Tobacco Control Plan

Mary Kelly Foy Excerpts

Tuesday 16th November 2021 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Bone. I pay tribute to the hon. Member for Harrow East (Bob Blackman) for securing the debate and for his work as chair of the all-party parliamentary group on smoking and health, of which I am vice-chair.

Two years after the Government stated their ambition to make England smoke-free by 2030, projections show that they will miss that target by seven years, and double that for the poorest in society. Despite a promise of further action on tobacco, we are still waiting for the new tobacco control plan, which the Government pledged to publish this year. In the absence of that new plan, the Health and Care Bill is a timely opportunity to take the first step towards a smoke-free 2030.

Despite the urgency of the issue and my best efforts in Committee, the Health and Care Bill fails to make a single mention of tobacco or smoking. To correct that oversight, I tabled amendments to the Bill, based on recommendations made by the APPG on smoking and health, including proposals for a “polluter pays” levy, health warnings on cigarettes and inside packaging, and to close the loophole allowing e-cigarettes to be marketed at children. Those measures are all low-cost or revenue-generating, are popular with the public and could be implemented quickly and easily by the Government. Although the Government expressed support for the principle behind the proposals, they rejected every single one, saying that they wanted to wait and see the evidence.

The Government have cited the need to wait for the publication of the post-implementation reviews of the Standardised Packaging of Tobacco Products Regulations 2015 and the Tobacco and Related Products Regulations 2016. The Government were required by law to publish those by May 2021. That has now drifted to an aim to publish by the end of the year. Will the Minister say how much longer we will have to wait for the Government to start taking action to deliver the smoke-free 2030 ambition? She should know that if the APPG’s amendments are not adopted in the House of Commons, they will be retabled in the other place.

Today I want to briefly make the case for my proposals and address the Government’s arguments against them. The first proposal is to include health warnings on cigarettes and cigarette papers. Substantial research supports their implementation, and they are already under consideration in Canada, Australia and Scotland. Such warnings would be cheap and easy to implement through a simple amendment to the Standardised Packaging of Tobacco Products Regulations 2015. The Government said they were sympathetic to the aims of the measure, but they are not willing to adopt it, citing the need to conduct further research and for more evidence. Warnings such as “smoking kills” have been shown to be effective on billboards and tobacco packs, so why would they not be effective on cigarette sticks, too? Adding warnings to cigarette sticks is also important because young people in particular are likely to begin smoking with an individual cigarette rather than packs. There have also been at least eight peer-reviewed academic studies published since 2015 that specifically looked at warnings on sticks and found them to be effective, particularly in making cigarettes less attractive to younger adolescents and never-smokers.

Cigarette pack inserts that provide health information have been required in Canada since 2000. Substantial evidence shows that they are effective, and research supports their use in the UK, too. The Government have already acknowledged in the prevention Green Paper that there could be a positive role for inserts giving quitting advice in tobacco products. Pack inserts are easy and cheap to introduce and, as the Government have acknowledged, could be implemented by a simple revision of the Standardised Packaging of Tobacco Products Regulations 2015. Again, the Government refuse to adopt the amendment, citing the need for further research and public consultation and to wait for the recommendations of the post-implementation review of the SPOT regulations, yet there is no guarantee that the review will contain concrete recommendations. Indeed, the 2019 review failed to do that. My concern is that the measure needed will just get kicked into the long grass, putting the 2030 ambition at risk.

There are currently no controls on the use of branding to promote e-cigarette products, some of which, particularly e-liquids, are branded in a way that is clearly attractive to children through the use of bright colours, sweet names and cartoon characters. Research by YouGov for ASH found that in 2021, 3.3% of 11 to 17-year-old never-smokers have tried e-cigarettes once or twice; 0.5% use them less than weekly; and 0.2% use them more than once a week. Although those percentages seem low, it still amounts to 174,900 never-smokers trying e-cigarettes. Another 26,500 carried on using them, and 10,600 used them more than once a week. The ASH YouGov survey of adults and young people found that standardising the packaging of e-cigarettes and refills reduces the appeal of vaping to young people, particularly young children, while having little impact on adult smokers’ interest in using the products to quit smoking. Frustratingly, the amendment was voted down by the Government in Committee.

