Tobacco and Related Products Regulations 2016
Lord Hunt of Kings Heath Excerpts(9 years, 7 months ago)
Lords ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Lord Hunt of Kings Heath
As an amendment to the above motion, to leave out “and calls upon Her Majesty’s Government to withdraw them” and insert “and further regrets that the Regulations are not to be accompanied by a public information campaign to reassure smokers that electronic cigarettes are less harmful than normal smoking; that smoking cessation services are being cut back at the same time as the Regulations are being introduced; and that the Regulations are due for implementation before the Government have published their tobacco strategy.”
Lord Hunt of Kings Heath (Lab)
My Lords, I welcome this debate and thank the noble Lord, Lord Callanan, for allowing us to have a further go, since we have already debated it in Grand Committee. I am sure the Minister is looking forward to winding up at the end of the debate.
I should declare an interest as president of the Royal Society for Public Health, which has pronounced on e-cigarettes. I would say to the noble Lord, Lord Callanan, who was a mite critical of the organisation, that as a Minister I established the MHRA, and I am glad to see that it is doing so well in relation to this matter. I liked his rousing endorsement of the record of Ministers in his Government on this matter. When he mentioned Edwina Currie, I thought he was going to talk about eggs—he will recall that she had a bit of a downer on egg production—but she did not quite take it to Europe in the way he suggested.
I have moved an amendment to the Motion because, although I share some of the noble Lord’s concerns about the regulations in relation to e-cigarettes, my problem with his Motion is that he calls on the Government to withdraw the entire set of regulations. The regulations cover e-cigarettes, but there are also a lot of useful measures that will discourage smoking in general. That is why I cannot support the noble Lord’s Motion, although I share some of his concerns.
It is pretty clear from the work of my own organisation, the Royal Society for Public Health, as well as from that of the Royal College of Physicians and other health bodies, that e-cigarettes can actually be an incredibly useful tool in encouraging smokers to give up smoking. The core of people who have already taken advantage of e-cigarettes are often those whom traditional public health measures have not touched. That is why I am particularly concerned about whether the regulations will have a negative impact on that group.
Equally, I know that noble Lords will quote the report of the Royal College of Physicians. It is worth reading because it says that there is a case for some regulatory provisions, and the Minister will no doubt refer to that. However, my main concern is the point, which was made by the noble Lord, Lord Callanan, that RSPH research has revealed that 90% of the public have the impression that e-cigarettes are at least as harmful as tobacco. That is not helped by the fact that some organisations have notices prohibiting not just smoking, but vaping. Because some elements in the public health field—how can I put this kindly?—perhaps got the wrong end of the stick when e-cigarettes were first produced, they have given the impression that e-cigarettes are much more harmful than they are. The problem with the regulations is that they colour the context, and the public may be confused about the positive effect that e-cigarettes can have. Therefore my amendment to the Motion—I do not intend to delay the House very long—seeks to draw attention to some of the concerns that we have about the regulations on e-cigarettes, although we wish to see the regulations introduced as a package.
However, I also draw attention to the other problem that we have with the Government’s current policies on smoking cessation, which is that budgets, particularly those which go to local authorities, have been drastically reduced, and we have seen a drastic reduction in smoking cessation services. As an example, the amount of money that has been spent on smoking cessation media campaigns has been drastically reduced. Some £24.91 million was spent in 2009-10, which has become £5.3 million in 2016. Of course, I understand budgetary constraints, but I would also say that because of the risk of confusion by the public over e-cigarettes, some Department of Health-sponsored public campaigning is necessary to get the right facts across to the public.
Lord Forsyth of Drumlean (Con)
The noble Lord said that he could not support my noble friend’s Motion because it referred to all the regulations. Why, then, does his amendment not seek simply to delete Parts 6, 7 and 8 of the regulations? Which parts of the regulations as they stand does he not agree with?
