Standardised Packaging (Tobacco Products)

Lord Young of Cookham Excerpts

Wednesday 21st January 2015 Commons Chamber

[Ann McKechin (Glasgow North) (Lab)]

There are now only a few weeks until Parliament dissolves, but tonight I want to urge the Government, even at this eleventh hour, to do something that can save hundreds, if not thousands, of people across the country from a premature death. They still just have the time to undertake one major reform that they promised long ago: the introduction of plain packaging for cigarettes. However, despite almost three years of consultations and reviews and clear evidence both at home and abroad to support regulation there has been a deafening silence for over eight months. Why is the Prime Minister prevaricating? I hope the Minister can answer that question this evening and show her resolve to be serious about this nation’s public health.

We have debated this issue many times but the need for tonight’s debate is simple: plain packaging works. Too many people suffer from diseases brought on by smoking and too many young people are still picking up the habit for the issue to be ignored until after the election.

Sadly, my own city, Glasgow, has one of the worst records for smoking-related premature deaths in the country. Of those who take up smoking, only about half will manage to stop before they die, and two thirds of current smokers started before they were 18 years old, so the early teenage years are the key period to hook people into the habit.

The cost to patients, their families and our NHS is still too high despite the considerable improvements in treatments and drugs over recent years. In Glasgow, according to the latest Scottish Public Health Observatory’s tobacco control profile there were over 1,900 deaths from lung cancer in 2012 alone and almost 47,000 smoking-attributable hospital admissions over that year. Almost 28% of the city’s population smokes against the Scottish national average of 23%. Even a small percentage drop in those figures would make a really big difference to a lot of people, save lives and alleviate the pressure on our health services.

Successive Governments over recent years have put in place a range of measures to assist public health. Duty on cigarettes has been routinely increased in Budgets above the prevailing rate of inflation and this has undoubtedly made a significant difference. However, the impact is clearly plateauing and there is evidence that in the poorest communities in particular the rise of the black market in cigarettes could be acting as a block on further smoking reduction.

Increasingly, non-economic measures need to be introduced to further limit the habit, the most obvious being the ban on smoking in public places. It was not without controversy when introduced, but with Scotland taking the lead it has transformed our communities, reducing overall smoking levels. It has been of benefit to workers and non-smokers alike, but if we are honest the smoking ban has also led to more people switching their drinking, and in turn smoking, habits to a domestic setting, rather than necessarily quitting.

Cessation services via GPs and local councils have become better organised and more comprehensive. The Local Government Association in England is producing a new report this weekend on cessation services, but has informed me that councils are committed to spending over £140 million in England on cessation services this year, and this is undoubtedly a sound investment.

The Government are to be commended for taking forward the legislation introduced by the previous Labour Government to prohibit the display of tobacco products at the point of sale, with all shops being subject to the ban by April this year. This, along with the ban on public advertising, has helped to change perspectives about the normality of smoking.

We know that children and young teenagers can be influenced by a complex range of factors and we must do more to protect them against the harm that smoking brings. Attractive colours and packaging have a strong influence on young people, and tobacco companies have not been slow to find other, indirect ways of promoting their products. In a presentation to an industry conference back in 2006, Imperial Tobacco’s then global brand director, Geoff Good, acknowledged that the tobacco advertising ban had

“effectively banned us from promoting all tobacco products”,

but noted that

“the marketing team have to become more creative…We therefore decided to look at pack design.”

In fact, the industry was even happy to admit this in its response to the Government’s consultation on the future of tobacco controls. Philip Morris stated in its response that

“packaging is an important means…of communicating to consumers about what brands are on sale and in particular the goodwill associated with our trademarks, indicating brand value and quality…placing trademarks on packaged goods is thus at the heart of commercial expression”.

I struggle to imagine what the good will of a cigarette might actually amount to, but there is no doubt that the industry has exerted enormous pressure to stop this move.

