Reforms to NHS Dentistry

Mary Kelly Foy Excerpts

Thursday 27th April 2023 Commons Chamber

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

Across Durham and the whole country, dentistry is in crisis. It is a system in need of urgent reconstruction, not tinkering. To be clear, the problem has not been caused by NHS workers or dentists. It has been caused by the Conservative Government, who have ignored the concept of prevention rather than cure. Dentists have told me that the key issue is the chronic underfunding of NHS dentistry. Let us not forget that it has been subject to cuts unparalleled elsewhere in the NHS.

There is a real recruitment and retention crisis in the workforce, but the situation cannot be improved by simply recruiting more dentists. The fact is that NHS dentists are made to work in a fundamentally flawed system that does not have prevention at its heart. I fear that if NHS dentistry continues down this road, England may have an entirely private dental provision, and the facts speak to that. In August last year, the BBC showed that eight in 10 NHS practices were not taking on children as patients, nine in 10 practices were not accepting adult patients, and a third of council areas were not taking on adult NHS patients. How can we have a preventive approach if my constituents cannot get to see a dentist? In addition, tooth decay is the most common reason for A&E hospital admissions in young children. That is a disgrace.

Nothing could reflect the current crisis more than DIY dentistry. People are fitting their own fillings and extracting their own teeth without anaesthetic or professional training. This week alone, I have been contacted by eight constituents who have performed DIY dentistry. The situation is compounded by the cost of living crisis, which is blighting the lives of ordinary people. If someone needs to choose between eating and heating, they will probably not want to fork out for an expensive root canal; they will probably choose to have an extraction instead or do it themselves. This is a stark example of health inequalities.

I have some questions for the Minister. When will the Government adopt a preventive approach to health and social care, particularly to dentistry? When will the Government provide NHS dentistry with the funding it desperately needs? Has the Department had meetings recently with the Treasury to discuss funding? When will the Government work with the British Dental Association to reform the current dental contract, to stop the exodus of staff from the NHS?

In 1948, Labour recognised that it was vital to integrate dentistry within the NHS and that oral health is not an optional luxury but integral to our national health and key to the NHS. How we tackle it must therefore be a priority, not an afterthought. Only a Labour Government can save dentistry from the rot and decay that has set in under the Tories’ watch.

Oral Answers

Mary Kelly Foy Excerpts

Tuesday 25th April 2023 Commons Chamber

[Neil O’Brien]

I pay tribute to my hon. Friend’s work as chair of the all-party parliamentary group for vaping. He is right; as well as the measures I mentioned, we have updated the guidance on Talk to FRANK, to illustrate for young people the dangers of consuming lots of nicotine.

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

In 2021, the Government rejected my amendment to the Health and Care Bill to tackle smoking and youth vaping. England is now set to miss the Smokefree 2030 target by at least seven years, and countless children are now addicted to vapes. I welcome the U-turn, but what steps has the Minister taken to make up that lost time?

[Neil O’Brien]

We are taking action across the board on smoking. I think we are in agreement on what has to be done. That is why we recently announced that we are giving vaping kits to a million smokers to help them swap to stop. We are also bringing in new health incentives for all pregnant women so that we can help them stop—that is based on good local evidence. We are taking preventative action, and I think the hon. Lady and I both want the same thing.

NHS Strikes

Mary Kelly Foy Excerpts

Monday 17th April 2023 Commons Chamber

[Steve Barclay]

I do agree with my hon. Friend. If that demand were agreed to, it would mean some junior doctors receiving a pay rise of over £20,000. We need to find a balance, with a fair and reasonable settlement for NHS staff, recognising the huge pressure from the pandemic and the backlogs it has caused, while at the same time bringing inflation down, because that matters not just to NHS staff, but to all working people who are impacted by inflation.

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

The BMA has made it crystal clear that it is willing to enter into negotiations, so will the Secretary of State commit right now to asking ACAS to negotiate and mediate? If not, why not?

National No Smoking Day

Mary Kelly Foy Excerpts

Thursday 9th March 2023 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Efford. I congratulate the hon. Member for Harrow East (Bob Blackman) on securing this really important debate to mark national No Smoking Day. For the record, I am vice-chair of the APPG on smoking and health and was Gateshead Council’s cabinet lead on public health for 10 years, so I am passionate about making smoking history. It is telling that a number of Members present are from the north-east, and we will be reiterating the same messages.

The last tobacco control plan expired at the end of last year, and we are still waiting for the response from the Government to Javed Khan’s independent review on tobacco control. While we wait, thousands of people are getting sick and dying from smoking-related illnesses that are wholly preventable. Since 2000, more than 113,000 people in the north-east have died from smoking, and one person is admitted to hospital in the UK every minute due to smoking.

Although there is rightly a lot of discussion about smoking being the No. 1 cause of cancer, it is important to recognise the host of life-threatening and life-altering illnesses caused by smoking, including COPD, heart disease, dementia, stroke and diabetes. I am therefore delighted that this year’s No Smoking Day campaign is shining a light on the link between smoking and brain health. Smoking has been identified as one of the 12 risk factors that, if eliminated, could collectively prevent or delay up to 40% of dementia cases. Alzheimer’s Research UK found that dementia is the most feared health condition for people over the age of 55. However, only one in five people who smoke in the north-east are aware that smoking raises the risk of dementia. It is therefore vital to get that message out there. It is great that Fresh’s radio ad on this issue is estimated to reach more than 670,000 people in the north-east. I am proud that the north-east has been a trailblazer on this issue, with local authorities across the region working together to fund Fresh, which is a highly effective tobacco control programme. It has nearly halved the smoking rate in the north-east since it was set up. I am pleased to hear that Fresh will once again be funded by all 12 local authorities in the region.

Although it is great to see that work happening locally, it is vital that it is supported by much more investment at a national level. It is shocking that England is on track to miss the smoke free 2030 ambition by nine years, while projections by Cancer Research UK suggest that it will take a further 20 years to get smoking down to 5% in England’s poorest communities. The north-east is the most disadvantaged region in England. With that come high rates of smoking, which means there is further for us to go to become smoke free. The fact that smoking rates are disproportionately high among deprived communities highlights the fact that smoking is one of the leading drivers of health inequalities in our society. As we have heard, smoking during pregnancy is five times more common in the most deprived communities than in the least deprived. In County Durham, 704 women a year are smokers when they give birth, while 41,233 children live in households with adults who smoke. That not only has severe health consequences for children living in deprived areas, but increases fourfold their chance of taking up smoking and remaining a smoker in adulthood.

