Under-age Vaping

Caroline Johnson Excerpts

Wednesday 12th July 2023 Commons Chamber

[Kirsten Oswald]

I am grateful to my hon. Friend, and am delighted that he is as enraged as I am about the harm that these products are causing. I know that in his community people are equally as concerned as in mine. His comment bears reflecting upon, because how realistic is it that children will find ways to recycle this disposable product, or so-called disposable product, which is undoubtedly targeted at children, given that they are probably hiding it from their parents in the first place? There are no positive grounds for keeping these things about. I secured a debate last year focusing on the environmental impact, which bears reflecting on. My hon. Friend is right, so I am glad that he made the points that he did.

I am also deeply concerned about the impact on children and young people, because these vapes are so available, so inviting, and so increasingly used by younger people. I am particularly concerned about under-18s. The hon. Member for Denton and Reddish (Andrew Gwynne), who opened the debate very powerfully, talked about the Health and Social Care Committee having heard from a headteacher about the significant proportion of children vaping regularly. If we speak to headteachers in any of our constituencies, they will say the same thing. I was also alarmed, though unfortunately not surprised, to hear him highlight issues of primary-aged children vaping. That is terrifying. It is why today’s motion needs to be taken seriously.

The Advertising Standards Authority says that

“adverts for e-cigarettes must be targeted responsibly”.

I am not sure that that is what is happening. Such ads must, apparently,

“not be directed at under-18s”.

Again, the ASA has a job of work to do there. I wonder, although I suspect that it is perhaps unable to, whether it would want to look at issues such as sports advertising. Blackburn Rovers—other teams may do this, but this is the only team that I am aware of that are doing it—are being sponsored by a vaping retailer, Totally Wicked, for the sixth season in a row. We would find it unacceptable if our football club came out with cigarette branding on their shirts. I cannot understand why it is any more acceptable for a football club to come out with vaping advertising. I am keen for the Minister, or Government Members, to address that.

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

Would the hon. Lady be similarly outraged to know that the same company supports St Helens rugby football club, and called the stadium Totally Wicked?

[Kirsten Oswald]

I would be equally outraged. I know how much work the hon. Lady does in this regard. I am unsurprised to find that we are both enraged by the same thing. This is really unacceptable. If we are serious about dealing with the harms to children and young people, we really should expect sports clubs to be somewhere that they can see positive imagery and have positive influences. I recently visited a vaping shop near to where I live. I know they are sold in other outlets too, in corner shops and supermarkets, on Amazon and eBay, and we have heard about them being sold in a barbershop as well. They are not difficult to find, and they are so inviting. When I went into the shop, it looked lovely: the display was beautiful, with nice colours and names and all kinds of fancy shapes that looked like highlighters or lipsticks. I have seen some online that look like brightly coloured fidget spinners. These things are quite enticing, are they not? They are very attractive, and that is obviously deliberate.

I was interested to hear about the King’s College study on plain packaging, because anything that makes vapes less attractive to young people is obviously worth considering. I say that for many reasons, one being that I heard recently about young people purchasing disposable vapes to match their outfits. I must say that that had never occurred to me before, but why not? If they are purchasing them, they might want them to match their outfits, just as they might think about what flavour they would like, such as bubblegum or grape soda. The hon. Member for Denton and Reddish talked about them looking like an old-fashioned sweet shop, and he was right about that.

Disposable vapes are designed to be enticing, to draw young people in. They are throwaway and they are affordable. The right hon. Member for Romsey and Southampton North (Caroline Nokes) was absolutely right to describe them as pocket-money purchases. Parents will not always know what their children are purchasing with pocket money; presumably children throw disposable vapes away, as I have said, before the parents find them. As parents, we have no idea whether our children are using them. I hope mine are not, but none of us can know that, because they are so easy to find and so easy to throw away that we must be alive to the fact that we might not have the full picture.

Presumably we cannot all have the full picture, because, if we look at the statistics, in a recent YouGov/ASH survey the proportion of children aged between 11 and 17 who vape has gone up from 4% in 2020 to 7% in 2022, and the proportion of children who have tried vaping overall is now sitting at 16%. We have heard significantly higher figures than that cited in this debate.

I think it is reasonable to look for disposable vapes to be removed from sale. That is certainly what I would like to see. I am pleased to hear calls for retailers to ban single-use vapes in Scotland, where environmental and health charities have joined forces to call for an end to the sale of disposable vapes. Groups such as Keep Scotland Beautiful, ASH Scotland and the Marine Conservation Society are urging retailers to follow the good example of Waitrose, who I take my hat off to here, in banning the sale of those single-use products.

Waitrose did that because of reports suggesting that their popularity was soaring among people who had not previously smoked, as we have heard already, including the younger generation. It is really important that we examine the subject. I am pleased about the Scottish Government’s action in that regard and I echo Barry Fisher, the chief executive of Keep Scotland Beautiful, who also talks about a “litter emergency” and emphasises that the time to act is now.

The time to act is now also on the illicit vapes we have heard about already—the dodgy vapes and the chemicals within them. Lab research shows that they have up to twice the daily safe amount of lead and nine times the daily safe amount of nickel. There is also chromium in there. We do not want our children to be ingesting those substances, and those studies are based only on some vapes confiscated from a school in England, so we do not know what else is out there; we just know it should not be. Dodgy vapes have deeply concerning health impacts. In Scotland, there have been reports of illegal vapes confiscated from a school that left children coughing up blood. Which of us wants that for our children? We need to act.

It is deeply concerning—and that is before we even get into the notion of young people who have never previously smoked using disposable vapes and then graduating on to smoking cigarettes. We know that is an issue. The producers of vapes would have us believe they were intended to rectify and remedy that very problem, but it turns out to be the opposite that happens. The World Health Organisation has expressed significant concern about that, stating that children who use such products are three times more likely to use tobacco products in the future. If the Minister is looking for evidence, that is the kind of statistic he ought to bear in mind.

Huge profits are being made on the back of all those sales of vapes to children. Big business is being done here, but it is not always being done by the rules. The most popular brand for children is Elfbar, but in July an Observer investigation found that Elfbar had flouted the rules to promote its products to young people in the UK. Advertising videos and promotions on TikTok, for instance, were felt to be of concern. Some of those videos attracted hundreds of thousands of views, on a platform that is used by three quarters of 16 and 17-year-olds.

We have already heard about children’s doctors calling for a complete ban on disposable vapes. The hon. Member for Sleaford and North Hykeham (Dr Johnson), who is herself a children’s doctor, has spoken out about that. If we will not listen to the views of children’s doctors about the impact of vapes on children’s health, who will we listen to?

I am heartened that Humza Yousaf, our First Minister, says that a ban on disposable vapes is under consideration, and by the incredible hard work being done by the campaign group ASH, which absolutely deserves our thanks. I also thank the organisers of the TRNSMT festival, which took place in Glasgow last weekend, because they did not permit disposable vapes there, and I absolutely applaud them for that.

Less positively, however, I cannot thank the administration of East Renfrewshire Council, which is where I live. The motion, which I think is a good one, includes a passage about working with councils, and that is absolutely right. Of the 32 councils in Scotland, 28 supported motions calling for a ban on disposable vapes. Regrettably, East Renfrewshire Council was not one of them. It did not support the ban, seemingly because a ban was supported by the SNP. I am really unimpressed by that. It is a poor show from that Labour Administration and their Conservative enablers that they could not bring themselves in step with the whole of the rest of the country and, I suspect, with the Members who are present in the debate. That seems somewhat ironic given the motion that is before the House. I hope that they will reflect on that and change their mind, and that we will get a full set of councils to support the ban—although the numbers so far are pretty impressive.

I hope that the Scottish Government come to the conclusion that these things are too dangerous and damaging, although I am grateful for their sterling work so far. I hope that the UK Government will listen to what is being said to them. Like my hon. Friend the Member for Angus (Dave Doogan), I was not entirely convinced that a huge degree of listening was going on, but I hope that I am wrong about that and that we will hear about a very serious focus on the matter. The industry will not take the steps that are needed; politicians need to do that. Disposable vapes are a danger to the environment and to our young people. It is high time that we took them off the shelf.

--- Later in debate ---

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

I thank the Labour Front-Bench team for a great choice of debate today. I thank, too, all those Members who have made nice comments about me today. I agree with the Chair of the Health and Social Care Committee, my hon. Friend the Member for Winchester (Steve Brine), who said that it is a shame to see children’s health being made a party political issue, because surely everybody in this House, from every party, wants children’s health to be as good as possible. In that vein I declare an interest as both a consultant paediatrician and a member of the Royal College of Paediatrics and Child Health.

