulations means that we can move swiftly when the industry seeks to get round the latest rules. I think that is great.

I have two examples for the Minister. Would they be covered by paragraph (1)(c)? The first is a mini-mart in Grantham. The entire shop window is covered in pictures of things such as Kinder chocolate, Haribos, fruit and very large-size vape devices in bright colours. I was in WH Smith in Nottingham last weekend; this is a shop that sells children’s books, children’s toys, sweets and children’s stationery, yet at the till there is a very large video display of vape adverts immediately behind the shopkeeper’s head. Will these two types of advertising and display be covered by the regulations?

[Dame Andrea Leadsom]

Again, I appreciate the sentiments expressed and associate myself with all of them. The hon. Member for York Central requested that we put in primary legislation that vapes must be behind the counter. It is clear from the impact assessment and the consultation that that is the intention. However, as my hon. Friend the Member for Sleaford and North Hykeham points out, the reason for taking the powers is that doing so allows us to stay ahead of the next place they might be sold, for instance outside the shop, on a bus or outside a school—we can imagine all sorts of other ideas. It is important to have the regulations to get ahead of other ideas, rather than saying, “They shall be behind the counter.” That is why we are taking regulatory powers right across the Bill, so that answer holds for all the areas in which we are taking powers: we are taking them to stay ahead of an industry that has shown itself to be very imaginative and brutal in its determination to addict children. We need to stay one step ahead, and that is the plan.

[Mary Glindon (North Tyneside) (Lab)]

Something has occurred to me rather later than sooner, as things often do. Vape shops are prolific in our town centres. Can anything be done to limit young people’s access to those shops, for instance a minimum age of entry, so that no one under 18 should be on the premises? I do not think that we have thought about that hitherto in our discussions.

[Dame Andrea Leadsom]

I appreciate the hon. Lady’s suggestion, and I will take it away and look at it. The immediate thing that springs to mind is that if someone is out with their children, it is difficult for them to say, “You stand out there; I am going in.” That could give parents concern. I take the point that, in a vape shop, someone cannot say, “Go and look at the toys while I choose my vapes,” but I can imagine all sorts of objections from a practical point of view. However, I will take the suggestion away and reflect on it.

[Mary Glindon]

Is it not the case that children are not allowed in bookies and betting shops? That is perhaps a similar situation.

[Dame Andrea Leadsom]

As I say, I accept the hon. Lady’s point and will reflect on it.

The broader point is that there is obviously a balance here. We want to exclude vapes from children, but we do not want to exclude vapes from adults who want to quit smoking, because that is the real prize that we are seeking to hang on to. The more difficult we make it for adults to access vapes as a quit aid, the more we are discouraging adults who, we have all agreed—violently—we want to stop smoking. That is the killer.

[Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (Con)]

The Minister is making an extremely important point: we have to do everything in a proportionate manner. Although we need to protect children, and do not want children—I have children of my own—to take up vaping in childhood or have access to vapes, vaping can be a harm-reduction approach for adults. Putting vapes behind the counter, like tobacco, might go against some of the evidence we heard about the harm of vaping being much less than that of smoking itself. It could perhaps give the wrong impression to the public: that vaping is not a harm-reduction tool, that it is not going to be useful to them, and that it is in the same category as smoking itself.

[Dame Andrea Leadsom]

My hon. Friend highlights exactly the challenge, which is the balance between helping adults to stop smoking, where turning to vapes can be the most successful tool in the toolkit, and preventing children from ever taking up and becoming addicted to nicotine.

[Dr Johnson]

I have a question, but I appreciate that the Minister may not know the answer. Adults who wish to stop smoking have many smoking services that they can go to for advice, such as their GP or pharmacist. Other mechanisms of giving up smoking, such as Nicorette gum and nicotine patches, are available, but they are nowhere near as widely advertised as vapes. Does the Minister think that smokers are unaware of them?

[Dame Andrea Leadsom]

That is a very tricky question to answer. I certainly think that stop-smoking services are fully aware of all the different alternatives that an individual can take up. There is of course the question raised in previous discussions, which nobody has raised today, about whether there should be a prescription-only vape. Many people would say, “No, I want the convenience of buying a vape. I don’t want to have to go and get a prescription, argue why I need it, and so on. I’d rather just buy one.” There is a genuine issue of convenience and accessibility, but my hon. Friend is absolutely right that it is vital that stop-smoking services set out the whole array of different choices to help adult smokers to quit, and that will include vapes. The evidence is that vapes are particularly successful in helping adults to quit smoking.

[Dr Johnson]

My point was about that balance between protecting children and making adult smokers aware that they can use vapes to quit or to change their habit to one that may be safer for them. There seems to be a reluctance to apply stringent methods that would protect children in order to protect adults. My point on advertising was really about whether adults are any less aware of gums and patches because they are not as floridly advertised as vapes. Do we really need to be as sensitive in protecting adults, or should we prioritise the protection of our children?

[Dame Andrea Leadsom]

Intellectually and morally, I completely agree that we need to protect children, and that is the priority. I think the Bill will do exactly that. We are taking the powers to restrict the flavours, the location and the accessibility, and we are massively ramping up enforcement. All of the measures that we are taking are exactly designed to strike the right balance between helping adults to quit smoking and protecting children.

I want to address one other point raised by the hon. Member for Birmingham, Edgbaston on vending machines, and I think the hon. Member for East Renfrewshire also raised it. There will be powers taken in the Bill to limit the use of vending machines for vapes. At the moment, the evidence is that it is not a real problem; vapes do not tend to be sold in vending machines. We need to take the powers, as I have already said, so that we can stay ahead of whatever approach is taken next by the tobacco industry.

[Dr Johnson]

May I push on that point? Does that mean that the Government will accept new clause 16—the vending machine clause?

[Dame Andrea Leadsom]

We are not at that point yet. We will come to those amendments and new clauses as and when.

Question put and agreed to.

Clause 11 accordingly ordered to stand part of the Bill.

Clause 12

Restricted premises orders

Question proposed, That the clause stand part of the Bill.

[The Chair]

With this it will be convenient to consider the following:

Clauses 13 to 15 stand part.

Clause 56 stand part.

[Dame Andrea Leadsom]

This group of clauses relates to restricted premises orders, or RPOs. These are existing measures that local authority trading standards in England and Wales, and district councils in Northern Ireland, can deploy when a retailer is found to persistently breach tobacco and vape age of sale restrictions.

Clauses 12 to 14 are based on and replace existing legislation in England and Wales. Clause 12 provides that a persistent offender can be issued with a restricted premises order, which could prohibit the sale of products— such as tobacco products, herbal smoking products, cigarette papers, vaping products and any nicotine products —on premises for up to 12 months. This is an important enforcement mechanism for tackling persistent offenders. A persistent offender is someone who has sold tobacco or vape products to someone under-age at least twice within the previous two years.

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[Bob Blackman]

I thank my right hon. Friend for explaining the nature of these various different measures. I think retailers will have a concern about, for example, where a manager or an errant individual breaches these rules and is therefore subject to action, what actions the retailer can then take to alleviate the challenge afterwards. For example, if the person is dismissed or is told they are no longer welcome on the premises, will that be sufficient, or will it have to be a case of serving a time before such premises can be brought back into action? Obviously, retailers will want to know what they must do to comply with not only the letter but the spirit of the law.

[Dame Andrea Leadsom]

My hon. Friend makes a really good point. It also justifies why this is particularly complicated to explain, let alone to take in. That is one of the reasons why there is a long lead-in period for that new regulation. There will be training for retail. We have discussed this with various industry bodies, and they support it and consider that there is enough time for them to get up to speed. Essentially, that strays into the issue of the quantum of fines. The idea is that it is effectively an on-the-spot fine; it is really, “Two strikes and you’re out.” If someone offends twice, they will end up with a restricted premises order, and if they offend again, they will get an unlimited fine. It is an appropriate escalation. At the starting point, there are a number of other fines that are of a similar quantum, where someone could potentially argue, “Well, I did not realise. I am new; I did not get the training; I was not here that day,” and then it is not such a painful fine. They would certainly learn their lesson, however, and after two offences it escalates very significantly.

Clause 56 amends the Tobacco Retailers Act (Northern Ireland) 2014 and introduces the power for the Department of Health in Northern Ireland to amend the definition of a tobacco, nicotine or non-nicotine vape offence for which a restricted premises order can be issued. That is the same provision made for England and Wales in clause 15. Clauses 15, in England and Wales, and 56, in Northern Ireland, are important to maintain the longevity of the legislation. They will ensure that enforcement action remains up to date to reflect any relevant new tobacco or vape products that come on to the market in future. I therefore commend the clauses to the Committee.

[Preet Kaur Gill]

We support the introduction of restricted premises orders for breach of age of sale laws on nicotine and vaping products in the same way that they already exist for tobacco. A repeat offender should know that there are serious consequences for breaching age of sale legislation, so I strongly support the principle of providing a strong deterrent to any retailers that would break the law. The threat of enforcement action cannot be seen as the cost of doing business.

I have a few questions about how the orders work in practice. The Bill introduces a requirement for trading standards authorities to consider whether to conduct a programme of enforcement at least once a year. That is not a strong requirement. There is nothing to say that local teams must conduct any enforcement action within a two-year period on the matter, even if they receive complaints, and many trading standards teams are woefully under-resourced. Therefore, the requirement for the powers to be used for “persistent” offences, meaning at least two breaches within a two-year period, suggests to me that the orders will be very seldom used.

That is not to mention the question of how the orders would be enforced once granted by a magistrates court, or indeed the backlogs before that. Can the Minister say how many times restricted premises orders have been used in relation to tobacco in recent years, or even in the last decade? We heard from trading standards at the evidence sessions that boots are needed on the ground to make this work. My understanding is that of the money that the Government have announced for enforcement, only £10 million will go to trading standards. Will the Minister confirm whether that is correct?

At the same time, the Chartered Trading Standards Institute is warning that its profession is in jeopardy because of a lack of investment. Its funding has been cut by 50% over the past decade, and it estimates that around the UK as much as half the workforce is set to retire over the next decade. Has the Minister heard any of those concerns? What conversations has she had with colleagues and other Departments about staff retention and investment?

I am foregrounding one of my amendments to a later clause, but I am of the view that the proposed fixed penalty notice powers will be a more effective mechanism to enforce compliance on age of sale, particularly given the clause on use of proceeds, if we do not have strong reassurances that trading standards will get the necessary resources from central Government.

We strongly welcome any measure that will aid authorities in cracking down on the sale of tobacco, vapes and nicotine products to children. However, I urge the Minister to look again at whether the new regulations will be coupled with the enforcement action needed on the ground. Without it, they will not achieve what we need them to, and more young people will fall prey to addiction.

[Dame Andrea Leadsom]

I am pleased that the hon. Lady supports the clauses. They are absolutely vital to ensure that we have the proper enforcement powers. She asked about the investment in enforcement. I can tell her that we are investing over £30 million of new funding a year into enforcement agencies, including trading standards, HMRC and Border Force. That increased investment will boost enforcement surrounding the sale of illicit tobacco and illicit vapes and help local trading standards with enforcement on underage sales of tobacco and vaping products at a local level. There will also be £100 million of funding over five years to support HMRC and Border Force’s new illicit tobacco strategy, which will seek to tackle the illicit trade and create a new illicit tobacco taskforce. Various measures are under way, including training, but enforcement will be absolutely key.

Question put and agreed to.

Clause 12 accordingly ordered to stand part of the Bill.

Clauses 13 to 15 ordered to stand part of the Bill.

Clause 16

Restricted sale orders

Question proposed, That the clause stand part of the Bill.

[The Chair]

With this it will be convenient to discuss clause 17 stand part.

[Dame Andrea Leadsom]

Clauses 16 and 17 are based on and replace existing legislation for England and Wales. They relate to restricted sale orders, which is one of several measures in the Bill that will ensure that our enforcement approach to tackling under-age sales is both effective and proportionate.

Clause 16 provides that a persistent offender can be issued with a restricted sale order, which is similar to a restricted premises order but puts a ban on an individual from selling tobacco or vape products rather than a business. The clause is important for the overall functioning of the Bill as it provides local authority trading standards with a further tool for enforcement. Restricted sale orders also act as a deterrent to persistent offenders as they apply to a specific person, regardless of their place of employment.

Clause 17 makes it an offence to breach a restricted sale order. The offence is committed when the individual has done something, such as sell a product, that they have been prohibited from doing under the order. As with restricted premises orders, making it an offence to breach restricted sale orders gives local authority trading standards the ability to escalate action to tackle persistent offenders. The penalty for breaching a restricted sale order is an unlimited fine, which will again be a good deterrent. I commend clauses 16 and 17 to the Committee.

[Preet Kaur Gill]

Once again, we support these clauses, which will provide an effective deterrent to those who would sell addictive products to children and ensure that repeat offenders have that freedom taken away. I echo my comments on restricted premises orders: the success of the policy will depend on effective enforcement. May I ask the Minister why the Government have not provided similar powers to add to the list of relevant offences for which a restricted sale order can be issued, as they have with a restricted premises order? What is the rationale there?

Likewise, I am interested in whether the Minister has data on how many of those orders have been issued in relation to tobacco in recent years. I think she has clarified that the orders are designed to stop repeat offenders being able to simply move around, but can she assure us that local trading standards authorities are sufficiently joined up, and that someone moving between different shops in other local authorities in a retail chain could be picked up?

Once again, we support the principle of the clauses, which brings the consequences of breaching age of sale law for vaping and nicotine products into line with the existing laws for tobacco, but I have some concerns about how it will work in practice. I would be grateful if the Minister could address those.

[Dame Andrea Leadsom]

I thank the hon. Lady for her points, which were all very well made. If I may, I will write to her about her question of how many times such orders have been used in the past. I will reflect on what she says about the ability to enforce. I have set out the amount of new funds going to enforcement and the plans for further education and training, but I will certainly reflect on her point.

Question put and agreed to.

Clause 16 accordingly ordered to stand part of the Bill.

Clause 17 ordered to stand part of the Bill.

Clause 18

Liability of others for certain offences committed by bodies

Question proposed, That the clause stand part of the Bill.

[Dame Andrea Leadsom]

The clause makes a person potentially liable for an offence committed by a body, when that offence has been committed with their consent, connivance or neglect. That means that a person would be liable in addition to the body, such as the company or partnership, that they are working for. It helps the overall purpose of the Bill by supporting local authority trading standards in enforcing tobacco and vape age of sale regulations, as they can punish both individuals and businesses when conducting their enforcement activity. I commend the clause to the Committee.

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[Dame Andrea Leadsom]

Clauses 19, 20 and 21 relate to the enforcement requirements of local weights and measures authorities in England and Wales. Clause 19 places the duty to enforce the tobacco and vaping measures in England and Wales on local weights and measures authorities. For England and Wales,

“local weights and measures authorities”

means local authority trading standards.

The clause provides local authority trading standards with the power to use the investigatory powers under the Consumer Rights Act 2015 to conduct their enforcement activity. The investigatory powers are comprehensive and include the power to purchase products, observe a business, enter premises with or without a warrant, inspect products, test equipment, require the production of documents, seize goods, seize documents as evidence, break open containers and require assistance from persons on the premises. The existing regulatory regime for tobacco enforcement provides for local authority trading standards to use the same investigatory powers, which are considered to be effective, and thus clause 19 provides continuity with the current enforcement approach, ensuring enforcement of this new legislation at the local level.

Clause 20 provides a requirement for local authority trading standards in England to consider yearly a programme of enforcement, and the potential design of such a programme of enforcement, for offences under part 1 of the Bill. A programme of enforcement includes at least one of the following: investigations of complaints regarding alleged offences, prosecutions in respect of such offences, and/or other measures intended to reduce the incidence of such offences. The clause is important to the Bill, as it reconfirms what local authority trading standards should consider as appropriate to enforce the tobacco and vapes regulations.

Clause 21 makes the same provision for programmes of enforcement in Wales as is made for England under clause 20. I commend clauses 19, 20, and 21 to the Committee.

[Preet Kaur Gill]

Trading standards officers are experts in this area. They know what they are looking for in retail settings, they are experts in the legislation they have to enforce, and they do an important job in difficult circumstances. As we heard in evidence, trading standards officers enforce dozens of regulations, but in many local authorities there are barely one or two officers to do the job. As we consider the new regulations that we give to them to enforce, it is important that we make sure they get the support they need to do the job.

As I mentioned, I have some concerns about clause 20, in that it provides a relatively weak basis on which to compel a programme of enforcement to be carried out. However, I am glad it at least sets out something of the Minister’s expectations, and we acknowledge that different local authorities face different local challenges. We do not want to be overly prescriptive in what we set in law. The issue therefore comes down to resources, so can the Minister tell us what has been the result of Operation Joseph and whether it will be continuing? I note that it received £3 million in funding last year, but the timeframe in which that was scheduled to be delivered was unclear. Can the Minister clear that up?

The Chartered Trading Standards Institute estimates that one in three vapes on British shelves may be illicit, which suggests that local authorities are struggling to fully get to grips with existing enforcement priorities, as we add new ones. What assessment have the Government made of authorities’ capacity to absorb these new responsibilities with the resources allocated?

[Rachael Maskell]

I want to pick up on this point as well because it is incredibly important, and we cannot put the responsibilities on to trading standards if they do not have the tools to do the job. Clearly, this is a new field and, as we have discussed throughout the Bill, new products will come out and be marketed if we do not get ahead of the curve. It is therefore important that we ensure that new testing kits are made available and that we look at how they can be brought into play.

We heard strong evidence last week about the benefits of introducing a track and trace system, which would simplify the work of trading standards. If a product has not been through that process, and there is therefore not an authoritative basis on which to say that it can be sold, it would clearly be an illicit product. If a proper track and trace process was put in place, that could aid the work of trading standards, and addressing the real challenges we are trying to deal with through these clauses would not require such extensive resourcing.

Will the Minister therefore comment on her appetite for bringing in a track and trace system for vaping and other nicotine products to get ahead of the curve? That would ensure that the illicit trade is suppressed and does not rear its ugly head and that it is as easy as possible for trading standards to uphold every part of the Bill.

[Dame Andrea Leadsom]

This is obviously an incredibly important area of enforcement, and successful enforcement is integral to the success of this policy.

To the question from the hon. Member for Birmingham, Edgbaston about Operation Joseph, in the year before the operation—2022-23—2.1 million illicit vapes were seized by trading standards across England. In the same year, 1,199 test purchases were carried out by trading standards in England, with 27.3% resulting in an illegal sale. Those are the numbers. As the hon. Lady says, Operation Joseph has had £3 million of investment over two years, led by National Trading Standards. It conducts a range of illicit vape enforcement activities, including data collection and analysis of the scale of illegal products and under-age sales; market surveillance; under-age sales testing; court enforcement action; and upskilling of trading standards staff. A further operation—Operation CeCe —was established in January 2021 as a joint venture between National Trading Standards and His Majesty’s Revenue and Customs to tackle illicit tobacco sales.

So those individual measures are in place. As hon. Members will know, the Medicines and Healthcare products Regulatory Agency looks at the product notifications for legal products, which have to meet the compliance standards of the MHRA. It is then for trading standards to enforce, and they have had a significant increase in resources to tackle enforcement, as I have set out. I am obviously happy to write to Members with more detail should they wish.

Question put and agreed to.

Clause 19 accordingly ordered to stand part of the Bill.

Clauses 20 and 21 ordered to stand part of the Bill.

Clause 22

Power of ministers to take over enforcement functions

Question proposed, That the clause stand part of the Bill.

[The Chair]

With this it will be convenient to discuss clause 23 stand part.

[Dame Andrea Leadsom]

Clauses 22 and 23 relate to powers for Ministers to take over enforcement in England and Wales. Clause 22 provides a power for the Secretary of State for the Department of Health and Social Care or Welsh Ministers to carry out the enforcement of a particular case, or a particular type of case, instead of local authority trading standards.

Trading standards operate in all local authorities, and it is standard practice that they undertake required local enforcement action, as will be the case for offences under part 1 of the Bill. However, a situation could arise where they are unable or unwilling to undertake enforcement in a particular case. For example, a tobacco company could develop a new tobacco product that it argues is outside the scope of enforcement, which could result in trading standards being hesitant about pursuing action—as we have discussed, tobacco companies are nothing if not inventive in their determination.

Clause 22 replaces, and is based on, existing legislation. It allows for the Secretary of State for Health and Social Care or Welsh Ministers to take over enforcement action, should that be deemed necessary, and it ensures consistent, strong and effective enforcement of the tobacco and vape measures in the Bill.

Clause 23 provides a power for the Secretary of State for Health and Social Care or Welsh Ministers to take over from trading standards the conduct of any legal proceedings relating to an offence under part 1 of the Bill. In a similar manner to clause 22, this clause replaces, and is based on, existing legislation. It allows the Secretary of State for Health and Social Care or Welsh Ministers to take over the conduct of any legal proceedings, should that be deemed necessary, and it ensures consistent, strong and effective enforcement of the provisions in part 1 of the Bill. I therefore commend clauses 22 and 23 to the Committee.

[Preet Kaur Gill]

Let me start by saying that I support these two clauses being added to the Bill, providing the Secretary of State with powers to take over enforcement functions from local authorities or to take legal proceedings in court instead of a local enforcement authority.

The rationale for these additions is, first, to ensure that where local authorities are unwilling or unable to take enforcement action, the Government themselves can intervene to speed that work up and get it done. That can only be a useful backstop, although it does underline the important points that I and other colleagues have raised about local authorities having appropriate resources to discharge their responsibilities in the first instance. Secondly, as we heard in evidence, there is the matter of illicit tobacco, and often vapes too, being linked to organised crime. Such criminal networks often span large areas, crossing local authority lines, and in theory it could be useful for national Government to intervene in large cases that extend beyond the jurisdiction of a single local authority.

We hope that the work of trading standards officers is sufficiently joined up with the work of officers in other local authorities and the work of national agencies such as the MHRA and Border Force, but the point remains that national authorities should be able to step in if required. Nevertheless, I would be grateful if the Minister could for the record expand on how she would expect to utilise the powers in clause 22 and in what scenario she would consider that necessary. Could she also confirm whether she plans to devote additional resources to national trading standards as part of her plans to deal with the rapid growth of the illicit market in vapes in recent years, including unsafe products with illegal nicotine strengths and so on?

Given the widespread appearance of some illicit products on the shelves of shops and the co-ordination work that will need to be undertaken with the likes of Border Force to stop such illicit products getting into the country, in what scenario would the Minister consider it appropriate for the national authorities to lead on certain priorities instead of local teams? We know that local trading standards officers are often intelligence-led, whereas national authorities have greater resources at their disposal. How is that work co-ordinated, and can we do it better?