As well as having a shorter life expectancy overall, men and women in the most deprived areas also suffer from ill health for more of their lives. The levelling-up White Paper identified addressing health inequalities as a priority, yet little has been done so far. The Government’s lack of action and their delay in responding to the Khan review threaten our ability not just to achieve the 2030 smoke free goal but to level up. They must take action now and look urgently to implement the recommendations in the report from the APPG on smoking and health and in the Khan review to tackle the prevalence of long-term illness in areas of deprivation.

We all know that smoking is our biggest preventable killer and, as we have just heard, it is devastating for the thousands of families who lose loved ones each year. It also has significant implications for our economy, our local authorities and our health service. It is estimated that smoking costs County Durham £211.9 million each year, £26 million of which is spent on healthcare. Preventing ill health is key, and it is clear that effective Government action on the issue would relieve the significant pressure that smoking places on our health and social care services. There is no time to waste when we consider that our NHS is in crisis as resources are stretched to the absolute limit.

We must also ensure that smokers have the best chance of success when they attempt to quit, whether that is through support from local stop smoking services or access to alternatives. At the same time, we must prevent children and young people from taking up smoking in the first place, reduce the demand for and supply of illegal tobacco, and support further enforcement around illicit tobacco.

Four years ago, the Government set out their ambition for England to become smoke free by 2030. In April 2022, I asked the Government to ensure that the tobacco control plan would deliver their ambition and that it would be published no later than three months after the Khan review. Here we are, nearly 12 months on, and I am still asking the same question and we are still waiting for action. The chair of the Durham health and wellbeing board even wrote to the Secretary of State about the Khan review, but she received a non-committal response. With that in mind, will the Minister tell us when he plans to publish the tobacco control plan and what the Government intend to commit to on the back of the Khan review? Every day that we wait, too many people are dying needlessly.

[Clive Efford (in the Chair)]

Absolutely impeccable. Thank you very much—you have made it very easy to chair.

NHS: Long-term Strategy

Mary Kelly Foy Excerpts

Wednesday 11th January 2023 Commons Chamber

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

Let us be clear: the NHS crisis did not begin with covid. It is the culmination of 13 years of failure and neglect by the Conservative party. Nye Bevan described the creation of the NHS as

“the most civilised step any country has ever taken”.

After hearing the horrifying testimonies today of delayed ambulances and operations, it is clear that we have taken a giant and shameful step backwards. Our overworked and underpaid healthcare staff are telling us that with more than 100,000 vacancies in the NHS, safe and timely care can no longer be guaranteed. Underfunding is causing delays, and delays have real-life consequences on people’s lives, as I know only too well.

In 1989, a decade into an earlier Conservative Administration, my daughter was born 10 weeks premature. She needed a ventilator before she could breathe on her own. The local hospital did not have one, and neither did any of the surrounding hospitals. Eventually, one was found 30 miles away, and Maria was born three hours later by emergency C-section. As a consequence she suffered brain damage, and lived her life with severe cerebral palsy. No parent should face such an agonising delay today, but the harsh reality is that there are no guarantees.

Decisions made in this place have life-changing impacts on the people we represent, and under the watch of the Tories, the words “NHS” and “crisis” have again become synonymous. Today, ambulance workers from the Unison and GMB unions have been forced to strike in order to protest against the underfunding of the service, and the dangerous disfunction it has created. People are dying needlessly. Labour has a clear plan to train a new generation of doctors, nurses and midwives, and to have meaningful negotiations to end the strikes.

Oral Answers to Questions

Mary Kelly Foy Excerpts

Tuesday 6th December 2022 Commons Chamber

[Neil O’Brien]

Absolutely; my hon. Friend and I have talked about this. We are looking urgently at payment models and measures to address areas that are struggling to attract the right workforce. The commissioning of dentistry will be coming down to a more accountable local level in April, and we need to build on that.

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

My constituents in Durham have told me tales of DIY dentistry, missing teeth, children in pain and the unfairness of only being able to access dental care if they can afford it. Things should not be this way. The British Dental Association does not accept that the Government’s new plans go far enough to halt the decay in NHS dentistry provision. Will the Minister tell me when the Government will put in adequate funding and reform so that people in Durham can get the dental care that they need and deserve?

[Neil O’Brien]

As well as increasing the number of dentists doing NHS work and the amount of work being done, we are taking further steps to look to the longer term and build NHS dentistry. The number of dental school places is up from 810 in 2019 to 970 in 2021, but of course we want to go further. We are making it easier for dentists to come to the UK to practise. In fact, we laid draft secondary legislation on 11 October to give the General Dental Council more flexibility to do that. Around the country, plans are advancing for centres for dental development to provide not only additional dentists but hygienists and other nurses.

--- Later in debate ---

[Steve Barclay]

My hon. Friend raises an extremely important case. I am happy to meet him to discuss it further, because it is a concerning case and I am keen to engage with him on it.

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

T9. My hon. Friend the Member for Denton and Reddish (Andrew Gwynne), the shadow Minister for public health, touched on health inequalities earlier, but I did not hear the Health Secretary recommit to publishing the White Paper by the deadline. Does he understand that the cost of living crisis and poverty are leading to greater health inequalities and that action is needed urgently? Can he recommit to that White Paper being published?

[Steve Barclay]

We are absolutely committed to addressing health inequalities. Rather than simply looking at 10 years’ time, we are looking at the immediate actions we can take, because what matters—[Interruption.] Those on the Opposition Front Bench chunter about White Papers, but what I am interested in is immediate delivery—what we can be doing now, rather than speculating about what is done in 10 years’ time.

Ambulance Services and National Heatwave Emergency

Mary Kelly Foy Excerpts

Wednesday 13th July 2022 Commons Chamber

[Maria Caulfield]

I have set out to hon. Members the work we are doing to increase capacity in the ambulance service, including £150 million in funding, training more paramedics, and increasing the workforce by 40%. We published the heatwave plan for England earlier this year—the shadow Secretary of State, the hon. Member for Ilford North (Wes Streeting), was not sure whether he had read it, but I urge all Members to do so. We are watching this issue on a daily basis. It is not just about the heatwave; it is about covid pressures, enabling hospitals to discharge patients, the winter pressures that will come later this year, and making sure we have resilience in the system.