Lord Hunt of Kings Heath
I thought that my amendment elegantly dealt with the broad principles rather than going into technical details such as which paragraph I do not like. I am disappointed by the noble Lord’s intervention on that matter. No doubt he is stunned by his noble friend’s remarks that in fact the EU came to the rescue of the UK. We know that if the EU had not legislated in this area, the Government would certainly have brought in legislation much earlier which would have been much more draconian than the regulations that are before the House tonight.
Lord Hunt of Kings Heath
No doubt we will of course be able to see in the future what a Government would do in the event of Brexit. However, to be fair, at the moment we are debating these regulations, which have come into force. I have attempted to signal some of my concerns that this would have a negative impact on the use of e-cigarettes without detracting from the overall regulations. I beg to move.
Baroness Walmsley (LD)
My Lords, I was most interested in the speech made by the noble Lord, Lord Callanan, and in particular his gallant admiration of his colleague the Public Health Minister, who in my experience has usually been quite on top of her brief. I venture to warn the noble Lord never to make a mistake in your Lordships’ House, because I suspect that Facebook might be watching. I was also very moved by his defence—in fact it was quite tear-jerking—of the discrimination against the multi billion pound tobacco companies compared with the multi billion pound pharmaceutical companies.
I agree with much of what was said by the noble Lords, Lord Callanan and Lord Hunt of Kings Heath, about the desirability of encouraging smokers to give up smoking. There is no doubt that vaping devices have an enormous role to play in this campaign, as many former smokers have managed to give up through using them. However, the regulations are not just about vaping devices but include, as the noble Lord, Lord Hunt, pointed out, standardised packaging regulations, which are essential for ensuring the effectiveness of the health information and warnings on cigarette packs. They also help to enable the UK to meet its obligations as a party to the World Health Organization’s Framework Convention on Tobacco Control with respect to tobacco packaging and labelling, and product regulation.
There is no doubt that vaping devices have already been an enormous benefit to public health—although I fail to see why we need 25,000 different kinds of them—and have saved the NHS a great deal of money. When the directive to which these regulations give effect was first discussed in the European Parliament, as has been said, the Liberal group, which contained at that time several Liberal Democrat MEPs, worked hard to ensure that while the regulation of tobacco packaging continued to be robust, the regulations about vaping devices would be proportionate. Given that the original proposals followed the World Health Organization’s recommendation that these products should be licensed as medicines and would therefore be extremely tightly regulated, the Liberal group had some considerable success in making them a bit more proportionate, resulting in the directive as it is now. However, one of the things on which the group was not successful was the prohibition of commercial advertising of vaping products. This is the major item contained in my regret Motion.
According to the Royal College of Physicians, vaping is 95% less harmful than smoking and half of all smokers die from diseases that result from smoking. That is why it is vital that smokers can get information about these products and their benefits, and I regret very much that publicity about them is to be restricted. However, I support the noble Lord, Lord Hunt, in his call for a new public information programme to inform smokers of the benefits of switching to e-cigarettes. It may surprise your Lordships to know that half of smokers are not aware of how much safer for their health e-cigarettes are. I also agree with the noble Lord, Lord Hunt, in regretting the cutting of smoking cessation services—one of the many results of the public health funding cuts which I have condemned many times in your Lordships’ House.
I suppose that one of the reasons for the advertising ban is the fear that advertising will attract young people to vaping even though they have never smoked. This is of course undesirable, because nicotine vapour is very addictive, and I would not want to see children being attracted to spending their money on something so addictive and with no known benefits to their health. Indeed, more research needs to be done on the effect of nicotine inhalation combined with the various flavouring chemicals used in e-cigarettes. Some evidence is emerging that if inhaled, some of the flavourings may be harmful to the delicate cells lining the lungs. But although e-cigarettes have been around for years, there is no significant evidence that they are attracting non-smokers to take them up. On the other hand, we now have a large and growing cohort of people who use vaping devices, which is why I call on the Government to fund research on the benefits and—if there are any—the dangers of vaping.
