NHS: Discharge to Assess Policy

Lord Naseby Excerpts

Tuesday 8th November 2022 Lords Chamber

[Lord Markham (Con)]

As mentioned, the Carers UK report and its findings made for sobering reading. It clearly shows why it was right to delay the guidance until we had that input; again, that will be followed up at the conference on Thursday. I think we all agree on the premise that we want to discharge people into their home quickly because that is the best place they can be, provided that they are medically able to be there. It is then in their home that the assessment takes place. Clearly, that must happen in a timely fashion and with the carer’s involvement but, again, the survey showed that that is not being done quickly enough in many cases. I accept that there are many things we need to learn from this but I think we can all agree on the direction: it is right to discharge people quickly provided that back-up and support are there to ensure that they have what is needed.

[Lord Naseby (Con)]

My Lords, as one who has been a carer in the recent past, I ask my noble friend the Minister to double-check that, before any patient leaves any form of NHS care, they have had a thorough checklist of every conceivable thing, including medicines, vaccination or any other procedure that has been undertaken on that patient.

[Lord Markham (Con)]

My noble friend makes the point well. I agree. It is my understanding that such a checklist exists but I will check that and come back to him.

National Institute for Health and Care Excellence

Lord Naseby Excerpts

Monday 23rd May 2022 Lords Chamber

[Lord Kamall (Con)]

I am aware of some of those issues, but I wonder whether the noble Lord could write to me with some more specific examples. In my meetings with various organisations, including the Health Technology Alliance and others, wherever they have raised these issues we have looked at them. The NHS, the department, NICE and others are trying to work with suppliers, manufacturers and providers to see how it can be more responsive. If we are going to realise the life sciences vision, we have to make sure that we make the best of the NHS as a global centre of excellence and show that we are at the forefront of research.

[Lord Naseby (Con)]

While we all understand the importance of NICE, can my noble friend reassure us that NICE is working within a fixed budget at this difficult financial time?

[Lord Kamall (Con)]

I think my noble friend will find that lots of departments and lots of public bodies are working within budgets at the moment, given the financial situation. NICE is very aware of this, and has looked at how it can do more with the same money to increase capacity and be more responsive.

Respiratory Viruses

Lord Naseby Excerpts

Tuesday 11th January 2022 Lords Chamber

[Lord Kamall (Con)]

There are a number of innovations when it comes to vaccines and testing for vaccines. Indeed, some of the companies and organisations we spoke to recently about future testing requirements, for example, have looked at multiple tests or tests where you can identify multiple conditions. It is one of the things that the department and the NHS are continuing to have conversations on with suppliers.

[Lord Naseby (Con)]

I congratulate my noble friend on the success of the flu jab and the way it has worked this year through general practice. In passing, I also reflect on the pre-testing of children going back to school and having a test just before school. There remains a concern, though, about the elderly who are housebound. There was a problem with ensuring extra Covid jabs for that category. Will my noble friend ensure that general practices check on a regular basis where appropriate that there are such jabs as are necessary for the housebound who are eligible?

[Lord Kamall (Con)]

I thank my noble friend for congratulating me, but I should not take any credit for this; it is thanks to the dedication of all the people who work in our health and social care system, and the innovation we have seen in the public and private sectors over many years to tackle many of these conditions. I will look into access for elderly people at home and commit to write to my noble friend.

Covid-19: PCR and Lateral Flow Test Providers

Lord Naseby Excerpts

Monday 13th December 2021 Lords Chamber

[Lord Kamall (Con)]

I do not have the exact numbers, so I will write to the noble Baroness. On loss-leading services, anything under £15 was removed because it was deemed that that was dishonest or underpriced.

[Lord Naseby (Con)]

Following on from that question, I remind my noble friend that, as far as I am aware, all the PCR tests are endorsed by Her Majesty’s Government, but the price varies from £60 to over £120. In that condition, if they are endorsed, will my noble friend talk to the companies concerned and decide on a recommended price level?

[Lord Kamall (Con)]

When I was discussing this with the people responsible for accreditation, they said that often a number of companies are reported to them and they look into them. Quite often companies will then be removed, but they can come back. The issue is that companies sometimes get provisional approval at the first stage while they are going through the full approval process. That will be reviewed in time.