A further issue that must be addressed is that although it is illegal for e-cigarettes to be sold to children under 18, it is not illegal for them to be given out as free samples to under-18s. That loophole fails to deliver on the spirit of the legislation, which is designed to protect children from nicotine addiction. Clearly, the legislation needs amending to ban the sale and free distribution of any consumer nicotine product to under-18s. The Government inexplicably voted down that proposal in Committee. They said that they did not have a firm or robust evidence base at present to suggest that there was a widespread problem. As stated, around 174,900 never-smokers aged 11 to 17 have tried e-cigarettes and another 10,500 use them more than once a week. Does the Minister genuinely think that we should wait until their use of e-cigarettes becomes a significant problem before taking action to remove this loophole?

Finally, I want to talk about flavourings. The ban on flavourings in smoking tobacco was introduced because flavourings, particularly menthol, make it easier for young people to start smoking and increase the likelihood that they will become addicted smokers. However, the flavour ban only prohibits characterising flavours, which are subjective and difficult to measure, making the ban easy to circumvent and complex to oversee. Legislation in Canada bans all flavours, which is easier to implement and enforce. There is good reason to do that, as the tobacco industry has introduced several innovations that have exploited loopholes in the regulations to undermine the impact of the ban. For example, Japan Tobacco International launched a range of alternative products containing menthol, but which they claimed complied with the law. Figures in the Express revealed that 12 months after the ban came into force in 2020, the company had sold more than 100 million packs and made around £91.65 million in profits from menthol brands.

In addition, modified smoking accessories have been introduced, including cards, filter papers and filters, that are designed to add a menthol flavour to both hand-rolling tobacco and cigarette sticks. UCL’s smoking toolkit study found no decline in the proportion of smokers in England reporting menthol cigarette smoking following the introduction of the ban, and it suggested that smokers of menthol cigarettes were able to take advantage of the loophole. The flavour ban is clearly failing to prevent the sale of flavoured tobacco, which is why I propose extending the ban to all tobacco flavours, not just those described as characterising.

Again the Government oppose the measure, claiming that

“it is not clear how a ban on flavours would be enforced in practice”.––[Official Report, Health and Care Public Bill Committee, 28 October 2021; c. 815.]

That is not logical as it is much easier to enforce a complete ban on flavours than on only those defined as characterising, which is very subjective.

Does the Minister agree that the tobacco industry is making a mockery of the current flavour ban? Will she commit to closing the loophole by removing the limitation to only include flavours defined as characterising as soon as possible and extending the ban, which currently only applies to cigarettes, to all tobacco products and smoking accessories?

Health and Care Bill (Twentieth sitting)

Mary Kelly Foy Excerpts

Committee stage
Thursday 28th October 2021 Public Bill Committees

[The Chair]

All the rules and regulations you have all heard four times this week still apply, so we will crack on.

New Clause 29

Health warnings on cigarettes and cigarette papers

“The Secretary of State may by regulations require tobacco manufacturers to print health warnings on individual cigarettes and cigarette rolling papers.”

This new clause would give powers to the Secretary of State to require manufacturers to print health warnings on individual cigarettes.—(Mary Kelly Foy.)

Brought up, and read the First time.

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

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

[The Chair]

With this it will be convenient to discuss the following:

New clause 30—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 31—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 32—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 33—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 34—Tobacco supplies: statutory schemes—

“(1) The Secretary of State may make a scheme (referred to in this section and section [Tobacco supplies: statutory schemes (supplementary)] as a statutory scheme) for one or more of the following purposes—

(a) regulating the prices which may be charged by any manufacturer or importer of tobacco products for the supply of any tobacco products,

(b) limiting the profits which may accrue to any manufacturer or importer in connection with the manufacture or supply of tobacco products, or

(c) providing for any manufacturer or importer of tobacco products to pay to the Secretary of State an amount calculated by reference to sales or estimated sales of those products (whether on the basis of net prices, average selling prices or otherwise).