Everything should be done to encourage smokers to switch to vaping, which is why my Motion also regrets that little attention has been paid to those vapers who claim that they need the higher-end concentration of nicotine products, which would be banned by some of these regulations, to help them give up smoking. Only time will tell whether that is the case. That is why the Government need to monitor and report on the implementation of these regulations and their impact on public health. While the further regulations on cigarette packaging are likely to be good, those on vaping devices could turn out to be bad.
Therefore, like the noble Lord, Lord Hunt, I do not support the Motion in the name of the noble Lord, Lord Callanan—that the Government should withdraw these regulations—because we need the ones that affect tobacco. However, although I sincerely regret the Government’s current intention to withdraw from the European Union in the fullness of time and hope very much that it never happens, the current situation does give us an opportunity. As things stand we are not able to keep the good tobacco regulations and ditch the undesirable ones, but the forthcoming negotiations do give us an opportunity to do a bit of cherry picking.
I therefore ask the Minister, what is the Government’s intention with regard to these and other EU regulations? Do they plan to adopt them all and then repeal the ones they do not like? If so, I call on the Government to consider carefully any deterrent to smokers switching that might result from these regulations, and to repeal the ones that deter them as soon as possible. Of course, that would require careful monitoring and publication of the results. On the other hand, in the unlikely event that the Government plan to repeal all EU regulations and then adopt new UK ones, I call on them to replace only the ones that affect tobacco packaging and marketing to further decrease the public health burden of tobacco and the terrible effects on the health of individuals and the NHS.
Given that all these regret Motions are non-fatal, I do not intend to vote on mine, although if the noble Lord, Lord Callanan, votes on his, my colleagues and I will vote against it. We are where we are. What matters now is what the Government do in future. Lives depend on it.
Lord Prior of Brampton
It is possible. There is always a possibility when there is a regulation that a black market will develop, and for the very high-strength products, which had to be regulated by the MHRA—the ones above 20 milligrams—there is a risk that there will be a black market. I think I recall that the noble Lord said earlier that a black market had already developed in this product. We are trying to bring some minimum quality standards, at least, into this market so that people who are thinking of moving from smoking to using e-cigarettes can have confidence that the product they use is regulated to a minimum standard.
I remind noble Lords that new and important tobacco control measures are also contained in these regulations. I have not talked about them specifically because they are slightly off the main point of this debate. The regulations will be reviewed within five years of entering into force. I also commit, here and now, to commissioning Public Health England to update its evidence report on e-cigarettes annually until the end of this Parliament and to include within its quit-smoking campaigns consistent messaging about the safety of e-cigarettes.
Clearly, there are strong arguments on both sides of the debate. As I said, I am not an instinctive regulator by any means but I feel that these regulations are proportionate. They do not go over the top, are entirely sensible and are backed by the RCP and all the major charities in this area. I hope that my noble friend Lord Callanan will not wish to push this to a vote, but of course that is entirely his decision.
Lord Hunt of Kings Heath
My Lords, I thank the Minister for his wind-up, which I think was very fair. I agree with him that this has been an excellent debate and various views have been put forward. I understand why some noble Lords have concerns about e-cigarettes, particularly in relation to young people. I understand that there are still some uncertainties. I accept that there is a need for some regulation in relation to e-cigarettes.
The Royal College of Physicians produced an excellent and dispassionate report but in the end it concluded that, while not absolutely safe,
“the hazard to health arising from long-term vapour inhalation from the e-cigarettes available today is unlikely to exceed 5% of the harm from smoking tobacco”.
That is a pretty powerful statistic. The royal college supports the regulations—I understand that. We have been told by the noble Baroness, Lady O’Cathain, that 2.8 million people currently use e-cigarettes. We know that often it is the poorest people in society whom many of the traditional approaches to giving up smoking have not touched. Equally, we know that there is a problem with smokers who think that e-cigarettes may be much more harmful than they actually are.
