Tobacco and Vapes Bill (Third sitting)

Mary Kelly Foy Excerpts

Committee stage
Wednesday 1st May 2024 Public Bill Committees

[Trudy Harrison]

Q It was more about the biological impact—how nicotine affects your body and makes it so very difficult to give up and be disciplined. It was about the biological impacts that nicotine has on the body, or the psychological impacts.

Sir Francis Atherton: As with any addictive substance, when you are deprived of it you suffer cravings and withdrawal symptoms of a sort, and that leads you to want the next hit—the next cigarette. That cycle of dependency and addiction is well known and well understood, but you would have to talk to a behavioural psychologist or a physiologist to get a more detailed answer.

Professor Sir Chris Whitty: To add to that, most smokers who are determined to quit make multiple attempts—even those who finally succeed, and many people do not succeed. As I was saying, so many people want to succeed and cannot because the addiction has a hold on their brain, essentially.

[Mary Kelly Foy (City of Durham) (Lab)]

Q I thank the panellists for being here. I want to go back to clause 62 and the issue of vapes and flavouring. In the interest of brevity, would you say that if we ban all flavours there is a risk that some ex-smokers will be dissuaded from continuing to vape?

Professor Sir Chris Whitty: There is a surprising degree of consensus on this issue, which is sometimes difficult to pick up. We know it is useful to have in the armamentarium the ability to have some flavours to help smokers to quit, but we also know that the cigarette industry is extraordinarily good at adapting its marketing techniques to whatever leeway it is given. If Ministers do not have the power to chase down the industry’s ability to market to children using flavours, that is what it will do: it will go for multiple flavours as a way to get to children and non-smokers. That is what it has always done, so that is what it will do. This Bill gives powers to Ministers in the four nations to make sure they can restrict these products to the extent that you can make them not attractive, but attractive enough to smokers to move on. It allows the slider to be moved left or right to balance attractiveness to smokers against not making it attractive to non-smokers.

[Mary Kelly Foy]

Q I have seen a product that is just a plain bottle with “vape” and a number written on it, which is exactly the same flavour as the one that is clearly marketed to children with a teddy bear on it. If we get rid of that packaging and advertising, could we still use some flavours?

Professor Sir Chris Whitty: Possibly, but this Bill gives powers that allow us to vary it depending on what the industry does. That is really the point.

[Angela Richardson (Guildford) (Con)]

Q I have just looked online and found the top influencers on social media for vaping. I know the Government sometimes use influencers in order to change behaviour. Has the NHS been involved in paying influencers for vaping? Related to that, a lot of young people and children feel under pressure a certain way, and nicotine is known as an appetite suppressant. What message do you have for young people on that basis?

Professor Sir Chris Whitty: I wonder whether I can turn to Sir Gregor first, and then maybe Sir Michael.

Professor Sir Gregor Ian Smith: I am not aware of the NHS ever engaging any of these influencers, in terms of how we approach the subject of vaping. There is certainly a real danger that social media is sometimes used by younger people, and they see things that become really attractive to them in terms of lifestyle. The misinformation and disinformation that exists across those platforms can lead them to participate in activities that are potentially harmful.

Directly to your question, my very strong answer to any young person thinking about using one of these products as an appetite suppressant is: please don’t. Please safeguard your health. Do not begin the potentially addictive journey of using these products. Do not do it for any reason.

Going back to the point we made earlier on, I would love to see a society where our sports organisations promote much more healthy behaviours, where we have a much better understanding of the huge variation in body image we have across our society, and where we promote the very positive and broad representation of who we are as the general public, because there is no “one size fits all” answer to who we are. We are beautiful in our diversity. Anything we can do to have a more positive representation of society across these platforms would be very beneficial.

Professor Sir Michael McBride: Believe it or not, I was a teenager once too, and I remember what it was like. Teenagers tend to push boundaries and experiment. It is all about finding yourself and your place and space in life. It is not cool to vape. It is not cool to succumb to peer pressure. Be yourself. Make sensible choices about what it is right for you. That is the message I would add to Sir Gregor’s point. We have an unfortunate situation where teenagers like to experiment and push boundaries and we have an industry that is only too willing to exploit that and market products at them with, as we heard, cartoon figures on the front, attractive colours and flavours that taste and smell nice. They are extensively marketed by opinion leaders. So don’t follow the crowd. Be yourself.

--- Later in debate ---

[Mary Kelly Foy]

Q This question is particularly for Professor Hawthorne. From your experience, can you tell us what impact smoking tobacco has on our most deprived communities?

Professor Hawthorne: It is much more prevalent. There is a theory called future discounting. If you have few choices—if you do not have much money and much choice in what you eat, what you do and where you work—you do not think about your health in 20 years’ time; you think about today. Many people feel that smoking helps them get through the day, and that is what they do. It is a really difficult thing to talk to people about because some people will say to me, “I’ve just got to. I can’t get through my day otherwise.” I can say, “There are alternatives. There are other ways that we can help you get you through your day,” but you have to get them round the clock face that I was talking about, until the point comes when they say, “I’ve got to do it now.”

[Nickie Aiken]

Q Vapes—or e-cigarettes, whatever you want to call them—were introduced to help people to stop smoking. Professor Hawthorne, I would be particularly interested in your view on this, as a GP. We know that vaping has been turned into a massive industry now, but if the whole point of vapes, or e-cigarettes, is to get people to stop smoking tobacco, what is your view about vapes being prescribed?

Professor Hawthorne: Do you mean as part of a smoking cessation programme?

Tobacco and Vapes Bill (Second sitting)

Mary Kelly Foy Excerpts

Committee stage
Tuesday 30th April 2024 Public Bill Committees

[Bob Blackman]

Q What is your view on the limitation of the number of premises that would be allowed to sell tobacco or vaping products?

Cllr Fothergill: I could not answer that one, I am afraid, but I would be happy to come back to you with a view on that.

Greg Fell: I have the same view. It is not my area of expertise so I would rather think about that one carefully.