(2) A statutory scheme may, in particular, make any provision mentioned in subsections (3) to (6).

(3) The scheme may provide for any amount representing sums charged by any manufacturer or importer to whom the scheme applies, in excess of the limits determined under the scheme, for tobacco products covered by the scheme to be paid by that person to the Secretary of State within a specified period.

(4) The scheme may provide for any amount representing the profits, in excess of the limits determined under the scheme, accruing to any manufacturer or importer to whom the scheme applies in connection with the manufacture or importation of tobacco products covered by the scheme to be paid by that person to the Secretary of State within a specified period.

(5) The scheme may provide for any amount payable in accordance with the scheme by any manufacturer or importer to whom the scheme applies to be paid to the Secretary of State within a specified period.

(6) The scheme may—

(a) prohibit any manufacturer or importer to whom the scheme applies from varying, without the approval of the Secretary of State, any price charged by him for the supply of any tobacco product covered by the scheme, and

(b) provide for any amount representing any variation in contravention of that prohibition in the sums charged by that person for that product to be paid to the Secretary of State within a specified period.”

This new clause and NC35, NC36 and NC37 would enable the Secretary of State for Health and Social Care to regulate prices and profits of tobacco manufacturers and importers.

New clause 35—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 NC34, NC36 and NC37 would enable the Secretary of State for Health and Social Care to regulate prices and profits of tobacco manufacturers and importers.

New clause 36—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 NC34, NC35 and NC37 would enable the Secretary of State for Health and Social Care to regulate prices and profits of tobacco manufacturers and importers.

New clause 37—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 NC34, NC35 and NC36 would enable the Secretary of State for Health and Social Care to regulate prices and profits of tobacco manufacturers and importers.

New clause 38—Age of sale of tobacco—

“The Secretary of State may by regulations substitute the age of 21 for the age of 18 for the sale of tobacco and make consequential amendments to the Children and Young Persons Act 1933, the Children and Young Persons (Protection from Tobacco) Act 1991 and the Children and Families Act 2014.”

This new clause would give powers to the Secretary of State to raise the age of sale for tobacco products to 21.

[Mary Kelly Foy]

The Government’s prevention Green Paper, published in July 2019, included an ambition to make England smoke free by 2030. Admitting that bold action would be needed, the Government promised further proposals in order to finish the job. Two years on, and with less than nine years to go before 2030, we are nowhere near on track to achieve that ambition. Using Government data, projections by Cancer Research UK show that we will miss the target by seven years, and by double that for the poorest in society. Despite the promise of further action on tobacco, there are no measures to tackle smoking in the Bill. That is a major oversight, which my new clauses seek to address.

The new clauses are based on the recommendations included in the latest report from the all-party parliamentary group on smoking and health, of which I am the vice-chair. They set out a range of complementary measures to deliver the smoke free ambition, which will also significantly increase productivity and reduce pressure on the health and care system. Although the smoke-free 2030 ambition applies specifically to England, all parts of the UK have stated an ambition to end smoking, so I am pleased that members of the Committee from Wales and Scotland support the new clauses.

I will briefly run through the new clauses and why they are necessary additions to the Bill. New clause 29 would give the Secretary of State the power to require tobacco manufacturers to print health warnings on individual cigarettes and cigarette rolling papers. New clause 30 would allow the Secretary of State to require tobacco manufacturers to display a health information message on a leaflet inserted into cigarette packaging, which the Government promised to consider in the prevention Green Paper two years ago. Those are simple, uncontroversial and effective measures that would help deliver the Government’s smoke-free 2030 ambition at minimal cost.

New clauses 31 to 33 would allow the Secretary of State to close loopholes and regulations that allow tobacco and e-cigarette manufacturers to market their products to children and to undermine regulations that are designed to protect public health. New clause 31 would give powers to the Secretary of State to prohibit branding on e-cigarette packaging that appeals to children, such as branding that uses sweet names, cartoon characters and garish colours.