Medical Schools: Training Places

Lord Naseby Excerpts

Monday 13th December 2021 Lords Chamber

[Lord Kamall (Con)]

I thank the noble Baroness for that question and for the advice and expertise that she has passed on to me in my short time in this place. As part of the expansion, we have opened five new medical schools across England, in Sunderland, Lancashire, Chelmsford, Lincoln and Canterbury. Sometimes we have the training, but it is difficult to find doctors in certain locations. We have tried to move training as close to those locations as possible.

[Lord Naseby (Con)]

My Lords, as well as increasing the numbers, is it not equally important that we ensure that every newly qualified doctor, on whom we spend well over £200,000, signs up for at least four years in the NHS, as do every male and female who joins our Armed Forces today?

[Lord Kamall (Con)]

I thank my noble friend for that suggestion. I will look into it and get back to him.

Covid-19 Update

Lord Naseby Excerpts

Wednesday 8th December 2021 Lords Chamber

[Lord Kamall (Con)]

I thank the noble Baroness for that question. As far as I am aware, the places administering the booster should be able to give that advice. For example, when I walked in for my booster, they asked which vaccines I had previously had and said that the half-dose I had was sufficient. When I asked about my children, they told me which vaccine was more appropriate for that age group, depending on which vaccine they had. If that advice is not available at the place of vaccination, please let me know. I was not aware of that and I promise that I can look into it.

While I am here, I realise that I did not answer the question from the noble Baroness, Lady Thornton, about the R number. It is currently at 0.9 to 1.1; the latest growth rate range for England is minus 1% to plus 1% per day. As the omicron data comes in, that may well increase, but we have looked at all these measures and are being as precautious as we can in balancing everything up.

In response to the earlier question about the pass—I apologise for the long answer—I have just been told that the NHS has tweeted:

“We are aware of an issue affecting access to the NHS COVID Pass on the NHS App and website. We are investigating this as a priority and will update as soon as we can”.


Clearly, the NHS has been listening to this debate and discussion, and I thank the noble Baroness for raising that. I am sure that noble Lords will agree that that tweet shows the effectiveness of having this debate, so that we can share as much information with the public as possible. I repeat this request: if any noble Lords are aware of any particular problems with the rollout, information et cetera, please let me know and I will investigate as quickly as I can.

[Lord Naseby (Con)]

Last evening, I mentioned to my noble friend the predicament of the 300,000 people who are housebound and cannot go and get a vaccination. I appealed to the Minister, saying that every GP practice knows who these housebound people are and where they live. Will my noble friend now commit himself and the NHS to making sure that every GP practice is asked to go out and give vaccinations to the 300,000 mainly elderly people who are awaiting vaccination?

[Lord Kamall (Con)]

I thank my noble friend for that question. As far as I am aware it has always been the advice that, if people are housebound, they should be able to receive their vaccination in their home. If my noble friend knows of any incidents where that has not happened, please let me know and I will chase them up.

Health and Care Bill

Lord Naseby Excerpts

2nd reading
Tuesday 7th December 2021 Lords Chamber

[Lord Naseby (Con)]

My Lords, this is a watershed Bill at a watershed time for the National Health Service. I shall touch on a few issues but many more will come up in Committee. Before I do anything else, I offer my congratulations to Her Majesty’s Government on two dimensions. First, for the first time in my experience, Her Majesty’s Government, the NHS and the pharmaceutical industry have got together, worked endlessly and furiously—spending money, yes—and succeeded in producing vaccines that no other country has done at the same pace. That is a huge achievement. Secondly, I thank the NHS front-line staff and our new noble friend, who led them so well.

Of course there are problems. I declare an interest. My wife was phoned while at a party conference and asked to take over a practice because the doctor had disappeared. There were only about 600 or 800 patients. We scrubbed down the old butcher’s shop in Biggleswade and started up, and she built up as a full-time doctor the largest practice in east Bedfordshire. My son served in the Armed Forces as an Army doctor, so I know a little bit about that world.

The greatest thing for me as a marketing man is that, if you are going to solve the problem, you have to look at what is going wrong. I shall highlight a few areas. Frankly, the GP system today is not working. It is poor. The problem arose in 2014 when—I do not say anything party political here—GPs were absolved from looking after patients 24 hours a day, 365 days a year. They were given the opportunity to opt out. Some 90% did so. We went on to this new system and so it has developed. It is not a good system. The worst bit of it is that, when we hit a real crisis, as we have done, we see where it has all gone wrong.