[Mary Kelly Foy (City of Durham) (Lab)]

Q This is a question for Greg. It would be useful for the Committee and for people watching to hear your view on the impact of smoking and tobacco on public health.

Greg Fell: It is the single biggest cause of death. There is no real question about that. It may not be in many years’ time when smoking prevalence has come down, but right here, right now, it is. No other product is available that kills more than half its users when used according to the manufacturer’s instructions. Death is often preceded by a long illness—sometimes a short illness, but often a long one—often in folk of working age. Most people who die from smoking-related illnesses die too early.

Sheffield-wise—I know my numbers locally—it is a bit north of 700 deaths a year out of 5,000 or so, so not insignificant. To give you a reference, covid killed 1,500 people over the period of the pandemic. Smoking kills 700 people every year, year on year, and that is before we get into the illnesses. Aggregated across the country, that is 80,000-odd people—a Wembley stadium-sized group of people, a non-trivial number. It is also very inequitable and led by addiction. People spend enormous amounts of money on smoking, so stopping smoking would free up that money to be spent in other ways. Smoking remains the No. 1 cause of death and it is very inequitable—almost certainly causing the largest gap in healthy life expectancy and life expectancy inequality.

[Mary Kelly Foy]

David, do you want to add anything?

Cllr Fothergill: I think Greg summed that up perfectly.

[Preet Kaur Gill]

Q Why do you support the complete ban as opposed to raising the age from 18 to 21, as many people often say? I know the Khan review has talked about not getting to a smoke-free future if we did that, but is there anything you would like to say about that?

Greg Fell: Years and years ago, the narrative was about raising the age of sale to 21, but I think the evidence has shifted. I hear from a number of stakeholders and sources that the tobacco industry is targeting its public relations at slightly older young people—the 18 to 25 age group. If you were to stop at 21, the tobacco industry would just change its marketing and you would therefore get a new target group recruited into smoking. Nobody thinks that that is a good idea, so the evidence is shifting.

The ban sets a really important norm. We can all remember walking out of a pub smelling of cigarettes. We cannot imagine that now, so continually shifting the norm changes population behaviour just by norm shifting, which is important and often underplayed. I would support the lifting lid—I think that is the right phrase.

Cllr Fothergill: I think Greg is absolutely right. At the LGA, we support the progressive lifting of the age as opposed to raising it to 21. We think that is the right way to go. It will then move through the population over a number of years rather than just being static at a single point.

--- Later in debate ---

[Trudy Harrison (Copeland) (Con)]

Q Thank you, Ailsa, for all the work that you do up north in the north-east. I represent the north-west, Cumbria, which also has higher than national average rates of mothers saying that they are smoking at the point of birth—about 12.3%. I am told by our authority in Cumbria that about 3,500 hospital admissions, 74,000 GP appointments and 80,000 sick days are caused by smoking-related illnesses. But why not just do more of what you are doing in the north-east? Do you really need this Bill to tackle the problem?

Ailsa Rutter: I think we are doing some really good work in the north-east but I absolutely think that this Bill is required. I go back to the uniquely lethal nature of tobacco smoking; that is the one key argument that we need to think about. This is guaranteed to kill. For me, this is about a societal shift.

I am really pleased with the huge shift in the north-east on the social norms of smoking. We talk to people who smoke every single day, and you have their backing because they desperately do not want their own children to fall into the same trap. As I mentioned before, this is about aspiring into the future. We are all conscious of the pressure and strain on our NHS. Think about the impact—one in four beds in the north-east and elsewhere with somebody suffering from a smoking-related condition. I think our NHS colleagues in particular really welcome this.

There is another important aspect when it comes to the economic costs. We all get the healthcare costs and we also really understand the strain on social care, but actually it is business that bears the brunt of this. That can surprise people. It is about the lost productivity and people having to retire early and dying early. I would like to think about who these people are. I have mentioned the pivotal role of Sue Mountain and the showing of her TV advert, but so many other people have come forward who sadly were diagnosed in their late 40s—women in the north-east who are desperate to tell their stories. Cathy Hunt, diagnosed with lung cancer at 49; Claire Oldfield, diagnosed with lung cancer at 49. Their real appeal to you today is to think about taking this seismic leap forward and about the leadership the UK can show globally by recognising that smoking had a beginning and a middle, and it is down to us to say that it can have an end.

[Mary Kelly Foy]

Q Thanks to Ailsa for everything that Fresh does in the north-east and for the wonderful results we have seen in the north-east, which is a very deprived area in places. I want to follow up on the question on evidence in vaping. Although there are still a few grey areas and unknowns about vapes, we know that vaping is much less harmful than tobacco. Crucially, it is a really important tool for those people who do smoke. What evidence does Fresh use to back up this argument? Do you feel there is a worry that if we focus too much in the Bill on youth vaping, we will leave behind those dependent, addicted and, very often, deprived smokers?

Ailsa Rutter: I think we are really fortunate in the UK. The UK has shown great leadership by commissioning evidence-based reviews that are completely independent of Government; we have had eight of those now since 2014. That has been incredibly important. Fresh is not complacent. We have been monitoring the evidence around the rise in vaping and how this is positioned in terms of public health for the last 20 years—since we were set up. I would strongly recommend that many of the really useful questions we have had today could be answered by looking at those systematic reviews from the Office for Health Improvement and Disparities. In particular, when people say, “We don’t know what’s in vaping,” there is a significant chapter on the constituent chemicals and so on in vaping, and the magnitude of potential harm.

I have forgotten the second bit of your question, Mary.

[Mary Kelly Foy]

It was about the use of vapes by heavily dependent smokers.

Ailsa Rutter: Yes. In the north-east, vapes have been a “game changer” for some of our heavily addicted smokers. I have permission to share with you the fantastic role that vapes have played in our biggest mental health trust, Cumbria, Northumberland, Tyne and Wear. We are talking about people who have been smoking 40 or 50 cigarettes a day, often for decades, who have really struggled to imagine that they could ever get off lethal smoking. Being able to give them something that still gives them their nicotine, but in a much purer, safer and cleaner form, has been a game changer.