New clause 32 would give the Secretary of State powers to block a shocking loophole in the law that means that, although e-cigarettes cannot be sold to children under 18, they can be given out for free. There is no reason why we cannot seek to rectify that anomaly today. New clause 33 would give the Secretary of State powers to ban all flavouring and not just that defined as characterising. That term is subjective and ill-defined and has allowed tobacco manufacturers to drive a coach and horses through the legislation.

The Government were required by law to review the relevant tobacco regulations to check whether they are fit for purpose, and to publish a report in May 2021, which they have not done. It is time for them to address these egregious loopholes in the regulations, and the Bill is an ideal opportunity to do so. These new clauses are uncontroversial, and would be of clear benefit to child public health. I will therefore seek to divide the Committee on new clauses 31, 32 and possibly 33.

Following on from those new clauses, we must accept that if England is to be smoke free by 2030 we need to stop people starting smoking at the most susceptible age, when they are adolescents and young adults. There is a real and present danger that must be addressed: new figures from a large survey by University College London found a 25% surge in the number of young adults aged 18 to 34 in England who smoked during the first lockdown. New clause 38 would give the Secretary of State powers to raise the age of sale for tobacco products from 18 to 21. That regulatory measure would have the largest impact in reducing the prevalence of smoking among young adults, as demonstrated by what happened in the United States when the age of sale was increased to 21.

Finally, I want to address the issue of funding. The coronavirus pandemic has meant that the need for more investment in public health is greater than ever before. The Government promised to consider a US-style “polluter pays” levy on tobacco manufacturers in the 2019 prevention Green Paper. New clauses 34 to 37 would enable the Secretary of State to regulate prices and the profits of tobacco manufacturers and importers, which could provide funding not only for England, but for the devolved Administrations, with any excess allocated to other vital public health interventions.

I want to express my gratitude to my hon. Friends for supporting these new clauses. I hope the Government will engage with these proposals in a similarly constructive manner with regard to the forthcoming tobacco control plan, ensuring that public health is at the heart of any discussions around smoking and tobacco.

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

Obviously, smoking has increased during covid, particularly during the lockdowns, which is quite depressing after some of the progress made in recent decades. This array of new clauses tries to tackle the issue from different angles. New clauses 32 and 38 relate to the age at which someone can purchase, along with other point-of-sale policies. Those issues are all under devolved control, so I have not got involved in those. However, the policy decisions around manufacturing, flavourings, packaging and so on are all reserved, and all four nations of the UK would agree that the biggest single favour anyone can do for their own health is to give up smoking.

As older people and people who have smoked for many years sadly succumb to the diseases we know are caused by smoking, such as heart disease, stroke and cancer, it is incumbent on tobacco companies to recruit a new generation. That is what ornate packaging and childish flavourings are clearly aimed at doing, and they are therefore completely counter to the policies of the UK Government and the devolved Governments.

This is an opportunity to stake the point, move forward and take action to prevent the recruitment of young smokers into cigarette smoking, which will inevitably cost the NHS—indeed the four NHSs—more, as they deal with the health issues over a number of decades, than is raised by tobacco duty. The Government need to stop looking at what they earn from cigarettes and focus on minimising their use. That is the Government’s stated policy, and these new clauses would take that forward.

--- Later in debate ---

[Edward Argar]

Except perhaps the proper conduct of proceedings.

Moving on swiftly, new clause 33 seeks to change the current flavour ban, which would of course be the context in which I was referring to proper conduct proceedings requiring proper documents to be published. The new clause seeks to change the current flavour ban, which is based on characterising flavours in cigarettes and hand-rolling tobacco, to one based on flavours for all tobacco products, as well as accessories used to flavour tobacco products.