It is no coincidence that the colours and graphics used on these packs are designed to attract new and younger users, and research shows that this increased emphasis has had an effect. Between 2002 and 2006, there was an increase in the proportion of young people aware of new pack design from 11% in 2002 to 18% in 2006. As the Minister is well aware, the systematic review commissioned by her own Government of 37 different studies provided evidence of the impacts of plain packaging. Each of the 19 studies that examined perceptions of attractiveness found that standard plain packets were rated as less attractive than branded packs. The studies also showed that the awareness of health risks was higher with standard packaging. Younger respondents were more likely to perceive that standard packs would discourage the take-up of smoking. All those findings back up the case that such a change would have an impact on young teenagers who were tempted to smoke.

In Australia, where plain packaging legislation was introduced in 2012, smoking rates have fallen dramatically. Daily smoking levels are at an historic low of 12.8%, and the average number of cigarettes smoked is now just 96 per week, compared with 111 in 2010. Fewer young people in Australia are trying cigarettes, and those who do so start at a higher age than in the past. Opposition to plain packaging among the public has also fallen steeply since the legislation came into force.

Some have argued that such a move will open the doors to a massive black market, and I note that that allegation has been reported in The Daily Telegraph in the past week. However, the main driver of black markets is economic: the difference between the actual value of the good and the price set for the consumer. It should not be beyond the wit of the authorities to devise a form of unique marking to stem counterfeit products. As the Minister will be aware, Sir Cyril Chantler stated in his report last year that he had found

“no convincing evidence to suggest that standardised packaging would increase the illicit market”.

The Trading Standards Institute has helpfully advised me today that, having reviewed the proposed regulations, it understands that standardised packs will retain the same security features as those found on existing tobacco packaging. It is the institute’s professional view that standardised packs would provide no new challenges in terms of detecting illicit products.

We know from what has occurred in Australia that tobacco companies have been forceful in pursuing their opposition at every step of the way. On the day that the Australian Government passed their legislation, Philip Morris and a number of other producers immediately launched a lawsuit to challenge the law. That challenge was rejected by the Australian domestic courts in 2012, but Philip Morris was not prepared to give up. In addition to taking the domestic action, it rearranged its assets in order to become a Hong Kong investor and use the 1993 bilateral trade agreement between the two countries to initiate an investor dispute arbitration. That case is due to be heard next month in Singapore, behind closed doors.

In addition, the company helped to finance a separate World Trade Organisation action brought against Australia by five tobacco-producing states. Australia refused each of those countries’ first requests, as allowed under WTO rules, but Ukraine made a second request in September 2012, which led to the establishment and composition of a dispute panel. The panel was composed in May 2014, but no report has been adopted and this matter is still outstanding. Similar industry pressure in New Zealand led by British American Tobacco has led to a long postponement, despite the fact that the legislation was introduced in its Parliament more than a year ago.

Using the same ISDS dispute procedure that the UK Government are so keen to support in the current EU-US negotiations on the Transatlantic Trade and Investment Partnership—TTIP—Philip Morris is suing tiny Uruguay over its decision to increase the size of health warnings on cigarette packets from 50% of the cover to 80%. We now await the outcome of this David and Goliath struggle, but it does raise the question as to why our Government are not more questioning of the possible impact of investor-state dispute settlement clauses on our public health policy, given the lengths that the tobacco industry is clearly prepared to take.

We need the UK to be brave—to face up to the industry giants and act in the interests of the public we serve. The Minister will be aware that the Scottish Government have sensibly agreed that legislation should be brought in throughout the UK at the same time and have given their assent to regulations being brought in by this Government covering Scotland, too. I want her assurance tonight that she will act on this agreement to give the boost to public health that is so needed in my city.

Over the past few years there have been several well-supported public campaigns calling on MPs to act, and recent polling has shown that a majority of the public are in favour of this proposal.

[Sir George Young (North West Hampshire) (Con)]

The hon. Lady will be aware that a range of views may be held among Government Members, but may I assure her that within my party there is a strong body of opinion supporting what she is saying and joining her in urging the Government to take action?