Vapes are being used successfully in our drug and alcohol treatment services—on the point about alcohol, the two often go hand in hand. If we are really intent on ending smoking, we must do more on alcohol. Wearing my Balance hat—Balance is the alcohol bit—it is really important that we do not think of risk-taking behaviour in youth as just vaping. Last week, the World Health Organisation published a report that shows that across 44 countries, the UK sadly has the highest use of alcohol among 11-year-olds. I hope nobody thinks that the amount of alcohol promotion, advertising, marketing and so on is okay. I think it is quite important that we look at risk-taking behaviours in the round.

[Bob Blackman]

Q In answer to my colleague, Nickie Aiken, you raised the primary issue of age verification. We get an opportunity to change the law on tobacco and vaping only once every 10 years or so, so it is quite important that we get as much in as we can. What other improvements would you like to make to the Bill to strengthen the argument you are putting, to get people to quit smoking or not even start in the first place?

Ailsa Rutter: That is a really good point. I think it goes back to not wanting to delay the progress of the Bill. It is not necessarily for legislation, but it is important that we have a very clear communications strategy. Reflecting on previous legislation, much of the high levels of compliance we have seen in this country have come from very proactive communications in advance. We need to be really careful that the narrative does not get overly confused. It worries me enormously that too many people are staying on smoking because they are scared of even trying to switch over to a significantly less harmful product. I worry enormously about scaring people. It is absolutely right that we have evidence-based messaging to children and young people, but they are messengers who go back to their parents, and we know that it is very important that they are sending clear messages back. So, I will defer on your question about additional amendment—sorry.

--- Later in debate ---

[Dr Johnson]

Q I proposed a ten-minute rule Bill to ban disposable vapes last February, so I am delighted to see that the Government have brought in an statutory instrument to do exactly that. I am disappointed, but not surprised, to hear you say that industry is doing its best to circumnavigate the regulations before they are even brought in.

I have two questions. First, how do we ensure that the regulations are flexible enough for us to be able to stay ahead of such measures? Secondly, could you say a bit about the effect on wildlife? My hon. Friend the Member for Penrith and The Border (Dr Hudson) has talked about puppies picking these things up in their mouths and the danger they can pose if the puppies bite into them. Could you talk a bit more about the danger that they pose to wildlife when they are thrown away?

Laura Young: Of course. On the regulations, I think that we have to think creatively and innovatively about some of the workarounds that might be being used. We are already seeing charging ports just being popped on the bottom. Of course, that might mean that the battery can be recharged a few extra times, but if it cannot be refilled with the solution, it is still, in practice, a single-use item and will have to be thrown away eventually.

The issue is about ensuring that we look at the builds and make sure that they are modular and that the circular-economy principles that we want to achieve are set in stone. I think that that means working as best as possible with the retailers and the manufacturers—although that will be really difficult—and looking to other initiatives, whether that is single-use plastics bans or treaties on plastic, one of which has just come to an end globally, to see what we can do.

I will tell you a story about the wildlife. A wildlife photographer, a birdwatcher, was taking some images of a marine bird doing a very normal activity, which was picking up a shellfish—what looked like a razorfish—and dropping it from a height to smash it open to get some delicious dinner. But after this young gull had failed multiple times, this photographer realised that, unfortunately, what it was actually picking up and dropping was a disposable vape. We are seeing not only domestic animals, such as cats and dogs and things that we love as pets, getting hold of disposable vapes and potentially breaking them open, but actual wildlife being impacted—picking them up, thinking they are shells on the beach, and trying to eat what is inside them.

That is just from the very short time that we have been paying attention and looking out for this, and from keen birdwatchers capturing it, so we know that there will be extensive wildlife impacts. We are only now scrambling around to try to find more evidence, but we know that it is already happening, and that that is just one example. The photographs are on Twitter, if anyone did want to go and find them. It is sad, but it is definitely the reality of what we are seeing.

[Mary Kelly Foy]

Q Just a very quick question: would you agree that this is symptomatic of the throwaway society that we live in? We have disposable vapes, plastic toys with happy meals and toasters—all small appliances that do not last long enough. They are all thrown away and are damaging the environment. I know that, in Durham, all sorts of electronic devices are thrown in the river, and that is interfering with wildlife.

[The Chair]

It is a fair question; it is not within scope of the Bill, but it is a fair question.

Laura Young: Yes, absolutely. Just last week, I and other leading scientists from across the UK published a piece in Science, the science magazine: a letter about disposable technology, using vapes as an example—the first in a wave of disposable, cheap tech that is having an impact—and about the need for a global effort to tackle this. That is absolutely a hot topic right now; if we do not get a grapple on it now and use vapes as an example of how to tackle it, we will just continue to see disposable electronics, which are all jam-packed full of things that we need for other devices for a green economy.

Tobacco and Vapes Bill (First sitting)

Mary Kelly Foy Excerpts

Committee stage
Tuesday 30th April 2024 Public Bill Committees

[Trudy Harrison (Copeland) (Con)]

Q Thank you. While the harms of vaping are becoming better understood, what do we know about the behaviours around vaping? I ask as an MP who represents the northern constituency of Copeland, where smoking levels are above the national average, where health inequalities are more prevalent, and where deprivation is also a factor. Are we seeing the same kind of mapping of deprivation in areas where people are starting to vape? Are we aware of copycat behaviour—children mimicking their parents or other people in their households—and are we starting to see some patterns in age groups starting to vape? That statistic—350 young people starting to smoke every day—is shocking. What do we know about vaping?