I was pleased to see the shadow Minister talk about Laranya Caslin, the headteacher of St George’s Academy in Sleaford, who spoke so eloquently at the Select Committee about her experiences of children vaping in her school. Let me reflect on some of the things that she said. She said that there was heavy peer pressure in school encouraging children to vape. She said that vaping was seen to be cool and that children had to vape to feel that they were part of the in-group. She also talked about how it has a higher burden of addiction. She said that, sometimes, children would go out at break time to have a cigarette, or to share a cigarette with friends, but now they vape not just during break times but need to top up during lessons. That continual top-up is something that we see in Parliament, too. Yesterday, while eating in the Tea Room, a Member of the House was vaping at the table. It must be said that we did have quite a long session of votes yesterday. During voting, in the Labour Members’ cloakroom, a Member of the Opposition Front Bench was sat vaping. We are seeing people topping up anywhere and everywhere it would seem, and that is something that I would like to see stop.

As many Members have mentioned, the flavours and colours of vapes are very child-friendly: there are even unicorn flavours, which I struggle to believe are directed at teenagers, never mind adults. My 12-year-old would not thank you for anything with a unicorn on, because that is very much for younger children. Indeed, we saw in the Healthwatch survey that 11% of 10 and 11-year-olds are already vaping. That grew to 42.4% of 16 to 17-year-olds, with a gradual increase during the teenage years. Laranya Caslin also told us that flavours are important to the peer pressure on children to vape. She talked about how children would discuss, “Have you tried the cherry cola? Have you tried the unicorn milkshake? Have you tried the green gummy bear?” It is the flavours that enable that discussion to take place among peers, which encourages children.

I asked the industry representative, “Why do you need these flavours? Why can’t you make them basic mint flavour, no flavour at all, or tobacco flavour?” He said that when people smoke they lose their sense of taste to an extent. Indeed, the NHS website says that one of the benefits of stopping smoking is that after 48 hours a sense of taste will start to return. What the industry has found, it told me, is that if it has tobacco or plain flavoured vapes, people will move off smoking on to the vape, but when their tastebuds return they will not like the vape anymore and will discontinue their vape use. That is of course what we want them to do, but it is perhaps not what the industry wants them to do. Making it cherry cola flavoured, bubble gum flavoured, or whatever flavour the person likes to inhale means that they will continue to be addicted to that product and continue to use it. I encourage the Minister to consider that when she considers banning flavours, or which flavours should be allowed to be used.

The ten-minute rule Bill that I introduced on 8 February this year would have banned disposables. I understand that the Minister has challenges in defining a disposable in a way that the industry, which has such a heavy financial interest in the product, cannot get around and make the legislation weak quickly. I look for an update in how that is going, but 1.3 million are disposed of every week. We have heard already about the fires that they can cause, and the fact that most of them are not recycled. I understand that they are very difficult to recycle, because the nicotine salts leak into the plastic. It is not like a plastic water bottle, which can be easily recycled if it is disposed of properly. These vapes cannot be, because they become a hazardous waste, because the nicotine has leaked into the plastic itself.

[Kirsten Oswald]

The hon. Lady is making an excellent speech. Does she agree that the whole way these things are designed seems as if it is to prevent them from being recycled? They are impossible to take to bits. They contain, as she said, plastic, which is then infused with other substances. There are lithium batteries, and all manner of things. How would one possibly go about recycling that properly? I think that the answer is that one could not unless one were a specialist.

[Dr Johnson]

The hon. Lady is right: these things are incredibly difficult to recycle, and since 70% of children use disposable vapes, and they are the most attractive and cheapest for children to use, it is increasingly important that we ensure that they are not available. The call to ban disposables has been backed by a wide variety of people, including the Royal College of Paediatrics and Child Health, of which I am a member, the Children’s Commissioner, and the Royal Society for the Prevention of Cruelty to Animals. There is a widespread desire across all parties, and across communities, to see these products banned.

The industry said at the Select Committee that a ban will drive the industry underground and make things illicit, but as we heard from the hon. Lady earlier, that is already happening. There are already illicit vapes. When a school in my constituency confiscated five vapes and the police tested them, they found antifreeze and all sorts of products, including trichloroethylene, which was banned before I was born. All those types of products are contained in vapes already, so that cat is very much already out of the bag and should not dissuade us from getting rid of these disposable products.

We also heard on the Health and Social Care Committee about the health challenges. We hear that vapes are 95% safer than smoking. The industry continues to repeat that statistic. Where does it come from? How could anyone possibly quantify that? It comes from 2013, when a group of people who were not specifically experts in tobacco control got together and had a discussion. They then published a paper. Let me read something that was published in The Lancet at the time, which was more than 10 years ago. The editorial of The Lancet said:

“But neither PHE nor McNeill and Hajek report the caveats that Nutt and colleagues themselves emphasised in their paper. First, there was a ‘lack of hard evidence for the harms of most products on most of the criteria’. Second, ‘there was no formal criterion for the recruitment of the experts’. In other words, the opinions of a small group of individuals with no prespecified expertise in tobacco control were based on an almost total absence of evidence of harm. It is on this extraordinarily flimsy foundation that PHE based the major conclusion and message of its report.”

The Lancet also noted that

“one of the authors of the Nutt paper…reports serving as a consultant to…an e-cigarette distributor”,

and that another

“reports serving as a consultant to manufacturers of smoking cessation products.”

In the Westminster Hall debate on 29 June I asked the Minister to look further into the veracity of the claim that vaping is 95% safer, and whether, given that that study was 10 years ago, the modern evidence for that still stacks up. I look to the Minister for an update on how they are getting on with that, because we heard in the Health and Social Care Committee that there are significant health impacts for children, with eight children hospitalised from St George’s Academy in Sleaford alone.

We also heard about children being frightened to go into toilets, as the Select Committee Chair said. Some of those children were frightened to do so because they found that when they did, it triggered their asthma symptoms. Those are children who do not vape, but who have asthma and are frightened to go into the toilets because there is so much vaping vapour left in the toilets by other children that it is triggering their asthma and making them unwell. Some of these children are unable to go to the toilet all day, which leads them to have problems not only with asthma, but with urinary retention, which potentially leaves them at risk of urinary infection and incontinence issues in later life. It is for that reason that Dr Stewart from the Royal College of Paediatrics and Child Health told us that she supported a ban on the use of vaping in public places.

I would also like the Minister to look at the use of accessories. On Etsy.com today, under the categories “girly smoking accessories” or “cute smoking accessories”, for £7.78—within the pocket money range—one can buy a teddy bear vape stand. It is a tiny teddy bear that people can stand their vape in when they are not using it. Will the Minister look at whether such items are suitable for sale, given that they are essentially there to attract children to this activity?

Moving on to advertising, we have a bizarre situation where Transport for London banned an advert for “Tony n’ Tina’s Wedding” that initially featured a picture of a three-tier wedding cake, because it would encourage people to eat fat, salt and sugar and that might drive the obesity crisis. That was on the tube, yet TfL buses have many adverts for vaping, including ones that appear to me personally to make vaping look cool and something to be aspired to.

I think TfL’s priorities are all wrong. The London Bus Advertising group states, as part of the group’s advertising to encourage people to put their adverts on the buses, that 5.8 million people would see the buses per week. I would ask those on the shadow Front Bench to use their good offices with the Labour Mayor of London to consider whether he can influence the chair of TfL to remove not just cake adverts, but vaping adverts from places such as tubes, buses and taxis, where they may be seen by children.

In the Minister’s opening remarks he talked about tobacco track and trace, and I wonder whether he is planning to bring in the same for vaping.

The other thing I want to talk about is taxation. Other hon. Members have talked about the price of disposable vapes and how they are accessible with pocket money. Very rarely comes an opportunity for a Chancellor to bring in a tax that will promote the public’s health, still make vaping cheaper than smoking, protect our children’s health and be relatively popular, yet raise revenue. While we wait to ban the disposable versions, I encourage the Chancellor to consider adding at the next fiscal event perhaps £5 to the price of a vape, to move them out of the pocket money range.

In summary, the Minister needs to look at a whole range of measures to challenge children’s vaping, including price, location, sale and use, colours, flavours, disposable items, advertising, education and enforcement.

--- Later in debate ---

[Jerome Mayhew]

As the hon. Lady says, that is what they all say. Obviously that is wholly inappropriate, but part of the problem in reaching the correct solution to this shared concern has been demonstrated by the richness of the debate we have had today.