[Dame Andrea Leadsom]

I thank the hon. Member for Birmingham, Edgbaston for her comments and views. She asked a really important question: will we enforce at a national level? The answer is that, at the moment, we want to be able to enable that, should it prove necessary. She will be aware that, as I set out, we are expanding—by £30 million a year—the resourcing available to His Majesty’s Revenue and Customs, trading standards and Border Force to clamp down and enforce. As that work progresses, we may well uncover organised crime, for example, or significant bad practice that, as she rightly pointed out, crosses local borders and where a national-level intervention would be more appropriate. I cannot tell her right now what the plan is, because it will emerge over time, but having those powers is essential.

Question put and agreed to.

Clause 22 accordingly ordered to stand part of the Bill.

Clause 23 ordered to stand part of the Bill.

Clause 24

Fixed penalty notices

[Preet Kaur Gill]

I beg to move amendment 20, in clause 24, page 12, line 14, leave out “£100” and insert “£200”.

--- Later in debate ---

[Rachael Maskell]

I rise to support my hon. Friend the Member for Birmingham, Edgbaston. I completely agree that when we set these figures, we often forget that the economy has moved on so much, and that the rise in inflation has meant that so many things cost so much more. Just £100 is a very small amount to many shops, which take their cut from these products. It is therefore essential that we move into the realms of reality, not least because the consultation advised the Government that £200 would be an appropriate starting point and would have public support.

Clause 26 says that the figure can be amended by the Secretary of State, should they choose to do so. So the amendment would not place a limit in primary legislation, but it would make this a more realistic deterrent to ensure that shopkeepers abide by the law. It is also really important to have an incentive for them to ensure that they are fully up to speed with their obligations. This change would focus their minds as regulations are introduced, as the Minister alluded to, and ensure that they keep themselves up to date, because they know that the penalty makes it worth doing that. I therefore urge the Committee to adopt my hon. Friend’s amendment. It is a simple measure that would not cause the Minister any grief as the Bill passes through its later stages.

[Dame Andrea Leadsom]

I am grateful to the hon. Member for Birmingham, Edgbaston for bringing this discussion to the Committee, and I fully appreciate the sentiment behind the amendment. I completely understand why it is attractive to raise the fixed penalty notice and make it more material to the individual, but I urge hon. Members to take into account the fact that local trading standards take a proportionate approach to tobacco and vape enforcement. The Bill proposes fixed penalty notices of £100 to enable trading standards to take swifter action by issuing on-the-spot fines, rather than needing to go through lengthy court processes. Littering, parking or under-age alcohol sales attract on-the-spot fines. The proposal in the Bill is for £100, or £50 if it is paid within two weeks. That avoids people thinking, “I can’t pay this, so you’ll have to pursue me through the courts.” That creates an incentive for these issues never to come to court, and it can clog up court time and so on. I fully appreciate the hon. Lady’s point, but this is about practicality.

I find it slightly odd that the hon. Lady says £100 is affordable but £200 is not. I would be shocked to get a £100 on-the-spot fine, and I am sure she would, too. Most retail workers would find a £100 fine to be quite devastating vis-à-vis their daily cost of living. I fully understand the sentiment behind the amendment, but £100 is in line with the precedent set by penalties for comparable offences. The fixed penalty notice for under-age alcohol sales is £90. If the penalty were raised to £200, as the amendment suggests, trading standards could issue higher on-the-spot fines, but how many of us have that kind of money on us? It would push a person into severe difficulty. As we have discussed, there is a very swift escalation—it is a “two strikes and you are out” policy—and there is the ability to take the business to task, too, so I think the current penalty is actually quite stringent.

[Dr Johnson]

The Minister will not be surprised to hear that I think we must always consider the most stringent possible fine for selling these things to kids. Will she confirm that, in the event that someone is selling age-restricted tobacco and vaping products to children, the shop worker, who is unlikely to be on a particularly high income, could receive an on-the-spot £100 fine, which they would have to pay immediately; and that the shop premises can be taken to court, and if necessary, enforcement can result in the shop not being able to sell these products at all? In addition, under clause 1 an individual can be taken to court for selling these products and can get a level 4 fine. There is a whole range of options, from on-the-spot fines, which may be relatively low and can be used if the trading standards officer wants to quickly remind someone not to make such mistakes in future, to much more severe penalties for those who are more persistent or deliberate.

[Dame Andrea Leadsom]

My hon. Friend is exactly right, and I will run through the levels of fines for the benefit of hon. Members.

[Mary Glindon]

Is not the whole point of having fines that they act as a deterrent? We do not want lots of people just paying £100 because it is manageable. The thought that they may have to find £200 on the spot could be more of a deterrent. The reason we have these fines in the first place is that they act as deterrents, is it not?

[Dame Andrea Leadsom]

I completely agree; the hon. Lady makes a good point. What people would see as a deterrent is an open question. I would see a £100 fine as a deterrent; I do not have £100 in my purse, so I would have to go to the cash point. I would not be keen to do that, and Members of Parliament earn quite a bit more than most retail workers. That is the truth of it. I actually think that setting the fine in line with the £90 fine for the offence of selling alcohol to someone under age is quite a material deterrent.

[Rachael Maskell]

I think the Minister is making slightly the wrong comparison. A retail outlet will have a till, and that till will have money in it. Therefore, it will be the business, not the shop worker, paying the fine. She makes the point that for one person, £100 could be incredibly steep, but for someone working in a venue that sells products out of the scope of the legislation, paying £200 out of a till is not really out of the ordinary, and these businesses make extortionate profits out of these things. I wonder if she could address that point.

[Dame Andrea Leadsom]

The hon. Lady makes a good point. There is an open question as to what the right level is, but it is for trading standards to decide whether the individual member of staff or the business pays the fine. So this is a very relevant point, but it is not just about taking the money out of the till. That is not necessarily the choice that trading standards would make; the fine may well be imposed on the individual.

[Kirsten Oswald]

I wonder whether looking at what an individual person may have in their purse is the right way to think about this. The Minister is right that I do not have £100 in my purse, but I am fortunate enough that I do have £100. It strikes me that in these situations, there would be a more modern way of paying the fine than expecting people to have it on their person at that moment. That puts a whole layer of obligation on them. I am slightly agnostic about what the level should be, but I wonder if we could look at what is reasonable rather than what people might have about their person.

[Dame Andrea Leadsom]

The hon. Lady makes a good point. Of course, most of us do not carry £100 in cash, because we do not need to these days. My point was more that if the fine is £200, an individual might say, “Well, you’ll have to take me to court over it.” That creates a huge administrative burden that will slow down justice.

I will turn to the other clauses, because I think that will help in this debate. Clauses 24 to 26 relate to fixed penalty notices in England and Wales. Clause 24 introduces fixed penalty notices for the under-age sale of tobacco and vaping products and for the free distribution of vaping products to under-18s in England and Wales. The current penalty regime requires trading standards to prosecute an individual or business, and they must be convicted in a magistrates court. The new fixed penalty notices will allow trading standards to take swifter action by issuing on-the-spot fines to retailers, instead of escalating to a court process. Fixed penalty notices are already in place in Scotland and Northern Ireland.

Fixed penalty notices offer an individual the opportunity to avoid prosecution for an offence if they make a payment within a specified period. They are already in place for proxy purchases of tobacco and vape products. A strong approach to enforcement is vital to ensure the smoke-free generation policy, and that our approach to tackling youth vaping has real impact. Fixed penalty notices will complement the existing sanctions and strengthen the toolkit available to trading standards officers, allowing them to take swifter action to fine those selling to anyone under the age of sale.

[Dr Johnson]

Will the Minister give way?

[Dame Andrea Leadsom]

I will make progress, if that is all right—I will give way before I finish. I just want to ensure that hon. Members are aware of the facts.

Clause 25 states that funds received from fixed penalty notices issued in relation to the offences in the Bill will be retained by local authorities and must be used in connection with their functions under the Bill. That means that if trading standards issue a fixed penalty notice, the local authority will retain the funds from the fixed penalty notice, and those funds must be used by the local authority to support the enforcement of tobacco and vape legislation. That allows local authorities to cover the enforcement costs of issuing fixed penalty notices, and to reinvest any remaining funds in enforcement regimes.

Clause 26 provides the Secretary of State for Health and Social Care and Welsh Ministers with the power to change the amount of a fixed penalty notice and the percentage discount for early payment as set out in clause 24. The power provides flexibility for Ministers to adapt the amounts specified and will future-proof fixed penalty notices, ensuring that they remain an appropriate and proportionate enforcement tool to deter offenders.

[Dr Johnson]

I thank the Minister for giving way. The purpose of the penalties is presumably to punish those who have deliberately acted against the rules, and to be a deterrent against those who consider doing so. I am satisfied that the Minister has thought very carefully —I know she has—about the level at which the fines should be set. She has come up with £100, but can she reassure me that the Government will monitor to see whether that is sufficient and, if it is not, that they will increase it accordingly using the regulations provided for under the Bill? Secondly, when an individual is deciding to break the rules and to sell an age-restricted tobacco product to a child, could they know whether they would be dealt with under the fixed penalty notice or under clause 1, which carries a much bigger and more deterring fine?

[Dame Andrea Leadsom]

I can give my hon. Friend the reassurance that she seeks. With regards to the issuing of fines and whether the shopkeeper would know, it will be for trading standards to have the total range of enforcement tools that are available to them, including being able to impose a fine of up to £2,500 upon conviction in a magistrates court, as well as the other, potentially unlimited fines that we have discussed—for breach of a restricted premises order—or, indeed, this on-the-spot fine, which hon. Members will appreciate is a much faster way to provide swift and immediate punishment of offenders. Its escalation has already been set out—two offences in two years leads to the restricted premises or sale order.

[Bob Blackman]

I always seek a spirit of compromise in such circumstances. At the moment, the Bill states:

“The amount specified in a fixed penalty notice must be £100.”

I am concerned about how that could be altered by regulation. Clearly, a consultation or other measures might be needed. A relatively simple amendment could have the clause state that the fixed penalty must be a minimum of £100 and can be varied by regulation. Will the Minister consider that as not necessarily an amendment today, but as something she might consider taking forward so that we can satisfy all sides?

[Dame Andrea Leadsom]

My hon. Friend makes an excellent suggestion, and I will certainly take that away to reflect on it. My initial thought is that we could, unfortunately, end up with a situation where a particular individual or premises felt that they were being unfairly penalised, because they got £100 and I got £200. We can imagine that. Nevertheless, I think it is a really good idea and a very good proposal for compromise, so yes, I will reflect on it.

I think, Dame Siobhain, we have come to the end of the discussion, so I commend clauses 24 to 26 to the Committee.

[The Chair]

I apologise, Minister, but as this is the shadow Minister’s amendment, she in this case gets an opportunity to respond.

[Dame Andrea Leadsom]

Indeed.

[Preet Kaur Gill]

I thank the Minister, although of course I am disappointed at her rejecting the arguments that she has heard today. I welcome the suggestion from the hon. Member for Harrow East. I think that that would be a fairly reasonable way forward. Of course, we do not know whether the Minister will make those amendments.

The Minister talked about a fixed penalty notice of £100, but actually, that is not true, because people have 14 days and it is reduced to £50. I do not see £50 as a deterrent. I think that if it were £200, for example, and people therefore had to pay £100 within 14 days, that would be more likely to be a deterrent. I would therefore like to press the amendment to a Division.

Question put, That the amendment be made.

--- Later in debate ---

[The Chair]

With this it will be convenient to discuss schedule 1.

[Dame Andrea Leadsom]

Clause 27 provides that schedule 1 amends aspects of the Public Health (Wales) Act 2017. It amends the existing provision relating to the handing over of tobacco to under-age people to align to the new age of sale. It also extends the offence to cover the handing over of vaping products to those under 18. The schedule updates definitions in the Public Health (Wales) Act to align to the definitions set out in the rest of the Bill, including the definitions for herbal smoking products and nicotine products. These are needed to ensure that the law in Wales is correct and accurate and aligns with the provisions that the Bill is introducing across the rest of the UK. I therefore commend the clause and schedule to the Committee.

Tobacco and Vapes Bill (Fifth sitting)

Andrea Leadsom Excerpts

Committee stage
Thursday 9th May 2024 Public Bill Committees

[The Chair]

With this it will be convenient to discuss the following:

Clause 2 stand part.

Clause 37 stand part.

Clause 41 stand part.

Clauses 48 and 49 stand part.

[The Parliamentary Under-Secretary of State for Health and Social Care (Dame Andrea Leadsom)]

Clauses 1, 37 and 48 change the age of sale for tobacco products, herbal smoking products and cigarette papers so that no one born on or after 1 January 2009 will legally be sold those products in England and Wales, Scotland, and Northern Ireland, respectively. That replaces the existing legislation, which sets the age of sale at 18 years old. The clauses are core to the ambition of being the first country in the world to create a smoke-free generation, which is supported by the public, including a majority of retailers: nearly 70% of people support our plan to create a smoke-free generation. But why is it necessary?

First, this new age of sale will save tens of thousands of lives. Tobacco is devastating for the health of smokers. It is the single biggest preventable cause of death, responsible for about 80,000 deaths in the UK each year. Smoking causes one in four cancer deaths, including 70% of lung cancer cases. It is not just those who smoke who experience the harms; second-hand smoke also causes enormous harm to children, through no choice of their own.

There is no safe age to smoke. We know that 75% of smokers would never have started if they had the choice again, and those who start smoking as a young adult lose an average of 10 years of life expectancy. As we heard from the chief medical officer for England in his oral evidence session, individual smokers should never be blamed for the situation they are in. An incredibly wealthy and sophisticated marketing industry deliberately addicted them to something, at the earliest age it could get away with, and they have had their choice removed.

Secondly, this measure will boost our economy. Each year, smoking costs our economy a minimum of £17 billion, which is far more than the £10 billion income per year that the Treasury receives from taxes on tobacco products. That is equivalent to 6.9p in every £1 of income tax received. Therefore, reducing the prevalence of smoking will reduce these costs, helping our economy to become more productive.

On that note, reducing smoking will also cut the burden on the NHS. As Sir Stephen Powis outlined in his oral evidence, smoking impacts the NHS at all levels. Almost every minute of every day, someone is admitted to hospital with a smoking-related disease and over 100 GP appointments every hour are because of smoking. Reducing this burden will allow us to invest more in vital care, focus on major conditions and cut waiting lists.

Thanks to years of decisive Government action and stop-smoking support, smoking rates are coming down, but we want to build a brighter future for our children, grandchildren and great-grandchildren. I know that there are concerns about this policy, which were discussed at length on Second Reading. I want to reassure all colleagues that this policy is not about taking away people’s rights. There is no liberty in addiction and nicotine robs people of their freedom to choose.

I also urge all members of the Committee not to be taken in by the tobacco industry’s claims that the black market for tobacco products will boom. Before the legal smoking age was increased from 16 to 18, the tobacco industry sang from that same hymn sheet, but the facts drowned them out. The number of illicit cigarettes consumed actually fell by 25%, and smoking rates for 16 and 17-year-olds dropped by almost a third. In fact, consumption of illegal tobacco has plummeted from 17 billion cigarettes in 2000-01 to 3 billion cigarettes in 2022-2023.

To crack down on illicit tobacco and under-age tobacco and vape sales, we are putting an extra £30 million of new funding per year over five years into our enforcement agencies and we are working closely with enforcement colleagues to ensure that these measures are successfully implemented. And we have not forgotten current smokers. The measures in the Bill are accompanied by a suite of measures to support current smokers to quit. They include nearly doubling the funding for local stop-smoking services with an additional £70 million each year over the next five years, providing a new financial incentives programme to support pregnant women and their partners to quit, and providing additional funding for stop-smoking campaigns and to ensure that retailers and the public understand the changes in the law.

On Second Reading, there were also discussions about what products were in scope of the new restrictions. Let me clarify matters by saying that the new age of sale restrictions will apply to all tobacco products, including tobacco that is smoked, smokeless or chewed. When it is smoked, tobacco kills up to two thirds of its long-term users, and all smoked tobacco, including in shisha and cigars, is harmful. There is also clear evidence of the toxicity of heated tobacco in laboratory studies; the aerosol generated by heated tobacco contains carcinogens. I know that some of our colleagues have championed heated tobacco products as a smoking quit aid, but there are less harmful tobacco-free products that can support people to quit smoking.

Tobacco products such as paan, betel quid and chewing tobacco are also covered by the Bill. Tobacco that is not smoked is not a safe way to use tobacco. Using smokeless tobacco increases the risk of both mouth cancer and oesophageal cancer.

[Bob Blackman (Harrow East) (Con)]

I thank my right hon. Friend for the speech she is making and of course I absolutely support all the measures in the Bill. One concern, which I think was raised on Second Reading, about paan and chewing tobacco is that they are currently not specified very clearly in the Bill. Is she planning to introduce any further measures, either in Committee or in regulation, to address this concern? One of the problems is that at the moment those products are freely sold in a range of different environments.

[Dame Andrea Leadsom]

First, I pay tribute to my hon. Friend for his very long-standing campaign to stamp out nicotine and tobacco. He is absolutely right that we will need to make it very clear to members of the public, retailers and health organisations our intention to stamp out all tobacco products, because they are all unsuitable for our smoke-free generation. I will make a note of his concern, take it away and make sure that the legislation makes things as clear as it possibly can.

The Bill also applies to cigarette papers, as do current age of sale restrictions. Their bleaches and dyes add to the volume of smoke and the range of toxicants in the smoke, contributing additional risks to smokers. Likewise, herbal cigarettes are included in the legislation, as they are harmful to health. Although their smoke does not contain nicotine or tobacco, it does contain cancer-causing chemicals, tar and carbon monoxide similar to a tobacco cigarette.

I will briefly mention clause 41, which amends the Scottish legislation to include herbal smoking products under provisions for age of sale, age verification policy, sales by under-18s, proxy purchasing and vending machines. With their harms outlined above, it is right that herbal smoking products be included within the current and future tobacco control legislation. By extending this legislation, Scotland will be aligned with the other UK nations. This measure will also support the effective implementation and enforcement of the Bill by providing consistency for enforcement officers, industry, retailers and consumers across the UK.

To complement the smoke-free generation policy, we are also bringing forward clause 2, which makes it an offence for someone over the age of 18 to purchase tobacco products, herbal smoking products or cigarette papers on behalf of someone born on or after 1 January 2009 in England and Wales; this is known as proxy purchasing. Proxy purchasing of these products by an adult for someone under age is already prohibited; the clause makes it an offence for any adult to buy these products for someone in the smoke-free generation—that is, born on or after 1 January 2009. That means someone might be caught by the offence if they are also too young to be sold the products themselves, but we did not want to overcomplicate the application of this offence.

We hope this measure will send a clear message to stop people trying to buy products for people under the age of sale. Proxy purchasing in Scotland and Northern Ireland will also be updated through clauses 37 and 48 to align with the new age of sale. These provisions are essential to ensure there are no loopholes in the age of sale legislation, and build on what we have found to work in the current age of sale legislation.

Finally, I present clause 49 to the Committee. The clause amends a provision in the Health and Personal Social Services (Northern Ireland) Order 1978 to provide the Department of Health in Northern Ireland with the power to amend the definition of “sale” to mean “sale by retail”. If the power is used, only sales from a retailer to a customer will be caught by the tobacco age of sale offence, which will therefore not include business to business sales, such as sales between a wholesaler and a retailer. This measure would bring the type of sales caught by the tobacco age of sale offence in Northern Ireland in line with those in England, Wales and Scotland. Fundamentally, the clauses included in this group are essential to implementing the smoke-free generation policy.

There is both strong cross-party and cross-nation support for these measures. It is clear that we all acknowledge the need to protect future generations from the harms of smoking. No one wants their children to ever start smoking. In England alone, it could prevent almost half a million cases of heart disease, stroke, lung cancer and other deadly diseases by the turn of the century, increasing thousands of people’s quality of life and reducing pressures on our NHS. Thanks to the collaborative work we have undertaken with the devolved Administrations, we have produced a Bill that will save lives right across the United Kingdom. I therefore commend these clauses to the Committee.

[Preet Kaur Gill (Birmingham, Edgbaston) (Lab/Co-op)]

It is a pleasure to serve under your chairship, Dame Siobhain, and to serve on this Bill Committee. I will start with some general remarks about the context of this legislation.

This is an important Bill. As we heard on Second Reading, there is vanishingly little opposition to the central point that nicotine addiction is a scourge on our society, and that it is right the Government take steps to reduce its harms. Nicotine addiction cuts lives short and worsens healthy life expectancy disproportionately among more deprived communities; the toll it takes on the economy, and in particular on our NHS, far outweighs any benefit the Exchequer receives in taxes.

Labour proposed a progressive increase in the age of sale for tobacco in January 2023, and the Minister can be reassured that we will continue to support this Bill. If Labour win the next election—if we are privileged enough to do so—we will implement it. It will be a pleasure to genuinely lead the world on tobacco control, given that tobacco kills an estimated 8 million people a year.

--- Later in debate ---

[Kirsten Oswald (East Renfrewshire) (SNP)]

I, too, welcome the provisions in the Bill and the contributions that have been made so far from both sides of the House. It is very important that we have a collective voice on this, wherever possible. We know that smoking is a leading cause of preventable death in Scotland and the rest of the UK. In 2022, smoking accounted for an estimated 8,942 deaths of those aged 35 and above in Scotland. We have also heard about the significant impact that smoking has on those who are already suffering from inequality and are in the most disadvantaged situations in our community.

The work on the Bill has been constructive, and it contains a number of measures pushed for by the Scottish Government; of course, part 2 specifically relates to Scotland. Jenni Minto, the Scottish Public Health Minister, has spoken positively about how Scotland has dealt with tobacco control measures, being a world leader. Although we know that there has been a reduction in the proportion of people smoking, it is still damaging far too many lives and killing too many people. We heard about the huge damage to the capacity of our NHS because of the difficulties caused by smoking, and the damage to people’s lives.

Scotland has long led the UK on tobacco control. We in the SNP really welcome this collaborative step towards creating a smoke-free generation. As the first UK nation to introduce an indoor smoking ban, and having led on the overhaul of tobacco sale and display law, we can clearly see the important steps we are taking and the significant, positive impact on public health that is possible. We support the new age regime and the greater powers for Scottish Ministers to tackle youth smoking and vaping. It would be very helpful to hear further about how it is anticipated that the powers will be used. We need to make sure that this works in practice.