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

I have heard from one of my constituents who suffered a stroke and was left to wait for nearly two hours for an ambulance, and is now severely disabled. That issue is being seen repeatedly across the country, so can the Minister tell me what she is doing now, urgently, to make sure that when my constituents in Durham need an ambulance urgently, they get one? The plans she has outlined and the investment she has spoken about are obviously not good enough.

[Maria Caulfield]

We are working urgently on this issue—as, I am sure, are the health services in Wales and Scotland, which are facing the same problems. We are all working hard to address them. As I have said, we have procured a contract with a value of £30 million for an auxiliary ambulance service to increase capacity, should we need it. I will be meeting all ambulance trusts in the coming days to make sure we have the resilience we need, not just to catch up with some of the pressures that existed before covid or to deal with the pressures that those trusts are facing now, but to future-proof them for the coming winter months.

Access to GP Services and NHS Dentistry

Mary Kelly Foy Excerpts

Tuesday 21st June 2022 Commons Chamber

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

There are many issues that my constituents are experiencing when trying to access GP services, but I will focus my remarks on the crisis affecting dentistry across England and the impact that is having on people in Durham. I want to start by paying tribute to the dentists, dental nurses and other key workers in practices in County Durham and across the country.

Sadly, despite the brilliant work of dental workers, NHS dentistry is on the brink of collapse. Whether in Bowburn, Brandon or Pity Me, my constituents are struggling to access the dental services they need and deserve. Four in five people who contact Healthwatch say they have found it tough to access timely dental care, while tooth decay, as we have already heard, is currently the most common reason for hospital admissions among young children. In County Durham, 245 children under the age of 10 were admitted to hospital for tooth extraction between 2020 and 2021. Thousands of children are currently in pain, distracted as they learn, in pain as they eat and struggling to sleep because they cannot access vital treatment. Let that sink in.

Why is it so difficult to access NHS dental appointments? Because dentists are being driven away from NHS dental services en masse. A recent poll of dentists in England found that 45% had reduced their NHS commitment since the start of the pandemic, while 75% were likely to reduce their NHS commitment in the next 12 months. Alongside that, an alarming 87% of dentists say they have experienced symptoms of stress, burnout or other mental health problems in the past year. In total, 3,000 dentists have moved away from NHS work completely since the start of the pandemic.

As the British Dental Association has said,

“This is how NHS dentistry will die”.

The warning is not sensationalist; it is the reality that dentists and their patients in Durham are facing. This crisis is entirely avoidable. It is certainly not the fault of our rail workers striking today, as the Secretary of State would like us to believe—utterly disgraceful. What planet is he on when he talks about record funding? That is certainly not the case for NHS dentistry, which has faced cuts unparalleled to the rest of NHS services. In real terms, the Government’s net spend on general dental practice in England was slashed by over a quarter between 2010 and 2020, while the Government’s £50 million injection into dentistry will fund less than 1% of the appointments we have lost since March. In fact, the British Dental Association estimates that it would take £880 million a year to restore dental budgets back to the level when Labour left office.

Let us be clear: these issues will hit the poorest in our society the hardest. For many, the fees for private dental treatment are simply unaffordable. As one desperate constituent put it to me, “I can’t afford private treatment, so what on earth am I supposed to do?” There will be terrifying delays for children, adults and the poorest among those in County Durham, and I am sure across the whole country. Children in deprived areas are already three times more likely to have hospital extractions, while oral cancer, which kills more people than car accidents in the UK, is significantly more likely to affect those in our poorest communities. Dentists are frequently the first to spot health problems. Without access to regular appointments, our least well-off constituents will continue to be more likely to develop serious health problems than the wealthiest in society.

I take this opportunity to remind the Minister that it is the Government’s job to reduce health inequalities, not widen them. As elected representatives, we are responsible for protecting and improving access to key public services for our constituents. It is time the Government stopped treating dentistry as an afterthought and urgently took action to widen NHS dentistry. For my constituents in Durham, this crisis in healthcare is very much at the forefront of their minds.

Smokefree 2030

Mary Kelly Foy Excerpts

Tuesday 26th April 2022 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Ms Nokes, and I wish my hon. Friend the Member for Harrow East (Bob Blackman) many happy returns. I declare an interest as a vice-chair of the APPG on smoking and health; I hope, therefore, that I can speak for a little more than six minutes, if that is okay.

The north-east is the most disadvantaged region in England, with high rates of smoking and all the harms that it brings. However, I am proud to say that in the last five years, the fastest declines in smoking rates have been in the north-east. Credit goes to our local authorities, which prioritised tackling smoking and banded together to fund Fresh—the longest-running and most effective regional tobacco control programme in the country. However, the north-east started with much higher smoking rates than the rest of England, so we have further to go to achieve a smokefree 2030.

More than 4,000 people died prematurely from smoking in our region last year, with 20 times as many suffering disease and disability caused by smoking, yet there is also an economic cost to our already disadvantaged communities. Smoking costs the north-east £685 million in lost productivity, £125 million to the NHS and £67 million in social care costs to local authorities. We simply cannot afford this strain on our economy.

When the smokefree 2030 goal was launched nearly three years ago, the Government acknowledged the scale of the challenge, admitting that it would be extremely challenging and promised bold action to finish the job. Since then, however, the Government have sat on their hands. Rather than stepping up their efforts to achieve the smokefree 2030 ambition, the Government have failed to announce a single new policy to that effect, while the £1 billion cut to public health funding since 2015 appears to be baked in.

The Minister knows that half the difference in life expectancy between the rich and the poor is due to differences in smoking rates. The Government’s lack of action threatens our ability to achieve not just the 2030 smokefree goal, but their levelling-up mission to narrow the gap in life expectancy between areas where it is highest and lowest by 2030 and to increase healthy life expectancy by five years by 2035.

