E-cigarettes

Kevin Barron Excerpts

Thursday 31st October 2019 Westminster Hall

[Norman Lamb]

I totally agree. The statistics that I am citing make the point about raising awareness, even among clinicians. We thought that it was just the general public who needed to understand better the relative risks, but clearly clinicians also need to understand the relative risks so that they can advise their patients more effectively.

Two in five clinicians feel uncomfortable recommending e-cigarettes to their patients who smoke. Again, that is an extraordinary finding. Fewer than three in 10 agree that their current knowledge is enough for advising patients about e-cigarettes. That extraordinary data reveals a clear need for the awareness raising to which the hon. Member for Dartford (Gareth Johnson) has just referred.

What assessment has the Minister made of the number of smoking cessation services in the NHS that are actively promoting e-cigarettes as alternatives to conventional cigarettes? It ought to be every single one throughout the country, but are they actually doing it? Do we know? Can the Minister tell us what work the Government are doing with NHS England on increasing knowledge among clinicians of the uses, benefits and risks of e-cigarettes for current smokers?

Our report recommended that NHS England should create a post for someone who is responsible for implementing the Government’s tobacco control plan. The response said:

“The Government broadly accepts this recommendation.”

However, no specific steps to implement our recommendation were set out. We pursued that with NHS England, which in January told me:

“It is our intention to appoint an individual with lead responsibility for this role. This will be an important part of our delivery programme for the NHS Long Term Plan.”

We would all assume that that person was appointed long ago and that active work is now underway to pursue this vital agenda, which will save lives, but can the Minister confirm that NHS England has created that post and, if so, is someone actually in post and doing the job?

The Government say that, in their long-term plan, provision is made for

“all smokers who are admitted to hospital being offered support to stop smoking”.

That is not due to be fully implemented until 2023-24. Again, given the extraordinary health benefits of stopping people smoking, I would have hoped for a tighter timescale than ’23-24 to implement that. Will the Minister tell us how implementation of that proposal is going and whether consideration is being given to implementing it fully before 2023-24?

Our report recommended that the NHS should have a clear policy on e-cigarettes in mental health facilities that establishes a default of allowing e-cigarette use by patients. This comes back to my point that approximately 40% of those with severe and enduring mental ill health still smoke. The attitude and culture within mental health trusts is critical if we are to enable and help people with severe and enduring mental ill health to give up smoking. We said that it should be the default that e-cigarettes should be made available in mental health facilities unless there are clear evidence-based reasons for not doing so.

The Government response said:

“NHS England will provide guidance to mental health trusts that sets out that existing vapers should be permitted to use e-cigarettes as part of smoking cessation programmes, and…tobacco smokers should be supported to stop smoking through smoking cessation programmes”.

Can the Minister tell us whether that guidance has been issued? I very much hope that it has. If not, when will it be issued and what is the reason for the delay in issuing such important guidance? If it has been issued, what assessment has been made of how it is working?

The UK is making good progress in getting people to stop smoking and use e-cigarettes to achieve that, but that is at risk from recent concerns about e-cigarette use. Those concerns have been expressed particularly in other countries. We have put the concerns to Public Health England. The first is the claim that deaths in the US have been linked to the use of e-cigarettes and vaping products. The reality is that the US operates in a totally different regulatory context and “illicit products” were

“implicated in this outbreak…including vaping cannabis derivatives.”

That is from Public Health England. It has also explained that

“the suddenness of the outbreak across many USA states in just a few months, suggests that this is not a gradual effect of long-term use, but because of a specific agent coming into use in the affected population.”

Next are the concerns that flavoured e-cigarettes are “luring” children into vaping. Public Health England’s response explained that the data it had seen so far was reassuring that e-cigarettes were not re-normalising smoking. Furthermore, the UK and the US have different rules on advertising, nicotine concentration and education on vaping, which explains why flavours of e-cigarettes are less impactful in the UK compared with the United States.

The next issue is the introduction of a ban in India on the production, import and sale of e-cigarettes because of concerns about the risks that they pose to health and to the young. Again, an assertion has been made that is at risk of infecting the debate that we have in this country. However, Public Health England has explained:

“India is one of several countries that appears to be responding to the outbreak of lung disease among cannabis”

vapers

“by proposing a ban on nicotine inhalers.”

It has also explained that smoking is far more prevalent in India and causes 7 million deaths a year there.