Dr Griffiths: Not as much as we would like. That is the headline, but I do not think it will surprise any of us to know that people follow cues in their environment. That is partly what happens around them in their social environment, but I would like to draw attention to what happens in shops and convenience stores where people buy vapes. I was looking around my local convenience store, which is not far from a school, and thinking about today. It does not take a lot to look at what is happening behind the counter and see the packaging, the marketing and the highly, brightly coloured products that are clearly labelled, named and flavoured in a way to be attractive to children, whether it be cherry cola vapes or cotton candy vapes. They are things that are deliberately sweet and targeted at children, so it causes us great concern that that will be such a huge influence on so many children. We see that playing out in prevalence. I do not know if there is anything that you would add, Sarah.

Sarah Sleet: I think you are right that there is no real evidence base around this. That research should be done and we would very much like to look at. Where smoking is very prevalent—as you say, in more deprived areas—people take cues from the people around them in terms of their behaviour. I have no doubt that look to similar cues for vaping. Are people around them smoking? Is it easy to get hold of vapes? Is it completely normalised? I think we would find a very similar pattern, but we need to get that evidence.

[Mary Kelly Foy (City of Durham) (Lab)]

Q We have heard that this Bill covers tobacco and vaping, and we have talked quite a bit about the advertising and packaging of vapes. Do you think that we could go further in actually tackling tobacco, which is the biggest killer, around the advertising and packaging of tobacco and flavoured tobacco?

Dr Griffiths: We would welcome anything that stops people smoking or beginning to vape as a starting point for their addiction to nicotine. Given the scale of the devastation that that has on people personally as well as on our NHS in terms of cost burden and all the other impacts that it has, we fully support the Bill going through in full as it is now. If there are opportunities and support for strengthening it, I am sure that we would welcome that too.

The majority of people across the UK support the Bill and would love to see a smoke-free generation. The fact that you have 51% of retailers supporting it also speaks to how powerful a moment it is. We should do anything that we can to strengthen the Bill and prevent it from being diluted. We know that the tobacco industry will be campaigning in the opposite direction to limit any restrictions that would reduce its success, so we are really mindful of that. We urge the Committee and everyone who can to protect the Bill from dilution. It can save and improve lives. It is potentially a transformative piece of legislation.

Sarah Sleet: We asked our supporters who was in favour of the Bill. Bearing in mind that many of our supporters may still be smoking or are ex-smokers, 84% supported the Bill and really wanted to see it come through. Daily on our helplines we hear people saying, “I wish I had never taken up smoking.” They are completely addicted and find it almost impossible to get out of smoking, and their health is being slowly degraded over time. They are having to come out of the workforce and retire early and potentially face death as well.

--- Later in debate ---

[Bob Blackman]

Q You talked about the escalation whereby young people, possibly as young as 10, start by vaping and then go on to other tobacco substances. What further measures would be required, in your view? What further support would teachers need to explain the harm that young people are doing to themselves as a result of vaping and smoking?

Matthew Shanks: There are lots of campaigns that explain the harms of vaping and smoking. Sometimes people do not listen and do not engage with them. The only thing that I would say is that more people vape and smoke than take drugs, because drugs are illegal. If we are saying that tobacco is dangerous and harmful to people in our society, and our role is to protect them and educate them to see what is better, why is tobacco not illegal as well? Vaping started as an alternative to tobacco, but it is now catching on with young people. Is there a similar thing to be done with vapes? That is the view within schools on how we can help children to engage in what they should be doing at school, which is working at their education. There will be other things that have come along, but 15 years ago it was chewing gum everywhere—nicotine chewing gum was a big thing.

Patrick Roach: The reality is that schools are doing an awful lot to inform, to educate and indeed to regulate the conduct of children and young people, as well as to engage with parents and carers, but schools by themselves cannot change society. They can have a tremendous influence over wider society, but by themselves they cannot change it.

Anything that we can continue to do to educate young people about the harms and dangers of smoking and vaping, we should continue to do. Notwithstanding this legislation, that is essential, because no legislation is going to eliminate illegality. We have to continue to strive to eradicate those behaviours wherever they manifest themselves.

What other practical measures could the Bill include? I have mentioned the way in which vape products are described. We think that something could be done there. On availability—this is potentially outwith the scope of the Bill, but it could happen through other legislation and regulation—we think that the prohibition of disposable vapes is an issue that needs to be addressed.

There is also the issue of enforcement measures. There is no point in passing legislation if it is not enforced in practice. We need to ensure that the enforcement measures are absolutely robust. The proximity to schools of any retailer selling vaping products also needs to be looked at.

[Mary Kelly Foy]

Q Following on from Bob’s question, you are in a position to educate young people about the harms of tobacco. Is there a point here about educating young people about the harms, about the unscrupulous measures that the tobacco industry takes and about the horrific products that it is making? Young people are often interested in climate change and wider issues. These industries and organisations are having an impact across the whole world. It could be something that young people are interested in—not just for their health, but for the wider impact on their local communities and across the world. If we had more funding for education, maybe with a payer levy, those types of measures could be looked at. Is there any opportunity for that type of education in schools?

Matthew Shanks: That is happening at the moment within education, in curriculums and so on, but there is a lack of messaging around vaping, its harmful effects and its cheapness compared with tobacco. Even with the teaching of the harmful effects and the messaging compared with tobacco, there are still some families who smoke and you still see celebrities smoking. You are fighting that all the time.

It is good that we are educating young children about the harmful effects of things and the need to change, and we will continue to do that. We talk about big tobacco companies, big pharma, the global environment and so on, all within the curriculum.

Patrick Roach: The reality is that we need more space in the curriculum to do all that and to make the connections between vaping, the impact on a child’s health, and how these companies are profiteering, often from the most vulnerable. The producers of vaping products, the degradation of the environment, the way products are manufactured—all of this is very rich territory.

I would like to see more by way of permission for teachers and school leaders to engage with their pupils about the real everyday concerns that young people have. There should be more scope and space in the curriculum to do that. That is not to argue against the teaching of maths, science and languages; it is about saying that we want to produce well-rounded individuals. For us, that is the purpose of education. This is an area where educators have an important role to play.

Matthew Shanks: I would just add to that by encouraging you to visit your local schools and see what they are doing.