I close by reflecting what others have said about the uniquely lethal and addictive nature of smoking, and the far-reaching problems it causes in people’s lives. We need to take whatever steps we can to prevent this addiction—so enthusiastically encouraged by the marketing teams of these industries—from taking hold in the first place. It is really important that we take all the steps available to us while we have this unique opportunity. We need to look at closing some small gaps, which I am sure we will discuss further. I would be very happy to hear from the Government Front Bench team about sponsorship, which is an interest of mine in terms of vapes, but I hope that we can make constructive progress on making this Bill a reality.

[Dame Andrea Leadsom]

I appreciate the clear cross-party support for the measures in the Bill. I understand that hon. Members will have views on ways to amend or strengthen it, but I urge the Committee to appreciate how little time we have. As we heard clearly from last week’s evidence sessions—from the chief medical officers from all parts of the United Kingdom and from so many medical professionals—this is a very good Bill, so let us not make the perfect the enemy of the good. Let us get this through.

I very much appreciate the welcome of all colleagues, and I assure them all that I will take away any suggestions and requests and come back with clear answers. Where something is relatively simple to do, we will seek to do that, but equally, as Members will appreciate, it is not always possible to accept every suggestion, no matter how well-meaning—and I absolutely accept that, in this Bill, it is always well-meaning.

I will answer the points that hon. Members specifically raised. The hon. Member for Birmingham, Edgbaston asked about how we will encourage young people to quit smoking at an early stage. She will be aware that there are lots of measures to try to help people to stop, including the financial incentives that we are providing, particularly for those expecting a baby and their partners. There are also the quit aids to help people to swap to stop—to move to vapes, which I think we all recognise can be a useful quit aid. They are not harmless, but are less harmful than smoking cigarettes.

We are working at pace with online retailers on how to support them to ensure age verification, and I hope that we will be able to say more about that. The issue of duty-free sales is a tricky one, as my hon. Friend the Member for Harrow East will appreciate, because we do not want to put the burden of legality on the purchaser. The idea is that it should be illegal to sell, and, of course, we have jurisdiction only in the United Kingdom, but I take his points on board and will come back to him on that.

The hon. Member for York Central is right that we need to do everything we can to stop advertising. There are already very strict rules around advertising, and smoking and vaping are severely restricted when it comes to advertising to children. But I think—I hope that the hon. Lady will agree—that the vaping measures, including the powers to limit packaging, flavours and in locations in stores, will do a lot to reduce the appeal to children, which I know we are all incredibly concerned about.

[Dr Johnson]

I say, first, that I fully support this Bill and what it intends to do. Having worked in respiratory medicine in my very first job as a doctor, I saw far too many people suffering from and dying of respiratory illness, and suffering through the final years of their life due to respiratory illness caused by smoking. I think this is excellent legislation.

My right hon. Friend talked about advertising being quite restricted, but, with vaping, we see sports teams—rugby teams and football teams—using vaping brands as adverts for children. These are not recreational substances, or should not be recreational substances. They are supposed to be quit aids and do not need advertising where children can see them.

[Dame Andrea Leadsom]

My hon. Friend makes an extremely good point. She will be interested to know that I have recently written to the Advertising Standards Authority to ask about how well it considers enforcement to be working, and what more it can do to enforce the already strict regulations. I am happy to share its response, when it comes, with all members of the Committee.

[Rachael Maskell]

rose—

[Kirsten Oswald]

rose—

[Dame Andrea Leadsom]

I will give way to the hon. Member for York Central and then to the hon. Member for East Renfrewshire.

[Rachael Maskell]

I am really grateful to the Minister for the work that she is doing in this area, but clearly, for vaping, there is not equality with smoking in terms of an advertising ban. For simplicity’s sake, equalising the law would make a significant difference. We often think about packaging in shops, but today, the social media space is an incredibly powerful tool that young people are exposed to on a continuous basis. Therefore, extending the advertising, promotion and sponsorship ban could have such a significant impact, and it could be legislated for simply. As we have got so accustomed to the advertising ban for tobacco products, it can simply be translated for vapes. Will the Minister look into that?

[Dame Andrea Leadsom]

With your permission, Dame Siobhain, I will take the intervention on the same subject from the hon. Member for East Renfrewshire.

[Kirsten Oswald]

Is the Minister able to tell us a bit more about the interaction with the Advertising Standards Authority? What jurisdiction does it have in relation to the advertising of vapes on football strips, for instance? Is it not in fact our job to deal with that, rather than the job of the Advertising Standards Authority?

[Dame Andrea Leadsom]

In response to all those points, I am extremely sympathetic to the need to clamp down on advertising. It seemed to me, when I came to the Bill, that it was important to get a “Where are we now?”-type assessment of what the current regulations say, how well they are being enforced and what more needs to be done. Like many colleagues, I am interested to hear what the Advertising Standards Authority has to say about that, and I am sure we will come back to this subject.

The hon. Member for York Central raised age verification. As she knows, retailers will be required to challenge and seek age verification from those who are born on or after 1 January 2009. As the Bill continues its passage, we will look at the amendments that have been tabled and consider whether there is a need to change that age verification requirement. At the moment, I think the Bill strikes the right balance. As I said at the beginning, it is essential that we make progress with the Bill in the short time remaining in this Parliament.

The hon. Lady’s points about the visitor economy were well made. It is essential that we ensure wide communication about the new measures in stores, at the point of sale; to retailers, who will have just over two years to enforce this legislation and undertake the training; and to members of the public. I commend the clauses to the Committee.

Question put and agreed to.

Clause 1 accordingly ordered to stand part of the Bill.

Clause 2 ordered to stand part of the Bill.

Clause 3

Tobacco vending machines

Question proposed, That the clause stand part of the Bill.

[Dame Andrea Leadsom]

The clause restates the ban on tobacco vending machines in England and Wales. This prohibition came into force in 2011 in England and 2012 in Wales through regulations made under the Children and Young Persons (Protection from Tobacco) Act 1991, which made it an offence for anyone who manages or controls premises to have a tobacco vending machine available for use. The offence applied to selling both tobacco products and herbal smoking products from a vending machine. Herbal smoking products were included due to their harmful nature when smoked.

The prohibition was originally introduced because tobacco vending machines were largely unsupervised and allowed under-age access to tobacco. In 2010, 8% of 11 to 15-year-olds who regularly smoked said that vending machines were a usual source of cigarettes. This policy has successfully reduced smoking rates among young people and has been effective at enabling the age of sale restrictions to be implemented and enforced properly.

The existing legislation has been restated to provide a coherent narrative in the Bill on tobacco measures and to assist with the tidying of the statute book. I therefore commend the clause to the Committee.

[Preet Kaur Gill]

We of course support the aims of this clause, which as the Minister said, effectively restates regulations that were introduced under the previous Labour Government, making the person who controls or is responsible for the management of premises where a vending machine is located liable to commit an offence if tobacco sales are made.

We are concerned about how easily children could access tobacco from vending machines, and the availability of tobacco from machines undermines efforts by adult smokers to quit. As the Minister said, when Labour introduced these regulations, evidence showed that vending machines were a usual source of cigarettes for 12% of young people aged 11 to 15 who were regular smokers. I venture that is 0% now, so the measure has been effective. Why has she decided to re-enact existing law on that matter through the Bill, given the existing regulations?

On a wider point, the purpose of those regulations was to stop children readily accessing tobacco products, but I note that the Bill contains no similar provisions on the availability of other vaping and nicotine products through vending machines. I would be surprised if her officials had not looked at this issue, but there is no mention of vending machines in the entire 164-page impact assessment, despite reports of new vending machines being introduced in England that include an automated age-verification feature.

I am keen to hear the Minister’s thinking on that point. Could vending machines undermine other regulations in the Bill that are providing powers to regulate vape and nicotine product points of sale and displays, as well as reinforcing and closing the loopholes on the age of sale?

--- Later in debate ---

[Dame Andrea Leadsom]

The purpose of clause 3, as with a lot of the clauses that we will debate in line-by-line consideration of the Bill, is to tidy up the statute book for the whole tobacco regime, both to align all four nations and to make sure there is a clear understanding of the law where it relates to tobacco, tobacco products and vaping. The fundamental purpose is to tidy up the statute book by restating it with clarity at this critical time.

My hon. Friend the Member for Sleaford and North Hykeham made a point about vaping and vending machines. As she will be aware, the Government are taking powers in the Bill to look at issues such as location of sale, packaging and flavours. It was felt that it was important to have further consultation under those powers to look at issues such as whether vaping products should be sold in vending machines. It will be debated at a future time under those regulations. The key point is that we have clarity in the Bill.

[Dr Johnson]

I thank the Minister for that information. She talks about location of sale. I understood location of sale to refer to a geographical location, rather than a method of sale, such as through vending machines. Could she be clearer on that point?

[Dame Andrea Leadsom]

I will get back to my hon. Friend on that point, which is a good one. This clause and many others are intended to tidy up the statute book, rather than to introduce new subjects that would be more appropriately considered somewhere else.

[Kirsten Oswald]

I wonder whether I can reflect some of the Minister’s words back to her. She talks about clause 3 providing clarity, but I am afraid that I do not think it provides clarity—it adds a degree of confusion. This is the Tobacco and Vapes Bill, and it is reasonable that people look for measures relating to both those products. It adds an unwelcome level of confusion for us to deal so differently with vapes.

[Dame Andrea Leadsom]

I am grateful to the hon. Lady for her views. As I said earlier, I will take away all the views expressed in Committee and reflect on them. I am grateful to her for her comments.

Question put and agreed to.

Clause 3 accordingly ordered to stand part of the Bill.

Clause 4

Sale of unpackaged cigarettes

Question proposed, That the clause stand part of the Bill.

[The Chair]

With this it will be convenient to debate clause 38 stand part.

[Dame Andrea Leadsom]

Clauses 4 and 38 restate that it is an offence if tobacco retailers do not sell cigarettes in the packaging in which they are supplied. Selling unpackaged cigarettes is currently an offence in England, Wales and Scotland under the Children and Young Persons (Protection from Tobacco) Act 1991. The prohibition was originally introduced to reduce smoking among children, because there was evidence that children were purchasing single cigarettes. As with clause 3, we have included these provisions to help to tidy up the legislation related to the age of sale for tobacco products, so that it is clear for tobacco retailers, enforcement agencies and other relevant parties across the UK.

The clauses ensure that the sale of loose cigarettes continues to be prohibited and that cigarettes are sold in the appropriate packaging. Additionally, clause 38 inserts the definition of “retail packaging”, aligning with the definition used in England and Wales. I commend the clauses to the Committee.

[Preet Kaur Gill]

Clause 4 is another that re-enacts existing law that we support. The sale of unpackaged cigarettes is a practice used to short-circuit the enforcement of age of sale law and other regulations such as flavour bans, and only benefits the illicit trade.

Particularly now that the Government have introduced the track and trace system, packaging is useful in monitoring the flow and patterns in the trade in tobacco products around the country. However, it is notable that the clause opts to restate the law’s focus on cigarettes instead of other products. In 1991, the Government faced a lot of opposition from Members on their Back Benches when they proposed to include cigars in the definition, so can the Minister tell us why she has not considered extending the provisions and treating other tobacco products in the same way? Can she reassure me that trading standards has not found instances of, for example, cigars or hand-rolling tobacco being kept and sold unpackaged, and that that does not have the potential to be a loophole that will later need to be closed?

[Rachael Maskell]

I support the points that have already been made, but I will not repeat them, because they have been made eloquently.

Why is the fine in clause 4(2) only at level 3, whereas elsewhere in the legislation the fines are at level 4? We know that cigarettes being sold as single items, and packs being broken up and sold in that way, encourages people to smoke. We also know that they will be targeted at children and young people, as well as people in greater deprivation.

There are 14.5 million people in our country who are living in poverty, and there is a much higher prevalence of smoking in that population. The increase in the price of tobacco products has been a major determinant of how much people smoke and whether people smoke at all. It therefore seems perverse that the fine applied to breaking up cigarette packs is less than that applied elsewhere in the Bill, where there is a level 4 fine. Can the Minister explain the reasoning behind dropping the level of fine? Why is it not in line with the other measures in the Bill?

[Dame Andrea Leadsom]

I do not have all the answers to hon. Members’ questions. The purpose of the clause is to restate and clarify the statute book, so the answer to many of the “Why haven’t you done this or that?” questions is that the intention was to tidy up the statute book rather than address all the other potential issues that could be solved. I will certainly come back to hon. Members with the answers to their questions.

As colleagues will appreciate, there are thousands of potential add-ons to the legislation, but it is important to remember that the core purpose of the Bill is to create the smoke-free generation. On those well-made points and suggestions, I do not know whether they were considered and ruled out or whether they were not considered, but I will come back to hon. Members with answers.

Question put and agreed to.

Clause 4 accordingly ordered to stand part of the Bill.

Clause 5

Age of sale notice at point of sale: England

Question proposed, That the clause stand part of the Bill.

[The Chair]

With this it will be convenient to discuss the following:

Clause 6 stand part.

Clause 42 stand part.

Clause 50 stand part.

[Dame Andrea Leadsom]

Clauses 5 and 6 introduce a requirement for age of sale notices in England and Wales to align with the new age of sale for tobacco products. Additionally, clause 42 provides Scottish Ministers and clause 50 provides the Department of Health in Northern Ireland with the powers to make provisions about warning statements. Warning statements are notices that reflect the new age of sale requirements. Age of sale notices currently must state in a prominent position:

“It is illegal to sell tobacco products to anyone under the age of 18”.

Clauses 5 and 6 update the wording of the notices so that they now reflect the requirements of the new age of sale. They will therefore state:

“It is illegal to sell tobacco products to anyone born on or after 1 January 2009”,

alongside the Welsh translation of the statement in Wales.

Additionally, under clauses 5 and 6, the Secretary of State and Welsh Ministers have been granted powers to introduce further requirements on the size or appearance of the notice. This allows for colour requirements and other changes to be introduced in the future should they be needed. Clauses 42 and 50 provide Scottish Ministers and the Department of Health in Northern Ireland with the same powers to set requirements.

Similar powers on the appearance of the age of sale notices have previously been included in legislation and regulations have been made, but these powers broaden the scope of the provisions. We do not anticipate requiring further amendments beyond the text of the age of sale notices prior to the change in the age of sale.

The updated wording on age of sale notices will support tobacco retailers in implementing the new age of sale restrictions by helping to clarify and underline it for customers and staff. I therefore commend the clauses to the Committee.

[Preet Kaur Gill]

I support the clause. For consistency and public acceptability, it is important that there is clear and consistent messaging to help the public understand the changes. It is already a requirement for premises to display notices to sell tobacco to under-18s, so I cannot see there being any issue in the implementation of the clause. Indeed, it is in the interests of retailers to have standardised notices across shops as we know that asking for ID is an issue that can cause customers to give shop workers grief at the till. When someone can say, “I am sorry, but it is the law and I could be fined or even have my ability to sell these products taken away,” that will greatly aid them in their job.

When customers can see that there is consistency across all retailers and that there is not the scope to twist anyone’s arm or get the impression that the issue is not taken seriously, we will see more people follow the rules. As we would expect, the responses to questions in the consultation were overwhelmingly supportive, with opposition mainly limited to arguments against the progressive rise in the age of sale.

Will the Minister comment on the consideration she has given to other forms of words, some of which she mentioned? Should the wording of the notice be limited to the focus on the age of sale and not, for example, proxy sales? Although one is the responsibility of the retailer and the other of the customer, would it not reinforce the understanding of the law and make people think twice about committing that offence? Will she set out the Government’s thinking on that? However, I support the clause.

[Dame Andrea Leadsom]

The hon. Lady makes a fair point. The clarity of the single message is, on balance, considered to be more important. If it is absolutely clear that products may not be sold to anyone who meets the 1 January 2009 criterion, that clarity and simplicity makes the message more punchy.

Question put and agreed to.

Clause 5 accordingly ordered to stand part of the Bill.

Clause 6 ordered to stand part of the Bill.

Clause 7

Sale of vaping products to under 18s

Question proposed, That the clause stand part of the Bill.

[The Chair]

With this it will be convenient to discuss the following:

Clauses 8 and 9 stand part.

Clause 44 stand part

Clause 51 stand part.

Government amendment 25.

Clause 53 stand part.

[Dame Andrea Leadsom]

Before I speak to the clauses, I want to set out, for the purposes of clarity, what we mean when we refer to vapes. Different terminology is used in law, depending on whether we are referring to legislation for England and Wales, for Scotland or for Northern Ireland. However, although there may be minor differences in terminology, the products are the same. When referring to vapes, e-cigarettes or nicotine vapour products, I will use the generic term “vapes” throughout.

Vaping is never recommended for children. It risks addiction and unknown long-term health impacts while their lungs and brains are still developing. These clauses are important to ensure that vaping products and nicotine products cannot easily be accessed by children.

Clause 7 will mean that it continues to be an offence to sell a nicotine vape to a person under the age of 18 in England and Wales, and anyone found guilty of the offence will be liable to pay a fine of up to £2,500 if convicted. The clause will also extend that age of sale restriction to non-nicotine vapes, as we know that children are accessing those products. The provision on non-nicotine vapes will come into force in both England and Wales six months after the Bill receives Royal Assent, to allow retailers time to introduce the measure. The clause provides businesses with certainty about whom they may legally sell products to, and reinforces our health advice that children should never vape.

Clause 8 will mean that it continues to be an offence for a person aged 18 or over to buy, or attempt to buy, a nicotine vape on behalf of a person under the age of 18. The clause will also extend those restrictions to non-nicotine vapes. Non-nicotine vapes may be used as a gateway for children to start using nicotine vapes, which is why the clause extends the scope of the current restrictions to include non-nicotine vaping products.

Clause 9 will close an existing loophole and make it an offence to give away a vaping product, or a coupon that can later be redeemed for a vaping product, to someone under the age of 18 in England and Wales. Given the clear and unambiguous health advice that children should not vape, and the fact that under-18s cannot legally be sold a nicotine vape, it is completely unacceptable that the industry is not prohibited from giving free samples of vapes to children. That loophole needs to be closed to ensure that we can protect children from addiction and potential health harms.

Clause 44 will amend Scottish legislation to extend existing regulation-making powers to prohibit or restrict the free distribution and nominal pricing of vapes to cover nicotine products such as nicotine pouches. Regulation-making powers on the sale of nicotine products to under-18s, on proxy purchasing and on free distribution to under-18s are provided for England and Wales in clause 10 and will be discussed separately.

Similarly, clause 51 will give the Department of Health in Northern Ireland regulation-making powers to prohibit the sale of non-nicotine vaping products to persons under 18. That will align with measures in the Bill for England and Wales and with measures already in place in Scotland for this offence. To ensure alignment across the UK, clause 53 will provide the Department of Health in Northern Ireland with regulation-making powers to prohibit the free distribution of nicotine products and non-nicotine vaping products to those under the age of 18. I commend clauses 7 to 9, 44, 51 and 53 to the Committee.

Government amendment 25 to clause 53 was tabled at the request of the Health Minister in the Northern Ireland Executive. It will change the mode of trial and maximum penalty for an offence of free distribution of nicotine products or non-nicotine vaping products in Northern Ireland, removing the potential for anyone convicted of the offence to be imprisoned. Instead, on conviction, the penalty will be a fine not exceeding level 5 on the standard scale in Northern Ireland. That small change will align the penalty that could be imposed with the penalty for the age of sale offence for vapes in Northern Ireland. I am sure that the Committee will agree that that is a more proportionate penalty for the offence. For those reasons, the UK Government accept the amendment.

[Preet Kaur Gill]

First, I want to make some general points about these first vaping-related clauses of the Bill. We agree fundamentally with the Government in their efforts to find a balance by phasing out tobacco use and cracking down on youth vaping while being careful not to undermine the proven success of vaping as a stop-smoking aid. There is no doubt, however, that the rise in youth vaping is a serious concern.

My main question about the Government’s response is “What took them so long?” Labour proposed measures more than two years ago to stop vapes being branded and marketed to appeal to children, but that was blocked by the Government. I am glad that the Government have listened to us. I hope that they will continue to do so as we debate the Bill; I firmly believe that some of its provisions can still be strengthened.

I am pleased by the inclusion of clause 7. Coupled with clause 34, which defines a vaping product in a way that includes non-nicotine vapes, it will tackle a substantial loophole that we have been calling on the Government to close for a long time. Youth vaping is a serious and growing issue. In 2021, Labour voted for an amendment to the Health and Care Bill to crack down on the marketing of vapes to children. Since then, according to the most recent survey by Action on Smoking and Health, the number of children aged 11 to 17 who are vaping regularly has more than trebled. That is more than 140,000 British children. Meanwhile, one in five children have now tried vaping. In clause 7, a couple of issues therefore intertwine.

I think most people would be surprised to learn that it is legal to sell non-nicotine vapes to children, which could so obviously be designed as a gateway to addiction to the real thing, as the Minister mentioned. It is doubly concerning when we think about the illicit vapes that end up on British shelves. Testing by Inter Scientific, from which we heard last week, has found that a considerable percentage of seized vaping products that it tested contained nicotine, even when they were marketed as 0%.

That is highly concerning. It means that for the past several years, we may have seen a spate of accidental addictions among children. According to survey data from ASH, 9.5% of vapers aged 11 to 17 exclusively puff on so-called 0% nicotine vapes. Analysis of that and of data from the Office for National Statistics suggests that at least 40,000 child vapers could have been exposed to nicotine-containing vapes without their consent, becoming accidentally addicted by illegal products masquerading as nicotine-free that, under existing regulations, they are allowed to buy. That is an important testament to why not just regulation, but effective enforcement— especially over the illicit market—is vital to the success of the Bill.

The two-tier system of regulation for nicotine and non-nicotine vapes is not robust. The exclusion of non-nicotine vapes from the Tobacco and Related Products Regulations 2016 is important for a few reasons. Primarily, it is confusing and more difficult to enforce the rules on the ground if it is not clear which products contain nicotine and which do not. As 0% nicotine vapes are out of the scope of the current regulations, they do not need to be notified through the Medicines and Healthcare products Regulatory Agency process, on which trading standards officers often rely to identify illicit products. I raised that point with the Minister in a debate in January and am keen to seek clarity. Does the Minister think that all producers should have to notify vape products, regardless of nicotine content, to the MHRA?

I note that clause 71 provides the power to extend the notification process to non-nicotine vapes, but the Government have not, to my knowledge, explicitly expressed a view on the matter. Will the Minister do so now? In theory, including non-nicotine vapes in the notification process should allow for a complete database of products. Currently, it is difficult to identify which products are legal or illegal, which really undermines enforcement action.

As we heard in evidence, the impact of vaping products on the developing bodies of children has the potential to be very harmful. It is vital that we take every step to make sure that our systems of regulation and enforcement are as robust as possible to stop a new generation of products hooking our children on nicotine and harming their long-term health. We absolutely support the clause, and I am keen to hear the Government’s view on the issues that I have raised.