The noble Lord, Lord Prior, rightly said that smokers are aware of e-cigarettes: I take that point. However, there is this worrying statistic that many smokers feel that e-cigarettes are very harmful—almost as harmful as smoking cigarettes. That worries me. I worry that the regulations may make that worse. This is where the absence of cohesive, strongly financed public health programmes comes in. That is why I believe that my amendment finds a delicate way through the morass that we have been debating today and why I wish to test the opinion of the House.
Health: HIV
Lord Hunt of Kings Heath Excerpts(9 years, 7 months ago)
Lords ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Lord Hunt of Kings Heath
To ask Her Majesty’s Government whether they will instruct NHS England to commission the use of pre-exposure prophylaxis (PrEP) for patients with HIV.
The Parliamentary Under-Secretary of State, Department of Health (Lord Prior of Brampton) (Con)
My Lords, after taking legal advice, NHS England has concluded that it has no legal power to commission pre-exposure prophylaxis. NHS England’s decision is currently subject to judicial review by the National AIDS Trust and we are therefore unable to comment further on the legal position. We will consider the options available following the outcome of the legal review.
Lord Hunt of Kings Heath (Lab)
My Lords, this is a perverse decision on a ground-breaking drug that could save many people’s lives. Essentially, NHS England is hiding behind the responsibilities of local authorities in relation to sexual health services. How long must we wait before the public get the use of this drug, which is widely available in other countries? The Government should instruct NHS England to get on and make it available.
Lord Prior of Brampton
My Lords, the judicial review is being held next Wednesday, which is only 10 days from now, at which point we will know the exact legal position. I really cannot comment further on it today. As far as this drug being widely available as a prophylaxis, it is widely available only in some countries for very specific groups of people. If we commission it in the future, it is important that we are clear about where we can get the most benefit from it.
NHS: Unsafe Hospital Discharges
Lord Hunt of Kings Heath Excerpts(9 years, 8 months ago)
Lords ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Lord Prior of Brampton
The noble and learned Baroness is right, up to a point. I said one or two because the PSHO report focuses on nine individual cases. In so far as they are representative of behaviour across the country, they are important, but I want to put on record that the vast majority of hospitals the vast majority of the time are getting their discharge procedures right and are doing an outstanding job.
Lord Hunt of Kings Heath (Lab)
My Lords, the Minister has readily identified the problem of unsafe discharges. Why is there no explicit reference to this issue in the NHS mandate to NHS England for 2016-17?
Lord Prior of Brampton
I cannot give the noble Lord a reason off the cuff. It is very much a part of the better care fund. There is a CQUIN for 2016-17 that is focused on delayed discharges. One of the fundamental purposes underlying the STPs and the vanguards, which are a critical part of taking the Five Year Forward View into a serious plan, is to reduce delayed discharges and improve the relationship between acute care and social care.
Learning Disabilities: Transforming Care
Lord Hunt of Kings Heath Excerpts(9 years, 8 months ago)
Lords ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Lord Prior of Brampton
My Lords, progress since the horrendous events at Winterbourne View some five years ago has not been as fast as we would like. Under the Building the Right Support programme, NHS England is putting in an extra £30 million, which will be match-funded by CCGs, and another £20 million for capital investment. That is a very significant commitment of extra resource, but the proof will be in the eating.
Lord Hunt of Kings Heath (Lab)
My Lords, as the noble Lord said, it is five years since “Panorama” exposed the scandals in Winterbourne View. Ministers’ responses at the time and since have been admirable in their expressions of concern and the action they require in the NHS. The problem is that very little has happened. Is the Minister satisfied that NHS England, which has been consistently charged with implementing the changes, understands what it is required to do by Ministers? So far there is very little evidence that it does.
Lord Prior of Brampton
It is very clear in the NHS mandate that it knows exactly what it has to do. It was NHS England that produced Building the Right Support. There is a lot more governance around the programme now. Every month we will see the numbers of patients in in-patient care settings. The noble Lord will be interested to know that over the last year 185 people who had been in hospital for more than five years have now left hospital and gone into the community. There are signs that things are happening, but I would advise the noble Lord that what is needed is constant scrutiny.