All sorts of suggestions have been made. My non-exhaustive list indicates that some hon. Members said that we should ban flavours. Some of them said that we should ban all flavours; others said that we should ban only flavours that are targeted directly at young palates. There have been suggestions that we should ban disposable vapes, or that we should require bland packaging for vapes, although others suggested that the issue is not so much the packaging as the fact that they should be hidden behind closed doors. There has been a suggestion that we should increase the cost of vapes, but that was controversial—the hon. Member for North Tyneside (Mary Glindon) rightly pointed out that for adults seeking to give up smoking who are on very limited means, the cost of vapes is a very relevant consideration.

[Dr Caroline Johnson]

The cost is indeed important, both in pricing children out of the pocket money market and in ensuring that smokers who are seeking to quit can do so. However, to a smoker who can afford a packet of cigarettes, even if £5 is put on the cost of a disposable vape, as my right hon. Friend the Member for Romsey and Southampton North (Caroline Nokes) described, the vape is still cheaper.

[Jerome Mayhew]

I am grateful for that intervention. I do not have skin in the game about whether it is better to have a higher cost or a lower cost, but my hon. Friend’s intervention has highlighted my fundamental point, which is that this is a complex area where we need evidence to base our policy on.

It has been suggested that we should crack down on marketing. Others have suggested that we should increase education in schools, and there is a wider debate about schools policy and the use of loos in schools. There are other concerns, overriding all of these, about what impact our actions in relation to vapes—including single-use vapes—could have on the ability of adults to give up smoking, in order to continue the downward trend of smoking addiction in this country. These are serious and interrelated issues. If this debate were to result in a Division, there is no way that I could support the Labour motion, which focuses solely on banning branding and advertising for the young, because it may not go far enough. It may just focus on one little area, when the richness of the debate on both sides has highlighted how much wider and more complex the issue is.

As such, what we are really talking about is not so much our concerns about vaping, including by children: the main issue is, “How should we make our law?” It is a given on both sides of the Chamber that action should be taken, and the first speech on behalf of the Government, made by the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Harborough (Neil O'Brien) made it clear that the Government have already acted and are intending to go further. In fact, the Secretary of State said at Health questions yesterday that the Government were looking to go further, particularly on single-use disposables. It is not a question of whether we are going to act: the question is, on what basis do we act? For my money, we should act on the evidence and not solely on anecdote, important though that is.

--- Later in debate ---

[Helen Hayes (Dulwich and West Norwood) (Lab)]

I am grateful to all right hon. and hon. Members who have taken part in what has been a largely consensual debate. We have heard from colleagues across the House about the growth in the number of children who are vaping, concerns about physical and mental health impacts, the disruption to education and the drain on staff time in schools.

The Chair of the Health and Social Care Committee, the hon. Member for Winchester (Steve Brine), spoke of the evidence that the Committee has heard on the impact of vaping on the education of students, including interruptions to exams. My hon. Friend the Member for Ealing, Southall (Mr Sharma) highlighted the ongoing prevalence of smoking and the need for further work to tackle illegal tobacco sales as well as work to tackle vaping. The right hon. Member for Romsey and Southampton North (Caroline Nokes) spoke about the important role of vapes in smoking cessation. There is no disagreement from the Opposition on that. I am not so grateful to her for taking me back to the revolting smoke-filled environment of the toilets in my secondary school in the 1980s, which is a memory that I had long since sought to banish.

My hon. Friend the Member for North Tyneside (Mary Glindon) spoke about the need for better enforcement of the existing age verification regulations regarding vapes. The hon. Member for Erewash (Maggie Throup) highlighted the sophistication of the packaging, design and presentation of vaping products in retail outlets and how attractive that makes them. My hon. Friend the Member for City of Durham (Mary Kelly Foy), who has a long track record of work on this issue, highlighted the extent of the evidence on vaping that is already available to the Government. The hon. Member for Darlington (Peter Gibson) highlighted the impact of disposable vapes on the environment and the increase in plastic pollution. My hon. Friend the Member for Birmingham, Erdington (Mrs Hamilton) spoke from her experience as a former nurse and highlighted the serious problem of vaping equipment being used to distribute more dangerous substances by young people.

The hon. Member for Sleaford and North Hykeham (Dr Johnson), who spoke from her extensive work on this subject, highlighted concerns about the accuracy of data on the safety of vaping. The hon. Member for Tiverton and Honiton (Richard Foord) spoke about work in his constituency that shows it is possible for retailers to take a different approach to vapes. My hon. Friend the Member for Stockton North (Alex Cunningham) highlighted the Government’s failure to act on advertising. My hon. Friend the Member for York Central (Rachael Maskell) spoke about the lessons that can be learned from the anti-smoking measures that have been so successful as well as the need to recognise this issue as one of addiction and to locate it in the wider landscape of the addiction economy.

Vaping has shifted from a smoking cessation tool to a recreational activity in its own right, driven by the rapacious desire of tobacco companies—which fund many of the largest vape suppliers—to keep making a profit from the highly addictive substance of nicotine. The growth in the use of vapes by 11 to 15-year-olds has been rapid, increasing by 50% in the past three years. One in five 11 to 15-year-olds in England used vapes in 2021. The figure will be higher now.

The important role of vaping in smoking cessation has led to a widespread perception that it is a harmless activity, rather than a less harmful activity than smoking. Last year, 40 children were admitted to hospital for suspected vaping-related disorders. Young people using e-cigarettes are twice as likely to suffer from a chronic cough than non-users. There are reports that nicotine dependency contributes to cognitive and attention deficit conditions, and worsened mood disorders.

[Dr Caroline Johnson]

The brain develops gradually over time, and is thought to continue developing in people until they are 25. Some countries have different age limits for different things. Does the hon. Member think that 18 is the right age limit for vaping?

[Helen Hayes]

The hon. Member speaks from her experience on this issue. We have set out a motion containing some immediate actions that the Government can take, which are well-evidenced, particularly from the approach taken to combat smoking. I agree that the Government should look urgently at other aspects of the regulatory framework on vaping, some of which we have heard about today.

Vaping products are marketed directly to children, named after sweets such as gummy bears, Skittles and tutti frutti, in brightly coloured packaging decorated with cartoon characters. There is also evidence, including from research undertaken by one of my constituents who I met during evidence week last week, of the burgeoning growth in vaping among 18 to 25-year-olds, almost entirely unrelated to smoking cessation. A new generation of vaping products has been designed to be desirable objects in their own right. If action is not taken to tackle the accessibility of vaping to children, we can only expect vaping among young adults to continue to grow.

--- Later in debate ---

[Maria Caulfield]

That is the balance we have to create. We do not want unintended consequences whereby we reduce the use of vapes in under-18s but also stop their use among those who are quitting smoking. We know from our evidence that vaping is much safer than smoking. For those communities, very often in deprived areas, where there are higher rates of smoking, we do not want the cost of vapes to be prohibitive and for people not to switch to them instead of smoking.

Our current laws protect children by restricting the sale of vapes to over-18s and limiting nicotine content, and there are regulations on refill bottles, tank sizes, labelling requirements and advertising restrictions. It is important that we remember that regulations are in place, and it is important that they are enforced.

[Dr Caroline Johnson]

The Minister is talking about evidence that vapes are much safer, but I notice that she has not used the 95% figure that is used by the industry. Clearly, the absence of evidence of harm and evidence of the absence of harm are different things, so will the Minister clarify whether she has evidence that vaping devices are much safer? Or does she just not have evidence yet, because they are so new, that they are not dangerous?

Electronic Cigarettes

Caroline Johnson Excerpts

Thursday 29th June 2023 Westminster Hall

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

I beg to move,

That this House has considered electronic cigarette use.

E-cigarettes were introduced as a stop-smoking device, but in my opinion they have moved from being a stop- smoking device to an alternative addiction. Indeed, they are attracting many non-smokers. In 2007, there were around 10.6 million smokers, according to official figures. The number fell to 6.6 million in 2022, so 4 million smokers had stopped. Sadly, it is estimated that around 1 million of those people died, which means that around 3 million quit smoking. That is undoubtedly a huge success, although it cannot be attributed entirely to vapes.

In the Health and Social Care Committee yesterday, we heard from the industry that it estimates that around 5 million people currently vape in the UK, which means that, even by the most generous estimates, 2 million of them were not smokers beforehand—a significant proportion of the vaping market. With the market estimated to be worth £4 billion a year, these products clearly have huge profit margins. Vapes have been available for a long time, but if they are genuinely safe, healthy devices that save lives by stopping people smoking, why does the NHS not provide any on prescription? I wonder whether it is because they are not safe and the NHS has been unable to develop the safety profile as well as it might wish.