I have no substantial comments to make about clause 8. It is a common-sense reapplication of the principles of clause 2, which we have debated and which I support.

Clause 9 will finally address a loophole that I regret to say the Opposition raised in an amendment to the Health and Care Bill in 2021; I am glad that it is now receiving the Government’s attention. Our 2021 amendment would have prohibited the free distribution or sale of any consumer nicotine product to anyone under 18, while allowing the sale or distribution of nicotine replacement therapy licensed for use by under-18s. The then Minister rejected the amendment. To quote my hon. Friend the Member for City of Durham:

“There was no evidence of a serious problem, but the Minister sympathised with the argument for preventive action.”—[Official Report, 22 November 2021; Vol. 704, c. 56.]

Two and a half years later, it is clear what a widespread issue this has become. It goes without saying that Opposition support clause 9, which will close the loophole, as well as clause 44, which will introduce powers for the Scottish Government to extend the existing powers to regulate the free distribution of vapes and other nicotine products such as pouches, as mentioned by the Minister. Likewise, clause 51 will mean that age of sale restrictions can be extended to non-nicotine vaping products.

Finally, clause 53 relates to the free distribution of vapes and nicotine products in Northern Ireland, whether or not they contain nicotine. As I have discussed, I am very concerned that that has presented a loophole that has undermined enforcement, so I support a consistent approach across the United Kingdom. May I ask the Minister to set out what the words “in the course of business” will mean in practice when it comes to the free distribution of harmful products, given that we would expect any person caught out by the provision to argue that there is no “business” in giving away something for free? Of course, we know that that is not true in the case of addictive products, but I will be grateful if the Minister can reassure me that the clause will do in practice what it needs to do. Can she also please reassure me that it will not prohibit under-18s from accessing nicotine replacement therapies?

I reiterate that the Opposition support these clauses, but I am very interested in the Minister’s views on how the Bill should affect the notification process for vapes.

--- Later in debate ---

[Rachael Maskell]

I am grateful to the hon. Lady for the point she made. Certainly, I did highlight that transitional benefit of moving from smoking to vaping to, hopefully, stopping altogether. However, we must also highlight that vaping is not without risk, and we need to give that serious consideration. I am just concerned that the Government are slightly light, shall I say, in terms of their concern about vaping, in order to drive down the smoking. I absolutely understand that, because smoking kills, but I just think that we could be on the “too light” side. I know that it is about balance, but I hope that we can reflect on that during the course of the Bill.

I want to draw out one question that I have about clause 9 and giving away vapes. I certainly understand why the measures would be applied to industry, but I want to ask about public health measures that could be deployed. I recognise that the clause is about under-18s, but unfortunately, despite the current legislation, we know that many people under 18 smoke, and we obviously need to ensure that they stop and move into a safer space. The Government have been very much pressing the idea that vaping is a route out of smoking. Does the Public Health Minister see vaping as a means to help people under the age of 18 to stop smoking, or will they have no access to vapes? I would just like some clarity around that. Clearly, there are other smoking-cessation programmes and products available, but it would be useful to know the answer to that question. If vaping is to be used in that way, and clinicians are to be able in future to prescribe or indeed provide vapes for young people to stop smoking—if that was the only tool—we need to understand whether we are to have a blanket ban in the Bill. It would be very useful to understand that.

[Dame Andrea Leadsom]

Once again, I thank all hon. Members for their thoughtful and considered remarks —I really do appreciate them. Essentially, the questions are pretty much around the product notification and the availability of quit aids to under-18s. Hon. Members may not have spotted this, but the notification of vapes to the MHRA is something on which we are taking powers. There will be a further consultation on that point because it did not come under the scope of the original consultation. We will have the powers to require notification of vapes to the MHRA.

The other point that has been raised by a few colleagues is, “How do we help under-18s to stop smoking?” Under the MHRA, there is licensed nicotine replacement therapy, which is licensed for 12 to 18-year-olds. Of course, all under-18s can go to their local stop-smoking services.

To the point from the hon. Member for York Central about whether young people should be able to access vaping as a quit aid, my instinct would be, “No, absolutely not,” and I think that that would be her instinct also. However, I must slightly correct the record: it is certainly not the Government’s position that vaping is in any way safe; it is merely less harmful than smoking. I would reiterate that if you don’t smoke, don’t vape. And children should never vape, so they should not be turning to vaping, even as a quit aid. In my view, that would also be the thin end of the wedge, because people would simply say, “Well, I am only vaping because I am trying to stop smoking.” I cannot imagine that ever being a suitable way to help children to stop.

[Bob Blackman]

One issue that has been raised in the debate is non-nicotine vapes and the potential to get people on to vaping, followed by the escalation, presumably, to nicotine and then, potentially, as has been mentioned, to cigarettes. What action will my right hon. Friend take—although not necessarily in these clauses—to make sure that that escalation path cannot be followed?

[Dame Andrea Leadsom]

My hon. Friend raises an important point. The legislation covers non-nicotine vapes, and unfortunately, as has been pointed out, a number of illicit so-called non-nicotine vapes have up to 30% nicotine content, which has completely undermined the argument for those. Quite clearly, they are designed by the industry to get people hooked on the idea of vaping so that it can get people on to higher nicotine levels in due course. That is why the legislation covers non-nicotine vapes and all tobacco and vaping products.

[Preet Kaur Gill]

What more can the Minister do about the growing illicit market in vapes? The MHRA’s evidence was interesting; it said that a lot of what is in the notification process is considered illicit, but the Minister did not have the figures and she was going to provide those to us. There is an issue there in terms of triangulation and what trading standards has found to be illicit and not compliant with the notification process. At the moment, the MHRA does not have the powers to withdraw those products; it is down to the provider themselves to remove them from the notification process and then to become compliant and to reapply again. That does not seem to be the right approach, because the manufacturers are marking their own homework in terms of what they are notifying. The Minister also recognised that what might have been notified and what actually comes into the country are very different. There has to be a better way of ensuring that we grip the illicit vapes market—hence the requirement for the notification process to include non-nicotine vapes that contain nicotine.

[Dame Andrea Leadsom]

The key point is that legal vaping products must be notified to the MHRA. If they are compliant, they go ahead. If they are not compliant, they go away and make themselves compliant. That is how the system works at the moment. With illicit vapes, it is an entirely different issue. I can point the hon. Lady to the evidence. When the age of smoking was raised from 16 to 18, the number of illicit cigarettes reduced significantly, so it is our expectation and hope that the same will be true with illicit vapes.

At the same time, as the hon. Lady will be aware, there was an announcement to impose an excise duty on vapes. A benefit of that, which she and I remarked on after the evidence sessions last week, is that we hope that that would enable His Majesty’s Revenue and Customs to enter the vape market into the track and trace that already exists for cigarettes and therefore to have much better control over what products come on to the market. I am sure we will talk further about that during the passage of the Bill.

[Preet Kaur Gill]

On that basis, does the Minister think that the MHRA should have the powers to test a percentage of products that come on to the market, given that we already know that what is being notified to it is non-compliant and given what is coming into the country? I appreciate her comments on the excise duty, but does she have a timescale for when we could see a track and trace system, as we have for tobacco, extended to vapes?

[Dame Andrea Leadsom]

As the hon. Lady will know, the MHRA is not an enforcement body; enforcement is for trading standards. As I mentioned earlier, there will be new resources for trading standards, as well as new training and guidelines. Also, fines will go direct to local authorities, which employ enforcement officers, so there will be a huge ramping-up of enforcement on illicit vapes, non-compliant vapes and so on. That is the place for enforcement.

On the MHRA and notification of other types of vapes, there will be powers, and the consultation will take place in due course.

[Rachael Maskell]

While the Minister is doing the work on vapes, will she also look at nicotine pouches, which are incredibly concerning? We have heard that the strength of the nicotine in pouches far exceeds that in vapes. People are therefore getting a very high dose of nicotine and are sometimes not aware of the level they are getting.

[Dame Andrea Leadsom]

I am frantically looking through my pack here. Clause 10 covers nicotine pouches, so we will come on to that—[Interruption.] The Whip is saying it will be after lunch, if that is not too much of a sneaky “get out of jail” card. With the hon. Lady’s acceptance, I will defer that until later.

Question put and agreed to.

Clause 7 accordingly ordered to stand part of the Bill.

Clauses 8 and 9 ordered to stand part of the Bill.

Ordered, That further consideration be now adjourned. —(Aaron Bell.)

Tobacco and Vapes Bill (Third sitting)

Andrea Leadsom Excerpts

Committee stage
Wednesday 1st May 2024 Public Bill Committees

[Preet Kaur Gill]

Q Finally from me, and this question is for Frank and Michael, the latest ONS figures in 2022 show smoking prevalence in Wales and Northern Ireland remaining constant rather than continuing to fall in the way that it did in England and Scotland. Do you think Wales and Northern Ireland have specific challenges related to smoking prevalence?

Sir Francis Atherton: It is certainly true that we are not going as fast in Wales as we would like to see. Smoking prevalence has dropped, from about 22% in 2020 down to 13% at present, but our target is to reach 5% by 2030, and we are not currently predicting that we will meet that target unless we go further and faster. We believe that this Bill will enable us to do that.

You asked for the reasons. One of the reasons is that we have deep-seated sociodemographic problems in Wales, which you have been referring to. Given the inequity that we see, meeting the needs of current smokers from those really deprived socioeconomic groups is really quite a challenge. We are doing everything we can in Wales to try to address that through “Help Me Quit” and smoking cessation support, but we really need to prevent the next generation from coming on board with smoking.

Professor Sir Michael McBride: Just following on from Sir Frank’s comments, you are absolutely correct that, while population prevalence of smoking sits at around 14% at the moment—behind the 12% in England and the 13% in Wales—we are doing slightly better than Scotland at the moment, which is sitting at about 15%. The figures for the Republic of Ireland are somewhere in the region of 18%. There is absolutely no doubt that we have the same socioeconomic drivers, in terms of social deprivation and health inequalities, that are fuelling this. Should the Bill succeed and pass into legislation, I see this as a once-in-a-generation opportunity to make a significant change to protect future generations and their children from all the harmful consequences of smoking tobacco and other forms of tobacco use.

[The Parliamentary Under-Secretary of State for Health and Social Care (Dame Andrea Leadsom)]

Q I thank all you chief medical officers for being here; we appreciate it. You will understand that your witness evidence is crucial to easing the passage of the Bill. I would like to get you on the record talking, first, about the start of life. The shadow Minister has just asked about pregnancy and, only this week, I was talking to a neonatal nursing lead, who said of the pregnancies of women who smoke that the children had a low birth weight and go on to have severe learning difficulties throughout their lives. That is heartbreaking, but also has significant implications for NHS and educational services, and for whole-life costs to the taxpayer. I would be grateful for your comments on that.

At the other end of the age range, elderly people who have smoked all their lives end up with decades of ill health brought on by a lifetime of smoking. I would be grateful, too, if you talked about some of the health outcomes for those who have smoked all their lives—some of the horrors of that. Sir Chris, you told me an anecdote of when you were a young vascular surgeon. For the record, it is important to talk about some of the heartbreak for those who wish they could stop smoking.

Professor Sir Chris Whitty: I completely agree with all the points you made. Starting off with the beginning of life, there are clear and significant increases in stillbirths, premature births, birth abnormalities and long-term effects from smoking just in the pre-birth period. Then, of course, if parents are smoking around babies and small children, that affects lung development and, if children have asthma, that will trigger asthma effects. Young children are significantly affected by passive smoking from their parents. The parents, of course, want the best for their children, but the problem is that they are now addicted to a product that has taken their choice away. We get those problems right from the very beginning, and we have talked about some of the issues in young pregnancies and where that leads.

Moving to the other end of the age spectrum that you were talking about, the full horrors of smoking for most people start to take effect from middle age onwards. At this point, people get a range of things. Everyone knows about lung cancer, I think, and most people know about heart disease, but there are effects on stroke or increases in dementia, which are significant—one of the best ways to delay dementia is not to smoke or to stop smoking at an early stage. That is a huge problem for all of us. Smoking also exacerbates any problems people have with diabetes—it makes that much worse—and people have multiple cardiac events leading to heart failure. In heavy smokers, we see extraordinary effects, like people having to lose their limbs. As you and I discussed, it is a tragedy to be on a ward with people with chronic obstructive airways disease, or on a vascular ward as a vascular surgeon with someone who has just had an amputation, weeping as they light up another cigarette, because they cannot stop, because their choice has been removed. I cannot hammer that point home firmly enough: this is an industry built on removing choice from people and then killing them in a horrible way.

Sir Francis Atherton: Minister, you also pointed out the cost to the NHS. In Wales, we estimate that we have about 5,500 deaths every year from smoking-related diseases. If we look at admissions to hospital, about 28,000 in the over-35 group is about 5% of overall hospital admissions. That is an enormous burden to the NHS. On a more personal basis, in a former life I was a GP, and I remember sitting with an elderly gentleman who at the end of his life was suffering with chronic obstructive pulmonary disease. There is no worse death than not being able to breathe when just sitting there. I remember sitting with him as he was trying to talk to me and trying to express that same level of regret that Sir Chris talked about. If you talk to any smokers towards the end of their life, who are facing such terrible ends to their life, the sense of regret that you hear as a doctor is quite overpowering.

Professor Sir Michael McBride: It is estimated that in Northern Ireland there are more than 2,000 deaths each year directly attributable to smoking cigarettes; over the past five years, smoking makes up 12% of all deaths in Northern Ireland. Sir Frank and Sir Chris have clearly described the horrors of the impact that it has at an individual level, and as doctors we have all experienced that. We have all had those conversations with individuals who look back on a lifetime of regret.

On a more personal level, I also think at this moment about the impact that premature death, and the morbidity and mortality associated with smoking, has on families and children. My own father died at 46 years of age, when I was 16, from acute myocardial infarction as a consequence of a lifetime addiction to smoking cigarettes. So, we need to bear in mind the very human costs, family costs and wider societal costs as well. It is not just the cost to the health service, but the societal cost, the family cost and the cost to the wider economy.

Professor Sir Gregor Ian Smith: We should never forget the societal cost that Sir Michael just spoke about. I am the child of two smokers who died in their mid-60s from smoking-related disease. We see it all too often in Scotland. In fact, in Scotland we still have 9,000 deaths a year attributed to tobacco addiction and smoking. That is one death every 61 minutes that families suffer across Scotland as a consequence of addiction to smoking.

As a clinician, one of the diseases that I had become quite specialised in treating and led a lot of work on is chronic obstructive pulmonary disease. That is a smoking-related disease that people develop, often at too young an age, and begins to really impair their ability to participate fully in life—not only in employment, but in the pastimes that they love. Gradually, over time, it becomes worse.

Sir Frank touched on the sense of regret that people have that they ever started smoking in the first place and find themselves in this position. Beyond that, there is an even sadder element: many of the people who experience these chronic life-limiting illnesses have not only regret that they ever started, but guilt about the burden that they place on the health service and their family because of the illness and disability that they develop. That guilt sometimes reaches to the extent that they do not seek full care. Many people’s attitude is, “I deserve this. I started smoking; I need to pay the consequences.” That is a terrible psychological position for any person to find themselves in. Removing the starting point for that addiction, so that people will not experience that through their life, is the aim of the Bill.

Let me make one last point. We talk about the health impacts of all this. The Scottish burden of disease study projects that over the next 20 years, up until 2043, we will see a 21% increase in the general burden of disease across our population in Scotland, despite having a falling population during that time. Much of that projected burden of disease is smoking related; it relates to cancers, cardiovascular disease and neurological conditions such as dementia, which are all influenced by smoking. It is absolutely necessary for us to address this in a preventive way, and I believe that the Bill is a very good way of doing that.

Professor Sir Chris Whitty: I want to reinforce the point that Sir Gregor just made, with which I am sure the Committee fully agrees, that individual smokers should never be blamed for the situation they are in. An incredibly wealthy, very sophisticated marketing industry deliberately addicted them to something, at the earliest age it could get away with it, and they have had their choice removed. It is important that people do not feel guilt and come forward for care, and that no one blames them for a situation that was deliberately put on them by industry marketing.

[Kirsten Oswald (East Renfrewshire) (SNP)]

Q I will continue on the theme of marketing. Do you have thoughts about the measures relating to the product restriction of vapes in the Bill? Are they robust enough, in your mind, to prevent the harm that is caused by vapes, particularly to young people? I am thinking of the study that came out yesterday that, concerningly, suggested a risk to teenagers who vape of exposure to toxic metals, potentially harming their organ and brain development.

As a follow-on from that, I am concerned about the advertising of vape companies on sports kits, which is profoundly unhelpful. When we look at sporting figures who young people can admire, that has absolutely no place. I wonder what your views are on that.

Professor Sir Gregor Ian Smith: My views are very clear on vaping in young people and on sales to the youth categories. This is an activity that we are still learning much about but that the evidence, as it emerges, appears to suggest is very harmful to them. In my conversations with my paediatricians and with the Royal College of Paediatrics and Child Health, they are very concerned about the impacts on health of young people from beginning vaping. Any attempt to make products such as single-use vapes or flavoured vapes, or the packaging used or the marketing around vapes, more attractive to that age group is something that we need to counter and resist.

I would say that the aims of the Bill will allow us the means by which we can properly consult on the way that we attempt to reduce overall vaping use in this age group. I am very clear in my views on this: while I understand that vaping may be an assistance to people who are already addicted to tobacco and nicotine products as a consequence of use of many years—I see that there may be an argument that it allows them to reduce the level of harm they are exposed to—I am not convinced or led by any of the arguments that starting vaping in a younger age group is a safe activity at all. I do not believe that that is the case; I believe that it is harmful to those groups. We must try to counter that, and to counter the marketing machine that Sir Chris has spoken about, by reducing the flavours and packaging that are attractive to younger people.

--- Later in debate ---

[Preet Kaur Gill]

Q We should all be concerned about the increase in the use of vapes by young children, so it is important that the Bill will ban the sale of vapes to under-18s. It will also close the loopholes for under-16s, because we know that vapes are being marketed and given out for free. That is the issue we must address. My concern with the Office for Health Improvement and Disparities being disbanded is on public health messaging. Parents and families are really concerned that some of their children are going through a number of these vapes per day or per week, and they do not know what is a safe amount.

There is a growing illicit vape market, but how would parents know what is illicit or what the Medicines and Healthcare products Regulatory Agency has notified as being compliant? Where is the public health messaging to support schools? We heard really good evidence yesterday from the union. This is my concern: where can people access support and information? We already have a generation of kids addicted to vapes that are marketed as having 0% nicotine, but we know that there is nicotine contained in them. What would you say to that?

Sir Francis Atherton: There is some messaging going on through the various Governments. In Wales we have a “No Ifs. No Butts.” programme, which tries to work at an individual level, to alert people to the dangers that we have been discussing, and with wider society, about the dangers and links between illicit tobacco and illicit vaping and organised crime. Bringing that awareness to the population is really important for those two reasons.

We work with trading standards to try to tackle the issue of illicit tobacco and vapes. It is important that we continue that. My understanding is that wherever we have been successful in reducing demand, which the Bill intends to do, the illicit supply also decreases. We would expect that to be a consequence of the Bill.

Professor Sir Chris Whitty: One of the many talking points of the cigarette industry is, “Well, any kind of downward pressure on cigarettes would lead to an increase in the illicit market.” All the evidence shows that the reverse happens. When you bring in reduced demand, the illicit market decreases.

[Dame Andrea Leadsom]

Q I think we might be out of time, but I have one more question. In the passage of the Bill, there is a concern that some may wish to fix flavours on the face of the Bill, rather than allow the powers. Sir Chris, can we have a comment on the record on how damaging that would be?

Professor Sir Chris Whitty: That would be very damaging, because we know that this is one of the most innovative marketing industries in the world. That is how they have managed to sell to people something that will addict them and then kill them. If we give them room for manoeuvre by nailing things down, they will find a way around it, because they always have found a way around regulations. I am absolutely supportive of the comment you have just made.

[The Chair]

I am afraid this brings us to the end of the time allotted for the Committee to ask questions. I thank all the witnesses, because you answered a huge number of questions and provided great information.

Examination of Witnesses

Professor Sir Stephen Powis and Kate Brintworth gave evidence.

--- Later in debate ---

[Preet Kaur Gill]

Q Would you like to say anything about admissions of young people in relation to smoking?

Professor Sir Stephen Powis: I will make a few broad comments on smoking, if I can. Seventy-eight years ago, Parliament passed the National Health Service Act 1946, which led to the formation of the NHS on 5 July 1948. In my view, the legislation that you are considering here today is one of the most important—possibly the most important—pieces of legislation since the passage of that Act. Why? Smoking has an extraordinary impact upon the health of the nation, and of course directly upon the NHS.

To put that into a bit more context—you have heard some of this already, but maybe I will provide some more detail—smoking is associated with, or causes, over 100 individual conditions that are managed and treated within the NHS. It impacts the NHS at all levels: almost every minute of every day there is a hospital admission related to smoking; there are over 100 GP appointments every hour for smoking-related disease; and 400,000 admissions a year are related to or associated with smoking. You have heard the chief medical officers briefly talk about the impact on specific diseases. Lung cancer is the one that everyone knows about, and 80% of lung cancers are caused by smoking. This Bill has the opportunity to transform lung cancer from a common disease into a relatively rare disease, and one that clinicians of the future will not see in any way as commonly as clinicians of my generation.

It is not about just lung cancer; you have heard about the impact on cardiovascular disease, and clearly, chronic obstructive pulmonary disease would again become a rare disease for the clinicians and the patients of the future. This Bill can also have an early impact on diseases that affect young people. Asthma is a disease not caused by smoking but a condition exacerbated by it. We see such admissions particularly over the months when asthma is worse and when there are respiratory infections, which are no doubt exacerbated by smoking.

In mental health, smoking doubles the risk of developing depression. More than one in two people with severe mental health conditions smoke, and the life expectancy of those with mental health conditions is reduced because of smoking. Mental health issues in our young people and children are well-known and well-described, and smoking simply exacerbates them. There is great potential, even in the early years, in the passage of this Bill for an impact on conditions that we see and manage in the NHS. Over the long term, that potential impact is extraordinary on those conditions, which number over 100.

You may know that I am a kidney doctor, but you may not know that smoking can impact on kidney disease. The kidney, like any organ, is supplied by blood vessels. When smoking impacts on the health of blood vessels and causes vascular disease, that can reduce the bloody supply to the kidney, which can cause kidney failure and lead to dialysis and transplantation. There is a large range of conditions that are impacted by smoking, and it will be extraordinary for those clinicians of the future not to have to do what we have done—tell patients and their families that people are going to die prematurely. That is an extraordinarily difficult thing for clinicians to do. Those are preventable diseases, and this Bill will prevent them.