[Angela Richardson]

Q This morning, in evidence from previous witnesses, we heard a lot about how vaping is a great smoking cessation tool, but there is not enough evidence about the harms of vaping. You have described social harms; you probably see health harms as well. You have surveyed people, and you have come to give evidence this morning. Have you been asked, outside this, for evidence of the harm from vaping to the young people you look after? Do you believe that the evidence gathering on whether vaping is harmful is going at a fast enough pace?

Matthew Shanks: No, prior to now. This is very welcome, which is why we have both given our time because this is important. There was something in the papers this morning about evidence of harms of vaping for children, but it is not the headline; it is seven or eight pages in, so people will not read it.

I absolutely think that there should be more about the harm of vaping or just the unknown. You do not know necessarily what the dangers are, so therefore why would you engage in it? We talk a lot when we are doing drug prevention with children about—apologies if this offends—where the drugs come from, what the base of them is and what they contain. In the same way, you do not know what is in a disposable vape or another type of vape, so why would you put that in your body? Those are the lessons we are talking about, so we would certainly welcome more evidence to support that.

Patrick Roach: We know, from the feedback we have had from teachers as part of the research we have done, which includes both quantitative and qualitative feedback, that children are getting ill as a result of using vaping products. That is the daily reality that school leaders and teachers have to deal with.

The more that we can systematically collect and collate that data and evidence—whether that is a child who ended up being rushed into hospital because they became very ill on the school premises or, indeed, a near miss within the school—the better we will be. But the reality is, on an everyday basis, that teachers are experiencing this and having to deal with these issues and to intervene on and support pupils who are impacted physiologically by other harms of vaping products.

Illegal Vapes

Mary Kelly Foy Excerpts

Tuesday 16th January 2024 Westminster Hall

[Mary Kelly Foy (City of Durham) (Lab)]

I thank the hon. Member for Darlington (Peter Gibson) for securing this afternoon’s debate. I am sure he knows that I have been discussing this issue and campaigning against the sale and use of illegal vapes throughout this Parliament, and I am sure he is aware that I tabled several amendments to the Health and Social Care Bill in 2021, when it was in Committee. I understand that the hon. Member was not a member of that Public Bill Committee, but he must share my frustration with his party on this issue. The Tory Whips instructed Conservative Members to vote down my amendments in 2021—amendments that were very similar to the proposals in the King’s Speech last November. If my amendments had been voted for, it is fair to argue that fewer people—particularly young people—would be addicted to nicotine, and that as a result the tenor of this debate would be different.

“What ifs” aside, we need to see robust regulation and enforcement at local level. My constituency needs that, and I am shocked at the extent of illicit, non-compliant and even untraceable vaping products in my constituency. Over 6,000 illicit vapes were seized last year across County Durham, with three prosecutions linked to under-age sales and illicit vapes. I express my thanks to The Northern Echo for its investigation into that.

Although I welcome the Government’s announcement of an illicit vapes enforcement squad, we are now nine months on from that announcement, and unregulated and potentially dangerous products continue to fly off the shelves. All the while, the tobacco industry is making profits off the back of youth vaping rates. Cuts to trading standards have not helped, either. Trading standards workers in Durham are at full capacity, so when will they receive something from the £30 million that was announced in October to help them do their job?

We need the Government to be bold. We need to stop rogue vape traders in their tracks, and we must ensure that the sale of illicit vape products does not deter smokers from switching to vaping. I welcome any Member’s raising the issue of the use and sale of illegal vapes. Like the hon. Gentleman, I was pleased to be part of a rare example of cross-party unity in The Northern Echo but, at the end of the day, what matters in this place is how we vote on policies. If an issue similar to that posed by the Health and Social Care Act 2022 arises in the future, I hope that the hon. Gentleman and Members who are about to contribute to the debate will put their constituents before their party Whips.

Smokefree Future

Mary Kelly Foy Excerpts

Thursday 11th January 2024 Westminster Hall

[Mary Kelly Foy (City of Durham) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Sharma. I thank the hon. Member for Harrow East (Bob Blackman) for securing the debate, and I declare my interest as a vice-chair of the APPG on smoking and health.

The Government’s announcement of their smoke-free generation policy was welcome after several years of inaction on tobacco from successive Conservative Governments, which have left us playing catch-up to achieve the Smokefree 2030 ambition. Indeed, regulations to protect children from taking up vaping and smoking in the first place would already be in the law today if the Government had accepted my amendments to the Health and Care Bill three years ago. Nevertheless, I welcome the commitment to curb youth vaping with tighter rules around packaging and promotion. The right balance needs to be struck to ensure that vapes are used only by adults who want to quit smoking.

In the north-east, the most disadvantaged place in England, we know better than most that smoking is not only the greatest cause of preventable deaths, but responsible for half the difference in life expectancy between the most and least advantaged in society. Smoking rates are a clear expression of the health inequalities that divide our country. That is why my colleagues and I show up time and again to demand that real and bold action be taken to make smoking history. Children of parents who smoke are three times more likely to take up smoking themselves, more likely to suffer significant income loss and more likely to live a shorter life.

It is high time to break the mould. The Government now need to make the best use of the additional funding that they have attached to the smoke-free generation policy. The Fresh tobacco control programme in my own region is a long-standing example of how budgets can be pooled and partners can work together to bring about positive results. I would be delighted to welcome the Minister to Durham and the north-east to learn more about the work of Fresh, which has been so crucial in reducing smoking rates far more rapidly than the national average.

Preventing the next generation from starting to smoke is not enough. There are 6.4 million adult smokers who need support to quit. The additional funding being provided to stop smoking services is vital, but we cannot ignore the threat to NHS provision of tobacco dependence treatments for in-patients, mental health patients and pregnant smokers. In November, the Health Service Journal revealed that NHS trusts were being told that they could raid these budgets to fund urgent and emergency care. At a time when the roll-out of those programmes has already been cut and is well behind schedule in many areas, the Government pay lip service to the need for prevention if we are to reduce pressure on our NHS. It is yet again a Cinderella service, trumped by the need to do more to treat those who are already sick.