The idea that e-cigarettes are 95% safer than smoking was quantified by Public Health England. Members will no doubt have heard the figure before, because the vaping lobby never tires of repeating it, but if we look into its origins, its veracity seems to suddenly disappear. The figure originated in a 2014 paper in a journal called European Addiction Research, but it comes with some important caveats. The study was partly funded by the Italian Anti-Smoking League, and one of its authors was a member of that organisation and served as a consultant to an e-cigarette distributor at the time. That blatant potential conflict of interest did not escape the journal’s editors, who added a warning note at the end of the paper, but it certainly escaped subsequent reporting of the figure.

The scientific journal The Lancet was even more excoriating of the original article, accusing it of having

“an almost total absence of evidence”

and of being based on

“the opinions of a small groups of individuals with no prespecified expertise in tobacco control”.

Furthermore, it is worth noting that the paper is seriously outdated. Since 2014, a plethora of evidence has emerged about the negative effects of these novel and fast-evolving devices, in studies that were never considered when the figure of 95% was reached. I am concerned that the statistic will age about as well as the claims made to past generations about the health benefits of smoking.

As we delve deeper into the topic, it becomes evident that a growing body of evidence links vaping to severe complications. Chronic bronchitis, emphysema, increased blood pressure and significantly worse physical performance are just some of the adverse effects associated with vaping that scientists have found. Furthermore, the high nicotine content, which some say is roughly equivalent to between 40 and 50 cigarettes in a disposable vape, poses a grave risk to the health and wellbeing of young people. We heard yesterday in the Health and Social Care Committee from Dr Helen Stewart of the Royal College of Paediatrics and Child Health—I should declare my interest as a member of that college and a consultant paediatrician—who told us about the difficulties that children are facing. Some of them are not going to the toilet during school time because the clouds of vapour they experience there trigger their asthma and make them unwell. We heard about children collapsing, too.

The number of children vaping is increasing. The evidence submitted to the Health and Social Care Committee by the vaping industry suggests that over 83% of children have never vaped or are unaware of vaping, but that flies in the face of the experience of most of the children, teachers and doctors I have spoken to. Indeed, a report on Blackpool published by Healthwatch in May found that a staggering 31% of children and young people claim to vape or sometimes vape. More disturbingly still, when I asked Healthwatch if it could break down its figures by age, it said that one in ten 10 and 11-year-olds vapes. These are children in year 6. That rises to nearly one in five 12 to 13-year-olds, while for 16 to 17-year-olds the figure was almost one in two. We have also noticed that the number of children vaping is rising extremely quickly.

I would like share a distressing incident from my constituency. In just one school, St George’s Academy in Sleaford, there have been eight reported cases of children collapsing after vaping. Those incidents occurred at different times with different children. I was deeply troubled to hear about this, so I went to visit them and met with one of the intelligence officers from Lincolnshire police, who had collected five vapes from another school.

In just those five vapes they found Velvana Fridex Eko, a modern non-toxic coolant intended for cooling cast iron and aluminium engines, as well as Avanti coolant antifreeze, Steol-M, which is designed for filling hydraulic devices, and Rauvolfia serpentina, or Indian snakeroot. Also found was Agip antifreeze, trichloro- ethylene, and poster and watercolour varnish—1-methoxy-2-propanol—along with diethylene glycol diacetate and 2-methoxyethyl acetate, a substance that may damage fertility and unborn children and is harmful to the skin if inhaled or swallowed. They also found aviptadil, a synthetic vasoactive intestinal peptide that is used to treat certain medical conditions.

These vapes do not contain what the children think they do, and they can be very dangerous. The police found that some children had significant health issues. The eight children who collapsed in Sleaford were taken to hospital. Thankfully, they have all recovered, but in one description given to me, a child taken to hospital in the back of a car had one side of his face drooped down as if he had had a stroke. His mother was clearly terrified by this. Another young boy said that he thought he was walking along through the marketplace in Sleaford when he realised that people were gathered around someone who had collapsed. Then he realised, as if looking from above, that that person was him. We have heard some really scary stories about what has been going on.

We hear that vaping is a good route to quitting, but we should balance the fact that it may help adults to quit with the need to keep these devices away from children. One of the things that makes vapes attractive to children is how inexpensive they are. We have seen them at £4 each, three for a tenner and those sorts of prices, which is clearly within pocket money range. When children can get disposables so cheaply, they are easy to discard. If a child finds that mum or dad is coming down the corridor or up to the bedroom, they can dispose of them quite quickly. When teachers come into the toilet, they can be disposed of, including in sanitary waste bins, which poses other hazards, too.

How much nicotine is in vapes? The average disposable contains 2 ml of e-liquid at 20 mg/ml nicotine strength, which I am told is the equivalent of 40 to 50 cigarettes. The reason for that is that people only take about 10% of the nicotine from cigarettes into their lungs—the rest of the time it just goes into the air—so vapes are stronger in many cases than cigarettes.

The other issue I want to raise with the Minister today is marketing tactics. We heard yesterday from the chief executive of Totally Wicked, who I challenged on his marketing techniques. Totally Wicked sponsors Blackburn Rovers and a rugby team as well, so the stadium is called Totally Wicked. The young men on the pitch—the heroes, as he called them, who those young men and women admire so much—are running around with T-shirts emblazoned with “Totally Wicked”. He said that the young people’s ones do not have that logo on. I checked this morning and found no evidence of them selling any junior shirts, which begs the question of what happened to them all. The suspicion might be that they have disappeared off sale—we do not know.

The Online Safety Bill offers an opportunity to ensure that vapes are not advertised on platforms such as TikTok. Vapes have bright, attractive packaging, with colours and flavours such as bubble gum. Why does an adult smoker need a unicorn milkshake-flavoured vape to quit? My 12-year-old daughter is too old for unicorns, she would tell me now, so why an adult would need a unicorn, I do not know. These vapes have become fashion accessories, and are being matched to outfits. Walk into any corner shop and we can see a whole rainbow from which to choose. There are understandable concerns that some manufacturers are deliberately doing that. They would all deny it, of course, and I hope that it is not the case, but with flavours such as unicorn milkshake, bubble gum, candy floss and green Gummy Bear, it is clear that these things are far too attractive to children. I ask the Minister to consider whether, if these are truly stop-smoking devices and not lifestyle products that are attractive to children, they really need to be coloured and flavoured. I do not think they do.

The environmental impact of disposable vapes has been highlighted by a number of my colleagues in the House on a number of occasions. Some 1.3 million disposable vapes are discarded in the UK every week. The vast majority are not recycled. Their complex construction and high nicotine concentration make proper disposal challenging. They also contain lithium batteries, a precious and vital resource in our transition away from fossil fuels that is being discarded willy-nilly, sometimes into rivers and water courses. That further exacerbates the environmental consequences.

Vapes have also been known to cause fires in bins, bin lorries and recycling centres. They pose a danger. I am also advised that the plastic, because the nicotine salts leak into it, becomes hazardous waste and is non-recyclable in any case. I urge the Government to back my ten-minute rule Bill and to ban these devices. A ban has been backed by the Royal College of Paediatrics and Child Health, and by the Royal Society for the Prevention of Cruelty to Animals. It is a widely supported measure.

As well as the issue with colours and flavours, we need tougher regulations on the advertising and marketing of vaping products. Health warnings should cover 65% of the front and back of the pack, in the same way as for tobacco. Sports club sponsorships should be banned. I cannot see why these products need to be advertised on sporting shirts; there is also the worry that that will make them more attractive to children.

When the former Government brought in bans on where people could smoke and where cigarettes could be displayed, the number of smokers dropped dramatically. I appreciate that that is a nanny state measure and, as Conservatives, we are reluctant to bring in nanny state measures. Nevertheless, it did work. If we were to ask people now whether we should reverse that measure, I do not think that many, if any, would agree. I suggest that as a sensible step forward.

At the moment, we are banning sweeties at the till because we think that will help to stop people becoming obese, but I have been into shops where those sweeties have been replaced with vapes. I am sure most people would much prefer that their child had a packet of Rolos than a vape.

My third point is about regulation. The industry is actually quite positive on this issue, and is keen for regulation—at least, that is what they say. At the moment, anyone can sell a vape. When I take my son for a haircut, we could get three lemon-flavoured vapes for £1 while we are there. He is only eight, so he will not be getting any, but we could. If we go to the sweetie shops on Oxford Street, we can buy them along with the candy.

Having the same sort of regulations as for tobacco or alcohol would mean that people would have to be licensed and would be challenged to make sure that vapes did not get into the hands of children, and there would be bigger fines. I saw an example of someone being fined £200 for selling these things to children. That is clearly no disincentive. A proper regulatory framework, where people lose their ability to sell these fairly lucrative products in the event that they break the regulations, will reduce the supply to children.