I know it is wonderful to have all these magical technical things but triage is not working. You cannot get through to a doctor. How many people have told me that as a politician? You get through to a receptionist only after you have started at number 15 or 16 in the queue. There are no home visits. My dear wife got really bad Covid. Yes, 111 came out three times, but not once did we see our GP, although we had a couple of phone calls. She is recovered and well. Did we get a home visit afterwards? No. Does anyone who is elderly get a home visit? No, hardly anyone does. Even worse, yesterday’s newspaper said that 300,000 of our citizens are housebound. Every one of those is on a GP’s list, so I hope that every GP who covers those 300,000 people will be out next week ensuring that every one of them gets a jab.

Secondly, I have gone on about medical schools. I asked a Question about them in this Chamber on 26 October 2016. The point was made that medical school places were going to go up by 25%, with an additional 1,500 of them. Yes, that happened, but it was not enough. The crunch, as I said in my supplementary question to my noble friend Lord Prior of Brampton, the then Parliamentary Under-Secretary, was this:

“Today, 56% of the intake of medical students is female.”


That was five years ago; it is worse than that now. I have nothing against that—I am quite happy with 50/50—but, as I said then,

“70% of female GPs today work part-time, and a recent survey by the King’s Fund says that 90% of all medical students in training want to work part-time.”—[Official Report, 26/10/16; col. 197.]

Given the cost of £200,000-plus to train a GP, I proposed at that point that we have a situation, as in Singapore, where you have to sign on for four or five years to work in the NHS, which has paid for your career. I was told that that was perfectly “reasonable” and that the Government would consult on four years. Nothing has happened. If Singapore can work this, why on earth can we not? Our young people, male and female, after they have been given a superb education, should give back to society for four or five years. My son in the Armed Forces had to do that, so the precedent has been set.

One area that will need to be looked at is obesity. The Government are working with the industry, which has worked with the Government before. We need to have a situation where we look closely with industry, and not at the proposals that are currently in the Bill.

Cigarette Stick Health Warnings Bill [HL]

Lord Naseby Excerpts

2nd reading
Friday 3rd December 2021 Lords Chamber

[Lord Naseby (Con)]

My Lords, I declare an interest; I have never smoked in my life, but I hold a modest amount of stock in British American Tobacco. More importantly, in the late 1960s, I was a director of a substantial advertising agency handling the Gallaher brand’s advertising, and I have therefore taken a particular interest in this market ever since.

I remind the House that we are talking about a legally marketed product, not one that is illegal on the market. There are, as noble Lords will know, significant health warnings on the packaging. That was introduced not so very long ago. I was in the communications industry; there is no evidence that those warnings are now useless or diminishing in effect. If you go into any CTN or tobacconist’s today, the cigarettes are not on display; they are behind the shutters, and that is all well controlled.

In my judgment, the Government should focus on investing in public information campaigns, which they have been doing. That is a much more effective way to raise awareness of the impact of smoking and highlight the widespread availability of alternative smoke-free nicotine products such as e-cigarettes, nicotine patches and heated tobacco products.

In addition, the regulations are already clear that tobacco products with a clearly noticeable taste or smell other than that of tobacco are prohibited. We do not need any new regulation. When one looks also at the purported health benefits of implementing a ban on using flavours as ingredients, it is entirely speculative. The ingredients do not encourage smoking or prevent smokers quitting.

On the question of age, I remember that when I was flying for national service in Canada at the age of 18, there was a ban on young men going into pubs if they were under the age of 21. All we did was make sure we found someone who was 21 and he bought the alcohol. Exactly the same would happen here. At the age of 18, adults are well aware of the risks associated with smoking and should be free to access a legal product if they so wish, as they do with alcohol. Raising the age to 21 will not change the demand for the product. Instead, it will result in 18 to 21 year-olds shifting from legal, tax-paid products to unregulated and untaxed products from illegal channels.

On a practical level, the age at which people can access restricted projects such as alcohol, tobacco, vaping, betting and the National Lottery has thankfully been standardised by Her Majesty’s Government, and it would be an absolute waste of time and confusing to the consumer if this bit of another market was done at different age.