[Ann McKechin]

I am grateful to the right hon. Gentleman for his support tonight. This matter should, I hope, elicit cross-party support, because the health of our young people is a key issue that all of us should be deeply concerned about.

Antibiotic Resistance

Lord Young of Cookham Excerpts

Wednesday 15th October 2014 Westminster Hall

[Sir George Young (North West Hampshire) (Con)]

It is a pleasure to follow the hon. Member for Inverclyde (Mr McKenzie), who set out clearly the problems of antibiotic resistance. I compliment my hon. Friend the Member for York Outer (Julian Sturdy) on his choice of subject and on how he developed the argument and presented the case, ending with a three-point action plan, which I hope that the Minister will be able to smile on when she responds to the debate.

Over the recess, I read Dame Sally Davies’s book, “The Drugs Don’t Work”, which was published last year. It is concise and understandable by a layman, but deeply alarming, particularly as it comes from the country’s chief medical officer. She warned that antibiotic resistance should be treated as seriously as terrorism when we rank threats against this country. The hon. Gentleman and my hon. Friend set out the problems as the risks of antibiotic resistance become greater because of over-prescription and overuse. At the moment we are all preoccupied with Ebola, which is a virus and not a bacterium, but many lower-profile cases of new strains of antibiotic-resistant bacteria are being introduced into NHS hospitals as a result of the admission of patients who have recently arrived from overseas.

As my hon. Friend the Member for York Outer said, if we do not raise our game against the superbugs, the chief medical officer warns that a cut finger could lead to a festering death. Each year across Europe, some 25,000 people die from drug-resistant-bacterial infections. As he said, the new antibiotic-resistant threat is from the less well known, so-called gram-negative bacteria, which have names such as Klebsiella, Pseudomonas and Acinetobacter. In many parts of the world, those bacteria are either untreatable or only treatable by a toxic antibiotic called colistin, which was discovered in the 1940s. Its use carries huge risks, as my hon. Friend said, because of its toxicity. The new strains of gram-negative bacteria create severe clinical problems for patients in intensive care units or other critical care units, such as oncology or transplant. The highly antibiotic-resistant bacteria affect very sick patients, who are found in intensive care and other high-risk units. Some of those bacteria lead to death rates of 50%.

Again as my hon. Friend said, no new gram-negative antibiotics are at an advanced stage in the drug discovery pipeline, so the historical approach of relying on the pharmaceutical industry to come up with a solution will not come to our rescue this time. He explained why we have a classic case of market failure. The business case against developing antibiotics is powerful. It can take 10 years and cost more than £1 billion to bring a new drug to market and, because those bacteria evolve fast and rapidly become resistant to new antibiotics, the research needs to be ongoing. Even if a successful drug is developed, a course of antibiotics might only last a week, so the revenue potential of any new drug is relatively low. My hon. Friend contrasted that with investment in statins, for example, which a patient may take for the rest of his or her life without developing resistance, so in a sense the question of where to put the money is a no-brainer. As a result, AstraZeneca is scaling back research into antibiotics and Roche has issued warnings about the terms of trade.

There is some good news. The severity and acuity of the problem is beginning to be recognised. WHO published a document highlighting the problem in April, and President Obama signed the Generating Antibiotics Incentives Now legislation. As both the previous speakers said, we await Jim O’Neill’s report next spring on why the industry has failed to deliver any new antibiotics. It is not clear, however, how the market failure can be addressed without Government intervention of some sort —my hon. Friend the Member for York Outer outlined a number of possible solutions. It would be helpful if the Minister could confirm that she has an open mind about changing the terms of trade with the pharmaceutical industry, if that proves to be the only way forward.