I also wanted to raise taxation. I appreciate that it is not the Minister’s responsibility, but he can raise it with the Chancellor and other colleagues. This measure was supported by Action on Smoking and Health in the Health Committee yesterday. If vapes are around £4 and a packet of cigarettes is £12, we could add considerable amounts—ASH is asking for a £5 tax on every disposable vape—as a way of taking them out of the range of children’s pocket money, while making sure that they are still cheaper than a packet of cigarettes for those adults who genuinely are smokers who wish to quit. Children are very price-sensitive and we need to deter them from this harmful habit.

My final point is about education. We heard from the headteacher of St George’s Academy yesterday in the Health Committee. Children need to know about vapes, and understand that they are not lifestyle products for them to use but aids for adults to stop smoking. The relationships, sex and health education curriculum review that is being done at the moment offers Ministers an opportunity to ensure that that happens. I am interested to hear what the Minister has to say.

--- Later in debate ---

[Dr Caroline Johnson]

I thank everyone who has contributed to this debate. It was interesting to hear that my right hon. Friend the Member for Calder Valley (Craig Whittaker) has given up smoking, on which I congratulate him. I hope he will soon be able to give up heated tobacco as well; I am sure his health will benefit.

I also thank the SNP spokesperson, the hon. Member for Paisley and Renfrewshire North (Gavin Newlands), and the Opposition spokesperson, the hon. Member for Ilford North (Wes Streeting), for their support. I think I am correct in saying that there was support from all corners of the House for doing everything possible to ensure that children cannot get their hands on vapes.

I welcome the measures in the Minister’s speech, particularly those on education, preventing the distribution of free vapes, the introduction of the enforcement team and nicotine-free vapes. I also welcome the consultation, but we need to be quick about this because more children are vaping every day. That means that every day more children are becoming addicted and developing a nicotine habit that they will find difficult to break.

One of the challenges of quitting smoking is giving up nicotine, and giving up the nicotine in vapes is no different; in fact, it may be more difficult. I urge the Minister to look very closely at banning disposables and at marketing. He did not mention this in his speech, but I do not think that vapes should be advertised on the kits of any sports team. In shops, vapes are often positioned in the front of display cabinets where children can see them. I have seen advertisements for vapes on taxis and things like that—they should not be there.

The Minister’s review should look closely at flavours and colours, because I do not think they are necessary for stop-smoking devices. He should regulate where they can be sold and increase the penalties for those that break the rules. The Minister did not mention tax. I appreciate that that is a matter for the Treasury, but vaping companies should be taxed heavily to lift their pocket money. That is the right way to go.

As well as education, children need support. A huge number of children are already addicted to vaping products, and they need support. When they realise and are educated about the harms and wish to quit, they will need support and help to do so.

Perhaps my most important ask of the Minister is for him to look at the latest evidence. The 95% safer approach was predicated on evidence that is not terribly robust and on a study that is nearly 10 years old. It was based on an apparent absence of evidence of harm, but we are now seeing evidence of harm. I urge him to review the evidence. We are in a situation in which our headteachers are telling us that children must be able to vape so that they can discuss the flavours to fit in with their peer group, and we must get away from that. This issue is urgent and I urge the Minister to act quickly.

Question put and agreed to.

Resolved,

That this House has considered electronic cigarette use.

Oral Answers to Questions

Caroline Johnson Excerpts

Tuesday 6th June 2023 Commons Chamber

[Maria Caulfield]

I thank the hon. Gentleman for his question. We take this issue very seriously, and we have already made interim payments to those infected. The Minister for the Cabinet Office came to the Dispatch Box in April when Brian Langstaff’s review was published, and we are working night and day to respond to those recommendations and get that plan out as soon as possible. We recognise the impact on families, and on those infected and affected.

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

I refer Members to my entry in the Register of Members’ Financial Interests. Today Dr Mike McKean, a respiratory consultant and vice-president of the Royal College of Paediatrics and Child Health, said that vaping is “fast becoming an epidemic” among children. The Royal College of Paediatrics and Child Health said that we should ban disposable cigarettes—e-cigarettes—“without a doubt”. Will the Minister do all he can to prevent children from starting vaping, and will he back my ten-minute rule Bill, which was first introduced in this place in February, to ban disposable e-cigarettes?

[Neil O’Brien]

I pay tribute to my hon. Friend and her leadership on this issue. Many of the ideas that she has been putting forward are already in the plan that we set out to tackle youth vaping, including the creation of the “flying squad”, the ongoing call for evidence on youth vaping, and all the different things we could do to continue to drive it down.

Recovering Access to Primary Care

Caroline Johnson Excerpts

Tuesday 9th May 2023 Commons Chamber

[Steve Barclay]

I have touched on the numbers a few times, but let me give the hon. Gentleman the precise figures. There are 335 more pharmacists than there were in 2010, so it is simply not the case that there are fewer. There are 2,000 more doctors in general practice, and there are also the extra 25,000 in additional roles. As I have said, someone who wants a prescription review should see a pharmacist, and someone with back pain should see a physiotherapist; not everything has to go through a GP, and it is better for GPs’ time to be used more effectively. There are also more doctors in training: 4,000 are receiving training in primary care, as opposed to 2,600 in 2014. So we are seeing more staff, more effort on recruitment, more effort on retention through the pension changes, and better use of the additional roles.

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

I am pleased that the Government are looking at how they can best support GPs and improve access to primary care, but how will these plans protect and enhance the role of GPs who dispense in their own practices? How will my right hon. Friend deal with concerns about antibiotic resistance, and how will he solve the root cause of the problem, which is the fact that there are not enough GPs?

[Steve Barclay]

In respect of my hon. Friend’s first point, these plans will not make any changes. As for the second, about prescribing, that will be part of the consultation, and we will be learning lessons from what is being done elsewhere: for instance, Pharmacy First is already up and running in Scotland. We are looking into what tests can be performed alongside those prescribing rights so that antimicrobial resistance is targeted effectively.

Vaping: Under-18s

Caroline Johnson Excerpts

Tuesday 2nd May 2023 Westminster Hall

[Dr Hudson]

I completely agree, and I want to stress that key point: it is illegal to sell vapes to under-18s. I will be asking the Minister about that. I know that the Government are moving on it, and we need to address it going forward.

Similarly, an NHS survey in 2021 said that 9% of 11 to 15-year-olds, and 18% of 15-year-olds, had used vapes. Those are alarming statistics. ASH England also noted that the most frequently used e-cigarettes among young people are disposable vapes, with an astonishing increase from 7.7% in 2021 to 52% in 2022. Although this is not the main focus of my speech, I will point out that, quite aside from the health concerns associated with such a marked rise in the sale and consumption of disposable vapes, they are a major environmental concern, with over 1 million of them thrown away every week. It is estimated that the lithium used in those batteries equates to about 10 tonnes of lithium per year, which is equivalent to the lithium used in approximately 1,200 electric vehicle batteries.

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

My hon. Friend will be aware of my ten-minute rule Bill to ban disposable vapes for exactly the reasons he has described: the effects on children’s health particularly, and on the environment. Does he agree that the Government should support the Bill?

[Dr Hudson]

I very much agree with my hon. Friend. I thank her for intervening and I welcome her medical expertise in this debate.

I have touched on some of the environmental concerns, and there are also concerns about fires related to disposable vapes. However, at the heart of my speech is the impact that such a frightening level of vape use is having on our young people, even as young as primary age. I urge our policymakers not to underestimate it. There are increasing reports suggesting that the use of vapes has negative effects on heart and lung health, and may be associated with tooth and gum disease. Other issues reported include coughs, shortness of breath and headaches. Nicotine, which these products often contain, is highly addictive with potentially harmful effects on the adolescent brain, which is still developing.

--- Later in debate ---

[Dr Hudson]

I agree with the hon. Member. The industry needs to take a close look at itself, but it is also the case that a lot of the vapes that are ending up with children are coming through illicit means. We need to have a targeted approach to look at how best we can prevent our young people from accessing those products.

[Dr Caroline Johnson]

My hon. Friend made a very good point about advertising. We need to get across the nuanced message that vaping may be beneficial to people who want to quit smoking—although I would argue that it could become an alternative addiction rather than a stop-smoking aid—but we must also prevent children from using vapes. In the past, nuanced advertising for formula milk stated that breast milk was better at the beginning but that formula milk was a reasonable alternative for six month olds. Could a form of words be used in vaping adverts to make it clear that the products should be for people who smoke, not for those who do not?

--- Later in debate ---

[Neil O'Brien]

Absolutely, and I will touch on that in just one moment. Vapes—

[Dr Caroline Johnson]

Will the Minister give way?