Then there is a call for stricter control of retail licensing of selling tobacco products. But the tobacco traceability and security features system, known as the track and trace system, already provides a de facto retail registration scheme. An important point is that retailers cannot legally sell tobacco products unless they are registered through this system. Alongside that are regular, unnoticed, unnotifiable checks on all retailers. That is the most effective way to ensure that they comply with that. The most effective way to protect legitimate businesses and government revenues, as I point out to my noble friend on the Front Bench, is through the tobacco traceability and security features system registration and the enforcement measures associated with it. That is key to the whole thing, really.

The tobacco industry itself supports a significant increase in penalty thresholds, reflecting the quantity of illicit tobacco that has been seized, and whether it is a first or second offence that has been committed. As I understand it, the tobacco industry currently adopts and advocates a wide range of measures to prevent young people taking up smoking. For instance, as we all know, there is the CitizenCard—although perhaps we do not all know, judging by one or two of the comments made this afternoon. That card is recognised by the PASS proof of age scheme and supported by the Home Office, the Chartered Trading Standards Institute, the Security Industry Authority and the National Police Chiefs’ Council. In conjunction with the proof of age card, the CitizenCard runs a wide UK campaign, and that creates a good barrier to prevent underage people buying tobacco products. If any retailers do not do it properly, they are reported to trading standards for follow-up and possible enforcement.

Finally, looking at the industry levy itself, following a public consultation by Her Majesty’s Treasury in 2015 into the design of a levy on tobacco manufacturers’ profits, the Government concluded that it would be unworkable and so decided not to introduce it. Nothing has changed since then, and the reasons for rejecting this approach remain valid. On 16 June Her Majesty’s Government restated their position on the tobacco levy:

“We do not believe a levy is an effective way to raise revenue or protect public health.”—[Official Report, 16/6/20; col. 189.]


I will finish on the question of whether there should be a profit cap on individual manufacturers and importers. At this time and in this country, we do not want to put a message out to the world that we, as a Government, are interfering in a legitimate business, and wish to ensure that it is difficult for that to go forward. This Bill is totally misguided. Its promoters are ignoring the extensive controls that there are already. It interferes with individual liberty to choose, and above all it sends out a message that the UK is hostile to business, which is not a message that I wish to see.

--- Later in debate ---

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

My Lords, I add my congratulations to my noble friend on progressing his Private Member’s Bill to this stage and on securing this important debate.

Over the past two decades the UK has introduced a range of public health interventions and a strong regulatory framework to help smokers quit, and to protect future generations from using tobacco. Thanks to these, smoking rates in England are down to a record low of 13.9%, from 19.8% in 2011. If we go back even further, we see that the smoking rate was at 45% in the 1970s. As the noble Baroness, Lady Merron, has said, these reductions have been cross-party; Governments of all colours have tried to tackle this issue.

Those reductions are something we should be very proud of but not complacent about. While we celebrate this success, we recognise that there are still 6 million smokers in England, with smoking remaining one of the biggest causes of preventable mortality and, as a number of noble Lords have acknowledged, one of the largest drivers of health disparities. One of the reasons why I am very pleased that we now have the Office for Health Improvement and Disparities is that there will be a laser-like approach in the attempt to tackle these disparities.

Smoking rates still range from 23.4% in Blackpool to 8% in Richmond upon Thames. In addition, smoking rates vary significantly among certain groups. Nearly one in 10 pregnant women still smoke, increasing the risk of health problems for their babies. The Government are determined to reduce smoking rates in groups that smoke disproportionately, as well as across the board—so, work is going on not just in respect of pregnant women but elsewhere. For example, we know that 23% of routine and manual workers smoke, while the rate among people with long-term mental health conditions is nearly 26%. That is why there is so much to do. We have to make sure that we understand those parts of communities where we can, laser-like, focus our action. That is why the Government have set the bold ambition for England to be smoke free by 2030.

The Government recognise the good intentions behind the Bill. I pay tribute to my noble friend Lord Young of Cookham not only for the Bill but for his long-standing commitment to encouraging smokers to quit. My noble friend himself has told me about his work in the 1970s but also as a Health Minister in the 1980s. Let no one be in any doubt that the Government are clear that we strongly support measures to stop people smoking but also to educate current smokers of its dangers. We have already introduced a number of measures, such as graphic health warnings on tobacco packaging and information on packs giving further advice on how to quit.

While we sympathise with the aims of the Bill, we believe that policy should be evidence-led. It is therefore vital that we conduct further research to build up a strong evidence base to support measures before bringing them forward. To date, sadly, no country has introduced such a measure so there is very little evidence so far on its impact in supporting smokers to quit, compared with other measures we are looking at. Several other measures have been tried in other countries—for example, warnings inside the pack as well as outside—and there are a number of other issues we are examining.