Today’s debate was originally secured to discuss the recommendations of the independent review. The fact that the review was delayed made the debate even more necessary. The Secretary of State committed, when he announced the review in February, that it would report back in April. Javed Khan said he would report back on 22 April, so we were very disappointed that the Secretary of State told Parliament last week that he hoped it would be published in May, with no commitment that that would be the case. That is just the latest of many delays and missed opportunities, which we want to put on the record.

We want a commitment from the Government that they will accept no further delays in bringing forward a plan to achieve a smokefree 2030. Let us start with the Green Paper that announced the Government’s goal of a smokefree 2030, which was launched with much fanfare in July 2019. Further proposals included considering the “polluter pays” levy, which my hon. Friend the Member for Harrow East mentioned, and giving the ultimatum of making smoked tobacco obsolete by 2030. Cabinet Office guidelines say that Departments should:

“Publish responses within 12 weeks of the consultation or provide an explanation why this is not possible.”

The Green Paper consultation ended in 2019. In July 2020, on the anniversary of the Green Paper, the then public health Minister, the hon. Member for Bury St Edmunds (Jo Churchill), told the APPG that work was under way to publish the further proposals envisaged in the Green Paper, and that she was keen to work with us to explore whether the current regulatory framework was sufficient. Since then, we have heard nothing.

The lack of an outcome on the Green Paper was disappointing, so in November 2020, we held a debate urging the Government to commit to publishing a new and ambitious tobacco control plan. We were therefore delighted when the then Minister committed in December to publishing a new tobacco control plan in 2021. The APPG commissioned Action on Smoking and Health, working in collaboration with SPECTRUM, the academic public health research consortium, to provide us with a report setting out our recommendations and the measures that the Government needed to take to achieve their 2030 ambition. The then Minister attended the launch of our report, welcomed our recommendations and committed to publishing the plan by the end of 2021. We are understandably disappointed by the delay in its publication.

There were other opportunities that could have been seized but were not. The Government were legally required to review the impact of existing tobacco product regulations, including those on standardised packaging, health warnings, product standards and e-cigarette regulations. The regulations set out in law a deadline for the review to report by May 2021. To that end, the Government launched a consultation last January to assess whether the objectives were still appropriate and whether the regulations were fit for purpose. Those regulations predated the Government’s commitment to a smokefree 2030, and it was blindingly obvious that they needed to be strengthened to match the scale of the Government’s new goal.

Since the regulations came into force, it has been clear that there are serious loopholes. The menthol ban relies on subjective rather than objective measurements to determine whether the regulations are being adhered to. An investigation by the Express newspaper revealed that the industry has exploited that loophole in the law and that Britain’s biggest tobacco giant sold £1 billion-worth of cigarettes flavoured with menthol in the year after the ban came into force.

That was not the only loophole; although e-cigarettes can be sold to those aged 18 and above, it is completely legal to hand them out free to children. While the advertising, promotion and sponsorship of e-cigarettes are heavily regulated, packaging and labelling are not. That has allowed the use of sweet names for vaping products, with cartoon characters and garish colouring, all of which appeal to children. Those are clear gaps in the law that need to be fixed without further delay.

The consultation was well timed to feed into the Health and Care Bill. ASH and SPECTRUM provided the Government with detailed and well-evidenced proposals for a number of improvements that would strengthen regulations and fix those loopholes. When the outcome of the review was not published in May 2021, as was required, we hoped that the Health and Care Bill would contain the further proposals the Government had promised to bring forward. Imagine our disappointment when the Bill was introduced to Parliament last July. Although it included measures on prevention and public health, there was nothing on tobacco or smoking, despite the Government’s much-trumpeted smokefree 2030 ambition.

That is why, in Committee, I tabled a set of amendments for increased regulation on tobacco, based on the APPG’s recommendations. The amendments included requirements to consult on a “polluter pays” levy; introduce pack inserts containing quit information; put warnings on cigarettes; close loopholes in the existing regulations on menthol and e-cigarettes; and consult on raising the age of sale to 21—a measure that has been proven to reduce smoking rates in the population at large by 30%. That measure has also been shown to reduce inequalities, because it has the greatest impact on the poorest and most disadvantaged communities. Throughout the passage of the Bill, Ministers in both Houses have repeatedly said that the Government were sympathetic to our aims and amendments, and that they would be considered for the next tobacco control plan. However, the tobacco control plan has already been delayed by a year and still does not have a publication date.

If the Government had supported those amendments, we would now have the foundation in place for a comprehensive strategy to end smoking by 2030. Instead, the Government have chosen to reject the amendments and, yet again, to kick tobacco control into the long grass. Now we are waiting for the tobacco control plan. Before the plan can be published, we have to wait for Javed Khan’s independent review, which will be followed by a public health disparities White Paper in the spring, which will in turn be followed by the tobacco control plan. That will leave only seven years to deliver the smokefree 2030 goal.

Since evidence first emerged of the harms caused by tobacco in the 1950s, smoking has killed more than 10 million people in the UK, and it continues to kill hundreds more every day. Up to two thirds of those smokers die prematurely from their addiction. There is a crucial message around children: every day, 280 children start smoking—that is more than 280,000 since the smokefree 2030 ambition was launched. Smoking is highly addictive; two thirds will go on to become daily smokers. With that in mind, can the Minister assure us that the tobacco control plan to deliver the smokefree 2030 ambition will be published no later than three months after the independent review? Will she also assure us that the Queen’s Speech will include a commitment to bring forward legislation in the next Session to deliver regulatory measures essential to delivering the Government’s ultimatum to the industry to make smoked tobacco obsolete by 2030?

I end with a comment from the chief medical officer. He pointed out that one in five people who die from cancer will die from lung cancer, and went on,

“the reason that people like me get very concerned and upset about it is that this cancer is almost entirely caused for profit…a small number of companies make profits from the people who they have addicted in young ages and then keep addicted to something which they know will kill them.”

[Caroline Nokes (in the Chair)]

I shall now put Members, starting with Hywel Williams, on a formal time limit of six minutes.

Health and Care Bill

Mary Kelly Foy Excerpts

Report stage
Monday 22nd November 2021 Commons Chamber

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

I beg to move, That the clause be read a Second time.