[Sir Kevin Barron (Rother Valley) (Lab)]

Is it not true that India has a massive vested public interest in the tobacco industry?

[Norman Lamb]

I suspect that the right hon. Gentleman knows better than I do, but I note the point that he makes. My view, based on the evidence that the Committee heard, is that the action taken by India is not based on evidence and is likely to result in more people dying of lung cancer. I think that is shameful.

I encourage all right hon. and hon. Members to read the helpful and comprehensive reply that we received from Public Health England on these issues and others, and which we have published so that anyone can delve into the detail. I am reassured that Public Health England is in “close dialogue” with a range of international partners, and I agree with Public Health England when it says:

“It is no exaggeration to say that inflating fears about e-cigarettes could cost lives.”

Incidentally, I have concerns about the attitude at the World Health Organisation, which does not take the same evidence-based approach, as far as I can see, as this country has done. Again, that has implications through the potential loss of life for millions of people across the globe.

It seems to me that people often conflate the fact that we do not have all the long-term evidence on vaping impact with an assertion that that should lead us to conclude that we should not be recommending vaping as an alternative to smoking. Frankly, that is stupid as a public policy approach, because we know that smoking is killing—I think—more than 70,000 people in England every year, and all the evidence so far shows that nothing like that is happening from vaping. According to Public Health England, it is 95% less dangerous than smoking. Therefore, the clear public health advice has to be that vaping is an appropriate way to help people give up smoking. Of course, the best thing of all is not to vape and not to smoke, but if that is not possible for someone, the clear public health advice needs to be that vaping is better than smoking.

Will the Minister set out what contact the Government —she or other Ministers—have had with other countries on international approaches to e-cigarettes? In particular, what are they doing at the World Health Organisation to encourage a more enlightened approach? What assessment have the Government made of the effects of those international approaches on public perception of e-cigarettes in the UK? What steps will the Minister take to ensure that this misinformation on e-cigarettes is challenged?

--- Later in debate ---

[Sir Kevin Barron (Rother Valley) (Lab)]

I am really happy to be here this afternoon, also giving my last speech in Westminster Hall, which is something that I have been looking forward to for a considerable time—since 2016, when something that I do not want to mention happened.

I have been active in smoking cessation over many years in Parliament. This is a good, well sourced and evidenced report about where we should move in the future to protect our fellow citizens. Let me admit two things—this is a bit of a confession. First, it has been more than 40 years since I stopped, but I, too, used to smoke cigarettes; I was quite addicted. Secondly, I ought to mention that although there is no money in it, I am an honorary fellow of the Royal College of Physicians.

The report makes it clear that e-cigarettes have proven to be a unique opportunity to steepen the decline of smoking rates in this country. They lack the dangerous tar and carbon monoxide components of conventional tobacco cigarettes and are consequently 95% safer, as Public Health England says. It should also be noted that second-hand vapour from e-cigarettes is substantially less dangerous than from tobacco cigarettes. As we all know, e-cigarettes can and do operate as a pathway from conventional smoking to quitting altogether. At present, something like 2.9 million Britons use them as a pathway towards quitting, with tens of thousands successfully stopping each year.

We were all surprised that under the previous tobacco control plan we got well below the target adult smoking rate: it is below 16% now, which is extraordinary. Sadly, that was not because e-cigarettes were used in smoking cessation programmes, although in my view that should be the future; it was because millions of our fellow citizens were buying those products themselves. Getting adult smoking below 16% is no mean feat, but more than 80,000 of our fellow citizens are still dying prematurely from tobacco use each year. We should never forget those statistics. If anything else were taking lives in this country every year at that level, we would be up in arms and this House would have done more to stop it.

Cancer Research UK’s briefing recommends that e-cigarettes be used as a tool to aid smokers who wish to quit in achieving their goal. However, it rightly points out —as the Chair of the Science and Technology Committee, the right hon. Member for North Norfolk (Norman Lamb) did—that unfortunately surveys have shown that 40% of clinicians are uncomfortable recommending e-cigarettes to their patients, and a further third are unsure whether they are safe to recommend, notwithstanding what Public Health England says about them. Moreover, just 30% feel that their knowledge is sufficient to advise patients on vaping.