The Government are in the process of developing a new tobacco control plan that will include an even sharper focus on tackling health disparities and will support the Government’s levelling-up agenda. We want to explore a broad range of new regulatory measures to support our ambition to be smoke free by 2030. So, I reassure noble Lords that we will be reviewing this proposal as part of that work.

I turn to some of the specific questions that were asked. A number of noble Lords asked about the tobacco control plan. Rather than implementing blanket measures that may not always reach some of the communities that need to be reached, we want to ensure that the plan has an even sharper focus on disparities and that it supports the Government’s levelling-up agenda. We need bold but impactful proposals. With the establishment of the Office for Health Improvement and Disparities, we are going to draw on its advice on how to address the high levels of smoking among some of these groups, and harness that advice to develop robust and effective proposals that will ensure that our plan delivers the smoke-free 2030 that this country deserves.

We are developing policy for the tobacco control plan and intend to publish it next year. There is a current tobacco control plan, which runs until 2022. We hope to include a number of measures that focus on health disparities and groups where smoking rates are not falling fast enough. I have already mentioned pregnant smokers and smokers with mental health conditions, but that also includes smokers in many deprived parts of the country.

We were asked about the amendments to the Health and Care Bill. We were grateful for the suggested amendments, which show support for strong tobacco control, but once again we need to see the evidence and make sure that such measures are targeted at groups we want to encourage, as well as more generally. At this stage we do not believe we should accept the amendments but, as I have said, next year we will be publishing our new tobacco control plan, since the current one runs until 2022.

Some of these examples include stop smoking services, which we have found produce high quit rates of 59% after four weeks. Since 2000, they have helped nearly 5 million people to quit. We have also protected a public health grant over the course of the spending review to ensure that local authorities can continue to invest in stop smoking services, because they have been seen to be successful. As long as they are successful, they will continue to be part of our armoury.

The noble Lord, Lord Moylan, asked about evidence. The Office for Health Improvement and Disparities continues to monitor developments in tobacco control across the world. We share our knowledge with international partners and draw on their evidence-led experiences to make sure that we are introducing effective measures, rather than just introducing measures we feel might work without evidence.

The noble Lord, Lord Rennard, talked about youth smoking. He is absolutely right, but youth smoking rates continue to decline, and they are currently at their lowest rate on record. In 2018, 5% of 15-year olds were regular smokers, 2% of 11 to 15 year-olds were regular smokers, and 16% had never smoked. While the youth rates are declining, we should not be complacent. We know that smoking remains an addiction largely taken up in childhood, with the majority of smokers starting as teenagers and then becoming addicted. We want to build on that recent success and protect young people from harmful tobacco, and we have an area of focus targeted at that.

My noble friend Lord Naseby talked about the tobacco levy. We recognise that the tobacco industry is already required to make a contribution to the public finances through tobacco duty, VAT and corporation tax—in many ways, it pays our wages. The department will continue to work with HMT regarding tobacco taxation and revenue funding. This includes reviewing options such as the future levy, but we want to make sure that it is an effective way to raise additional funds to support stop smoking services.

The noble Baroness, Lady Uddin, was very honest in her appraisal of her ability to stop smoking in her family. But she made some interesting points, not only about having failed to prevent her family smoking but about whether young people will read the warnings on the cigarettes. I think that is a point we have to look at. Will they be dismissed, just as the effectiveness of the warnings on the outside has waned over time? Will the same thing happen here?

[Lord Naseby (Con)]

As I mentioned, I spent 20-odd years in advertising. The Bill says that the warning has to be in red on blank white paper—quite frankly, that will be very difficult to read. If my noble friend is serious about this, I suggest he takes advice from those who know a little more about printing.

[Lord Kamall (Con)]

I thank my noble friend Lord Naseby for that intervention; I will take account of his advice. In fact, I want to thank him for his advice, given the number of years he spent in the advertising industry. Something we are looking at generally in the public health approach in this country are those experts from the advertising industry who have looked at behavioural studies and behavioural economics to encourage people to buy their products or to smoke, and to attract a number of them—as poachers turned gamekeepers—to help us understand the skills they use to attract smokers and people eating high-fat food, and to turn that around to discourage people from taking up smoking and eating food that might cause obesity.