[Mr Speaker]

With this it will be convenient to discuss the following:

New clause 3—Cigarette pack inserts—

“The Secretary of State may by regulations require tobacco manufacturers to display a health information message on a leaflet inserted in cigarette packaging.”

This new clause would give powers to the Secretary of State to require manufacturers to insert leaflets containing health information and information about smoking cessation services inside cigarette packaging.

New clause 4—Packaging and labelling of nicotine products—

“The Secretary of State may by regulations make provision about the retail packaging and labelling of electronic cigarettes and other novel nicotine products including requirements for health warnings and prohibition of branding elements attractive to children.”

This new clause would give powers to the Secretary of State to prohibit branding on e-cigarette packaging which is appealing to children.

New clause 5—Sale and distribution of nicotine products to children under the age of 18 years—

“(1) The Secretary of State may by regulations prohibit the free distribution of nicotine products to those aged under 18 years, and prohibit the sale of all nicotine products to those under 18.

(2) Regulations under subsection (1) must include an exception for medicines or medical devices indicated for the treatment of persons aged under 18.”

This new clause would give powers to the Secretary of State to prohibit the free distribution or sale of any consumer nicotine product to anyone under 18, while allowing the sale or distribution of nicotine replacement therapy licensed for use by under 18s.

New clause 6—Flavoured tobacco products—

“The Secretary of State may by regulations remove the limitation of the prohibition of flavours in cigarettes or tobacco products to ‘characterising’ flavours, and extend the flavour prohibition to all tobacco products as well as smoking accessories including filter papers, filters and other products designed to flavour tobacco products.”

This new clause would give powers to the Secretary of State to prohibit any flavouring in any tobacco product or smoking accessory.

New clause 8—Tobacco supplies: statutory schemes (supplementary)—

“(1) The Secretary of State may make any provision the Secretary of State considers necessary or expedient for the purpose of enabling or facilitating—

(a) the introduction of a statutory scheme under section [Tobacco supplies: Statutory schemes], or

(b) the determination of the provision to be made in a proposed statutory scheme.

(2) The provision may, in particular, require any person to whom such a scheme may apply to—

(a) record and keep information,

(b) provide information to the Secretary of State in electronic form.

(3) The Secretary of State must—

(a) store electronically the information which is submitted in accordance with subsection (2);

(b) ensure that information submitted in accordance with this provision is made publicly available on a website, taking the need to protect trade secrets duly into account.

(4) Where the Secretary of State is preparing to make or vary a statutory scheme, the Secretary of State may make any provision the Secretary of State considers necessary or expedient for transitional or transitory purposes which could be made by such a scheme.”

This new clause and NC7, NC9 and NC10 would enable the Secretary of State for Health and Social Care to regulate prices and profits of tobacco manufacturers and importers.

New clause 9—Tobacco supplies: enforcement—

“(1) Regulations may provide for a person who contravenes any provision of regulations or directions under section [Tobacco supplies: statutory schemes] to be liable to pay a penalty to the Secretary of State.

(2) The penalty may be—

(a) a single penalty not exceeding £5 million,

(b) a daily penalty not exceeding £500,000 for every day on which the contravention occurs or continues.

(3) Regulations may provide for any amount required to be paid to the Secretary of State by virtue of section [Tobacco supplies: statutory schemes] (4) or (6)(b) to be increased by an amount not exceeding 50 per cent.

(4) Regulations may provide for any amount payable to the Secretary of State by virtue of provision made under section [Tobacco supplies: statutory schemes] (3), (4), (5) or (6)(b) (including such an amount as increased under subsection (3)) to carry interest at a rate specified or referred to in the regulations.

(5) Provision may be made by regulations for conferring on manufacturers and importers a right of appeal against enforcement decisions taken in respect of them in pursuance of [Tobacco supplies: statutory schemes], [Tobacco supplies: statutory schemes (supplementary)] and this section.

(6) The provision which may be made by virtue of subsection (5) includes any provision which may be made by model provisions with respect to appeals under section 6 of the Deregulation and Contracting Out Act 1994 (c. 40), reading—

(a) the references in subsections (4) and (5) of that section to enforcement action as references to action taken to implement an enforcement decision,

(b) in subsection (5) of that section, the references to interested persons as references to any persons and the reference to any decision to take enforcement action as a reference to any enforcement decision.

(7) In subsections (5) and (6), ‘enforcement decision’ means a decision of the Secretary of State or any other person to—

(a) require a specific manufacturer or importer to provide information to him,

(b) limit, in respect of any specific manufacturer or importer, any price or profit,

(c) refuse to give approval to a price increase made by a specific manufacturer or importer,

(d) require a specific manufacturer or importer to pay any amount (including an amount by way of penalty) to the Secretary of State,

and in this subsection ‘specific’ means specified in the decision.

(8) A requirement or prohibition, or a limit, under section [Tobacco supplies: statutory schemes], may only be enforced under this section and may not be relied on in any proceedings other than proceedings under this section.

(9) Subsection (8) does not apply to any action by the Secretary of State to recover as a debt any amount required to be paid to the Secretary of State under section [Tobacco supplies: statutory schemes] or this section.

(10) The Secretary of State may by order increase (or further increase) either of the sums mentioned in subsection (2).”

This new clause and NC7, NC8 and NC10 would enable the Secretary of State for Health and Social Care to regulate prices and profits of tobacco manufacturers and importers.

New clause 10—Tobacco supplies: controls: (supplementary)—

“(1) Any power conferred on the Secretary of State by section [Tobacco supplies: statutory schemes] and [Tobacco supplies: statutory schemes (supplementary)] may be exercised by—

(a) making regulations, or

(b) giving directions to a specific manufacturer or importer.

(2) Regulations under subsection (1)(a) may confer power for the Secretary of State to give directions to a specific manufacturer or importer; and in this subsection ‘specific’ means specified in the direction concerned.

(3) In this section and section [Tobacco supplies: statutory schemes] and [Tobacco supplies: statutory schemes (supplementary)] and [Tobacco supplies: enforcement]—

‘tobacco product’ means a product that can be consumed and consists, even partly, of tobacco;

‘manufacturer’ means any person who manufactures tobacco products;

‘importer’ means any person who imports tobacco products into the UK with a view to the product being supplied for consumption in the United Kingdom or through the travel retail sector, and contravention of a provision includes a failure to comply with it.”