[Dame Andrea Leadsom]

Q Thank you so much for being here today. As I said to the chief medical officers, you will appreciate that your words can be very helpful in smoothing the passage of this very important Bill. I would like to talk to Kate, please, about the impact of smoking on mothers who are pregnant. What is the impact on their babies, on the delivery of the baby, and on the baby’s health outcomes? If you could give us an outline, that would be very helpful.

Kate Brintworth: It is important to start with the fact that we know that smoking is the single biggest modifiable risk factor for pregnancy, and we know that every women who gets pregnant wants the best for her baby. As a midwife, I have never sat in front of a woman who does not want the absolute best for her baby. It is important to build on what Chris Whitty said around the removal of choice. Women will go to extraordinary lengths to protect their bodies and babies to ensure that their children have the best start in life, and yet the quit rates that we see in pregnant women are between 30% and 40%, showing how difficult it is for women to extricate themselves from the situation in which they find themselves.

The effects are devastating: stillbirths are increased by 47%; you are twice as likely to have a baby that has not grown properly; and you are 27% more likely to have a baby that is born pre-term. You are more likely to have complications of pregnancy, such as bleeding, the placenta not forming properly or the waters that surround the baby breaking earlier with the risk of infection, so there are immediate effects that we can see. If a baby is small, it goes into labour more vulnerable to the stresses of labour, so we can have more complications there. If a caesarean section is needed, the mother is more vulnerable to recovery and it can be a much harder road to recovery for her, with the risk of infection and blood clots, but also for the baby. If the baby is born early, obviously the risk then is that the baby and mother are separated and you have this unnecessary trauma to a family of a baby having to go into a neonatal unit. The risks that come from prematurity are well-documented for children, for educational attainment and for their lung and health development, but when the children go home, they are more at risk of sudden infant death syndrome—up to three times more—in a smoking household.

There are then the long-term effects. We have already heard about asthma, chest infections and obesity. All those are heightened in children born into smoking households. You have a situation where children are at risk and women are at their most vulnerable when they are pregnant, and it really feels like it is our duty to support this Bill to protect the most vulnerable in our society, because there are the effects of having a child born with possible behavioural problems and malformations, which have been described. Those are really shocking events. I was talking to service users yesterday who have had children in the neonatal unit, and it is incredibly shocking when your pregnancy ends early and you are separated from your baby. There is a mental health impact on the family. There is also the point that this affects those coming from the most socioeconomically deprived backgrounds, for whom having any kind of health challenge makes it a much higher bar to fight.

[Dame Andrea Leadsom]

Q That is very harrowing to hear. Could you further expand on the impact on families of losing a baby due to stillbirth as a result of smoking? How does that impact on their mental health? As you said, parents will do everything they can to protect their baby, but the addiction to cigarettes is so strong that for many it must lead to them blaming themselves for the death of their baby.

Kate Brintworth: The birth of a child is so happily anticipated by every person who gets pregnant. From the moment that you see a thin blue line, you are having a baby. You have hopes and dreams for the expansion of your family, but not just for that individual family: a baby is born, and it is a niece, a nephew, a grandchild, a cousin. It really ripples out across the entire family. When there is then a 35% risk of miscarriage and a higher risk of ectopic pregnancy and, as you said, the absolutely awful, tragic and devastating news that your baby has died when it reaches term, that is something that no parent should ever have to face unnecessarily. It just feels like the worst thing you ever have to do as a clinician to tell someone that their baby has died. Every time I have ever had to do that, it has been the worst point in my career. It is difficult to explain how destroying it can be for families, and we see the long-term sequelae in terms of mental health, to the point where we have put in extra perinatal mental health support for families that have suffered that kind of trauma.

Professor Sir Stephen Powis: Can I pick up on the health inequalities aspect, because I think that is really important and I have the figures in front of me? In 2021-22, 21% of pregnant women in the most deprived areas smoked at the time of delivery, compared with 5.6% in the least deprived areas. That is a really stark difference. Smoking is widely accepted as the most significant driver of health inequalities in the UK. Detailed analysis has concluded that 85% of the observed inequalities between socioeconomic groups could be attributed to smoking. We spend a lot of time in the NHS quite rightly targeting our interventions and support to deprived areas to address health inequalities. At a stroke, this Bill would have the greatest impact that we could possibly see.

[Steve Tuckwell (Uxbridge and South Ruislip) (Con)]

Q Thank you for coming to address us this morning. We heard compelling insight from the chief medical officers earlier. Will you update the Committee on how you see this Bill supporting the NHS in the long term and the short term?

Professor Sir Steven Powis: I have already highlighted some of the short-term impacts, and there will undoubtedly be short-term impacts. Some conditions are exacerbated by smoking, with asthma in children being an obvious one. I have talked about mental health conditions and the way that smoking exacerbates conditions such as depression and chronic mental health illness.

We will start to see immediate effects, but those effects will grow over time. I have given you some of the conditions that are impacted on by smoking—there are well over 100 of them—but I can give some more stats. By stopping children from ever starting to smoke, we estimate that we will prevent about 30,000 new cases of smoking-related lung cancer every year. More than 1.4 million people suffer from chronic obstructive pulmonary disease, which is a chronic disease of the lungs caused by smoking—it causes nine out of every 10 cases. As I said, that is a disease that clinicians commonly see. A common cause of admissions to emergency departments, through the winter particularly, is other respiratory infections on top of COPD—these are diseases that future clinicians will see rarely. They will not see them in the way that clinicians of my generation have had to manage them. The impact will begin immediately, but over time that impact will get greater.

--- Later in debate ---

[Preet Kaur Gill]

Q There seems to be an issue around what is contained in illicit vapes, which we know include things like lead, nickel and high levels of nicotine, versus other vapes that have gone through a notification process. Do you feel that the research on the impacts of illicit vapes is not there, or is it the impact of vapes that have gone through a compliant process?

Professor Hawthorne: There is probably very little research on either.

Professor Turner: If I could just bring a bit of clarity, it is well known that nicotine is bad for us. Sir Walter Raleigh brought it back with some potatoes, and we have known for hundreds of years that nicotine is an addictive drug. As I said previously, it will shorten your life expectancy by between 10 and 15 years. Because we know nicotine is in all nicotine-containing vapes, whether licit or illicit, it is harmful regardless of what the other components might be. It is likely that those other components add to the harm, but there is substantial and well-described harm from nicotine addiction to us as human beings.

[Dame Andrea Leadsom]

Q Thank you both so much for being here. As I said to the other medical professionals, your words today will be incredibly valuable in ensuring the smooth passage of the Bill. Professor Turner, could you explain to us what happens to a baby born addicted to nicotine in terms of the withdrawal symptoms and the impact on its health and development?

Professor Turner: There is not a lot of research on that. Certainly, we know that if you are in utero and your mother is smoking, you will get the harmful effects of nicotine. That is a very good question—I honestly do not know what the effects on the unborn child would be. Certainly, we know that children born to parents who are addicted to morphine or cocaine have learning difficulties. I have to be honest and say that I might have to get back to you on that one, but I can assure you that it is not good to be in utero and exposed to nicotine.

[Dame Andrea Leadsom]

Q Professor Hawthorne, from a GP’s perspective, could you talk us through the impact of second-hand smoking on childhood asthma and how that presents in terms of the innocence of the child and the impact of something being done to them?

Professor Hawthorne: We have known for a long time that passive smoking increases the risk of not just asthma, but upper respiratory tract infections and ear infections. It is very much part of a GP’s role when they are consulting with such patients coming in with these infections to ask about parental smoking. It is interesting that the responses are nearly always the same. If the parent smokes, they will always say, “But I only ever smoke outside.” Of course, one has to take that as it is, but I suspect that they are probably not always smoking outside. It is definitely a well-recognised link, but I am seeing it a bit less than I used to.

Everybody knows about the dangers of smoking. A lot of my patients, when I talk to them about needing to stop smoking, already know what I am saying. Quite often, I will say to them, “Well, you know what I am going to say next, don’t you?”, and they will say, “Yeah, I know. I need to stop smoking.” The conversation then proceeds from there.

We also have evidence that, in general practice consultations, a short intervention can be very effective. We know that people are very pressed for time, and there is only so much we can cover in a 10-minute appointment, especially if the patient is coming with three different problems. But there is good evidence that with even a very short intervention—I think in about 10% of cases—patients will actually stop smoking. It is always worth talking about, and if I get the time, I have a much longer spiel, because you need to think about the behavioural and addictive aspects of smoking. We go through, “When are you most likely to want to smoke? Is it after a meal, when you are on the phone or when you first get up in the morning?” We talk about what else they can do instead. I had one patient who went and dug the garden whenever she wanted to smoke. It is that kind of conversation.

[Dame Andrea Leadsom]

Q We know that it takes up to 30 quit attempts to actually give up smoking. Can both of you give us a clue as to what is it about the 30th attempt that finally gets people over the line? Specifically to Professor Turner, is it being pregnant or having a partner who is pregnant? Is that the thing that makes people finally achieve their goal?

Professor Hawthorne: For adults, it is having that heart attack that maybe you could have avoided if you had stopped smoking before. Again, that is part of the conversation I have with patients. I say, “You are a heavy smoker, and you are at risk. Wouldn’t it be better if you stopped smoking before you have the heart attack, rather than after?” There are things like that, for sure.

We also operate a cycle of change psychological model—the Prochaska and DiClemente model. Essentially, it is a bit like having a clock face. We work out where the patient is on the clock face, and we are trying to get them round the clock to 12. If they are at somewhere like 2 o’clock, that is them saying, “Yeah, I know it is bad for me, but really no way am I going to do anything.” By 4 or 6 o’clock, they are saying, “Yeah, I know it is bad for me. I have tried a few times but it is just hopeless.” By quarter to, they are saying, “I’ve really got to do something”, and by five to, they are coming in and saying, “Doctor, you have to help me stop now.”

[Dame Andrea Leadsom]

Q And is that related to their declining health?

Professor Hawthorne: Not necessarily. It is about pushing people psychologically around that clock face. I try to work out where they are on the clock face and see if I can nudge them a bit further round, until one day they come and say, “I’ve got to stop now. What can you do to help me?”

[Dame Andrea Leadsom]

Thank you.

Professor Turner: As Kamila says, there are myriad drivers—teachable moments. Sometimes, when your child is admitted to hospital with an asthma attack, that might be the thing that makes both parents say, “That’s it.” It might be that the grandmother says to her daughter, “You’ve got to stop for your child.” Legislation might also be one of those teachable moments that make people reflect on their 29 past unsuccessful attempts and think, “I’m going to do it again.” There is no one thing, but there are clearly teachable moments, as we all have when we change our behaviour. As I suggested, I think this legislation will be one of those.

[Dame Andrea Leadsom]

Thank you very much. One last question: do you think the financial incentives for pregnant women and their partners would help?

Professor Turner: I think this is extremely contentious, but the evidence is that it does—sorry, you did ask me about pregnancy before. Pregnancy itself can be one of those opportunities to quit. Those parents who continue smoking—12% in Cumbria—feel terribly guilty. Anything we can do for that person, who has been addicted since she was 15 or 16, can help them to quit. There is no doubt—in Dundee, the trials have shown that, if you give mums incentives, in terms of vouchers rather than money, it helps them to quit, particularly if they are from deprived communities.

[Rachael Maskell]

Q We have already heard how addictive nicotine is, but do we have an understanding of the dosage of nicotine that people inhale through vaping versus through smoking? Secondly, are we missing an opportunity not to introduce a nicotine-free generation?

Professor Hawthorne: I am not a nicotine expert, but my understanding is that there is a risk from vaping, but it is about 5% of the risk from smoking. That is the best I can do in comparing the two. When I talk to patients about stopping smoking, vaping is one of the things we talk about as an alternative, with a view to eventually stopping vaping as well. Of course, there are all the other products: we use patches and chewing gum—all the usual things. It is difficult to quantify exactly how much less dangerous vaping is than smoking.

Professor Turner: Just to supplement that, as a user—if that is the right word—or a customer buying a vape, you can select the dose you want. There are doses that are equivalent to cigarettes and doses that you can wean yourself down on.

You asked whether we would be missing an opportunity if we do not introduce a smoke-free generation. I think we would absolutely be missing an opportunity. If we look back, the legislation on smoke-free public spaces across the UK was landmark. We all remember the days when you went on a plane and there was a smoking bit up front and a non-smoking bit at the back. If we were to go back and say there would be no smoking areas, we would think, “Wow, that would be transformational.” We have come on a journey, and the legislation has been part of it. I see a smoke-free generation as the logical next step, and I really think we have to take it.

Tobacco and Vapes Bill (Second sitting)

Andrea Leadsom Excerpts

Committee stage
Tuesday 30th April 2024 Public Bill Committees

[Preet Kaur Gill]

Q In what circumstances do you envision that local enforcement would not be enough and the Secretary of State would need to use the powers to intervene granted to her by the Bill? That is in clause 64.

Cllr Fothergill: We fully support the local penalty notice being issued by the councils. We believe that that is the right way to go and that it will not clog the courts, but there is always the option to refer to the magistrates court if required. Our big concern is the size of the fine, which we believe needs to be reviewed: £100 or, if paid within 14 days, £50 is hardly a penalty. We argue that we need to have greater opportunity to fine those in contravention of the law. Then, we believe, there would be less and less need for the Secretary of State to be involved. The reason he or she would need to be involved is if we cannot contain it—because we cannot issue enough penalty notices to contain it locally.

Greg Fell: A similar issue would be multi-local authority enforcement scenarios. We know that organised crime networks are not linked to an individual area, so it stands to reason that there will be a need for enforcement that cuts across many authority areas, hence there is a need for networked trading standards. That might also include, possibly, the borders—stopping the imports of illegal vapes and tobacco.

Additionally, as Councillor Fothergill said, we are concerned about the size of the fine. Certainly I hear through DPH parochially, who talk to their trading standards and licensing teams, that when there is a much larger fine that may or may not be linked to the removal of an alcohol licence, that will make a retailer really sit up and think.

[The Parliamentary Under-Secretary of State for Health and Social Care (Dame Andrea Leadsom)]

Q I appreciate you being here. Can you give me an idea of the LGA’s view of a licensing regime? That is not proposed in the Bill, but some people say that licensing would be a better alternative than the measures we are proposing here.

Cllr Fothergill: Certainly. Although we fully support the Bill, we think there could be one or two changes, which I have already referred to—we would like to see amendments—and there is the option of a licensing scheme, which we would support. If it was done on a similar basis to liquor licensing, we would be able to enforce that, because it would be backed by legislation. Of course, we would need to make sure that trading standards were fully funded for that. We would support that, if it was something that the Government brought forward.

Greg Fell: I cannot speak for the LGA’s position; ADPH does not have a formal view on licensing. I would broadly support it, but there is a danger that putting that into the mix delays getting the Bill through Parliament and turned into an Act, and getting the Bill through Parliament is arguably the most important thing.

I would broadly support that, but I come back to the complexity. Vapes are sold in hairdressers and beauty parlours and so on, so we would need to think it through. Arguably, if we are going to get into a licensing scheme, that should be for tobacco and nicotine-containing products, not just vapes; I would personally go to tobacco as well. Critically, the resourcing to make it work properly would need some very careful thought and consideration. All of that would need to be in the mix, but broadly I would support it, with those caveats.

[Dame Andrea Leadsom]

Q You have already said that you do not think the penalties are high enough, but do you think that the enforcement rules as they are, with the proposals to change the packaging, move the location of vapes and so on, will make it easier or harder to enforce? Do you think that enforcement officers will have sufficient time to train and gear up to meet the challenge of the legislation?

Cllr Fothergill: Specifically on vaping, we support the move to plain packaging, moving them away from the counter and restricting flavours—we support all those things. I have to say that we recognise the role of vaping in helping people to give up smoking, but where children and younger people are involved, we want to move the vapes away and make them less accessible. Trading standards will enforce that, as long as there are clear definitions of what can be sold, where it can be sold and who it can be sold to. A lot of the work that they do is evidence-led, so they will work on people who are giving them tip-offs or where they are seeing that there is a trend in an area where those products are being sold. As long as we are resourced and we recognise that a lot of that evidence-led work is required, it is entirely achievable.

Greg Fell: I have a fairly similar view. Largely, trading standards do this work now. The easier and simpler we can make it, and the more we make sure that it is resourced appropriately, the better, but they largely do this job now pretty well.

[Rachael Maskell (York Central) (Lab/Co-op)]

Q My question is for Greg Fell. The clarity and simplicity of knowing where you can smoke has meant that the universal principle of that bar has largely been applied, but it has not applied to vaping to date. Given that vapes contain not just nicotine but cannabis, Spice and other illicit substances, should the same restrictions be applied to vaping?

Greg Fell: Hopefully only illegal vapes contain cannabis or Spice, and not legally produced ones—I sincerely hope that is the case. I have mixed views on vaping in public. I think that Prof McNeill will talk later this afternoon. It is worth reading her evidence review for the Office for Health Improvement and Disparities, which has a whole chapter on the passive inhalation of vapes. The ADPH does not have an official position on the passive inhalation of vapes, but my personal view is that in open spaces I am not too worried about it. In enclosed spaces, I might be, particularly for people who have pre-existing respiratory conditions, but I do not think that the evidence supports it being as big an issue as people think. However, that is definitely a question for Prof McNeill, who is the expert on such matters.

--- Later in debate ---

[Bob Blackman]

I think we should have one.

Cllr Fothergill: I agree.

[Dame Andrea Leadsom]

Q You made a very good case for the age of sale rising each year, but as the LGA, do you think that will be tricky for enforcement purposes? An argument is often made that if you were 40 and I was 41, we would go into a store and I would have to buy your cigarettes for you. What would you say to that as an argument for continuing with the smoke-free generation legislation?

Cllr Fothergill: We have to be very careful that we do not spook ourselves out of doing something that is absolutely right. If people get to the age of 40 and have to show that they are 40 to be able to buy cigarettes, that is what they should do. I am sorry to say that I am 67. I have to show a bus pass every time I get on a bus to show that I am old enough to travel for free.

[The Chair]

You don’t look it.

Cllr Fothergill: Thank you very much—I’ll take that.

At every stage in life, you are asked for verification, and this is just another time. It should not stop us from doing the right thing and moving the age up so that we eventually achieve a smoke-free population.

Greg Fell: It is a long time since I have been asked my age. It may throw up some tricky moments, but as Councillor Fothergill said, let’s not stop ourselves doing the right thing here. I think most people agree that it is broadly the right thing. The Bill itself is massively important for norm-setting. Even if the norm-setting achieves half of the goal, thousands of lives will still be saved.

--- Later in debate ---

[The Chair]

Greg, before I bring Andrea in again, you do not look 67 either. I want to get that on the record.

Greg Fell: Not a day over 25, Chair.

[Dame Andrea Leadsom]

Q I beg people to ask me my age when I am buying a drink, and they just will not.

The additional things—heated tobacco, shisha and so on—that come under this legislation include cigarette papers. We all know that they can be used for rolling joints and other purposes, and that cigarette papers contain carcinogens. However, some have quite a strong desire to exclude them—I do not know why. What is the view of the LGA and ADPH on that point?

Cllr Fothergill: We believe that the scope of the Bill as it is currently written is right, and that is what we would support. We would not want to see anything excluded. Every time there is a change to smoking legislation, we hear the argument that it will increase the amount of illicit trade coming into the country. That is not a reason not to do it. It is our responsibility as trading standards to enforce, and although people always use that argument, we have to do the right thing and enforce by properly funding trading standards.

Greg Fell: If I had £1 for every time I have heard the illicit trade argument, neither of us would be here. The heat-not-burn—the clue is in the title—is a tobacco product, and I would treat it like a tobacco product. It may be safer than burned tobacco—we do not know. I would like to see some independent research. However, I would not delay the Bill until I see independent research. I would personally argue to not allow exclusions. It may seem much harder to enforce, but there will already be some tricky points in enforcement; we already know that we need to resource that properly. I would keep the simplicity and not allow exclusions.

[The Chair]

We have two minutes left. Is anyone burning to ask the last question? We have had very clear evidence and it has been an excellent session, but is anyone sitting on a question they have not yet asked?

--- Later in debate ---

[Preet Kaur Gill]

Q My first question to you is, what is the impact of tobacco smoking on public health? Secondly, do you think the Bill’s measures to prevent vaping products from being sold to children will be successful? That is essentially clauses 61 and 62.

Ailsa Rutter: Tobacco is devastating. It is devastating to every individual who dies way too young, and to the family who lose their loved one. In my region alone, just since the turn of the millennium, 120,000 of our loved ones have died from smoking. It is not an adult choice, but a childhood addiction. The vast majority of those smokers reach a point where they deeply regret having got hooked in childhood, not thinking that first puff on a cigarette would be so addictive. It is really important that we remember the 6.4 million remaining smokers in the UK and the fact that 350 18 to 24-year-olds will get hooked on lethal tobacco smoking today.

I would like the Committee to imagine that cigarettes did not exist. It is 2024, and here we are discussing a product that is designed to hook, kill, maim, and be completely addictive. This discussion today needs to be about the future world we want to strive for. We can talk a lot about how we will enforce it, which is very important, but for me this is about imagining that in 20 years’ time we have created an entire new generation protected from this uniquely lethal product. That is why in the north-east, all 12 local authorities, all 10 NHS trusts, our integrated care board—the biggest in the country—and our Association of Directors of Public Health have given whole-hearted, unanimous support to the “stopping the start” proposal on the age of sale of tobacco.

We absolutely recognise that smoking is much more harmful than vaping, but vaping is not risk-free. Vaping is playing a pivotal role in our region—with our higher levels of deprivation and addiction—to get people off lethal smoking, but that is not to say that we do not absolutely agree that much more needs to be done to reduce the appeal of vaping to young people. We wholeheartedly believe that we must address the inappropriate packaging that is too youth-friendly. Some of the in-store promotions are completely inappropriate, where children are really noticing it. We must ensure that we recognise that children are growing up within a family context; children do not live in isolation. There is also the importance in our region of sending clear, evidenced-based messaging. We can also see the positive impact on children’s health if we can get the parents and carers off lethal tobacco smoking and if we can reduce second-hand smoke harm. Really important as well is more money in people’s pockets, because cigarette smoking has such a negative effect on your income.

[Dame Andrea Leadsom]

Q Thank you so much for being here and for all you do in the north-east. It is fantastic.

As you will know, rates of smoking during pregnancy in the north-east are some of the highest in the country. Do you think this legislation will help to reduce those very high numbers? The rate is somewhere in the region of 14% in the north-east.