What is more, funding for financial incentives to support pregnant smokers to quit and for the Swap to Stop vape campaign is only guaranteed for two years. We need a long-term and sustained commitment to protect our most vulnerable from the harms of tobacco smoke, including unborn babies. I hope the Minister can ensure that those schemes will be funded for at least the full five years needed.

While the measures announced by the Government, which the APPG and Action on Smoking and Health have long called for, will have an important impact, they are not enough to achieve the Smokefree 2030 target of a maximum 5% smoking rate. We need further action. Of course, more action means more funding, which is where the APPG’s recommendation of a “polluter pays” levy on tobacco manufacturers comes in.

As always, more money is needed if we are serious about a smoke-free future. Why, then, are we not seriously considering making the polluter, the tobacco industry, pay to address the damage that its products are inflicting on our communities? The industry makes vast profits in Britain every year. Why is it not being made to pay, instead of the taxpayer? As the APPG report makes clear, a levy on the industry would raise the funding necessary to achieve a smoke-free future for all, not just the most advantaged.

Ahead of the spring Budget, will the Minister commit to discussing the APPG’s proposal of a “polluter pays” levy on tobacco manufacturers? Would she discuss this with Ministers responsible for tobacco policy in His Majesty’s Treasury? As health inequalities worsen and lives remain at risk, the Government must make up for their lost time with bolder action. They must make the polluter pay.

NHS Dentistry

Mary Kelly Foy Excerpts

Tuesday 9th January 2024 Commons Chamber

[Mary Kelly Foy (City of Durham) (Lab)]

It was music to my ears when my hon. Friend the Member for Ilford North (Wes Streeting) announced that a Labour Government will introduce 700,000 extra appointments each year, get more dentists into the communities such as mine that need them the most and ensure that everybody who needs an NHS dentist can get one, because I am fed up with the state of NHS dentistry. I am fed up that my constituents cannot get an appointment, fed up that people in Durham have resorted to DIY dentistry and fed up that Tory Governments have sat on their hands for over 13 years.

To be clear, NHS dentists are not to blame for the crisis. We know they are trying their best. It is Ministers on the Benches opposite who are to blame, and they cannot say they have not been told. I have raised this important issue for the last two years and other Members have done so for so much longer. Last May, I raised, as a point of order, that the Prime Minister may have made several inaccurate statements regarding the number of NHS dentists. For instance, in Prime Minister’s questions on 3 May, he stated that

“there are more than 500 more dentists working in the NHS this year than last year.”—[Official Report, 3 May 2023; Vol. 732, c. 111.]

However, a freedom of information request obtained by the British Dental Association threw the Prime Minister’s comments into doubt. According to the FOI response, the number of dentists is in fact down by 695 compared with the previous year, and there were fewer dentists undertaking NHS work than before the pandemic, bringing the workforce down to levels not seen since 2012-13. Unsurprisingly, the Government did not correct the record, and that says it all.

Everyone knows that NHS dentistry is in crisis—our constituents tell us regularly—but the Government continue with their “It’s all fine” attempt at message discipline. Why do they not just accept that vast areas of our country are now described as dental deserts and do something about it? I hoped that the Chancellor would have offered something—just anything—for NHS dentistry in the autumn statement, but dentistry was not mentioned in the Chancellor’s speech or the policy report. Not a penny was put forward, even though the Government announced a recovery plan in April last year. That recovery plan, as we have heard, still has not been published. Even worse, perhaps, was the sinister announcement, confirmed in the answer to a written question I tabled in November, that the Government would withdraw free dental care for the long-term sick.

Last year, I led an Adjournment debate on one such dental desert—my constituency, City of Durham—and I want to repeat what my constituents shared with me so that Ministers know what people are going through. One constituent told me that they had moved to Durham four and a half years ago, but could not find an NHS dentist. They were told that, after a kidney transplant, it was vital they had regular dental check-ups to monitor their health, but then they broke their tooth and could not afford to fix it. Another constituent told me she had to borrow money to afford a private appointment; after becoming pregnant, the exemption she got from dental charges was worthless because there were no appointments available. A young girl from my constituency tripped over and shattered her teeth, and her family could not find a dentist to help her. It was only after I reported the case on social media that a local dentist kindly offered their assistance. Another was unable to find an NHS dental appointment, so out of frustration decided to go private. Following that, they were diagnosed with oral cancer.

Why is this happening? A visit to a dental practice in my constituency provided some answers. The practice had just one dentist working two days a week seeing NHS patients and it had 10,000 patients on its books. In the north-east, almost 97% of surgeries are not accepting new adult patients. It does not take a genius to work out why my constituents cannot see a dentist.

The situation nationally is diabolical. Rotten teeth is the No. 1 reason why children aged between six and 10 are admitted to hospital, with an average of 169 children undergoing tooth extractions every working day. It is clear that a preventive approach to healthcare has eroded in Britain. Fundamentally, this is because of austerity. For over 13 years, the Government have hollowed out our welfare state.

[Peter Gibson]

The hon. Lady and I share the same integrated care board. If this is to do with austerity, why has she not engaged with our local ICB to ask it about the underspend and the provision in her constituency?

[Mary Kelly Foy]

I do speak to the ICB whenever I need to and it has told me, as I am about to say, that our welfare state, of which the NHS is a part, has been hollowed out. The system is wrong. Austerity has caused these problems: it is not the pandemic; it happened many years before then.

Supporters of austerity often say they do not want to burden future generations with debt, but austerity and preventive healthcare are incompatible; we cannot have both. The healthcare problems this Government have caused our constituents—issues that could have been prevented with funding and investment—will now be more expensive to resolve down the line. Conservative Members have saddled future generations with poorer health, poorer opportunities and ultimately a poorer country, and it is time for them to go.