The noble Baroness, Lady Uddin, also talked about smoking in pregnancy, and we recognise this problem. It is sad that 10% of pregnant women still smoke, and they are not falling in line with other groups. Therefore, we are looking at how we address that at prenatal and neonatal clinics, but also during that whole experience. How do we reach those mothers, and would that really be effective?

One of the questions asked was about a number of different ideas that came up. Basically, we want to follow the evidence. That is really important. There is a tobacco plan already in progress, which will end in 2022. Next year, in 2022, we will publish the new tobacco plan, and we are looking at evidence from around the world and at what works. But we also want to see how we can work across government. For example, we are working closely with the Department for Education to ensure that the harms of smoking are in the curriculum, but many of us will remember being at school and receiving education on a number of different issues related to lifestyle. A number of my friends would say, “I’m never going to smoke or drink”, and two years later, I would see them at parties, smoking and drinking.

Therefore, we have to understand how effective these messages are, how long they work for, and how we can make sure that they continue to work. We understand and accept that we need to continue to take action; we must not be complacent. We want to look at the evidence: some 64,000 people still die each year from smoking; two-thirds of long-term smokers will die from it; it is one of the greatest drivers of health disparities and, as many noble Lords have said, it causes a great, heavy financial burden. In fact, each year smoking costs society £12.5 billion, with a cost to the NHS of around £2.5 billion. We believe that making smoking obsolete would free up £15 billion per year, benefiting especially the most disadvantaged families and the most deprived communities.

Given the lack of evidence and the other measures being considered, the Government do not feel that the Bill is appropriate at this point in time. However, the Bill’s requirements will be considered as part of the wider range of regulatory proposals to support our smoke-free 2030 ambition. We want to see evidence-based, targeted proposals and to make sure that they are effective.

I once again thank my noble friend Lord Young of Cookham for this important debate and encourage him to continue pressing the Government. I also thank noble Lords for their insightful contributions.

[Lord Young of Cookham (Con)]

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

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

[Lord Naseby (Con)]

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

[Lord Young of Cookham (Con)]

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

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

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

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

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

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

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

Covid-19 Update

Lord Naseby Excerpts

Monday 29th November 2021 Lords Chamber

[Lord Kamall (Con)]

All I can do is thank the noble Baroness for her question. I will have to double-check; as she will imagine, I do not have all the answers at the moment. Throughout the day, as I was preparing for this, the advice was changing constantly, and things were being swapped in. Advisers from the Department of Health and Social Care were saying, “This is the latest advice”, but it was changing literally hourly. I will try to get the latest advice and share this with noble Lords.

[Lord Naseby (Con)]

In light of the overall success of the vaccination programme, is it now a condition of employment that every new recruit to the NHS, at every level, must be vaccinated against Covid and agree to accept any future recommendations on protection against it?

[Lord Kamall (Con)]

As my noble friend will be aware, vaccination as a condition of deployment has been brought in for the social care sector. It will be brought in for the wider NHS, but there is a grace period in certain cases. Management are being encouraged to meet with staff to encourage them, particularly staff who are vaccine-hesitant. There is a grace period to see us through the winter period; it runs up to April next year. However, we are encouraging as many members of NHS staff as possible to get vaccinated and we have a high rate of vaccination so far.

Smoking Cessation: Prescription of E-cigarettes

Lord Naseby Excerpts

Tuesday 2nd November 2021 Lords Chamber

[Lord Kamall (Con)]

As the noble Lord will know, some of the issues are related to leaving the EU, but it is interesting to learn from conversations with the MHRA that it is hugely excited about its ability to be more global in its outlook and to be a centre of expertise that many people across the world will want to learn from. With respect to international engagement, as well as making sure that it updates its guidelines to take account of medical technology there will be ongoing reorganisation and changes, and it hopes to be fit for purpose for many years to come.

[Lord Naseby (Con)]

My Lords, is the Minister aware that, as I understand it, there is a problem with the MHRA budget? This is important work. Furthermore, is it not a fact that the industry itself is supporting this work?

[Lord Kamall (Con)]

It is very important that we get the MHRA to approve these e-cigarette products. The MHRA is seen as a jewel, to which many experts from other countries look. One of my roles is international health diplomacy, and many people I talk to from other countries are very impressed with the work of both NICE and the MHRA. We can use that in our international health diplomacy.