I am interested in the subject because I have in my constituency a firm called Bioquell, which manufactures equipment and provides specialist services that eradicate micro-organisms—bacteria, viruses and fungi. Its new Pod product comprises single-patient rooms that can be rapidly deployed in hospitals. Crudely put, they can turn a “Nightingale” ward into US-style single rooms. The single-patient room Pod product is generating interest from hospitals around the world worried about Ebola.

As became clear in one of our exchanges on Monday following the statement by the Secretary of State for Health, hospital structures throughout the world vary. Most intensive care units in France and the USA comprise single-patient rooms, whereas most ICUs in the UK comprise open, multi-bed units, which are often linked to high infection rates. We therefore need to have tools available to combat the threat from antibiotic-resistant organisms, which differ from country to country.

At the moment, Bioquell is involved in the decontamination of health care facilities around the world that have housed Ebola patients. Those include three hospitals in the United States, as well as hospitals in the UK, France and Holland. Recently, 20 of the company’s single-patient room Pods have been deployed in the middle east to help a hospital combat the spread of viruses. A small technology company from Andover—this ties in with my hon. Friend’s third point—is therefore leading specialist decontamination work in Europe and the US, helping to combat Ebola through the provision of safe single rooms.

I ask the Minister for an assurance that the contribution companies such as Bioquell can make will not be overlooked. The NHS is sometimes slow to adopt new technology, but when it faces substantial capacity and cost pressures due to an ageing population, the adoption of new technology must form a key part of the solution to those ever-growing pressures.

We rightly celebrate our knowledge-based economy. My hon. Friend the Minister’s Department has done much to export life sciences, to encourage med-tech industries and to generate export earnings. In return, however, the Government must support British innovation in the NHS. It is unrealistic to expect companies to be successful at exporting if they do not have a robust domestic market.

I end with the point my hon. Friend made about public interest. I hope the debate he has initiated will begin to drive the issue up the agenda, and bring home to the public and, I suspect, many of our colleagues the real threat antibiotic-resistant bacteria pose to the NHS. I do not think our colleagues appreciate that, with these new strains of bacteria, the NHS faces a major challenge, with high associated death rates, and no effective antibiotics exist. Unchecked, these bacteria will limit the ability of the NHS to provide many of the life-saving procedures we all take for granted, and the costs to the NHS will increase substantially. That means there must be a positive response to Jim O’Neill and active engagement with companies at the cutting edge of research in this field so that we can begin the fight back against these antibiotic-resistant bacteria.

[Several hon. Members]

rose—

Community Hospitals

Lord Young of Cookham Excerpts

Wednesday 3rd September 2014 Westminster Hall

[Sir George Young (North West Hampshire) (Con)]

May I begin by saying that it is a pleasure to serve under your chairmanship, Mr Owen, and by joining my hon. Friend the Member for Dover (Charlie Elphicke) in his warm welcome to our hon. Friend on the Front Bench, who will make his maiden ministerial speech in Westminster Hall? I also congratulate my hon. Friend the Member for Dover on his choice of subject. As we approach a general election, it is worth remembering that a Member of Parliament actually lost his seat in 2001 because of a perceived lack of commitment to a community hospital, but my hon. Friend’s powerful speech will have consolidated his position in Dover and Deal on health-related matters. Listening to his speech and reading some of the comments made about the NHS, one can understand the concern that district general hospitals and specialist services might sap the life blood out of community hospitals, some of which are fighting to hang on to what they have or even face closure. I want to speak briefly in the debate to show that, so far as North West Hampshire is concerned, the opposite is now happening.

I have no district general hospitals in my constituency—Basingstoke and Winchester are the nearest DGHs and are in next-door constituencies—but I do have the Andover War Memorial hospital in my largest town and what has happened there over the past few years shows what can be done. In 2012, a new trust was formed, amalgamating Basingstoke, Winchester and Andover hospitals and there were fears that Andover, as the smallest, would be squeezed as services were centralised. In fact, the opposite has happened, and I commend what Mary Edwards, the chief executive of the combined trust and Elizabeth Padmore, the chair, have done to bring services to Andover and so reduce the need for people who live in and around the town to drive to the nearest DGH—and most people have to drive as access by public transport is difficult. The process has actually helped the DGHs by reducing pressure on some of their services, not least on car parking, and has made it easier to recruit and retain NHS staff, as not everyone in Andover wants to work in Basingstoke or Winchester.