Building an NHS Fit for the Future

Mary Kelly Foy Excerpts

Monday 13th November 2023 Commons Chamber

[Mary Kelly Foy (City of Durham) (Lab)]

Last week, we heard the longest King’s Speech in years, but it had very little in it. However, there was a silver lining: the announcement that the Government will bring forward legislation to create a smokefree generation. The devil will be in the detail, of course, and this certainly does not let Ministers, past and present, off the hook on the NHS. We see that if we just look at the state of NHS dentistry, an issue I have raised, and will continue to raise, in this place. Numerous Labour and other Opposition Members have also raised it in today’s debate.

I want to focus on smoking because it may be the single largest driver of health inequalities in England. Professor Chris Whitty argues in his latest report that central and local government has a key role to play in reducing smoking. It is an issue that the overwhelming majority of medical professionals agree on, as, I hope, do the majority of MPs. I have long taken an interest in the issue; as a councillor, I held the portfolio for health and wellbeing for nearly a decade, and this included chairing our tobacco control alliance. Working together with communities and local authorities to tackle tobacco harm, I saw at first hand just how much can be achieved with a comprehensive approach that drives change, through a multitude of initiatives. So although I welcome the Government’s proposals to create a smokefree generation and to curb youth vaping, the smokefree ambition must be delivered for everyone, not just the next generation. The measures announced to date have not gone far enough, not by any measure. As I walk through certain areas of my constituency, I continue to be struck by the number of people who still smoke. More than 117,000 people have died prematurely from smoking in the north-east since 2000; it is our biggest preventable killer and it is devastating for the thousands of families whose loved ones are lost each year. It also has significant implications for our health services and economic costs for our communities. It is estimated that smoking costs County Durham almost £190 million each year, £22 million of which is spent on healthcare. So preventing ill health is key. The concept that prevention is better than cure is a pretty old-fashioned idea, but it works. After 13 years, Ministers have finally picked up on that with their smokefree announcement.

Smoking is a deadly addiction, one that can lock people into a cycle of poverty and is difficult to break out of without support. We also know that regions with the highest rates of poverty have the highest rates of smoking in England and that smoking is one of the leading drivers of health inequalities in constituencies up and down the country. Not only do men and women in the most deprived areas have shorter life expectancy overall, but they live a larger number of years suffering from ill health. So far, the Government have wasted too much time. In 2021, I tabled amendments to the Health and Care Bill to tackle smoking and youth vaping. My proposals included a levy on tobacco companies’ profits to fund stop-smoking activities; inserts in packs containing health information, with links to smoking cessation services; and a ban on tactics such as branding and sweet flavourings to market vapes to children. To my amazement, not only did the Government fail to adopt my amendments, but they voted them down. Those were common-sense proposals that enjoyed cross-party support and the backing of health campaigners. If passed then, the amendments would have been law today. Instead, the Government chose inaction. I hope that the amendments will return in whatever the Government put before the House. Since then, tobacco companies have made record profits, leaving taxpayers and their families to pick up the pieces. We cannot afford to waste any more time.

Last week, the all-party parliamentary group on smoking and health published its latest recommendations for a smokefree future. The plans called for further regulations, such as increasing the funding levied from the tobacco industry on a polluter-pays principle—a measure that could raise up to £700 million a year. The APPG report shows that the polluter-pays levy is popular, feasible and supported by voters of all political parties, as well as the majority of tobacco retailers. Tobacco manufacturers make an estimated £900 million profit in Britain each year, with an average net operating profit margin of about 50%, compared with the less than 10% average for British manufacturing. Ministers must take the APPG’s recommendations into consideration.

While the measures that the Government have announced are a step in the right direction, the devil will be in the detail. To ensure that we have the best possible legislation, I hope that the Minister will work with the APPG. We know that a strong cross-party consensus for legislative measures can make a real difference. We have seen it all before. When a Labour Government banned smoking in enclosed public places in 2007, it was a measure that had once seemed inconceivable. Now it is baffling that we did not do it earlier.

In the seven minutes I have been speaking for, at least one person has lost their life due to smoking and tobacco use, which means that as MPs we have a responsibility to stand up on this issue. As health inequalities worsen and lives remain at risk, the Government must make up for their lost time with bolder action. They must ensure that the latest Tory turbulence and the exit of yet another Health Secretary does not thwart progress. They must get on with the job.

Under-age Vaping

Mary Kelly Foy Excerpts

Wednesday 12th July 2023 Commons Chamber

[Mary Kelly Foy (City of Durham) (Lab)]

I declare my interest as a vice-chair of the all-party parliamentary group on smoking and health. I thank the Labour Front Bench for choosing this topic as their second debate on their Opposition day today.

I welcome the motion, which gives a clear indication that the shadow Front Bench and the next Labour Government take this issue seriously. Given Labour’s polling right now, I think this will be policy next year, if not before.

I have repeatedly made clear my concern about the need to tackle youth vaping. In 2021, as we have heard, I tabled amendments to the Health and Social Care Bill to standardise the packaging of vapes. These amendments would have removed child-friendly branding and prohibited free distribution—in other words, free samples—to children. As Members may recall, the amendments had strong cross-party support. However, the Government did not adopt my amendments. In fact, they voted against them, and I am still in the dark as to why. Perhaps the Minister might explain in winding up.

Nevertheless, the Government must take forward these measures without further delay, because marketing addictive substances to children is unethical. Although it is vital to strengthen regulation on vaping, we must not forget that smoking still remains a far greater risk. Smoking is killing too many of our loved ones. There have been 117,000 smoking-related deaths in the north-east since the turn of the millennium. This is a public health emergency, and the Government are dithering yet again. We have waited since 2017 for the promised update to the tobacco control plan. We heard, just a few weeks ago, Ministers’ proposals for achieving their smoke-free 2030 ambition. They will not achieve it because their proposals do not go far enough and their actions are not bold enough. As we have heard, the Khan review found that we will miss the target by at least seven years without bold action. In the poorest areas of the country, the target will not be reached until 2044.