[Neil O’Brien]

I think I should try to answer the last intervention before taking another one; I will come back to my hon. Friend in a second. Vapes are not yet being used widely enough to reach their full potential as a quit smoking aid, so on 11 April, I announced new funding for a new national “swap to stop” programme—the first of its kind anywhere in the world. We will work with councils and others to offer 1 million smokers across England a free vaping starter kit. Smokers who join the scheme, which will run initially over the next two years, will join on one condition: they must commit to quitting smoking, with support. We will provide additional support to help them quit vaping after they have quit smoking. We will target the most at-risk communities first, focusing on settings such as jobcentres, homelessness centres and social housing providers. I do not know whether my hon. Friend still has a burning question.

[Dr Johnson]

Yes, and I thank the Minister for giving way; he has been extremely generous with his time. He has talked about the importance of educating children about the risks. Does he agree that a key problem is that many young people and children who use vapes do not believe that they are harmful at all?

[Neil O’Brien]

My hon. Friend is quite probably right. There is a lack of understanding of some of the risks, and of the effects on mental health and wellbeing. I am very, very worried when I hear about young people at school smoking, and about the disruption that various hon. Members have raised in this debate.

I conclude by thanking all Members here for highlighting concerns about these issues, and for their contributions, not only in the debate but over a longer period. That has had an effect on Government policy, and will continue to. The Government are committed to doing all we can to prevent children and young people from vaping, while also ensuring that we use the full potential of vaping as a tool to help smokers quit.

Question put and agreed to.

NHS Strikes

Caroline Johnson Excerpts

Monday 17th April 2023 Commons Chamber

[Steve Barclay]

I share my hon. Friend’s concern. We have worked constructively with the Royal College of Nursing and, as I say, I was happy to put on the record my acknowledgment of the exemptions it had previously granted. I hope that between now and the end of the month, it will further reflect on the fact that the 48 hours of continuous strike action will happen without consultation with other staff council members and without waiting for the decision of other trade unions that are currently balloting. He will know that “Agenda for Change” is a deal that covers all the trade unions, not just the RCN in isolation, and I think it is right to wait for all the trade unions to vote and for the staff council to meet.

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

I draw the attention of Members of the House to my entry in the Register of Members’ Financial Interests.

On Friday, I was working at the hospital and my usual clinic had cancelled all but one patient. I spoke to the secretaries about the various cancellations they had had to make as result of the strikes, and I was really sad to hear not only that they had often been verbally abused by people who were upset, but that they have had to cancel some patients on two occasions because of the earlier strikes and the more recent ones. I was also sad to hear that we are looking at further strikes in the next few weeks.

Will the Secretary of State join me in thanking the members of staff who came into work, who did not strike and who continue to deliver a very important and valuable service? What is he doing to expedite the legislation on minimum service guarantees, so that we do not have any implications from strikes on emergency and intensive care in particular?

[Steve Barclay]

First, I thank my hon. Friend for her service and for the work she was doing on Friday. I join her in putting on the record my thanks to all those staff who did provide cover, as I said in my opening remarks. She is right to highlight the minimum service legislation, and we will obviously need to reflect on recent events in that context. She also points to the fact that the decision by the BMA junior doctors committee to advise members not to notify hospital management about whether they were striking obviously made it more likely that clinics would be cancelled, even when it then transpired that doctors could have provided cover. That is clearly regrettable and indicates the need for resolution, and we want to work constructively with the junior doctors on this.

NHS: Long-term Strategy

Caroline Johnson Excerpts

Wednesday 11th January 2023 Commons Chamber

[Dame Angela Eagle (Wallasey) (Lab)]

Through neglect, ideological hostility and incompetence, the Tory Government are presiding over the worst crisis the NHS has ever seen. Some 7.3 million people are on the waiting list; there has been a virtual collapse of emergency response; and people cannot see a GP or get follow-up treatment without unacceptably long waits. Today, there have been reports of more than 1,000 excess deaths a week—the highest total, excluding the pandemic, since 1951. There have been many, many preventable deaths on the Government’s watch, and each and every one is a tragedy.

Our NHS is in crisis from top to bottom. There are patients in hospital beds who cannot be discharged because there is no domiciliary care and nowhere for them to safely go. Ambulances are queuing for hours, unable to admit critically ill patients. There are inhumane waits in A&E before anyone can be admitted to beds they desperately need. Staff, who are already burnt out from the stresses of the pandemic, are unable to care properly for patients and are barely able to get through a shift because of the emotional exhaustion of having to deal with those failures.

A nurse at Arrowe Park in the Wirral, which serves my constituency, wrote to me recently. After 21 years of service to our NHS, she says she has

“never worked in such an unsafe environment”.

She says:

“Staff are literally on their knees, leaving shifts late in tears, and leaving in their droves”.

My constituent went on to detail a case in another local hospital in which a patient had a cardiac arrest in a hospital corridor. Frankly, a hospital should be the best place to have a cardiac arrest if somebody is going to have one, but it is now not so in Tory Britain. The individual collapsed and died.

With 132,000 NHS vacancies in England—over 17,800 in the north-west alone—our NHS is dangerously understaffed, under-resourced and under-respected. That is why NHS staff at the end of their tether have taken the desperate decision to go on strike. That is why any Government worth their salt would have decided to negotiate properly with them, to listen to them and to try to deal with and recognise that, in the last 13 years, a real-terms cut of 20% in nurses’ remuneration is simply not acceptable, but what did they do? They chose to have a divide-and-rule strategy, and they chose to try to scapegoat and blame NHS staff for the terrible conditions I have been talking about.

Perhaps the Government should consider legislating for a minimum service outside of strike days, because we are going to be in the absurd position of having, by law, guarantees on strike days—they could be negotiated anyway and always have been—that do not apply on non-strike days. It is an insult when the Secretary of State meets the health unions and says they have to increase their productivity. They are working beyond any amount of time that any human being should be asked to work.

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

I confess to being a bit confused by the Labour party’s position on minimum service levels. We all want to ensure that our constituents are as safe as possible. The ambulance workers want to ensure that people are as safe as possible. The hon. Lady has said herself that these things would be negotiated anyway. But the challenge people face on the ground is not knowing who is going to come in, the fact that people do not have a say on whether they are going to come in and the fact that a negotiated settlement might be different in different areas of the country, which makes messaging and public health messaging very difficult and puts people at risk. So why is Labour so against minimum service guarantees?

[Dame Angela Eagle]

I think the hon. Lady, and I know that she is a doctor, needs to recognise that these agreements have always been made when there have been strike days in the NHS—always. I think she also needs to recognise that any Government who were being responsible would have negotiated to put an end to these strikes, recognised the fantastic service that nurses have given and dealt with the issue, instead of going for confrontation.

[Dr Johnson]

Will the hon. Lady give way?

[Dame Angela Eagle]

I am not giving way again.

I am going to leave the last parts of my speech to another constituent of mine, an 83-year-old who fell alone in his home and was left. The ambulance was called at 4.15 in the afternoon—it was thought he had a fractured hip—and he was warned of a potential 14-hour wait. My constituent said he

“naively thought this must be the worst case scenario and thought it was very unlikely to be that long”.

He could not move, he could not sleep and he could not go to the toilet. Eighteen hours later, the ambulance arrived—18 hours later—at 10.15 the following morning. At the hospital, things got no better. There were patients on trolleys lining the corridors. For nearly another 24 hours, this 83-year-old man immobilised with pain was to lie on a trolley in a hospital corridor after 18 hours of waiting for an ambulance.

This is in no way acceptable. This should not be accepted by any Government worth their salt. They should hang their head in shame at what they have done to our NHS. We need to have a Government finally, which we will after the next election, who will solve these problems, instead of seeking to blame everybody else—the weather, the pandemic, the staff and any number of other things. It is about time we had a Government who have the guts to take responsibility for the decisions they have made and put it right. We are going to have such a Government soon. Shamefully, we have not now.

--- Later in debate ---

[John Redwood (Wokingham) (Con)]

No one can deny that the health service is under extreme pressure. No one can look at it and not realise that there has been a big surge in extra demand, that there are problems from the hangover of covid when a large waiting list for less urgent treatments built up, and that we are short of doctors and nurses, not because Ministers will not authorise their appointment but because there are vacancies to be filled. As one of those who has been urging for some time to see a published workforce plan, I welcome the decision of Ministers to insist on that, and the sooner we get it the better. However, I am quite sure that there are a whole series of workforce plans already in the many dozens and hundreds of working trusts and quangos that constitute the NHS. It is about aggregating and making sense of those plans.