Ailsa Rutter: We have made really good progress in the north-east in reducing maternal smoking; that has come through very good collaboration between our local maternity services and our local authorities, as well as the fantastic leadership from key people in the local maternity and neonatal system, the LMNS, and the direction from directors of public health.

As with anything, there is not one magic solution; it is about taking comprehensive measures. The tobacco age of sale increase will undoubtedly have a really positive impact on reducing maternal smoking. It needs to be coupled with important things that we must continue to do as well, so we also welcome the increased investment for stop-smoking services.

We hugely welcome—thank you—the reinvestment in the evidence-based health harms campaigns. We are thrilled that nationally you are using our fantastic “smoking survivors” TV advert featuring Sue Mountain. The role of financial incentives is also really important; we know that they have a very strong evidence base. This will have a positive impact on maternal smoking.

[Nickie Aiken]

Q If there was one thing you could add to this Bill, what would it be?

Ailsa Rutter: Gosh! There are already some fantastic elements in the Bill. The key thing for me is to make sure that we can get the Bill through—particularly the focus on tobacco. It is really good to think that there is going to be subsequent consultation on the important elements around vaping. Factoring in what colleagues said previously, we need a simple mandatory age verification scheme. That is already in place in Scotland, and I would certainly welcome its introduction in England.

--- Later in debate ---

[Dr Johnson]

Q I want to ask you about the licensing regime. You have to have a licence to sell alcohol and tobacco, and some have suggested that you should have to have a licence to sell nicotine full stop because it is an addictive substance. That would mean that you would need to have a licence to sell vapes, partly as a way of making them less accessible to children in the places that they may be sold. Would you support that?

Adrian Simpson: It is not an issue that we have discussed at any length in the British Retail Consortium. We are aware, of course, that there are parts of the UK where licensing is required for certain tobacco products. We are well used to the alcohol licensing that has been going on for many years. Unfortunately, I cannot comment on whether the whole sector would be in support of that. We would perhaps need to see how a potential licensing system would operate before we gave our full support to it.

[Dame Andrea Leadsom]

Q Thank you so much for being here. You will be aware that, in putting together legislation, huge effort is made to be balanced and not excessive and to make it doable and achievable, nowhere more so than for those who are trying to enforce it.

May I press you a bit further on the point that Preet made about whether the fines are sufficient? You have said that it is a bit complicated and will require some lead-in time—which is obviously provided, with the 2027 date—to give appropriate training to shop staff. The quantum of the fine was intended to enable on-the-spot fines, rather than having lengthy litigation because the person who incurs the fine does not have the cash and needs to go away, may or may not pay it, may or may not have to be pursued, may or may not have to go to court, and so on. Understanding that there are different views on all sides, is the balance just about right or, if you could have put your own wish list together, are there things that you would have done differently?

Adrian Simpson: We would have liked to see more education provided to retailers who might have broken the rules. A fine can be life-changing for someone who is given one, so we like to see whether there might be a way around that; perhaps the shop worker could be educated first, rather than going straight to a fine, if at all possible. We would like to see that balance of education before strict enforcement, if possible. That would be our wish.

[Steve Tuckwell]

Q Thank you for coming in this afternoon. It is a pleasure to hear your thoughts. What will be the challenges for retailers in enforcing the ban on sales?

Adrian Simpson: The first challenge is education of all the shop staff. Our members are the very large, household-name retailers, and it will take a long time to get that education out to the hundreds of thousands—in some cases—of shop workers throughout the UK. We also think that there will be issues to do with changing our point of sale systems, things like where we are going to store some of these products if we need to, and even things like the size and nature of the tobacco notices. Retail operates in many different ways—we think of the large supermarkets, but there are very small stores as well—so a lot of thought needs to be given to the technical parts of the legislation, which of course we always work with you on.

--- Later in debate ---

[Dame Andrea Leadsom]

Q You mentioned that your members are used to working with Challenge 25. Do you see the Bill working in the same way? As the age of the smoke-free generation rises from year to year, will your colleagues in the retail sector manage to look at two different customers and ask the one that they are concerned about to verify their age?

Adrian Simpson: I think you made a wise point earlier, Minister, about the difference between a 40 and a 41-year-old. That is absolutely our concern: how will we do that? We hear a lot of things about artificial intelligence and new technology for age verification, but a lot of it is still down to human interaction—whether a human can tell the difference between 40 and 41, which can be difficult. That is certainly one of our biggest concerns. Again, we are keen to avoid situations where there could be a touchpoint for violence against shop workers.

[Dame Andrea Leadsom]

Q You will have heard Mr Fothergill from the LGA saying that he has to show his bus pass every time he wants free transport. Do you feel that that is where the solution lies?

Adrian Simpson: There certainly needs to be a bit more research into what the best methods are to keep this age restriction going. It is a new challenge in the retail sector. We have never had anything like this before, and the UK is a leader in this area. I think that, at the beginning, it will be about us all working together to try to get the age restriction going and to make sure that it is enforced, because—this is one point that I would like to make—our members are obviously very compliant and want to do the right thing. These household names are very protective of their reputations; they want to be good and to do the right thing for society. However, I certainly think that, with this new system that might come in, there could be some teething problems. We hope not, but that can naturally happen with all new systems.

[Dame Andrea Leadsom]

Q May I just clarify, then, that your members support the uplift in age, year on year? As you will no doubt be aware, there are some who challenge that and say, “Well, it shouldn’t keep escalating,” but the British Retail Consortium does support the idea of the increase, year on year, of the smoke-free generation, as so many of our other expert witnesses have done today. Would that be right? I do not want to put words in your mouth.

Adrian Simpson: It was definitely a point that came up quite a lot when we were debating this with members themselves. I would say that we are cautiously welcoming it, just because it will then bring about a level playing field for all retailers—because we know that these measures are not necessarily directed at our members, who are, as I say, in the legitimate, responsible retail sector. It will bring about a level playing field but, as I say, we might still need to see how it would operate in practice, I suppose, before we give it our wholehearted support.

[Mary Glindon]

Q I was just searching for a quote, which I think I cited in a debate last year, about a survey that had been commissioned about buying vapes. Out of the 28 vapes that were bought, 25 were illicit vapes. I presume that those are from places that are not responsible retailers—they clearly are irresponsible if they sell those. Are there a lot of retailers that do not subscribe to your organisation where this sort of thing could be occurring? If that is the case, how can we encourage them to become responsible retailers and join the consortium? What should be done? Do you try to reach out to retailers that you know are perhaps not the best and that you would like to see engage with your organisation to help to prevent this kind of illicit sale?

Adrian Simpson: Exactly. Our membership is predominantly the household-name retailers—the large retailers; the ones that certainly would not be selling illicit vapes. We have comprehensive supply chains, and our members put a lot of effort into making sure that their supply chains are operating with integrity, so that illicit products cannot enter them. I have not seen that report, but my feeling would be that the sellers mentioned in it are highly unlikely to be members of a reputable trade organisation. They might be ones that would not be looking for the same standards that our members would operate to.

--- Later in debate ---

[Preet Kaur Gill]

Q Finally from me, in your response to the Government’s “Creating a smokefree generation” consultation, you called for a fixed penalty notice of £200 and maybe the option of increasing that. Do you think that the fines and the monetary penalties in the Bill are appropriate?

Kate Pike: We really welcome the addition of a fixed penalty notice to our enforcement toolkit, but we absolutely want to have our own range of sanctions, which includes the opportunity to go to prosecution for persistent or egregious offenders. The fixed penalty notice can be a really quick solution, potentially against an individual salesperson, depending on the setting and the nature of the offending. I think that £100 can be quite a lot; £200 would be more. I think that is enough, given the opportunity in the Bill to increase it at a later stage if it is not working or having the impact that we want.

John Herriman: It is all relative at the end of the day. It needs to be tested first. To some illegitimate businesses, that will be seen just as a business cost. Whatever the amount is, we need to ensure that it is not seen as a business cost that can just be absorbed. It has to be a tangible deterrent: that is the key.

[Dame Andrea Leadsom]

Q It is great to see you—thanks for coming today. I think you are saying that at the moment the fine is set at the right level. It is a really important issue: by no means do we want it to appear to be a cost of doing business. Our previous witness was suggesting that for some shop workers it is a very significant sum and is quite problematic for them, so perhaps there should be training in the first instance.

We have sought to get the right balance, with a £100 fine that can be reduced to £50 if it is paid on the spot. For any of us, a day when we have to dish out £50 because we have done something wrong is a significant bad day. On the other hand, there is an escalation process to criminal prosecution. I am really keen that we get the balance right up front, notwithstanding that there will be powers to change it. Can I press you a bit further: is this or is this not the right place to start?

John Herriman: Can I make a broader point, and then maybe Kate can come in on the specifics? This is all about the market surveillance activity that allows you to understand what is happening on your local high streets and your ability to take enforcement action where necessary, whether that is a £100 fine or a prosecution. Fundamentally, that is the challenge at the moment. It is about the ability to have the right level of market surveillance and the right level of enforcement activity. I am sure it is a question that will come up. It is a challenge for trading standards at the moment, because over the past decade or so it has had significant cuts, in the region of 50%.

There are two halves to this question. First, is this the right legislation and are the amounts right? Secondly, legislation is only as good as the ability to enforce it. It feels as though the legislation is right—I will let Kate comment further on that—but the ability to enforce it is critical.

Kate Pike: Absolutely. Whenever we look at a new piece of regulation—as I think somebody mentioned earlier, we enforce more than 300 pieces of legislation across the spectrum—we ask, “Do we have the powers to enforce?” In the Tobacco and Vapes Bill, yes, we do. “Are there criminal penalties in there?” Yes, there are. The key things from our point of view—the building blocks—are there.

Across the spectrum, how many businesses sell tobacco? The impact assessment for the Bill says that there are something like 60,000 or 70,000 across the United Kingdom. On that spectrum, there are big businesses that know what they are doing and do not need a lot of support from us. There is a big chunk in the middle that might need a bit of support and guidance—they may make a mistake, but we can support them, help them and train them. Then there are a small amount at the other end that are the dodgy ones. We need to focus our enforcement efforts on them, because we will never be able to put one trading standards officer outside every business to be watching all the time.

[Dame Andrea Leadsom]

Q It is clear to me, having done a visit with enforcement officers, that some so-called specialist vape shops and some newsagents just have the vapes next to the sweets. It is a free-for-all: you get your bubble gum and your vape there. Is that problematic? Will this legislation mean that enforcement officers shut them down? Will there be enough powers and resources to ensure that this can no longer happen?

Kate Pike: The Bill will have enabling regulations on vapes, with powers and criminal sanctions. That is good, but the specifics around where the vapes are positioned in store will be down to the next stage. We get calls all the time from people saying, “There’s a shop in my area called Toys and Vapes—do something about it!” There is actually no legislation that we can use to tackle that.

If you do not want the vapes next to the sweets, legislate for it. We will enforce what it says in the legislation, but we cannot make it up. People are always saying, “That’s not right,” but we cannot enforce morals. We can only enforce the law, so get it in there. If you do not want the vapes there, for very good reasons, give us legislation and we can enforce it.

[Rachael Maskell]

Q My big concern is the illicit trade around vapes. What further measures would be helpful in the legislation to enable you to do your job? Vapes are clearly a delivery mechanism. We have particularly focused on lung health; I am more concerned about the use of vapes for synthetic drugs, which are available in my community and, I am sure, elsewhere. What more can be done to ensure that we do not see the growth of illicit vapes on our street corners or in our shops?

Kate Pike: Illegal drugs are not a trading standards issue. If drugs are consumed via vape or by injection or rolled up in a roll-up, that is not our issue; that is a police issue. We can only enforce the law around the products where the enforcement is given to trading standards. We have no role whatsoever in illegal drugs in vapes. But there is a huge amount of enforcement around illegal drugs in this country, with the police, and the public health approach, about ensuring that people do not use illegal drugs. However they consume them, it is really important that they are on board—

Health and Social Care

Andrea Leadsom Excerpts

Tuesday 30th April 2024 Written Corrections

The following extract is from Second Reading of the Tobacco and Vapes Bill on 16 April 2024.

[Dame Andrea Leadsom]

There is also a strong economic case for the Bill. Every year, smoking costs our country at least £17 billion, far more than the £10 billion of tax revenue that it draws in. It costs our NHS and social care system £3 billion every year, with someone admitted to hospital with a smoking-related illness almost every minute of every day, and 75,000 GP appointments every week for smoking-related problems.

[Official Report, 16 April 2024; Vol. 748, c. 265.]

Written correction submitted by the Under-Secretary of State for Health and Social Care, the right hon. Member for South Northamptonshire (Dame Andrea Leadsom):

[Dame Andrea Leadsom]

There is also a strong economic case for the Bill. Every year, smoking costs our country at least £17 billion, far more than the £10 billion of tax revenue that it draws in. It costs our NHS and social care system £3 billion every year, with someone admitted to hospital with a smoking-related illness almost every minute of every day, and 75,000 GP appointments every month for smoking-related problems.

Tobacco and Vapes Bill (First sitting)

Andrea Leadsom Excerpts

Committee stage
Tuesday 30th April 2024 Public Bill Committees

[The Chair]

Minister—your questions.

[The Parliamentary Under-Secretary of State for Health and Social Care (Dame Andrea Leadsom)]

Do you want me to ask both questions now?

[The Chair]

Yes.

[Dame Andrea Leadsom]

Could you talk us through ASH’s assessment of the economic cost to the UK economy of smoking? Secondly, what is your view on the importance of restricting vaping for children?

[The Chair]

Can we start with Sheila Duffy, please?

Sheila Duffy: In terms of a complete ban, you are talking about a ban on retail distribution of tobacco. The hope is that we will put it out of sight and out of fashion for the generation growing up. My preference is always to look at the product and the industry, rather than the consumer, so we need to maintain other issues like good fiscal policy, high price and tax.

On packaging and flavours, we know that the tobacco industry sold the sizzle on tobacco—it sold the image, it sold how it made people feel and it sold the very short-term-felt attractions and benefits. In the 1950s, people were recommended smoking to appear glamorous, to appear rugged and confident and to clear their chests in tuberculosis hospitals, and we did not know at that time how devastatingly harmful it was to health and how many years of life it would rob people of.

We must learn the lessons. It is the sizzle. It is the packaging, the marketing, the promotions that we must get on top of with vaping products, because that has driven the interest among young people, and the exponential —the doubling, tripling of regular use among children that were not smoking. There is a link between regular vaping and moving on to smoking, which I can send you the evidence for.

In terms of the economic cost, the World Bank looked at this years ago. Tobacco is not good value for any economy because the long-term costs are huge. What you are talking about is privatising the profit but socialising the costs, and that is a huge burden on the NHS and a huge burden on people’s lives. It undermines their health and the health of their families.

The final question was on the importance of restricting e-cigarettes for children. Well, let us learn the lessons from tobacco and let us take some strong steps to stop the next generation becoming addicted. I note that the devices mainly being used under-age and by children are of the highest permitted nicotine level. They are advertised with bright colours—cartoon characters in some places. They are absolutely all over social media and there is money going into influencing. These are being targeted. We are not talking about medicinal use. We are talking about recreational products, which are addictive and health-harming. We have to get on top of this.

[The Chair]

In view of the pressure on time, I ask the two other witnesses, if they agree with what has already been said, to say so and then make any additional points that need to be made. Obviously, if you do not agree, that changes the nature of it.

Deborah Arnott: I agree with the points being made. On the costs of smoking, the Minister has cited our figures to date—thank you for that. We have done a lot of work on this. New figures will be published next week, so we will give an update on those and on what additional costs we think there are, other than the ones that have been taken into account by the Government so far. That will be available for the Committee, too.

[Dame Andrea Leadsom]

Q Would you state your latest research for the record, though? Obviously, this Committee is here to provide the evidence on the record.

Deborah Arnott: I would rather not summarise it now, but it will come very quickly and we can provide it to the Committee in advance of publication, so the Committee will get the full details.

[The Chair]

Thank you.

Deborah Arnott: I would like to go on to talk about Preet’s question about clauses 61 and 62, and I would also like to talk about clause 63, because they are the ones that are absolutely crucial to prevent vapes from appealing to children.

I do not know whether I am allowed to do this, but I will show the Committee these things. This is a completely reusable vape and this is a completely disposable vape. They look almost identical and they are the same price. The disposable vapes ban being implemented by DEFRA will get rid of disposable vapes—

--- Later in debate ---

[The Chair]

We will also take the Minister, and then we can answer both sets of questions together.

[Dame Andrea Leadsom]

I am also interested in the impact of smoking and vaping on children’s hearts and lungs in particular. I would very much appreciate hearing the professional assessment of you both of the particular vulnerability of children’s lungs and hearts, as compared with adults. I know that the Opposition spokesman and I share that grave concern, as do a number of colleagues. My second question is: do you expect the smoke-free generation policy to stop young people starting smoking?

[The Chair]

I do not know which order you want to take the questions in.

Dr Griffiths: I am happy for us to do a double act between us.

Thank you for such clear questions. In terms of inequality, we know that the burden of smoking falls unevenly. We have a third more smokers in the third most deprived areas, so it affects people’s health unequally. Heart disease is the world’s biggest killer, and there is absolutely no doubt that smoking is one of the major drivers of cardiovascular disease, so the picture is clear and very well established from an inequalities point of view.

In terms of young people, we share your concern at the British Heart Foundation. It scares me to think that, today, 350 young people will start smoking for the first time—and the same tomorrow and the day after, and the day after that. We know that a huge proportion of them go on to become long-term smokers. Tragically, we see the burden and the cost to life and quality of life that that causes, with about 15,000 deaths every year across the UK from heart and circulatory disease associated with tobacco. So, we are deeply worried about people starting, and it is not just us at the British Heart Foundation who are worried. We know that the majority of smokers wish they had never started, but nicotine is an incredibly addictive substance. Once people have started, it is incredibly difficult to stop, so we share your concern.

Just to cover two things on the biology, the way that smoking is so damaging to our hearts and circulatory system is manifold. It damages the lining of our circulatory system, causing our arteries to clog up with fatty deposits, which puts us at an incredibly high risk of heart attacks and strokes. We know that a smoker’s risk of having a heart attack is double that of someone who does not smoke. For stroke, the risk is three times greater, but if someone smokes 20 cigarettes a day, they are six times more likely to have a stroke. So, there is really clear evidence on the biology that smoking is damaging.

We are deeply worried about young people starting, which is where the power of this Bill comes in. What an opportunity to create, for the first time, a smoke-free generation, relieving tens or hundreds of thousands of people from the risk of death and disability from smoking. We, as the BHF, would urge for the Bill to be pushed through in full.

--- Later in debate ---

[Dame Andrea Leadsom]

Q I asked a specific question about children’s asthma and children’s heart damage. Could I urge our witnesses to respond to that question?

Dr Griffiths: Thank you, and apologies if we did not cover that as clearly as we could have. Obviously, there is no such thing as a safe cigarette, there is no safe number of cigarettes to smoke, and there is no safe age to start smoking at all. We would emphasise our concern for children starting to smoke, because the damage starts as soon as you start smoking. There is no safe number of cigarettes to smoke. Combined with that, the fact that nicotine is so addictive that it leads to most people—over two thirds of those who start—becoming long-term smokers, worries us enormously. In terms of both the risk and the damage of starting smoking, the number of people who start and the fact that they go on to adopt a lifelong smoking habit caused by nicotine is of deep concern to us.

Sarah Sleet: It is worth thinking about children’s wider environment. Children who live in households where the adults smoke are four times more likely to smoke themselves, and find it much harder to give up. Children are getting into a cycle of deprivation and damage to their long-term health right from the very beginning. For children, stopping smoking availability is going to be profoundly helpful for their future lives, their ability to contribute to the economy and their overall prospects. This Bill, which tackles the issue from childhood up, will be one of the most profoundly important health interventions that you can make.

[Preet Kaur Gill]

Q I think the Minister was referring to vapes and the evidence based around the impact on growing lungs and hearts. Is there anything you would like to say about that before we move on?

Dr Griffiths: As Deborah from ASH said, vapes are a fairly new product, so the research and evidence base, which we have in abundance for tobacco and smoking, is still forming for vaping. However, there are indications that it is not great for health. We are cautious and worried about the long-term implications. What we do know is that vaping can be an important cessation tool for those trying to quit smoking, and that many do want to quit, so we strongly encourage anything that stops smoking, but the people who are turning to vaping as an alternative to smoking for the first time is of deep concern to us. We do not understand the long-term health implications, but the addiction to nicotine deeply concerns us.

Sarah Sleet: We strongly agree. It is a very delicate balancing act between stopping the harm caused by smoking and looking to the long-term with regard to vaping. Quite clearly, smoking is far more damaging for adults and children. Anything that can steer people away from smoking will be healthier than continuing to smoke in the long run, but we do recognise that more attention and more research need to be put into vaping.

--- Later in debate ---

[The Chair]

I am going to take the Minister at this point, and then Preet Kaur Gill.

[Dame Andrea Leadsom]

Q Some people say that the smoking generation does not need to be raised a year higher every single year. Can you say for the record what your view is of that? Does it need to keep lifting each year?

Dr Griffiths: We support the Bill exactly as it is written at the moment. It is really important to recognise that, as proposed, it does not inhibit anybody who is currently a smoker from purchasing tobacco, but it does take us on a really clear and, I believe, a transformative path to a smoke-free generation.

[Dame Andrea Leadsom]

I understand that, but why?

Dr Griffiths: Because it is a really clear path to make sure that we move to a situation where we have a generation that is prohibited from buying cigarettes, and who are disincentivised from doing so.

Sarah Sleet: We have heard today the evidence about just how harmful and destructive smoking is, particularly for people in more deprived areas. If we really want to tackle that, we need to remove smoking as a normalised, available, legal option going forward. This seems to me a very measured and thoughtful way of introducing a smoking ban that will take hold. It is very important for our children going forward.

[Preet Kaur Gill]

Q I want to ask about the information that is given to parents, especially if their children have never smoked but have taken up vaping. We know that a generation of children is becoming addicted to nicotine because products that have been classified as 0% nicotine do actually contain it. One of the parents that I spoke to asked, “Well, how many puffs are there in one vape? If my child has two or three of those in a day, what does that actually mean?” It is about the information on that sort of risk, and how we share that information with parents who are trying to address this issue with their children. Is there anything you want to say about that, and is there any research being done to look at that?

Dr Griffiths: I would observe that there is so much variation between products and how people are consuming them. I think it is quite difficult to give advice in a standard way, and that it is part of it being an emergent product and market. As we have discussed, there is no doubt that, with nicotine being so deeply addictive, it is an incredible worry that a child has a single puff on a vape, given the potency of nicotine and where we know it leads people, having seen that over generations with smoking.