We must encourage as many smokers as possible to quit their use of cigarettes, the most lethal consumer product, by any means that suit them, including the use of nicotine vapes. The Association of Directors of Public Health North East has made its position on vaping very clear, reassuring both the public and healthcare professionals that vaping poses only a fraction of the risks of smoking while, at the same time, stating clearly that vapes should not be accessible or appealing to young people.

Three quarters of adults in Great Britain support measures to prohibit vapes that appeal to children and the promotion of vapes in shops, which is currently legal. We have a lot of evidence to support the fact that vapes play a very important role in helping adult smokers to quit, but they should never be marketed towards children. As I mentioned earlier, marketing an addictive substance to children is unethical. Let us remember that nicotine carries health risks. Vaping may be preferable to tobacco as a cessation aid, but we have to remain vigilant to the risks to oral and respiratory health.

Underage vaping has increased by 50% over the past three years, and it is happening under the Government’s watch. They have had several opportunities to act: I tabled amendments to the Health and Social Care Bill; the Khan review was based on research and evidence; and ASH, Fresh, Cancer Research UK and others have provided evidence. There is no excuse for this delay. The first duty of a Government is to protect their citizens; Ministers are failing in their duties to our young people. Since Conservative Members voted down Labour’s amendments to tackle youth vaping, countless children have no doubt fallen victim to the disgraceful and unethical marketing of vapes allowed by this Government. How many more children must become addicted to nicotine before Ministers finally take action?

Oral Answers to Questions

Mary Kelly Foy Excerpts

Tuesday 11th July 2023 Commons Chamber

[Steve Barclay]

As my hon. Friend knows, I have already met her to discuss this scheme, and the impediment was the business plan that came forward from the local trust—further work was being done on that. She is right to highlight our capital investment more widely. This Government have committed to investing in the biggest ever hospital building programme, with more than £20 billion. That is in addition to our long-term workforce plan—the first time the NHS has done this—in which we are making a further £2.4 billion of investment.

[Mary Kelly Foy (City of Durham) (Lab)]

Is the Minister aware that the NHS North East and North Cumbria mental health and wellbeing hub is due to close this September? With mental health care in crisis in County Durham, that is an insult to the health and social care staff who desperately rely on those services. Will the Minister reverse that decision?

[Steve Barclay]

There are two issues here. One is how much investment we are prioritising towards mental health; the other is how local commissioners choose to prioritise services within those communities, and whether we try to run all of those decisions from the centre in Whitehall or embrace the 42 integrated care systems and allow them to make commissioning decisions. The bottom line is that we are spending much more on mental health, with an increase of £2.3 billion compared with the position four years ago. That is allowing us to replace 500 dormitory beds and provide 100 mental health ambulances, three new mental health hospitals, 160 projects such as crisis cafés to support accident and emergency, and £75 million to help those with mental health challenges get back into work, which is one of the best prevention measures we can take for people who are suffering with their mental health.

Smokefree 2030 Target

Mary Kelly Foy Excerpts

Tuesday 20th June 2023 Westminster Hall

[Mary Kelly Foy (City of Durham) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Sharma, and to follow my co-sponsor of this debate, the hon. Member for Harrow East (Bob Blackman). He is also the chairman of the all-party parliamentary group on smoking and health, of which I am a vice-chair. I declare that interest.

As we have heard, the measures announced by the Minister in April were a step in the right direction. However, they fell very short of the comprehensive strategy outlined by the APPG and the Khan review, and it has taken far too long—almost four years—for the Government to get going on this. In the meantime, tobacco continues to kill an estimated one person every five minutes in Britain. The deaths are disproportionately concentrated in regions such as the north-east—regions that have some of the highest rates of poverty and, in turn, the highest rates of smoking in England. In the north-east, nearly 13,000 people died prematurely from smoking between 2017 and 2019. This has an economic cost for our communities of over £100 million in healthcare costs and £64 million in social care costs. All the while, tobacco companies make record profits, leaving the taxpayer and families to pick up the pieces.

We are fortunate in the north-east to have a highly effective regional tobacco control programme—Fresh—funded by all the local authorities in the region and the local integrated care board, and it has proven successful over the years. Just yesterday, it launched a new behavioural change campaign called “Smoking Survivors”, which features two women from the north-east who have quit smoking and survived cancer. However, national funding for behavioural change campaigns such as that fell by around 90% between 2008 and 2018. Although regional activity is vital, we need strong leadership from the Government if we are to see every region be smoke free by 2030.

Like the hon. Member for Harrow East, I welcome the Minister’s recent announcement on tackling youth vaping, but why did it take so long for the Government to act? When the Health and Care Act 2022 was going through Parliament in 2021, I tabled amendments that would have given the Government powers to prohibit child-friendly branding on e-cigarette packaging and to ban the free distribution of vapes to under-18s, which, as we know, has strong cross-party support. To my amazement, not only did the Government fail to adopt my amendments, but they voted them down.

As the Minister will remember, one of Dr Khan’s must-do recommendations was raising the age of sale for tobacco beyond 18, so I was disappointed not to see that included in the April announcement. The all-party group has already urged the Government to launch a public consultation on raising the age of sale, and I urge them to do that too.

I will end with a few questions for the Minister, which probably echo what the hon. Member for Harrow East asked. Will the Minister commit to consulting on a “polluter pays” levy to raise funding for a comprehensive tobacco control strategy?

Will the Government consider measures to address the affordability, accessibility, appeal and advertising of vapes, which were recommended by ASH in its response to the Government’s call for evidence on youth vaping? Once again, I highlight the fact that big tobacco companies rigorously lobby against vaping regulations, so I would like the Minister to take note of that.

Will the Minister confirm that a consultation on raising the age of sale will be considered? Finally, will he reassure the House that a comprehensive strategy to address smoking and vaping will be delivered—if not through the tobacco control plan, as promised by his predecessors, then in the forthcoming major conditions strategy?

[Mr Virendra Sharma (in the Chair)]

I urge Members to stick to about five minutes.