National Clinical Director of Adult Neurology
Lord Hunt of Kings Heath Excerpts(9 years, 8 months ago)
Lords ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Lord Prior of Brampton
I do not want in any way to diminish the huge clinical importance of this and the suffering of many people with long-term neurological conditions. They are among some of the worst illnesses that anyone can have and I am delighted that my noble friend recovered from his. From everything that I have been told by NHS England and Bruce Keogh, I do not believe that the lack of a national clinical director will in any way detract from the resources that we are making available to neurology.
Lord Hunt of Kings Heath (Lab)
My Lords, I have enormous respect for Sir Bruce Keogh but, as my noble friend Lady Gale said, NHS England has essentially set out to decimate the influence of clinical advisers at the level of senior decision-making teams. When we set up national clinical directors, they were based in the Department of Health, had direct access to Ministers and were hugely influential. The current situation in NHS England is that they are often part-time appointments with virtually no support and limited influence. Is it not time that Ministers started to reassert control over services for which they are accountable to Parliament?
Lord Prior of Brampton
I do not think I agree with the last part of the question. We have set up NHS England as an arm’s-length body, and a key part of the reforms—the bit that probably everyone supported in the 2012 Act—was to get politicians more out of the day-to-day running of the NHS and to give more power to clinicians. It is better that clinicians rather than politicians should make these decisions. On what the noble Lord said about decimating the influence of clinical advice in NHS England, I just do not think that that is the case. In so far as he has raised it with me, I will have a meeting with Bruce Keogh and put that point to him and get his response.
Dental Health: Children
Lord Hunt of Kings Heath Excerpts(9 years, 8 months ago)
Lords ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Lord Prior of Brampton
My noble friend will be aware that a part—only a part—of the obesity strategy includes a levy on fizzy drinks. That will be a levy on the manufacturer not the consumer. That is a very important part of trying to improve the diet of young children.
Lord Hunt of Kings Heath (Lab)
My Lords, I should remind the House of my presidency of the British Fluoridation Society. I come back to the issue of fluoridation. The noble Lord has been rightly positive about its impact. The real problem is that the law gives responsibility to local authorities but local authority boundaries do not always fit with the way that water is produced by the water companies. Given that, does the noble Lord agree that there is a role for the Government, working in partnership with those local authorities, to give impetus to water fluoridation? Will he also pick up the point raised by his noble friend and work with the Greater Manchester Combined Authority to see whether Manchester could be brought up to the level of the health of people in the West Midlands?
NHS England: Pre-exposure Prophylaxis for People at Risk of HIV
Lord Hunt of Kings Heath Excerpts(9 years, 8 months ago)
Lords ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Lord Hunt of Kings Heath (Lab)
I am grateful to the Minister but this decision by NHS England not to commission and fund PrEP is a matter of great regret. In the UK there are more people living with HIV than ever before. Without any need for an evidence review, it is absolutely clear, without any uncertainty whatever, that PrEP has the potential to be a game-changer. It is proven to be effective in stopping HIV transmission in almost every single case. There is no need for an evidence review. It is simply a delaying tactic because of this absolutely disgraceful decision not to fund this drug. The Minister mentioned our record in relation to other countries. It is a matter of shame that this drug is being used extensively in other countries but is being denied to NHS patients without any justification whatever.
At some point the Minister will pray in aid the cost of new drugs. On a number of occasions I have asked him this question but he will never answer it—because, I suspect, the answer is too embarrassing. He knows that he is in the middle of a five-year agreement with the branded drug industry through which, if the cost of drugs goes over the base level plus a small allowance for inflation, the department receives a refund every three months. That agreement should enable new drugs to be funded, but that money is not being used to invest in those new drugs. If he says that this cannot be done because of cost, that is simply not true. I very much hope that the Government will reconsider this decision. It is utterly indefensible.