In Andover, as in other towns, the hospital has always had a strong claim on people’s loyalties, and we have to take note of that. Nowadays, however, one cannot make the case for investment on emotion alone; there has to be a hard-nosed business case to back it up. My hon. Friend drew on some research that underlines the need to invest in community hospitals. The reality is that bigger is better for some procedures, but smaller is better for others, and the position is not static as medical technology develops. A modern health service needs to make intelligent decisions about its assets to get the best value out of them.

After careful analysis of the best way forward by the new trust, we have seen service development in Andover and investment in the fabric, which has capitalised on the skills and commitment of the existing staff, whose energy and professionalism I pay tribute to, and has generated additional investment through, for example, an active league of friends. It has also helped to restore confidence in the NHS decision-making process as local people see the outcomes of the new method of running the NHS. For example, we now have a mobile chemotherapy unit that visits Andover weekly, avoiding a 50-mile round trip to Basingstoke or 30-mile round trip to Winchester, which was done in partnership with Hope for Tomorrow. A new minor injuries unit opened in 2010 and is run by highly skilled nurse practitioners with back-up support from the consultants in emergency medicine at the DGHs. We have a modern out-patients department to replace a building that dates from the era of “Carry on Nurse”. Instead of local folk having to travel to a DGH to see a consultant, consultants from nearly all the specialties now come to Andover. We have a mobile MRI scanner, and operations under local anaesthetic are now also taking place in Andover. The Hampshire hospitals birthing unit has just opened and is run by local midwives and provides ante and post-natal care. More and more local families are choosing a midwife-supported birth, and they can either have the baby at home or in the birthing unit.

The hospital campus is large and has always been used intelligently. The Countess of Brecknock hospice, run independently by a charitable trust, is next to the hospital. More consultants in palliative medicine are now based there and it is developing a hospice-at-home service. Also next to the hospital is a nursing home, funded and run by the county council on land provided by the NHS.

At this point, the cynic might ask what is so remarkable about a large building calling itself a hospital providing services for people who are ill, but that is to miss the point. The NHS must adapt and change if it is to continue to provide a quality service, which means specialisation where necessary and localisation where it is not and investment in both DGHs and community hospitals

I have two requests for the Minister—one general and one specific. First, I endorse the plea made by my hon. Friend the Member for Dover for an assurance that the Government support the continued provision of more services locally, as is happening in North-West Hampshire, and will encourage the trust to continue with its strategy of providing more services in the town, such as transferring patients who have had critical treatment elsewhere for rehabilitation in the hospital. We are pleased with what we have, but our appetite has been whetted and we want more. I was tempted to say, “Dover Andover again,” but I will not.

Secondly, and more specifically—I do not expect an answer this morning—the ugliest building in Andover is the Andover health centre, which houses a GP practice on the hospital campus owned by the trust. Not only is it ugly, it is past its sell-by date as a place where GPs can practise. Indeed, the trust wants to demolish it next year. The site could be sold for housing, for which there is great need, and could generate a capital receipt for reinvestment in health services. The dialogue between the various agencies of the NHS to relocate the practice, which is the largest in Andover with some 15,000 patients, has gone on for at least four years with no end in sight. It started off with the primary care trust, but now involves NHS England, the clinical commissioning group and the trust. The practice wants to be relocated near the hospital, where land is available, and there are advantages in having GPs next door. We need to resolve the matter before the Care Quality Commission looks too hard at the current building. In conclusion, I ask my hon. Friend the Minister to indicate that he will take a personal interest in the matter and use his influence to bring the dialogue to a satisfactory conclusion.