This new clause and NC7, NC8 and NC9 would enable the Secretary of State for Health and Social Care to regulate prices and profits of tobacco manufacturers and importers.

New clause 11—Age of sale of tobacco—

“The Secretary of State must consult on raising the age of sale for tobacco from 18 to 21 within three months of the passage of this Act.”

This new clause would require the Secretary of State to consult on raising the age of sale for tobacco products to 21.

New clause 14—Implementation of Restrictions on advertising of less healthy food and drink online—

“The regulator shall put in place a mechanism for the delivery of the requirements under Part 2 of Schedule 16 which shall require that advertisers—

(a) apply media targeting filters, based on robust audience measurement data, to ensure the avoidance of children’s media or editorial content of particular appeal to children;

(b) use audience targeting tools and, where available, proprietary audience or other first-party data to further exclude children; and

(c) use campaign evaluation tools to assess audience impacts and use any learning to continually improve future targeting approaches.”

This new clause would require the regulator to put in place a three-step “filtering” process for restricting online advertising by managing the targeting of an online advertising campaign for foods that are high in fat, salt or sugar, as developed by the Committee of Advertising Practice of the Advertising Standards Authority.

New clause 15—Alcohol product labelling—

“The Secretary of State must by regulations make provision to ensure alcoholic drinks, as defined by the Department for Health and Social Care’s Low Alcohol Descriptors Guidance, published in 2018, or in future versions of that guidance, display—

(a) the Chief Medical Officers’ low risk drinking guidelines,

(b) a warning that is intended to inform the public of the danger of alcohol consumption,

(c) a warning that is intended to inform the public of the danger of alcohol consumption when pregnant,

(d) a warning that is intended to inform the public of the direct link between alcohol and cancer, and

(e) a full list of ingredients and nutritional information.”

This new clause requires the Secretary of State to introduce secondary legislation on alcohol product labelling.

New clause 16—Annual report on alcohol treatment services: assessment of outcomes—

“(1) The Secretary of State must lay before each House of Parliament at the start of each financial year a report on—

(a) the ways in which alcohol treatment providers have been supported in tackling excess mortality, alcohol related hospital admissions, and the burden of disease resulting from alcohol consumption, and

(b) the number of people identified as requiring support who are receiving treatment.

(2) Alongside the publication of the report, the Secretary of State must publish an assessment of the impact of the level of funding for alcohol treatment providers on their ability to deliver a high-quality service that enables patient choice.”

This new clause would require the Secretary of State for Health and Social Care to make an annual statement on how the funding received by alcohol treatment providers has supported their work to improve treatment and reduce harm.

New clause 17—Minimum unit price for alcohol—

“(1) The Secretary of State must by regulations make provision to ensure alcoholic drinks, as defined by the Department for Health and Social Care’s Low Alcohol Descriptors Guidance published in 2018, or in later versions of that document, are liable to a minimum unit price.

(2) The regulations must provide for the minimum unit price to be calculated by applying the formula M x S x V, where—

(a) M is the minimum unit price, expressed in pounds sterling,

(b) S is the percentage strength of the alcohol, expressed as a cardinal number, and

(c) V is the volume of the alcohol, expressed in litres.”

This new clause requires the Secretary of State to introduce secondary legislation that applies a minimum unit price to alcohol.

Amendment 14, in clause 138, page 118, line 5, after “drink)”, insert

“and section [Minimum unit price for alcohol]”.

This amendment would bring NC17 into force at the same time as section 129 and Schedule 16 (advertising of less healthy food and drink).

Amendment 3, in schedule 16, page 222, line 8, at end insert—

“(3) A brand may continue to advertise, or provide sponsorship, if the advertisement or sponsorship does not include an identifiable less healthy food and drink product.”.

This amendment makes an explicit exemption from the advertising restrictions on television programme services between 5.30 am and 9.00 pm for brand advertising and sponsorship, where there is no identifiable less healthy food and drink product.

Government amendments 31 and 32.

Amendment 11, in schedule 16, page 222, line 26, at end insert—

“(da) a drink product is ‘less healthy’ if it is an alcoholic product in accordance with the Department for Health and Social Care’s Low Alcohol Descriptors Guidance, published in 2018, or future versions of that guidance;”.

This amendment ensures that alcohol is considered a “less healthy” product and therefore liable to the watershed proposed for TV programme services.

Amendment 111, in schedule 16, page 222, line 28, leave out from “meaning” to end of line 30 and insert

“given in Section 465 of the Companies Act 2006 (Companies qualifying as medium-sized: general)”.

This amendment, and Amendments 112 and 113, aims to define companies to whom the advertising restrictions imposed by this schedule would apply as medium-sized companies within the meaning given by section 465 of the Companies Act 2006.

Government amendment 33.

Amendment 6, in schedule 16, page 222, line 38, after “unless”, insert

“a public consultation has been carried out on the proposed change to the relevant guidance, and”.

This amendment requires a public consultation to take place before any change can be made to the Nutrient Profiling Technical Guidance under which a food or drink product may be identified as “less healthy” and its advertising restricted on television programme services between 5.30 am and 9.00 pm.

Amendment 4, in schedule 16, page 223, line 4, at end insert—

“(3) A brand may continue to advertise, and provide sponsorship as a brand, if the advertisement or sponsorship does not include an identifiable less healthy food and drink product.”.

This amendment makes explicit exemptions from the advertising restrictions on on-demand programme services for brand advertising and sponsorship, where there is no identifiable less healthy food and drink product.

Government amendments 34 and 35.

Amendment 12, in schedule 16, page 223, line 24, at end insert—

“(da) a drink product is “less healthy” if it is an alcoholic product in accordance with the Department for Health and Social Care’s Low Alcohol Descriptors Guidance, published in 2018, or future versions of that guidance;”.

This amendment ensures that alcohol is considered a “less healthy” product and therefore liable to the watershed proposed for TV programme services.

Amendment 112, in schedule 16, page 223, line 26, leave out from “meaning” to end of line 27 and insert

“given in Section 465 of the Companies Act 2006 (Companies qualifying as medium-sized: general)”.

See explanatory statement to Amendment 111.

Government amendment 36.