I should perhaps take a moment to emphasise that we also really support the £70 million investment being allocated to public health campaigning and cessation services, as well as enforcement. You are right that we need to be really clear with the messaging of the Bill to encourage support from parents and others around children in particular. We really applaud the decision to put resourcing behind this as well. We know that effective public campaigning can be an incredibly powerful tool. We were really proud to run the “Give Up Before You Clog Up” fatty cigarette campaign way back 20 years ago, and we know even that campaign led to 14,000 smokers seeking to quit. We know public campaigning works, and it was a great thought to allocate that resource as part of this work—it will be needed.

Sarah Sleet: The variation in nicotine levels and the method of delivery, which affects the uptake of the nicotine, is undoubtedly very concerning in vapes. I am a mother of three adult children who all vape, and I am very concerned about how often they are doing that and what impact that is having. We must also remember that, from what we know at the moment, it would appear that smoking is far and away the most damaging activity, compared with vaping. There is a little bit of concern that we overemphasise the harms of vaping to the extent that people say, “Well, I might as well smoke then. I’ll do that instead.” We need to be very careful about how we have this conversation.

--- Later in debate ---

[Preet Kaur Gill]

Q Thank you, Chair, and I thank the witnesses for giving evidence today. First, is under-age smoking or vaping the bigger issue in schools today, and what is the impact on education, behaviour and so on? Secondly, will the measures in the Bill to restrict sales of vaping products to children under 18 work, in your opinion?

Matthew Shanks: It is an interesting question, whether vaping or smoking is more popular among children in schools. All I can say is that it has increased in the past three or four years. We see evidence of vaping; it is more difficult to catch children vaping, because of the size of the vapes, the fact that the smell is slightly different and does not set off smoke alarms in the same way, and so on. I think it is fair to say that smoking and vaping are still as popular as they were among younger children in certain areas, and vaping is being seen to be a safe alternative.

The marketing of vapes in different flavours and colours makes them akin to a progression from chewing gum for some families—with bubble gum flavours and so on. There is also anecdotal evidence of parents talking about, “If it’s grapefruit, it must be safe.” There is that evidence around it as well out there—because of the way in which vapes are marketed, and if you see them in shops, they seem safe and okay.

With behaviour, the size of vapes makes it very difficult to admonish children, because they can hide them very easily. They can look like mini hard drive sticks—I think that is deliberate targeting in how they are marketed, with the cleverness of it. Certainly in terms of behaviour, it is something else that we are dealing with, when we say to a child, a teenager, “You’ve been vaping”, but they say, “No, I haven’t”—there is nowhere for us then to go, which immediately sets up an issue.

The earlier question about toilets was interesting, because children tend to vape in toilets. It is easier for them to vape in toilets than it was for them to smoke in toilets. You just need to see people on public transport vaping—it is easy for it to dissipate and disappear quickly. So, yes, I would say that vaping is a real issue in schools for children.

Patrick Roach: I support fully what Matthew has just said. I do not think that it is an either/or; the reality is that smoking is a threat to children and young people, in terms of their health and wellbeing and their ability to participate and progress educationally, but so too is vaping.

The NASUWT, at the start of this academic year, published our own research into vaping in schools from the perspective of teachers and school leaders, and it very much reinforces what Matthew has just said, in that vaping is pretty much predominant as an activity taking place among secondary-aged pupils. But we are also seeing teachers reporting pupils vaping from as early as 10 years of age, so the primary phase is also impacted. Three quarters of teachers report a significant increase in the participation in vaping by pupils in their schools, so we are seeing an upward curve in respect of vaping activity within schools.

On the issues that have just been mentioned about the difficulty that schools have in detecting and controlling this kind of behaviour, the way in which vape products are available to pupils is that they are masquerading as hard drives, as highlighter sticks or as other things that it would be legitimate for a pupil to bring into school. This is not like a situation in which you catch a pupil with a packet of cigarettes and you confiscate it; first, you have to identify what on earth it is that that pupil has. At the end of the day, good order in schools is dependent upon there being trust and respectful relationships between teachers and students. You cannot go around every moment of every day asking pupils to turn out their pockets and then inspecting what is in them.

The reality is that we are seeing the impact of vaping not just on pupils’ health, because we are seeing pupils who are presenting as ill as a result of the overuse of vaping products—although, in fact, all of it is overuse—and therefore becoming ill in schools, but on educational participation, progression and achievement. When pupils are diving off into the toilets to vape, that interrupts teaching and learning. When pupils are late arriving at school, perhaps because they have been vaping en route, that impacts on pupils’ learning. We are also seeing bullying behaviours within schools because, quite often, vaping products are being informally circulated, exchanged or acquired. Therefore, it becomes another source of behavioural challenges for teachers and head teachers. So, from a teacher’s perspective, vaping is a serious issue within schools, and one that we are pleased that this Bill is seeking to address.

[Dame Andrea Leadsom]

Q Thank you so much for being here, and also particularly for the work that the NASUWT has done in terms of the impact on schools. Could you expand on that a bit further? I have done a couple of visits ahead of this Bill. I met enforcement officers, for example, who gave me anecdotal evidence that teachers say that pupils will return to the classroom with their eyes spinning and unable to concentrate because of the heady nature of whatever it is they have just been vaping or smoking. There was another anecdote about a school where children decided to drink the vape fluid and the school actually had to have a sort of emergency evacuation as a result of that.

Could you therefore expand on that, in terms of the specific health impacts and, at the one end, the ability of children to concentrate on the class when they are spaced out on vapes, and, at the other end, the very real risk to children from doing something stupid with a vape that was entirely unintended, with disastrous consequences?

Patrick Roach: I very much appreciate your remarks about the research that the NASUWT has undertaken. We come at the problem of vaping from the point of view of our members in classrooms, in schools the length and breadth of the country. What do teachers need in order to be able to teach effectively and what do they believe that pupils need in order to learn effectively? They need good order in the classroom.

My perspective is not that of a medical practitioner or of someone wanting to assume that I have the knowledge about the impact of vaping on a child’s physical development. Our concern is the impact on a child’s educational development, participation and achievement. The reality is that everything you have mentioned there is absolutely right, whether it is about the way in which vaping products might be unintentionally used by pupils; or about how they seek to conceal them about their person; or, indeed, the drinking of vaping fluids, as if somehow that will get the high without necessarily being detected; or about the use of vaping products as a stimulant, which impacts not only on concentration but on behaviour and, indeed, on a child’s wellbeing in the classroom.

Matthew has already referenced the difficulty of detecting vapes sometimes, because they can dissipate very quickly; and they can also trigger fire alarms in schools. We have had plenty of examples of teachers and headteachers reporting that their school has had to evacuate the building not just on one or two occasions in a day but multiple times—five or six occasions. That is a loss of learning not just for one pupil or class of pupils but the entire school. We are really concerned about the impact of all that.

Teachers are not just concerned about a child’s educational development, though; they are also concerned about a child’s wellbeing in the round. Teachers are reporting the very damaging impact that vaping can have on a child’s mental and physical development, just as smoking can. That is one of the reasons we have spoken out—and we are pleased that the Government have responded—to say that we need to be doing more to strengthen the enforcement of rules around vaping, access to it and the availability for school-age pupils. We need to do as much as we possibly can to prevent any school-age pupil from getting access to vaping products, whether in or outside school. We are pleased that the Bill seeks to do just that.

Matthew Shanks: I absolutely echo and reinforce what Patrick has said. Also, as school leaders we are looking after teachers, but we are caring for families as well. The Bill will help families to understand that it is not okay for their children to vape. Anecdotally we have parents saying to us that they let children vape at home, because it is better than them smoking or being out on the streets; parents do not see the harm in it. It is really important that that is recognised. The banning of tobacco sale was interesting in terms of the prescription of it; I would posit that at the moment vaping is seen as safe by the general public.

[Kirsten Oswald]

Q I wonder if you can develop some of the points you have made, which have been very useful. I am hearing anecdotally about issues in schools where the addiction of children to these vapes is itself causing a problem, because the children are unable to sit in the classroom and have to go out to vape, with whatever excuse is made, so that they then feel able to come back to the classroom, such is the level of their addiction to these products. If I may go beyond that slightly, what are your views on the way these things are promoted—for instance, on our particular concern about vape companies advertising on sports strips and in sports stadiums, and the impact on the same young people who are so addicted?

Matthew Shanks: I completely agree. The way in which vapes are marketed—the colours, flavours and so on—and the places where they are marketed suggest to people that they are safe. The fact that they are put forward as a “safe” alternative to cigarettes, the fact that parents use them and the fact that there are lots of colourful vape shops open in high streets: all those aspects promote the idea that vaping is okay.

At the same time, getting into a child’s mindset—we have all been there, as children—we like to break the rules and feel like we are pushing at boundaries. We know that it is not okay, but it is made okay. I would suggest that more children engage in vaping than in cigarette smoking, because they are not sure what the harmful effects are. That is the danger in it. I do think it leads on, because the younger children vape, but by the time they are 16 or 17, vaping might not be cool any more, so they go on to cigarettes or other things.

Anecdotally, we have heard of schools down in the south-west where people are putting cannabis into the vapes, so the addiction grows from that point of view as well. It leads to children coming out of lessons agitated. If I did not have three coffees in the morning, my agitation would be quite high. If children are not getting nicotine, as well as going through all the other things they are going through, they really do present as confrontational to staff, which makes it difficult to deal with them in classrooms and engage them in their learning. At the same time, to repeat a point I made earlier, you have parents at home who are saying, “Well, it’s okay to do.” I absolutely concur about the way it is marketed and so on.

Patrick Roach: To add to that, because those are important points: vape producers and manufacturers, and indeed those supplying vapes, are advertising freely in ways that make their products increasingly attractive to children and young people, with the way vapes are advertised and the marketing descriptors used for them. All the evidence we have, and certainly what our members tell us—our survey was of 4,000 teachers, so this is not anecdotal; it has an impact right across the system— suggests that the way those products are marketed and described deliberately seeks to entice young people to make use of them.

We believe that this is a strong Bill that very clearly sets out the societal expectations in this space, but as with any legislation, there is always scope for loopholes. If there are areas in the Bill where there is potential to further strengthen the legislation, I think the enticing way products are described, before an individual understands what they are getting themselves into, is something that needs to be considered and addressed.

From our point of view, it is about advertising, but it is also about access to these products. With the best will in the world, and no matter how they are advertised, if the products are easily available at the point of sale it makes things incredibly difficult. I remember that when I was bringing up my own children I worried about going to the supermarket with them, because they would be surrounded by candy and sweet products at the checkouts. You could not navigate your way through the checkouts. Thankfully, things have moved on: that has changed, and many parents are benefiting from those changes.

Young people are very much interacting with many of these products at the point of sale. They are in the shops that are in the vicinity of or on the route to and from school. They are being marketed in places that young people will frequent, whether that be a local café, the hairdressers or the barbers. They are in places where young people will be. They are also immediately available. The more we can do to stop the immediacy of marketing of these products and that easy availability, no matter how they are described, the better.

--- Later in debate ---

[Preet Kaur Gill]

Q Welcome, Paul. It is good to have you here. My first question is simple and straightforward: what is Age UK’s view on the Bill?

My second question is this. I know that over-65s are much less likely to smoke. I have a constituent, Eric, who has suffered from a stroke and has suffered with chronic obstructive pulmonary disease and is now a tobacco campaigner in his 80s. Why is this Bill important to the people Age UK works with?

Paul Farmer: Age UK fully supports the proposed legislation, and we have been working alongside the Richmond Group of Charities to highlight the significant health benefits of phasing out smoking, which will help individuals and have a wider impact on society. It will have particular benefits for the NHS, which as we know faces significant challenges at the moment.

Our job at Age UK is to think about not just the health and wellbeing of older people as they are now—I will come to your second question in a moment—but issues affecting future generations of older people. This is quite a rare opportunity for us to have a significant impact on those future generations for reasons we will look at later.

It is worth noting, however, that this Bill is heavily supported by older people. Polling shows that 69% of over-65s support it. Why is that? That goes to your second question. We know from older people and the work we are currently doing that health and wellbeing in later life is pretty much the top priority for older people. Age UK has recently published our blueprint for older people for the next few years, as we enter an election year. It is very clear from the work we have done with older people that health and wellbeing is right at the heart of what is most important for people.

Of course, that is logical: the ability to feel well, remain active and maintain our independence is a major determinant of the quality of life that we aspire to in later life. We also know that there is a huge gulf in life expectancy and life experiences between those who have the opportunity to age well and those who do not. I will not go into the points your earlier witnesses made about the importance of healthy life expectancy in detail, but that is right at the heart of older people’s considerations. It is important that we do something about the fact that healthy life expectancy for those who are most disadvantaged is quite so stark.

How does that affect smoking? As you know, smoking is a leading cause of death and disability. It is responsible for half the difference in healthy life expectancy between the most and the least affluent communities. People living in the areas with the lowest healthy life expectancy are 1.7 times more likely to smoke than those living in the highest healthy life expectancy areas. These are fundamental reasons why the intervention of this legislation will make a difference.

[Dame Andrea Leadsom]

Q I really appreciate your being here—thank you. I would like to tackle the fact that young people tend not to consider either their own mortality or their health and wellbeing. The majority of young people tend to take those for granted, and yet there is a complete correlation: the age at which you take up smoking—or, indeed, vaping—is when you are young and feel pretty immortal, or are at least not concerned about later life.

Could you give us a view, as an Age UK representative, of the sort of advice that older people who have smoked all their lives and are now bearing the brunt of the decisions they took would give to those who argue, “It’s a matter of personal choice. Everyone should be free to smoke if they want”? What would an older person say to that young person?

Paul Farmer: I think a lot of people would say that they wish they had never started. Those are certainly the conversations we have been having with older people in preparation for this session. The reason for that is that, as you enter into your later life, you start to understand the consequences of smoking through your personal experience. The list is frightening.

[Dame Andrea Leadsom]

Q For the record, can you outline some of those experiences? Obviously this is a public evidence session and we are looking to make the strong case for this Bill.

Paul Farmer: Very clearly, there is the relationship between smoking and multiple forms of cancer, COPD, pneumonia, heart disease, aortic aneurysm and stroke, vascular diseases, diabetes, rheumatoid arthritis, hip fracture, cataract and macular degeneration—and dementia. In a society where we are increasingly debating dementia’s impact, I think the relationship between smoking and dementia is a really important context.

These are in and of themselves very challenging physical health conditions, but we can also see the correlation with people who experience multiple long-term conditions. I think many older people who experience those multiple long-term conditions—who have to live with the impact of them often because they smoked in their early life—would say this impacts on the individual being able to do the things they want to do in their later life. There is a severe detriment on pursuing their ambitions of later life as a result of having smoked in earlier years.

[Dame Andrea Leadsom]

My last point: may I just pursue that—

[The Chair]

Very briefly.

[Dame Andrea Leadsom]

Q Thank you. Would that older person suffering those consequences say: “Yes, it was all a matter of free choice”?

Paul Farmer: I think different people will have different opinions about choice, and whether it was as a result of choice. I think what many older people have been telling us is that if they had known about the damaging consequences of smoking, they would not have started in the first place and would certainly have considered it in a greater way.

I want to pay huge tribute to colleagues at British Heart Foundation, who I know you have just heard from, who I think have taken the best way of trying to campaign over a long term on this issue. This is a long-term issue. Sadly today’s generation of older people is seeing the consequences of what has not happened.

[Kirsten Oswald]

Q Could you explain who “older people” are? Sadly, I recently recognised that that might include more of us than we might like to believe. We need to take that on board. What I am really interested in are the different demographic groups, and where you think there might be disproportionate levels of harm from tobacco and vaping within the groups of older people that you support.

Paul Farmer: We work with people over the age of 50, which may be news to some of you here. One of the reasons why we have recently chosen to drop the age group that we increasingly work with is precisely for prevention and early intervention.

This is not the earliest intervention; you can, of course, argue that many health interventions need to take place among children and younger people. However, from an Age UK point of view, we know that there is potential to intervene in people’s lives and support them to live healthier lives—it is not just about health, but in this context it is mainly about health—which means that your healthy life expectancy can improve and, as I mentioned earlier, you can fulfil some of the ambitions of your later life. The burden on the NHS of unhealthy life expectancy is a big issue.

The bulk of our direct work is with people over pensionable age, if you like. In each of those generations, you see the differences in experiences of smoking. Somebody now in their 80s or 90s almost certainly will not be alive if they are a heavier smoker, because they probably will not have benefited from any of the public health information that has taken place under previous Governments, so that is obviously the major difference.

In terms of the different health conditions, we know that certain health conditions will increase with age. Dementia is the greatest example of that, where we know that the older you are, the more likely you are to develop dementia. In a sense, as our population as a whole has gotten healthier and lived longer, it has become increasingly apparent where those health inequalities are at their most acute.

Public Health (Control of Disease) Act 1984 (Amendment) Bill

Andrea Leadsom Excerpts

2nd reading
Friday 26th April 2024 Commons Chamber

[The Parliamentary Under-Secretary of State for Health and Social Care (Dame Andrea Leadsom)]

I am sure that the hon. Member for Birmingham, Edgbaston (Preet Kaur Gill) will want to welcome the news that in the past 12 months to March 2024, 63 million more GP appointments were delivered by our superb GPs and practice staff than in March 2019. That is more than 1.4 million extra per working day. I am sure she would be delighted to praise our GPs and health professionals for that.

I am grateful to my hon. Friend the Member for Christchurch (Sir Christopher Chope) for providing the House with an opportunity to debate an important area of public policy. I am aware of his ongoing interest in this area. We have discussed the pandemic on many occasions in this place, and no doubt we will do so again. The particular issue his Bill raises is parliamentary scrutiny of emergency legislation made under the Public Health (Control of Disease) Act 1984. That is also a topic we have debated before, and a matter about which he has tabled two identical private Members’ Bills in previous parliamentary Sessions.

We take the parliamentary scrutiny of new legislation and of the measures that the Government took to respond to the pandemic extremely seriously. However, such scrutiny must be balanced against the need to act quickly and decisively to respond to a health emergency and to protect the public. During the covid-19 pandemic, the Government had to move quickly to introduce new laws and guidance to protect public health and maintain access to essential services. My hon. Friend will be aware that during the covid-19 pandemic, as decisions were made at pace, Ministers from the Department made regular statements to the House and invited scrutiny on policy—indeed, my hon. Friend spoke on many of those occasions himself—as well as regular calls for colleagues across the House so that they could ask questions and seek solutions for members of the public who were looking for answers. Moreover, the Government have responded to numerous parliamentary inquiries and Committee reports and responded on a range of issues, including legislative mechanisms employed during the pandemic response.

Turning to the private Member’s Bill before the House, my hon. Friend seeks to amend section 45D of the Public Health (Control of Disease) Act 1984, which imposes certain restrictions on the power to make regulations under section 45C. Section 45C relates to the domestic regulations that can be made to counter the spread of infectious disease.

Part 2A of the 1984 Act, under which those relevant sections sit, was added following the global severe acute respiratory syndrome outbreak in 2008. Parliament gave the Government broad powers to deal with precisely the same types of threats as those we faced during the covid-19 pandemic. Parliament empowered Ministers to use regulations to prevent, protect against, control or provide a public health response to incidents, the spread of infection or contamination. Regulations made under section 45C that impose restrictions and requirements are subject to a requirement that there must be a serious and imminent threat to public health. That test was certainly met during the covid-19 pandemic.

The making of regulations is already subject to a test of proportionality, and where the regulations confer powers on others to impose restrictions and requirements, those persons must consider that their decisions are proportionate. So I do not support the proposal to make regulations under section 45C subject to additional—

Proposed Hospital: North Hampshire

Andrea Leadsom Excerpts

Friday 26th April 2024 Commons Chamber

[The Parliamentary Under-Secretary of State for Health and Social Care (Dame Andrea Leadsom)]

I congratulate my right hon. Friend the Member for Basingstoke (Dame Maria Miller) on securing a debate on this really important issue. I am responding on behalf of the Minister for Health and Secondary Care, my right hon. Friend the Member for Pendle (Andrew Stephenson), who tells me that she has been a tireless campaigner for Basingstoke on this matter, as well as on countless others.

The Government believe that the people of Hampshire should, of course, have a say on where their new hospital should be built. As my right hon. Friend said, we have asked people from across the county to share their views with Hampshire Hospitals NHS Foundation Trust. I am sure she understands, however, that it would be wrong of us to pre-empt their views, or indeed to interfere with their decision making, but I am happy to assure her that we remain committed to delivering the new hospital.

The trust and the integrated care board are going through the responses as we speak. They will submit a business case for NHSE regional approval through the ICB in a few months’ time. I should be clear that while the trust and the ICB do that, there will be no final decision on the new hospital’s location or the services it will deliver, but once a decision has been taken we will, of course, update the House. I am sure my right hon. Friend will have much to say about that herself, too.

I want to address the points my right hon. Friend raised on the importance of clinical guidance in forming decision making. She is absolutely right to say that decisions should be locally led and based on the best clinical evidence. That is why proposals must meet our tests for good decision making, which include a clear evidence base that is in keeping with clinical guidance and best practice. In developing the consultation, the trust has looked at a variety of options to deliver clinical care in Basingstoke and Winchester. Experts have been consulted at every stage of the process to provide appropriate clinical guidance. Two particular examples in the consultation demonstrate how the trust used clinical guidance to inform the options it has put forward.

First, on proposals around accident and emergency services, the trust received expert clinical guidance from local doctors, who strongly agree that maintaining emergency departments at both Basingstoke and Winchester would be unsafe and unsustainable. The trust also received advice from the South East Coast Clinical Senate, an independent panel of senior doctors who expressed concern over retaining an A&E department at both sites, due to serious concerns around patient safety. Instead, it has argued that acute medical services must be twinned with surgical services in order for patients to receive first-class care. Therefore, the proposal includes two brand-new 24/7 doctor-led urgent treatment centres and same-day emergency care to deal with most urgent care needs—one at the new specialist acute hospital and one at Winchester’s Royal Hampshire County Hospital.

Secondly, the proposals give the people of Hampshire an emergency department with a trauma unit and a children’s emergency department at the specialist acute hospital, which will treat the most serious conditions. As my right hon. Friend said in her remarks, it is essential for new mothers and mums-to-be to have the best possible care for themselves and their babies—she will know that this is an area of healthcare that is very dear to my heart. The trust has looked carefully at keeping obstetrician-led maternity services at the Royal Hampshire County Hospital, but found that many patient safety issues have left them not viable, particularly following the 2022 publication of the independent Ockenden review of maternity services at the Shrewsbury and Telford Hospital NHS trust, which set out the need for obstetrician-led maternity services to be in hospitals that can also provide emergency surgery and critical care.