[Dr Caroline Johnson]

We often talk about the shortage of doctors. We know we cannot create a doctor overnight. It takes a substantial amount of time to train them. The Chancellor, a former Health Secretary, invested in five new medical schools to increase the number of doctors in training. Does my right hon. Friend agree that the Chancellor, with the Health Secretary, needs to invest more money in more medical schools and medical school places, but also look at how we increase the number of doctors by reducing the amount of bureaucracy and paperwork they have to fill in, so that they can spend more time doctoring and less time filling in forms?

[John Redwood]

Yes, indeed. From my hon. Friend’s own expertise, I am sure she is right. When people talk about productivity, they do not believe that hard-pressed staff have to work harder; they are saying there must be smarter working, making jobs more manageable or enabling them to concentrate on the things they are most skilled at, with more relief for the other necessary record keeping, which may indeed need slimming.

My hon. Friend is right that we could expand our training places further, but as we have heard there has been a big increase in educational provision and it takes seven years for it to flow through. I am glad we are getting to the point where we will see some benefits from that. We need more homegrown talent. Many people are attracted to the privileged career of being a doctor and the more we can allow to do that, the better. However, given the immediate urgency of needing more capacity, and therefore more doctors and nurses, the most obvious place is to look at all those who have already had the training and have left the profession or the NHS for one reason or another. Some may be in early retirement. That is probably not something my hon. Friend wants to change because she enjoys her new job, but there are many others who are not in a very important job like her who might be attracted back. I hope the Treasury will be engaged in the review, because I hear from doctors, as many do, that the quirk in the tax system at just over £100,000 where some of the better paid doctors are resting, producing a more penal 60% rate, is an impediment to extra working. I also hear about the pension problems that have been cited on both sides of the House. The Government need to take those issues more seriously if they wish to accelerate returns.

Ministers have very clearly set out that they want more NHS staff and have obtained much larger budgets in the last three years to help bring that about. They have also said very clearly that the public’s priority—and indeed the Opposition’s priority—is to get more treatments and get those waiting lists and waiting times down for those needing more urgent or emergency care. Those Ministers must translate that through the senior health service managers into ways of spending that extra money. If it needs a bit more extra money, there is always some extra available—every time we meet another additional sum is announced—but it has to be well spent. It has to be spent on motivating and recruiting the medical workforce.

Oral Answers to Questions

Caroline Johnson Excerpts

Tuesday 6th December 2022 Commons Chamber

[Steve Barclay]

I refer the hon. Lady to the autumn statement, in which my right hon. Friend the Chancellor set out a wide range of support packages to help with the cost of living across the United Kingdom, including the cost of energy. That is part of wider discussions that we have on a regular basis with the Treasury.

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

The pandemic has had a devastating effect on the number of people waiting for treatment. In 2019, there were 54 women waiting more than a year to see a gynaecologist. That number is now more than 40,000. What is my right hon. Friend doing to reduce this wait?

[Steve Barclay]

This is a good illustration of the challenge the country faces with backlogs that are very much driven by the pandemic. We are working with senior figures such as Jim Mackey and Professor Tim Briggs and the Getting It Right First Time programme to look at patient pathways, how we use our diagnostics and our surgical hubs and streamlining the way we get services to patients where backlogs have built up.

Diagnostic Hospital: Stockton

Caroline Johnson Excerpts

Wednesday 26th October 2022 Commons Chamber

[The Parliamentary Under-Secretary of State for Health and Social Care (Dr Caroline Johnson)]

I congratulate my hon. Friend the Member for Stockton South (Matt Vickers) on securing this debate. He will appreciate that I am standing in for my right hon. Friend the Member for Newark (Robert Jenrick), who has been promoted to the Cabinet and the Home Office, so I ask him to forgive me if I do not have the answers to all of his questions, but I will ask the Department to write to him with those.

I know that this is an important subject for my hon. Friend and that he works tirelessly for the people of Stockton South on healthcare and on other matters. The waiting time for a diagnosis or an all-clear can be a very anxious one. It is something with which all of us who have been on a waiting list, or who have had a family member, a friend or a loved one on a waiting list, will be familiar. It is right that we do all we can to support services to recover from the pressures of the pandemic and to innovate and improve so that patients can have tests and receive diagnoses in a quicker and more convenient way.

Today, I will outline the work being done through the elective recovery programme to improve access to diagnostics and how that will impact patients across the UK, including in Stockton South. The waiting list for diagnostic tests in England currently stands at more than 1.5 million patients. Some 30% of those patients are waiting more than six weeks. That is up from a little under 1 million in 2019, before the pandemic. In the north-east and Yorkshire region, the waiting list for diagnostic tests is more than 213,000 patients, 26% of whom have been waiting more than six weeks. Community diagnostic centres are part of the answer and are a fantastic example of how we are providing more efficient, easier and more convenient access to vital services in the community.

The Government have committed £2.3 billion in capital spend as part of the 2021 spending review to support diagnostic services to recover and improve and to ensure that patients have access to often life-saving diagnostic tests that they need. This includes money to allow the NHS to continue to roll out a community diagnostic centre programme across England. This is a new way of delivering care, and it will ensure that elective diagnostic services are resilient in the face of winter pressures, because they have ring-fenced elective diagnostic activity.

Local healthcare systems, including NHS trusts, integrated commissioning boards, and local authorities, which know their patients and communities best, are being empowered to plan and bid for funding for new CDC sites, ensuring that they are placed where there is the greatest community need and the most clinical value, with successful bids ultimately signed off by the Secretary for Health and Social Care. I am pleased to say that 89 CDCs are currently operational across the country in a variety of sites, including hospitals, football stadiums and shopping centres, ensuring that patients have access to the care they need where they live. Those centres and hard-working NHS staff have so far delivered more than 2 million tests and are well on their way to providing capacity for 9 million tests a year by 2025.

With regard to the provision of a community diagnostic centre in Stockton, I am pleased to be able to inform my hon. Friend that the business case for the centre is currently in development. He will be pleased to learn that a large-model CDC, including capacity for imaging, physiological measurements, pathology and endoscopy, is planned for construction on the Castlegate shopping centre site, with plans for the centre to be fully operational by March 2025.

Castlegate is an ideal site for a CDC because of its accessibility for different population groups experiencing health inequalities, with excellent transport links. It is exactly the sort of area where the new centres can have the biggest impact. The Castlegate CDC will add to the 12 existing CDCs in the north-east and Yorkshire region and the four hub and spoke sites in the Tees Valley area, which have delivered more than 200,000 tests for patients in the north-east and Yorkshire region. Ten further sites across the north-east and Yorkshire are due to be approved in the near future and will all be operational by March 2025 to support our target of up to 160 CDCs.

I heard the comments of my hon. Friend the Member for Old Bexley and Sidcup (Mr French), but I am afraid I do not have the answers for him today. I will ask the Department to write to him with information on his specific bid.

[Alex Cunningham]

This is music to my ears. We have all worked very hard for this—local authority, health authority and politicians—and I am grateful for the positive message the Minister is giving us. Now I am going to be even cheekier and say that we desperately need a new general hospital to serve Stockton and the wider Hartlepool area. We need new facilities there. I hope, 12 or 13 years after the original hospital was cancelled, that this Minister will be the one to deliver it.

[Dr Johnson]

I thank the hon. Gentleman for his comments. The building new hospitals programme is in process and bids are in play, so I am afraid I cannot comment any further, as he will appreciate.

In conclusion, I encourage my hon. Friend the Member for Stockton South to continue his productive conversations with both his local ICB and NHS England to ensure that new developments in Stockton continue to support the local community health needs. I will ensure he is made aware when the proposal for the new centre has progressed further and when he can expect to see it open in his constituency.

I look forward to continuing to work with NHS England, local NHS systems such as the North East and North Cumbria ICS and fellow Members of the House to ensure that as a Government we meet the challenge posed by diagnostic waiting lists and ensure that patients are able to receive the often life-saving diagnostic tests that they need, as quickly and conveniently as possible.

Question put and agreed to.

Baby Loss and Safe Staffing in Maternity Care

Caroline Johnson Excerpts

Tuesday 25th October 2022 Westminster Hall

[The Parliamentary Under-Secretary of State for Health and Social Care (Dr Caroline Johnson)]

First, I thank all the Members who have taken the time to attend the debate and those who have spoken so openly about their own, and their constituents’, experiences and concerns. I particularly thank my hon. Friend the Member for Hartlepool (Jill Mortimer) for securing the debate and enabling us to have this important conversation.