Amendment 7, in schedule 16, page 223, line 36, after “unless”, insert

“a public consultation has been carried out on the proposed change to the relevant guidance, and”.

This amendment requires a public consultation to take place before any change can be made to the Nutrient Profiling Technical Guidance under which a food or drink product may be identified as “less healthy” and its advertising restricted on on-demand programme services.

Amendment 106, in schedule 16, page 224, line 8, leave out “must not pay for” and insert

“must not market, sell or arrange”.

This series of connected probing amendments is intended to create parity in treatment of television and online advertising. The platform carrying the advertising, rather than those paying for advertising, would be responsible for the placing of advertisements. The wording to denote a platform mirrors that used by Ofcom in its recent regulation of Video Sharing Platforms consultation.

Amendment 110, in schedule 16, page 224, line 16, at end insert—

“(aa) in relation to advertisements placed on distributor or retailer websites which are associated with the sale of food or drink”.

This amendment aims to ensure paid-for branded HFSS product advertisements are treated as equivalent to HFSS own-brand products on retailer-owned spaces.

Government amendment 37.

Amendment 5, in schedule 16, page 224, line 26, at end insert—

“(4) A brand may continue to advertise, and provide sponsorship as a brand, if the advertisement does not include an identifiable less healthy food and drink product.”.

This amendment makes an explicit exemption from the restrictions on online advertising for brand advertising and sponsorship, where there is no identifiable less healthy food and drink product.

Government amendment 38.

Amendment 13, in schedule 16, page 225, line 10, at end insert—

“(fa) a drink product is “less healthy” if it is an alcoholic product in accordance with the Department for Health and Social Care’s Low Alcohol Descriptors Guidance, published in 2018, or future versions of that guidance;”.

This amendment ensures that alcohol is considered a “less healthy” product and therefore liable to the online ban.

Amendment 113, in schedule 16, page 225, line 12, leave out from “meaning” to end of line 14 and insert

“given in Section 465 of the Companies Act 2006 (Companies qualifying as medium-sized: general)”.

See explanatory statement to Amendment 111.

Government amendment 39.

Amendment 8, in schedule 16, page 225, line 24, after “unless”, insert

“a public consultation has been carried out on the proposed change to the relevant guidance, and”.

This amendment requires a public consultation to take place before any change can be made to the Nutrient Profiling Technical Guidance under which a food or drink product may be identified as “less healthy” and its advertising restricted online.

Amendment 107, in schedule 16, page 225, line 28, leave out “made a payment for” and insert “marketed, sold or arranged”.

See explanatory statement for Amendment 106.

Amendment 108, in schedule 16, page 225, line 30, leave out “made” and insert “received”.

See explanatory statement for Amendment 106.

Amendment 109, in schedule 16, page 227, line 3, leave out from “with” to end of line 4 and insert

“the person marketing, selling or arranging advertisements published on the internet”.

See explanatory statement for Amendment 106.

--- Later in debate ---

[Mary Kelly Foy]

Before I address the amendments tabled in my name, I want to briefly voice my support for amendments 11 to 13 and new clauses 15 to 17, in the name of my hon. Friend the Member for Liverpool, Walton (Dan Carden), which call for improved regulation of alcohol marketing and labelling, for minimum unit pricing in England and for better assessment of treatment outcomes. Sadly, my hon. Friend cannot be here today, as he is with his family and his father Mike, who is receiving palliative care after many months of treatment for lung cancer. I know how important these issues are to my hon. Friend; I express my love and solidarity, and that of the whole House, at this difficult time for him and his loved ones.

Smoking is one of the biggest causes of ill health. It has a devastating impact on our population: it killed approximately the same number of people in 2019 as covid 19 in 2020, and one in every two smokers will die from smoking-related illnesses. The Government and the Opposition both support a smoke-free 2030, but without meaningful action, that ambition will be missed by seven years—or by double that number of years, in the case of the poorest in society.

[Catherine West (Hornsey and Wood Green) (Lab)]

Does my hon. Friend agree that Professor Marmot’s work on social and health inequalities shows that 0.5% of GDP should be spent on health inequalities such as those she describes?

[Mary Kelly Foy]

I could not agree more. Michael Marmot is one of the most important health inequalities experts around.

To make matters worse, smoking rates among young adults have surged to 25% above pre-lockdown rates. However, despite the damage that missing the 2030 target would cause, there is nothing in the Bill that would help to achieve the Government’s ambition to make smoking obsolete. That is why the all-party parliamentary group on smoking and health, of which I am the vice-chair, is fighting to get the 2030 ambition back on track. I was delighted to hear the Minister say in Committee that the Government would review the APPG’s proposals as they developed their own tobacco control plan, but that plan, which was due this year and expected in July, is now likely to be delayed beyond the end of the year. If the Government are serious about creating a smoke-free England by 2030, they will implement the APPG’s recommendations as soon as possible, and the Bill provides the ideal opportunity for them to do so.

Let me quickly summarise new clause 2. It gives the Secretary of State powers to add health warnings to cigarettes and cigarette papers. The Government are reviewing the proposal, but have said that more research is needed. Health warnings such as “Smoking Kills” have been shown to be effective on billboards and tobacco packs, so why on earth would they not be effective on individual cigarettes? At least eight peer-reviewed papers have been published in the last five years showing that the measures are effective. Similarly, new clause 3 would give the Secretary of State powers to require health information messages to be inserted in cigarette packs. That has been a legal requirement in Canada since 2000, and there is substantial evidence to show that it works there. Research carried out in the UK supports its use here as well.

[Jonathan Edwards (Carmarthen East and Dinefwr) (Ind)]

The hon. Lady will, of course, understand that one of our key aims must be to stop younger generations taking up smoking in the first place. Does she believe that her proposals—which I fully support—will help to achieve that key strategic aim?

[Mary Kelly Foy]

Most of my new clauses are indeed intended to prevent young people from starting to smoke in the first place.

[Hywel Williams (Arfon) (PC)]

The hon. Lady has said that these measures apply to England, but they will of course have an effect throughout the United Kingdom—and rightly so—contributing to our aim to bring about a smoke-free Wales as well.

[Mary Kelly Foy]

Again, I could not agree more.

In Committee, the Minister said that the Department could already legislate under the Children and Families Act 2014 to require the insertion of such information messages. In that case, why do the Government not commit themselves to doing so now?