Healthcare professionals must be made aware of the benefits of e-cigarettes in aiding people to quit. Although vaping is not completely risk-free, the reality is that it is significantly safer than smoking conventional cigarettes. Healthcare professionals must be made fully aware of that, so that they can ensure that their patients have the strongest chance of quitting smoking. It is difficult, and it may not necessarily be something that new doctors or doctors in training will be looking at. However, any health professionals attending or reading this debate, especially general practitioners, could do worse than go round to the vaping shop on their local high street to talk to the people who sell the products, because those are the people who trace their patients. They will know people who have gone from 50 cigarettes a day to none, or who used to need higher hits of nicotine but are now on lower and lower doses. I know people who still vape but use no nicotine at all; they are satisfying not an addiction, but a habit of using their hands. That is what ought to happen. It is quite true that there is no long-term evidence, just as there was not when the first heart transplant happened in South Africa, but it is pretty clear that there is evidence out there in our communities. We need our health professionals to go and talk to the people who have probably been dealing with their patients for some time.

Naturally, many people have raised deep concerns about whether vaping can operate as a gateway to smoking conventional tobacco cigarettes, but there is no evidence to suggest that such a phenomenon has materialised in any meaningful or demonstrated way. ASH, which I have been active with in this country for decades, has been monitoring what is happening annually, particularly around young children, and there is no evidence that it is causing nicotine addiction and leading people on to cigarettes.

I have to say that some of the evidence that we have seen about vaping in America is shocking. Some of the stuff that they put in is class A drugs—that is why we are having deaths. I know from going to America from time to time, where I have two step-grandchildren, that one company, which shall remain nameless in this debate, has been promoting vaping to young children with different flavours, although not necessarily with nicotine. When we talk to schools about it, they are up in arms about the nuisance and the litter. There is something to think about there, but we should not be too scared of it.

Although there are advertising restrictions and regulations on vaping, they are less stringent than those that apply to tobacco products. In June, the Library published a briefing paper that is well worth reading, “Advertising: vaping and e-cigarettes”. I first campaigned against tobacco in the 1993-94 Session when I introduced the Tobacco Advertising Bill, a private Member’s Bill to ban tobacco advertising and promotion. We are a long way down the road now, but there are still lessons to be learned from the Library’s paper about how these products are advertised.

The Science and Technology Committee has recommended that cigarette pack inserts could be used to refer smokers to e-cigarettes as a healthier alternative, but unfortunately that is currently banned under the Standardised Packaging of Tobacco Products Regulations 2015. We need to think quickly, because the people addicted to cigarettes are the ones who are going into shops and buying e-cigarettes. They are the people we should be targeting; I do not think that we can do it with things like websites. We could change those regulations in super-quick time—I can’t, because I’m off, but Parliament could, which would put us in a position to get to the people who are still addicted.

E-cigarettes need to be endorsed as mainstream in cessation programmes. About three years ago I visited the Leicester smoking cessation programme, which has been at the forefront of using such products. It has a wonderful scheme—led by a nurse at the time—in which pregnant women vaped at least throughout their pregnancy, which greatly enhanced the health and the life chances of their child. There is no reason why we should not make that mainstream. I know that people who smoke will now be referred to community pharmacies; that is good, but we should be looking at specific interventions with these products for people who are vulnerable, including unborn children.

Smoking cessations ought to be funded directly by the tobacco industry. I know that that would be an issue for the Treasury, but the Minister will need to talk to it. We often talk about making the polluter pay; tobacco companies should be paying for our smoking cessation programmes. Sadly, as we have said in previous debates, some of those programmes are now fading away. There are parts of this country that still have heavy and intense levels of adult smoking but have no smoking cessation programmes at all. That is wrong and, with more than 80,000 deaths a year, it should be stopped.

[Gareth Johnson (Dartford) (Con)]

Unlike the three previous speakers, I rather hope that this will not be my last speech in Westminster Hall—but that is up to the people of Dartford, not me.

I am pleased to contribute to the debate, because I feel strongly that vaping is something that we should embrace as a country. It has been mentioned that Public Health England says that vaping is 95% risk-free; that is really significant, and it is not just Public Health England making such statements. Cancer Research UK says that there are significant benefits from vaping in comparison with tobacco consumption. ASH, the British Heart Foundation and the British Lung Foundation—organisations that understandably have traditionally frowned on anything associated with smoking—recognise that vaping saves lives. That is what we are talking about, and the sooner the country recognises that we have an invention that could save thousands of lives in the UK, let alone the rest of the world, the sooner we can start saving the maximum possible number of lives.