Let me take this opportunity to recognise the work of everyone who has been involved in Baby Loss Awareness Week. It is important that we make it easier to speak about pregnancy loss and enable people to have open conversations about their experiences, which in turn can help those who have experienced the tragic loss of a baby. I also take this opportunity to commend the work of the charities that provide excellent support to families experiencing baby loss, including all the members of the Baby Loss Awareness Alliance and the Lily Mae Foundation, which was mentioned by my hon. Friend the Member for Meriden (Saqib Bhatti).

As we take time to reflect, I want to acknowledge how difficult the loss of a baby is. Everyone’s grief will be different. It is a personal, individual process, which people will try to navigate in many different ways. Although it can be challenging to reflect on such tragic losses, this week provides an opportunity for people to remember, reflect, share and seek support and comfort from other people.

This is the seventh year in a row that a debate has been held to mark Baby Loss Awareness Week. I am honoured to take part as the new Parliamentary Under-Secretary of State at the Department of Health and Social Care and to work with everyone to continue making a difference in an area as vital as maternity and neonatal safety.

The independent review into maternity and neonatal services at East Kent Hospitals University NHS Foundation Trust, as mentioned by my right hon. Friend the Member for North Thanet (Sir Roger Gale), was published last Wednesday. I take this opportunity to extend my condolences to the families who suffered due to the care they received and express my gratitude to the individuals who were instrumental in establishing the review and to the inquiry team for carrying out the review to such a high standard. The Government and I take the findings and recommendations of that report extremely seriously, and I am committed to preventing families from experiencing the same pain in the future.

Our maternity safety ambition, as mentioned by my hon. Friend the Member for Hartlepool, is to achieve half the 2010 rates of stillbirths, neonatal and maternal deaths, and brain injuries in babies occurring soon after birth. Since 2010, the rate of stillbirths has reduced by 19.3%, the rate of neonatal mortality for babies born over 24 weeks gestational age has reduced by 36% and maternal mortality has reduced by 17%. However, it is important to note that there was an increase in the rate of stillbirths between 2020 and 2021. This increase occurred at the same time as the covid pandemic, and detailed work is going on to establish why that was the case. I reassure hon. Members that we remain committed to our maternity safety ambition.

Every woman giving birth has the right to a safe birth, and the Government and NHS England are committed to providing women with personalised and individual maternity care. The role of NHS staff in maternity services is critical to safe care for families, and I recognise all the great, hard work by teams across the country and thank them for it.

Members on both sides of the Chamber have talked about funding and workforce. NHS England has invested £127 million in bolstering the maternity workforce even further and in programmes to strengthen leadership and retention and provide capital for neonatal maternity care. We will keep that funding under review. That investment is on top of the £95 million investment made last year in the establishment of 1,200 more midwifery posts and 100 more consultant obstetrician posts. There are increasing numbers of midwifery and obs and gynae trainees.

I am grateful to the APPGs on maternity and on baby loss for producing their report into the maternity workforce, and I acknowledge the important themes in it. The hon. Member for Enfield North (Feryal Clark) raised the issue of retention. NHS England has established a nursing and midwifery retention programme, supporting organisations to assess themselves against a bundle of interventions aligned to the NHS people promise and it will use the outcomes to develop high-quality local retention improvement plans. In addition, in 2022-23 we made £50,000 available for each maternity unit in England to enhance retention and pastoral support activities.

[Bell Ribeiro-Addy]

Will the Minister give way?

[Dr Johnson]

I will not, because I have a lot of questions to get through in a really short time.

Many hon. Members talked about bereavement. In the difficult scenario of baby loss, we understand that bereavement care for women and families is critical. We continue to engage closely with the bereavement sector to assess what is needed to ensure that bereaved families and individuals receive the support that they need. This year we have provided £2.26 million of national funding to support trusts, expand the number of staff trained in bereavement care and directly support trusts to increase the number of days of specialist bereavement provision that families can access.

In the women’s health strategy, which hon. Members mentioned, published earlier this year, we discussed the introduction of pregnancy loss certificates for England. This will allow a non-statutory, voluntary scheme to enable parents who have experienced a pre-24 weeks pregnancy loss to record and receive a certificate to provide recognition of their baby’s potential life. The certificate will not be a legal document, but it will be an important acknowledgement of a life lost, and we hope that it will provide comfort and support by validating a loss.

We understand the impact of pregnancy and childbirth on mental health, especially for those affected by the loss of a baby, and we are committed to expanding and transforming our mental health services so that people can receive the support that they need when they need it.

As part of the NHS long-term plan, we are looking to improve the access to and quality of perinatal mental health care for mothers and their partners. Mental health services around England are being expanded to include new mental health hubs for new, expectant, or bereaved mothers. These will offer physical health checks and psychological therapy in one building.

[Guy Opperman]

I accept that my hon. Friend has many things to cover today. As a former Minister, may I advise her that she might want to be encouraged to write to everyone with detailed answers from civil servants to the points raised?

Does my hon. Friend agree on one key point—that the collation of data and the consistency of approach must be nationwide? While we have many wonderful trusts, that has to be driven by the NHS, for which she is a Minister.

[Dr Johnson]

I absolutely agree with my hon. Friend.

Going back to the issue of perinatal mental health, we have previously funded Sands, the stillbirth and neonatal death charity, to work with other baby loss charities and the royal colleges to produce and support the roll-out of a national bereavement care pathway to reduce the variation in the quality of bereavement care provided by the NHS and ensure that, wherever a woman and family are being cared for, they get a high standard of care. The pathway covers a range of circumstances of baby loss, including miscarriage. As of April this year, 78% of trusts in England had committed to adopting the nine national bereavement care pathway standards.

The hon. Member for North Ayrshire and Arran (Patricia Gibson) talked about pre-eclampsia. NHS England is establishing maternal medicine clinics. These are specialist networks across the UK, which will manage pre-conception, antenatal, post-natal and medical issues in women, and reduce long-term morbidity, thereby improving outcomes for those women who have co-existing medical conditions.

My hon. Friend the Member for Macclesfield (David Rutley) spoke about the maternity unit in his constituency. I know that he is a doughty campaigner for that unit. I will write to him with further information on progress in that area.

The hon. Member for Caithness, Sutherland and Easter Ross (Jamie Stone) talked about the Scottish health service and how it is performing in relation to maternity care. It is, of course, a devolved issue in Scotland, but I was moved to hear about what is happening in areas of the north of Scotland near Elgin. I would encourage the devolved Scottish Administration to consider carefully what is going on there and to see what they can do to improve care. It seems unacceptable for women to travel 102 miles to give birth.

The NHS in England has a medical education reform programme, co-sponsored by NHS England and Health Education England, to direct investment for specialty training for population needs back towards smaller and rural hospitals. That programme entered its implementation phase in August 2022.

Hon. Friends mentioned The Lancet recommendations. While the pregnancy loss review will be published shortly, I am not in a position today to commit to what it is going to say, but we will consider it carefully.

[Feryal Clark]

I understand that the Minister is not in a position to comment on that review, but now that she has had the opportunity to review the recommendations from the East Kent investigation by Dr Kirkup, is she in a position to say whether the Government will accept those recommendations, or when the Government will announce whether they are going to accept them? They will have a nationwide impact.

[Dr Johnson]

I thank the hon. Lady for her question. We were both horrified by the East Kent report, which made for extremely difficult reading. We are carefully considering the review. The hon. Lady will appreciate that we are having a change of Prime Minister today and possibly a change of Minister too, so it is difficult for me to make any commitments at this stage, beyond that the Government will consider the matter carefully and further information will be provided in due course.

Let me conclude by making three broad points. First, we appreciate how difficult and distressing baby loss can be at any point in pregnancy and childbirth. I highlight again the importance of sharing experiences and coping mechanisms that may guide other families through their own bereavement. It is important to continue this conversation past this year’s campaign and, again, I thank my hon. Friends who shared deeply personal experiences.

Secondly, I touched on the important range of targeted programmes we are developing to better support families with their bereavement and ensure all families have access to the care they need and deserve, such as pregnancy loss certificates and the national bereavement care pathway. We understand how difficult baby loss can be, and families deserve compassionate and personalised care from their local health professionals.

Thirdly, we are committed to our maternity safety ambition to halve the 2010 rates of stillbirth, neonatal and maternal death, and brain injuries in babies occurring during or soon after birth. NHS England will consider the actions from both the Ockenden report and the East Kent report and map a coherent delivery plan for maternity that will be delivered through the maternity taskforce programme. We have also established a joint working group led by the Royal College of Midwives and the Royal College of Obstetricians and Gynaecologists to help deliver the plan as effectively as possible. I thank hon. Members for taking time to be here today and I thank everyone who took part in Baby Loss Awareness Week.