New clauses 4 to 6 address loopholes in current legislation. Now that those loopholes have been identified to the Government, they should be fixed without delay, and today we have the opportunity to do so. New clause 4 would give the Secretary of State powers to remove child-friendly branding elements from nicotine products. There are e-liquids on the market that are given sweet names, such as “gummy bears”, and that have branding that is in garish colours and features cartoon characters. Surely more evidence is not necessary to prove that such branding risks attracting children.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

Is this not one of the most important of the hon. Lady’s new clauses? As people age and die—events often driven by cigarettes—or perhaps manage to give up, the tobacco companies must recruit the young, with the indefensible aim of persuading them to start smoking.

[Mary Kelly Foy]

I entirely agree. Tobacco is the only legal product that kills one in two of those who use it, and most people start smoking at a young age. These new clauses are therefore extremely important, because they would tackle that problem.

[Jim Shannon (Strangford) (DUP)]

The figures back up what the hon. Lady says. Two thirds of smokers in the UK start smoking under the age of 18, and over a third—39%—start under the age of 16. What she proposes will address that issue in a substantial way. We need legislation in place, and there needs to be punishment as well; that is the only way forward.

[Mary Kelly Foy]

I thank the hon. Gentleman, and I will address that issue.

New clause 5 would close another loophole in the law, which allows the free distribution of e-cigarettes and other consumer nicotine products to children under 18. The Government rejected the proposal, saying that there was no evidence of a serious problem, but the Minister sympathised with the argument for preventive action. Prevention is precisely our intention. Fixing this loophole is an appropriate application of the precautionary principle.

New clause 6 would remove the limitations on the ban on flavourings in tobacco products. That ban currently applies only to characterising flavours. The new clause would extend the flavour ban to all tobacco products, as well as to smoking accessories, including filter papers, filters and other products designed to favour tobacco products. In Committee, the Minister claimed it was unclear how a ban could be enforced in practice, as it would include a ban on flavours that did not give a noticeable flavour to the product. I suggest that he seek advice from Canada on this point, where a complete ban on flavours is already in place and has been highly effective.

The new clauses on the tobacco levy would give powers to the Secretary of State to implement a “polluter pays” levy on tobacco manufacturers. The Minister dismissed this in Committee as a matter of taxation for the Treasury to consider. However, we are not proposing additional taxation. Our new clauses are modelled on the American user fee and on the pharmaceutical pricing scheme in the UK.

[Janet Daby (Lewisham East) (Lab)]

Does my hon. Friend agree that prevention is much better than cure, because so many adult smokers have a terrible experience when trying to give up, and it comes at a huge cost to their health?

[Mary Kelly Foy]

I thank my hon. Friend for that intervention. A theme throughout these new clauses is that most people start smoking when they are children or when they are young, and most of them say that they wish they had never started. The new clauses would tackle young people’s access to tobacco-related products.

[Paula Barker (Liverpool, Wavertree) (Lab)]

It is often vulnerable children, and often those in care, who start smoking early, so does my hon. Friend agree that it is incredible that the Government have so far said that they will not support these new clauses?

[Mary Kelly Foy]

Yes, it is absolutely incredible. We have heard that a tobacco plan might be on its way, but every day that goes by without our putting these recommendations in place is another day on which someone dies of tobacco harm, and on which more young people become addicted to nicotine products.

Discussions with the Treasury on the “polluter pays” levy would not be necessary. The Food and Drug Administration administers the user fee in the United States, and the Department of Health and Social Care could and should administer such a scheme here.

New clause 11 has been revised in the light of the Government’s response to our proposal in the Committee, in which they cited the need to

“review the evidence base of increasing the age of sale to 21 in more detail”.––[Official Report, Health and Care Public Bill Committee, 28 October 2021; c. 816.]

They also stated the need for a public consultation. I agree that a consultation is the appropriate next step, so the new clause has been revised to require the Government to consult on raising the age of sale for tobacco from 18 to 21 within three months of the passage of this legislation.

To sum up, my new clauses address loopholes in the law. They would take incremental and obvious next steps to strengthen tobacco regulation still further, and they would provide the funding that is desperately needed to deliver the Government’s smoke-free 2030 ambition—funding that the spending review failed to deliver. When I was chair of the Gateshead tobacco control alliance, I saw the damage that smoking can do. It shortens life expectancy, increases the pressure on our health services, drives down productivity and drains wealth from our poorest communities—and for one in every two smokers, it will kill them. Eventually, the Government will have to accept that the measures proposed are necessary. The only question is how long they will wait, and how many lives will be ruined by tobacco in the meantime. I urge the Government to accept these new clauses in full.

--- Later in debate ---

[Edward Argar]

I am afraid I will not. I suspect that point will be pertinent to the debate on the first group of amendments tomorrow.

First, we intend to merge Health Education England with NHS England and NHS Improvement, putting education and training of our health workforce at the forefront of the NHS. By bringing this vital function inside the NHS, we can plan more effectively for the long term and have clear accountability for delivery.

Secondly, we also intend to take forward the recommendations of the Wade-Gery report, which included merging NHSX and NHS Digital with NHS England and NHS Improvement, building on the huge progress made on digital transformation during the pandemic and bringing together the digital leadership of the NHS in one place. I take this opportunity to pay tribute to all our colleagues at Health Education England, NHS Digital and NHSX for their exceptional work. These changes build on that contribution and allow us to drive forward further integration and changes that will put the NHS on a firmer footing.

I hope I have reassured hon. Members of the Government’s commitment to improving public health. I urge those who have tabled amendments to consider not pressing them to a Division.

[Mary Kelly Foy]

I have listened carefully to the debate, and I beg to ask leave to withdraw the clause.

Clause, by leave, withdrawn.

New Clause 4

Packaging and labelling of nicotine products

“The Secretary of State may by regulations make provision about the retail packaging and labelling of electronic cigarettes and other novel nicotine products including requirements for health warnings and prohibition of branding elements attractive to children.”—(Mary Kelly Foy.)

This new clause would give powers to the Secretary of State to prohibit branding on e-cigarette packaging which is appealing to children.

Brought up, and read the First time.

Question put, That the clause be read a Second time.