It was with great regret that we heard the stories coming out of the United States. It was only when we starting drilling down and saw that the deaths were potentially linked to acetates, cannabis oil and so on—those are the irritants actually causing the deaths—that we recognised that we should not allow those tragic circumstances to cloud people’s image of vaping. It is not only clinicians who are unsure about vaping, and whether they can recommend it to patients; the general public are also unsure whether vaping is as safe as some experts have said. We need to educate people, and say that it is a well-known fact that tobacco seriously damages health and therefore is highly risky, but that with vaping the risks are substantially smaller.

Nobody in this debate, or anywhere in the House of Commons that I am aware of, is suggesting that people who do not smoke should take up vaping. The suggestion is that it is people who smoke, and who are addicted to tobacco and nicotine, who will benefit from vaping. There are risks associated with pretty much anything, and vaping is no exception. The message should go out loud and clear that people who do not smoke should not start vaping, but people who smoke may wish to try that alternative as an effective way of reducing their tobacco consumption, or helping them to come off tobacco completely.

I welcome the fact that some tobacco companies have embraced vaping; they realise its potential. Japanese Tobacco International has highlighted to me some of the dangers associated with products that do not contain nicotine, and so do not come under the Tobacco and Related Products Regulations 2016 and can be targeted at children. They can be marketed to look like food, or something trendy that people will want to get involved with, and as they do not have to comply with the tobacco regulations, their ingredients are not known. We need to look at that.

The Science and Technology Committee, chaired by the right hon. Member for North Norfolk (Norman Lamb), has looked at the 2016 regulations, which have serious flaws. For a start, they should not lump together tobacco and vaping products; they should be covered by separate regulations. That would bring an end to the ridiculous situation whereby a vaping product that has no nicotine in it must have a warning on its front saying, “This product contains nicotine”. If the vaping company does not put that warning on its product, it will fall foul of the regulations, but if it does, it might fall foul of other regulations. It is a crazy situation that has developed.

We need to consider whether it is right to allow more advertising of vaping products. I believe that it is, but regulations seem to prevent that. I think it is right that we should enable people to be educated, and aware of the products available and their potential benefits.

I do not want to turn this into a debate on Brexit, but there is no getting away from the fact that once we leave the European Union, we as a country can look at the regulations ourselves, and see what best suits our needs and what would be a sensible approach to vaping. We can ensure that people are aware of vaping and can benefit from it, so we should do so.

I have met a number of organisations that are trying to push forward a change in vaping regulations. Imperial Brands—formerly Imperial Tobacco—is doing a lot, and there is also a company called Blu, whose products are pioneering. That is a key part of the process. Companies are investing a lot in developing products that will be attractive to smokers, in that they will satisfy their cravings, so that they feel less necessity to smoke cigarettes.

I do not want to demonise smokers. If an adult chooses to smoke, knowing the risks, that is their decision. However, it is incumbent on the Government to ensure that people are aware of the alternatives to smoking, of the risks, and that there is comparatively less risk associated with vaping.

The Government are rightly pursuing a target of reducing the number of people who smoke and eventually eliminating smoking in this country. That is very ambitious, and if we are to achieve that, it will be necessary to introduce people to vaping through their GP.

[Sir Kevin Barron]

On this idea that smoking is an adult thing, very few people start smoking after the age of 21. The hard reality is that for most people, the starting point comes when they are quite young. I think I was about 11 or 12 when I started getting addicted to nicotine. I think we have to be very careful about this. It is not really an adult choice; it is just something that adults have done from a very early age.

[Gareth Johnson]

I totally agree. I take the view that if adults want to smoke, knowing the risks, that is up to them. However, there is a duty of care on the Government to ensure that tobacco products are not consumed by children. That is absolutely clear, and it is right that we keep the age at which people can start vaping at 18; we do not want vaping products targeted at children. In my experience, no responsible vaping company would do that or has done that.

The Government approach is sensible. I believe that they can embrace the potential of vaping to save lives. There are so many measures that could be taken—through the taxation system, through advertising, through education, and by making people aware of these products and making them more accessible to smokers.

We must recognise that for the first time in my life, there is something that genuinely can help people to get off tobacco—something effective that works. If we look at a graph of the number of people smoking and a graph of the number of vapers in this country, we can see a direct correlation: the more people vape, the fewer people smoke. We need to highlight that and celebrate it, and the Government should take that forward.