Lord Prior of Brampton
My Lords, I am not going to proffer the argument that it is too expensive, because that is not the issue today. The issue today is that NHS England feels that it does not have the power to commission this particular drug. Whether or not it has that power may well be judicially reviewed, so I cannot comment on the outcome of that judicial review.
The PROUD study produced strong evidence of the effectiveness of Truvada as a preventive drug. The work that NICE is going to do, and the pilot scheme to look at the effectiveness of this drug—it will cost £2 million and will be funded by NHS England and PHE—will ensure that when the question whether NHS England has the power to commission this drug is resolved, there will be the evidence on which to make that decision.
NHS: Diabetes
Lord Hunt of Kings Heath Excerpts(9 years, 8 months ago)
Lords ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Lord Prior of Brampton
As the noble Baroness will know, the Government will produce their childhood obesity strategy later in the summer. I am sure that advertising, particularly before the 9 pm watershed, will be addressed in that strategy.
Lord Hunt of Kings Heath (Lab)
My Lords, I hope that “Bake Off” will not be removed from our screens as a result of the strategy. The Minister said that the strategy has now moved from being published in the summer to later in the summer. Will he say a little more about when we can expect to see it? Also, will it answer my noble friend’s original point? Will he crackdown on clinical commissioning groups that are making arbitrary decisions to cut foot care services, which are a short-term saving but a long-term disinvestment?
Lord Prior of Brampton
My Lords, on the first point, I think we can say that “later in the summer” means before the parliamentary Recess. I do not mean the Recess starting tomorrow, but the main Recess later in the summer. On foot care services, this goes back to the unconscionable variations we have across the country. These are being addressed in part by the diabetes audit and in part by the improvement and assessment frameworks that have been developed for CCGs, so that we can see the results of different CCGs around the country and take action accordingly.
NHS: Bursaries
Lord Hunt of Kings Heath Excerpts(9 years, 8 months ago)
Lords ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Lord Hunt of Kings Heath
To ask Her Majesty’s Government whether they intend to halt plans to withdraw National Health Service bursaries.
The Parliamentary Under-Secretary of State, Department of Health (Lord Prior of Brampton) (Con)
My Lords, the Government do not intend to halt plans to withdraw National Health Service bursaries for nursing, midwifery and allied health students undertaking pre-registration training at university. The Government are currently running a public consultation on how to most successfully implement those reforms. The changes will affect only new students commencing courses on or after 1 August 2017.
Lord Hunt of Kings Heath (Lab)
But, my Lords, has the Minister seen the PAC analysis which says that, because of the loss of the bursary and the introduction of loans, there is a real risk that many people, particularly older people with children, will be dissuaded from applying to train as nurses and in allied health professions? Given that, and given the desperate shortage of nurses and other professionals, should not the Government take a little time to examine whether their original decision was justified rather than simply consulting on the way that it is going to be implemented?
Lord Prior of Brampton
My Lords, all the evidence is—not just from nursing but from other university courses—that loans have not reduced the numbers of people wishing to go to university: indeed, quite the contrary. The number of people going to university has gone up since student loans were introduced. The demand from young men and women who wish to go into nursing is very strong. The noble Lord will know that 57,000 people apply every year to become nurses and there are only 20,000 places, so we are confident that this will result in more, not fewer nurses.
Health: Alcohol
Lord Hunt of Kings Heath Excerpts(9 years, 9 months ago)
Lords ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Lord Hunt of Kings Heath (Lab)
My Lords, I commend the Minister on his courtesy in answering Questions in your Lordships’ House. Perhaps one or two of his colleagues might learn from that example. The logic of the Chief Medical Officer’s position is that essentially all alcohol is harmful. Is that the position of the Government?
Lord Prior of Brampton
Thinking very quickly, my Lords, our position is that alcohol is not safe but it is low risk depending on how you drink. It is a low-risk activity at a level of about 14 units spread evenly across the week. I am sure that the noble Lord will adhere strictly to that guideline.