In Hampshire, those services could only be provided at the new specialist acute hospital, because the neonatal units at the Winchester site currently do not treat enough babies to meet the requirements for level 2 care, while consolidated services at the new specialist acute hospital will meet that requirement. The rationale is that the proposals will lead to fewer babies’ being transferred out of the area to receive vital neonatal care, and I think the whole House will agree that the last thing new mothers need after giving birth is an extra journey to receive critical care.

I thank my right hon. Friend for raising this important issue and for continuing to engage with the new hospital scheme. She is a real champion for her constituents in this place, and they will have seen her fighting their corner today. We want to do everything in our power to get the people of Hampshire the world-class care they deserve. We will continue to support the trust throughout the development of the business case, to ensure that plans meet the needs of staff and patients as well as offering value for money for taxpayers. I understand that my right hon. Friend the Member for Pendle has recently committed to visiting Basingstoke and I am sure my right hon. Friend the Member for Basingstoke will take immense pride in showing him around one of England’s extremely beautiful towns.

[Dame Maria Miller]

I thank my right hon. Friend for confirming that her, and my, right hon. Friend the Member for Pendle will be taking the time to come and visit the new hospital. May I encourage her to encourage him to visit the new hospital site that the hospitals Minister has already announced that he is in the middle of procuring?

[Dame Andrea Leadsom]

I shall certainly pass that message on to my right hon. Friend the Member for Pendle, and I again congratulate my right hon. Friend the Member for Basingstoke on securing a debate on this very important topic.

Question put and agreed to.

Liver Disease and Liver Cancer

Andrea Leadsom Excerpts

Thursday 25th April 2024 Westminster Hall

[The Parliamentary Under-Secretary of State for Health and Social Care (Dame Andrea Leadsom)]

It is a pleasure to serve under your chairmanship, Sir Christopher. I have to say that I am a bit disappointed, because the hon. Member for Birmingham, Edgbaston (Preet Kaur Gill), in particular, knows very well my personal commitment to the best start to life, so to hear her saying that the Government have done nothing and Labour is going to fix it is a bit rich, but there we are.

I congratulate the hon. Members for Stockport (Navendu Mishra) and for Glasgow Central (Alison Thewliss) on securing this important debate; it is an absolutely vital debate. All hon. Members, including the hon. Members for East Renfrewshire (Kirsten Oswald) and for Washington and Sunderland West (Mrs Hodgson), have raised the importance of prevention, early intervention and, in particular, early diagnosis. I commend them all for doing that. The Government are taking significant steps. The hon. Member for Glasgow Central talks about what the Scottish Government are doing. I can absolutely assure her that the Government of the United Kingdom are totally committed to improving early diagnosis and treatment, and I will go on to explain exactly what we are doing.

First, it is important to set out that we know that there are 6,000 new cases of liver cancer each year, making it the 18th most common cancer, with 5,000 deaths a year; that is 5,000 deaths too many. As my right hon. Friend the Member for Bromsgrove (Sir Sajid Javid) said during his tenure as Health Secretary, regional inequalities are “the disease of disparity”. He was absolutely right because—as the hon. Member for Stockport stated in his opening speech—economic and health inequalities go hand in hand.

Blackpool is a perfect example. It is one of the most deprived cities in England and flashes red on every indicator—for life expectancy, alcohol dependence and liver cancer. No fewer than 40% of the people unemployed there are not fit to work due to ill health, and the rate of death from chronic liver disease is almost two and a half times the average for England. That is an area that I have visited a number of times, to visit its family hubs and to look at the excellent work and huge efforts that go on there to level up to improve the disparities. Nevertheless, there is so much more to be done, and our strategy to eliminate disparities in liver disease and liver cancer is based on two key facts.

First, 90% of liver diseases are caused by alcohol dependency, obesity or viral hepatitis. Secondly, the five-year survival rate for liver cancer is only 13% precisely because people do not come forward with their symptoms until it is too late; early detection is vital. We know what causes liver disease, and we know that diagnosing it more quickly will save thousands of lives. That is why prevention and diagnosis are the twin pillars of our strategy to end inequalities in liver disease and liver cancer across our country.

To be clear, this is not about criticising people for drinking alcohol, but stopping the level of drinking that leads to liver disease and liver cancer. We know that rates of alcohol dependency are double in the most deprived local authorities. That is why, in December 2021, we published our drugs strategy, which does three things. First, it has brought the greatest-ever increase in funding —an extra £780 million—for drug and alcohol treatment, over £500 million of which is going straight to local authorities with the highest levels of deprivation and alcohol dependence. Secondly, the strategy is boosting screening capacity for liver disease, and thirdly, it is beefing up referral pathways to build a seamless system from diagnosis to treatment.

Since we published our strategy, we are treating more people than ever before for alcohol use. In February, almost 135,000 people were receiving treatment, compared with just over 117,000 just under two years ago, which is an increase of more than 15%. NHS England is investing almost £30 million to bring specialist alcohol care teams to hospitals in the most deprived parts of England. Those experts in addiction identify people in hospital with alcohol dependence, start their treatment and refer them to local authority community services where they can complete their treatment, overcome their dependence and move forward with their lives. I pay tribute to all those brilliant clinicians who are helping vulnerable people to turn their lives around.

Obesity is another major risk factor for liver disease and is a real scourge on the poorest parts of our country. During last week’s debate on the Tobacco and Vapes Bill, we came under fire from hon. Members on both sides of the House who said, “Well, what about sugar? Are you going to ban that too?” This Government are not in the habit of banning things, but I am proud of our record on sugar reduction, healthy eating and obesity.

We have made strong progress in reducing the average sugar content in soft drinks through the soft drinks industry levy: we almost halved the sugar content in soft drinks between 2015 and 2019. I want to make the point that that is not with people saying, “Oh, this drink I used to like, I don’t like it anymore because it’s not sweet enough,” but was actually the result of reformulation that nobody noticed, which is the great thing about reformulation. If we can reduce the sugar, salt and fat content in foods so that people can carry on as normal without having to undertake some punishment routine, that is a good way to tackle the obesity problem.

[Alison Thewliss]

Having paid close attention to the sugar tax when it was brought in, there was a particular exemption in the products that required reformulation. Milkshakes could contain as much sugar as any of the full-fat fizzy drinks, but were somehow exempted because they had milk in them. Will the Minister perhaps take the opportunity to go away and think about whether they ought to be contained within a future iteration of the scheme?

[Dame Andrea Leadsom]

The hon. Lady will not be surprised, because she knows me well, that I am absolutely determined to tackle childhood obesity in particular, so that we can reverse the problems that we have seen in recent years, especially the spike in unhealthy eating and overeating during the covid pandemic. We know that people—both adults and children—are consuming too many calories. As she would expect, I am all over this and I am happy to debate any point with her. I agree on the sugar content in milkshakes, but there are many other foods that we also need to focus on. I hope I can reassure her on that.

For two years, we have been restricting the placement of less healthy products in shops and online to help consumers to make healthier choices. We are building on that progress. By the end of next year, further restrictions on price promotions on television and three-for-the-price-of-two offers in shops will come into force. I have been encouraging the big takeaway companies, the big supermarkets and so on to try to do it anyway— to get ahead of the regulations and to take action now. A number of them, I am pleased to say, are doing just that.

I am also pleased to update the House on the recent success of the NHS digital weight management programme. This week, the Obesity journal published a study showing that almost 32,000 people achieved sustained weight loss with the programme over a single year, which is really positive news. The programme is helping people from deprived backgrounds: more than a third of those referred were from black, Asian and minority ethnic communities. It is obviously early days, but there are positive signs.

The other major contributor to liver disease is hepatitis. Thanks to increased testing and improved access to treatment, we have reduced the number of people living with chronic hepatitis C virus in England by more than half since 2015. Deaths related to hepatitis C have fallen by just over a third since 2015, well above the World Health Organisation’s 10% target.

Liver disease is known as the silent killer because many people are unaware of their condition until it is too late. That is why, as part of our ambition to detect 75% of cancers at an early stage by 2028, NHS England has launched the early diagnosis programme for liver cancer, which aims to prevent liver cancer by actively checking for liver disease in our most deprived areas.

An important part of the early diagnosis programme includes 19 community liver health check pilot sites that were launched in 2022. The most recent data shows that the CLHC programme reached more than 7,000 people in our most deprived areas using mobile units between June ’22 and January ’23. These units are equipped with fibroscans, which is a fantastic new technology, as many hon. Members have mentioned, for detecting liver damage and identifying liver disease before it becomes life threatening. These non-invasive tests have diagnosed more than 830 patients with cirrhosis or advanced fibrosis. I am pleased to update hon. Members that there are now eight community diagnostic centres providing fibroscans and a further 14 planned.

For my entire career, I have fought for the principles of fairness and equal opportunity—from helping children and babies in deprived areas to get the best start in life to levelling the playing field for small businesses when I was Secretary of State for Business, Energy and Industrial Strategy and encouraging young women in my constituency to get into politics. I have done that throughout my career and I will not stop now. I am passionate about making our health service faster, simpler and fairer for all who use it, and tackling liver disease and liver cancer is at the heart of that mission. We have already delivered significant progress and, through prioritising prevention and driving early diagnosis, we have a plan to go further and faster in the years ahead.

Oral Answers to Questions

Andrea Leadsom Excerpts

Tuesday 23rd April 2024 Commons Chamber

[Vicky Ford (Chelmsford) (Con)]

4. What recent progress she has made on retaining GPs.

[The Parliamentary Under-Secretary of State for Health and Social Care (Dame Andrea Leadsom)]

General practitioners are a rock. They are the underpinning force of primary care. I want to take the opportunity to pay tribute to them for all they do for the health of the nation. My right hon. Friend is right to raise the issue of GP retention. During covid and since, GPs have been exhausted and the return to primary care provision has been difficult. The Government are doing a lot, such as improving digital telephony and reducing the administrative workload. I am about to launch a future of general practice taskforce to look at what more we can do to provide more support to this critical part of our primary care.

[Vicky Ford]

Chelmsford is a growing city, and it is very good that, compared with pre-covid times, we have more clinicians in our GP surgeries, but we need more surgeries as well. One new surgery is being built. I have been told that the limits that local district valuers impose on NHS lease costs make it increasingly difficult for developers to deliver new surgery buildings, not only in Chelmsford, but in other parts of the country. Will my right hon. Friend meet me and other affected MPs to see whether we can resolve that issue and help growing areas, where there are more houses, to deliver the new surgeries that we need?

[Dame Andrea Leadsom]

Of course I would be delighted to meet my right hon. Friend to discuss that issue, which several colleagues across the House have raised with me. She will appreciate that the District Valuer Services is crucial in ensuring value for taxpayer’s money from the rents that are charged for GP practices. Nevertheless, the Department is working hard to support better primary care facilities. I understand the point and would be happy to meet her.

[Sarah Dyke (Somerton and Frome) (LD)]

There are 56 fewer fully qualified GPs in Somerset now than there were in December 2016, so it is no surprise that my constituents in Wincanton feel that they can never access one. How will the Minister support general practice to enable it to continue to provide the vital services that our communities deserve?

[Dame Andrea Leadsom]

It is fantastic that hard-working GPs have delivered 60 million more appointments a year than in 2019. That is a credit to their efforts. The Government have undertaken a wide range of approaches to try to reduce the administrative burden. We are focused on trying to deal with some of the issues that GPs have raised with me about the primary and secondary care interface so that they do not have to write all the fit notes and liaise with consultants. We have also spent more than £200 million on digital telephony. Importantly, the additional roles reimbursement scheme has added more than 36,000 more professional staff, from physios to pharmacists to those in GP practices, to try to support patient access.

[Mr Speaker]

I call the shadow Minister.

[Preet Kaur Gill (Birmingham, Edgbaston) (Lab/Co-op)]

At the last general election, the Government promised to deliver 6,000 more GPs by 2024-25, but there are still 2,000 fewer GPs than in 2015. Part of the problem is that morale has plummeted in the past decade, meaning that experienced family doctors and newly qualified GPs are hanging up their stethoscopes. What does the Minister say after scrapping two GP retention schemes last month? Will she come clean today about another broken manifesto promise?

[Dame Andrea Leadsom]

The hon. Lady is choosing numbers out of the air. She will be aware that there are almost 3,000 more GPs now than in 2019, and very importantly the long-term workforce plan is scheduled to introduce 6,000 new training places by 2031-32. In 2022, we had the greatest number ever of new trainee GPs. That is great news for GP practice, as they are crucial to primary care.

[Anna Firth (Southend West) (Con)]

5. What steps she is taking to ensure adequate funding for hospital repairs.

--- Later in debate ---

[Mrs Paulette Hamilton (Birmingham, Erdington) (Lab)]

7. What steps she is taking to increase levels of nurse recruitment and retention in GP practices.

[The Parliamentary Under-Secretary of State for Health and Social Care (Dame Andrea Leadsom)]

We hugely appreciate the work that general practice nurses do. I know that the hon. Lady was a nurse in her previous life, and I absolutely pay tribute to her for her service. She will be aware that last year the Government provided additional funding for the general practice contract to uplift pay by 6%, in line with the pay review body’s recommendations. We are very much aware of the need to try to ensure that general practice nurses feel appreciated and are keen to be retained in GP practices, which is one of the reasons I have launched a taskforce on the future of general practice. As she will know, it is for GP practices themselves to determine the pay uplift for their nurses. I am looking closely at that, because we know that sometimes the pay rise provided by the Government was not passed on.

[Mrs Hamilton]

We have all seen images of people queuing around the block for an appointment at their GP surgery, and in my local integrated care board, there has been a decline in general practice nurses since June 2020. It currently takes 12 months to train nurses wishing to move into general practice. Will the Minister tell me and my constituents in Erdington, Kingstanding and Castle Vale what she is doing to ensure that the retention of experienced nurses and the training of new nurses does not add to the pressure that GPs are already facing?

[Dame Andrea Leadsom]

The hon. Lady raises an important point. The long-term workforce plan commits to increasing the number of general practice nurses by more than 5,000 by 2036-37. In her area, the number of doctors in general practice in the NHS Birmingham and Solihull ICB increased by 134 full-time equivalents between 2019 and 2023, but the number of nurses decreased slightly, by 34 full-time equivalents. However, over the same period, direct patient care staff increased by 1,195 full-time equivalents. I think that demonstrates to the hon. Lady that the actual resources in GP practice are increasing, with specialisms such as physiotherapy and pharmacy, as well as nurse prescribers, to provide patients more access to good healthcare.

[Kenny MacAskill (East Lothian) (Alba)]

8. What steps she is taking to support the recruitment and retention of community and district nurses.

--- Later in debate ---

[Rachel Hopkins (Luton South) (Lab)]

21. What steps she is taking to improve patient access to primary care.

[The Parliamentary Under-Secretary of State for Health and Social Care (Dame Andrea Leadsom)]

We are enormously grateful for the work of GPs in delivering 64 million more appointments nationally than in 2019. Our primary care recovery plan enhances GP access by expanding community pharmacy services nationwide. Some 98% of community pharmacies have signed up to the Pharmacy First offer, with over 125,000 consultations claimed in the first month.

[Alistair Strathern]

Across Bedfordshire, we suffer from patient to GP ratios that are well in excess of the national average; high housing growth is simply not matched by GP capacity. At Wixams, we have been able to break through 15 years of deadlock by putting stakeholders together, but issues still remain across the county. From Shefford to Stondon, heartbreaking stories are commonplace. The issue is not ICB-specific; it affects people right across the country. What more can we do to ensure that areas with high housing growth have the GP capacity that residents deserve?

[Dame Andrea Leadsom]

The hon. Gentleman raises a really important point. He may be aware that the Bedfordshire, Luton and Milton Keynes ICB received £36 million for its operational capital budget in 2023-24, with over £118 million for this spending review period. That operational capital is core funding provided to ICBs for delivering primary care, among other things. In addition, he will be aware that ICBs are able to provide input to planning permissions to ensure that primary care is delivered where there are new housing developments. I have worked with other hon. Members across the House to tackle this issue, and I am very happy to meet him to discuss it further.

[Kerry McCarthy]

When I speak to my constituents in Brislington, they tell me they have to wait an inordinate time to get through on the phone to their GPs at the Brooklea health centre, and wait over two weeks for appointments. Constituents in Fishponds have been told that it is over an hour’s wait for prescription medication at the local pharmacy—and we all know the situation with dentists. The other thing my constituents are waiting for is a general election. Does the Minister agree that that is the only way we will sort out these problems in the NHS?

[Dame Andrea Leadsom]

I certainly do not agree. If Labour were in government, we would see significantly worse outcomes. Covid was a once-in-100-years pandemic, and we have pulled out all the stops to recover from that. It is a huge tribute to all those working in primary care that they have done so well. In the hon. Lady’s ICB— Bristol North, North Somerset and South Gloucestershire —38.4% of all appointments were delivered on the same day they were booked in February this year, and 84% were delivered within two weeks of booking, with 66% of them face to face. These are extremely positive numbers for the 482,000 appointments delivered in February 2024. What is really important is that the number of patient care staff has increased by 656 full-time equivalents since 2019.

[Rachel Hopkins]

I have listened to the Minister’s comments, but the number of patients per GP in the Bedfordshire, Luton and Milton Keynes area is nearly 25% higher than the national average. Will the Minister explain why her Government think it is a good idea to cut the proportion of doctors being trained as GPs from around one in three to around one in four?

[Dame Andrea Leadsom]

The hon. Lady is simply wrong. She will be aware that, in fact, our long-term workforce plan is intended to raise the number of training places for GPs to 6,000 by 2031-32. In 2022, we had over 4,000 new GPs apply to take training places—an absolute record. There is much more to do, and I am working with GPs on a future for GP practice taskforce to make sure that we do everything we can, including hiring the 36,000 additional professionals now working in GP practices, in order to relieve the pressure on GPs and deliver much better patient access.

[Dame Andrea Jenkyns (Morley and Outwood) (Con)]

Last week, a constituent contacted me to say that her teeth crumbled during pregnancy and she was unable to get a dentist appointment. Another constituent, who was in agony, desperately pleaded for help to find a dentist. My own son, Clifford, has been waiting two years for a tooth extraction, and I have received hundreds of emails about similar issues. It is simply not good enough. What plans do the Government have to sort this out once and for all, and what advice does the Minister have for my constituents?

[Dame Andrea Leadsom]

My hon. Friend raises an incredibly important point. We know that because all dentists were locked down during covid, the recovery in access to NHS care has not been as fast as we would like. That is why we announced our dentistry recovery plan, including a new patient premium, which, since it was launched on 1 March, has already seen hundreds of thousands of new NHS patients who have not seen a dentist in two years. Some 240 dentists will receive golden hellos to encourage them to work in underserved areas. We also have our new Smile for Life prevention programme, which will ensure that babies receive an early dental check for their milk teeth in family hubs, and that pregnant mums receive better dental care and advice. We are now trying to work with dentists to look at reform of the units of dental activity contract, but following the first meeting of the group yesterday, it seems that dentists feel that all the parameters are in place. What we now need to do is ensure that the incentives are there and that we see things changing rapidly.

[Siobhan Baillie (Stroud) (Con)]

My GPs are working extraordinarily hard to increase access in the face of ever increasing public demand. I am alarmed by the Labour party’s talk about scrapping the GP partnership model, as I find in the Stroud district that GP practices are some of the most efficient parts of our NHS services. They need support, the removal of bureaucracy and the opening up of funding pots, rather than dismantling. Will my right hon. Friend explain how access to primary care would not be helped by removing the partnership model, and what are the Government doing to help ICBs create more flexible partnership funding pots?

[Dame Andrea Leadsom]

My hon. Friend makes a fantastic point, and I say again that GPs absolutely underpin our primary care. We all absolutely rely on them, and our measures to create 36,000 additional roles in GP practices will provide them with the additional capacity they need so that they can serve their patients better. That is good for patients, good for primary care and incredibly good value for the taxpayer. It is ludicrous that Labour is proposing to undermine the GP partnership model; that would be a disaster for primary care.

[Mark Eastwood (Dewsbury) (Con)]

T1. If she will make a statement on her departmental responsibilities.

--- Later in debate ---

[Maggie Throup (Erewash) (Con)]

Just yesterday, the Office for National Statistics released data showing that alcohol-specific deaths in 2022 were 4.2% higher than in 2021 and a massive 32.8% higher than in 2019. Will my right hon. Friend now seriously consider a stand-alone alcohol strategy based on this worrying trend and agree to meet me and other interested parties to discuss a way forward to tackle alcohol-specific deaths?

[The Parliamentary Under-Secretary of State for Health and Social Care (Dame Andrea Leadsom)]

My hon. Friend was an incredibly hard-working health Minister and I pay tribute to her for all she did in this area. She will be aware that our groundbreaking drug and alcohol strategy commits more than half a billion pounds of new funding over the spending review period to rebuild drug and alcohol treatment services, with plans to get an additional 15,000 alcohol-dependent people into substance misuse treatment by 2024-25, which we are currently on track to achieve. I would be delighted to meet her to talk about it further.

[Ruth Cadbury (Brentford and Isleworth) (Lab)]

At my last surgery, a young woman told me that, thanks to the delay in her GP diagnosing her ovarian cancer, she is now infertile and receiving aggressive treatment. She had made four GP appointments over several months for her unexplained stomach cramps. Only in an emergency admission in another country was the ovarian cancer diagnosed and the tumour removed. How long will it be before the symptoms of female-specific conditions are taken seriously by our medical establishment, from initial training onwards?

--- Later in debate ---

[Stuart C. McDonald (Cumbernauld, Kilsyth and Kirkintilloch East) (SNP)]

Mandatory fortification of flour with folic acid could save many thousands of children from spina bifida, so why is it happening so slowly, at such a low level and applied to too few products?

[Dame Andrea Leadsom]

I assure the hon. Member that we remain firmly committed to the mandatory fortification of flour with folic acid. That will help to protect around 200 babies each year from being born with neural tube defects. The policy is being delivered across the UK as part of a wider review of bread and flour regulations. In January we published our consultation response, and we will bring forward legislation to implement the policy later this year.

[Stella Creasy (Walthamstow) (Lab/Co-op)]

Ten days ago I went to the Whipps Cross A&E department to see for myself the pressures that the brilliant team there are under—pressures that are heavily exacerbated by the failure to redevelop the hospital. Originally, we were promised that the new hospital would be open by 2026, but we have still not agreed with the Department a plan and timetable to submit to the Treasury for that redevelopment. As a result, the hospital is having to spend huge amounts of money trying to stem the damage as well as being able to treat patients. It is costing us all. For the sake of patient care and NHS budgets, will the Minister meet me to work out where the hold-up is in getting Whipps Cross redeveloped?