The Government are committed to protecting the population from the harms of tobacco. Tobacco for smoking that has a detectable flavour—for example, menthol—has been changed to be more appealing to young people and easier to inhale. That can often result in a lifetime of tobacco addiction. Through the Tobacco and Related Products Regulations 2016, we have already banned characterising flavours in cigarettes and hand-rolled tobaccos. That means flavours that are noticeable before or during smoking of the product.

Again, the Government are sympathetic to the aims of the new clause, which would prohibit flavours in all tobacco products and accessories, but it is not clear how a ban on flavours would be enforced in practice, as it would include a ban on flavours that do not give a noticeable flavour to the product. Furthermore, it is not clear how this may be a better option than the current regulations, although the hon. Member for City of Durham might wish to address that point in her winding-up speech. As ever, I will reflect carefully on what she says and then discuss it with my colleague, the Public Health Minister. We are currently in the process of developing our new tobacco control plan. We are exploring, as I have said, a broad range of additional regulatory measures to support our Smokefree 2030 ambition.

New clauses 34 to 37—which, with your permission, Mr Bone, I will take in one bundle—seek to provide the Secretary of State with a power to enable the introduction of a scheme on tobacco manufacturers, limiting profitability by regulating prices. Tobacco taxation matters are, it will not surprise hon. Members to hear, a matter for Her Majesty’s Treasury. Although earlier this week I found myself answering an urgent question relating to matters pertinent to Her Majesty’s Treasury, I will not stray into its territory, beyond saying that reducing the affordability of tobacco is one of the most effective measures to trigger smoking cessation. Tax increases are particularly effective among a range of groups of smokers, and therefore this is a key tool in helping to address health disparities and health outcomes associated with smoking.

As part of the annual Budget process, the Treasury will continue the policy of using tax to raise revenues and encourage cessation through high prices on tobacco products. The tobacco industry is already required to make a contribution to public finances, through tobacco duty, VAT and corporation tax. While the Government are open to the idea of the tobacco industry providing additional funds beyond taxation, further consideration of the potential options for and impacts of a scheme, including a robust impact assessment, would be needed. We would also need to consider how such a scheme would be implemented and how it would impact the taxation requirements currently placed on the industry. Such a scheme would likely take a number of years to develop and deliver to ensure that it was effective and robust.

The Department will continue to work with Her Majesty’s Treasury to assess the most effective regulatory means of making the industry pay for the harm that its products cause to our population, to support the Government’s Smokefree 2030 ambition, including exploring a potential future levy. Our ongoing work has contributed to smoking rates falling to their lowest on record, as the hon. Member for Nottingham North said, but there is still much more work to be done to protect people from the harms of tobacco.

Finally, new clause 38 would introduce a power to introduce legislation that would increase the age of sale on tobacco from 18 to 21. We have successfully made many regulatory reforms over the past two decades, and the UK is a global leader in tobacco control. Measures include raising the age of sale from 16 to 18, a tobacco display ban, standardised packaging and a ban on smoking in cars with children, all strengthening the barrier between young people and tobacco products.

The Government remain committed to our ambition to be smoke free by 2030 and to continue to protect the population and future generations from the harms of tobacco. However, the Government would like to review the evidence base of increasing the age of sale to 21 in more detail—I am probably in the same place on that issue as the shadow Minister. We would like to further assess its full impact on public health, the costs of implementation and how it would be enforced by trading standards. We have not consulted publicly on raising the age of sale to 21 to assess public opinion and consider whether it is the right regulatory measure to take forward to protect future generations. I know it is an issue that the APPG and the Royal College of Physicians have recommended we should consider.

We are currently in the process of developing our new tobacco control plan. We will review all the proposals in that context, as well as the well-researched reports that the APPG has put forward. I suspect the hon. Member for City of Durham will still want to push us on a few of these points—if not disagreeing with the sentiment, then possibly with the speed or the timescale. I will listen very carefully to what she says. I encourage her not to press the new clauses, but I suspect I may be out of luck.

[Mary Kelly Foy]

I welcome the Government’s commitment to publishing the plan and the consideration of some of the recommendations. I hope we will see that very soon. I will not press the majority of the new clauses, but new clauses 31 and 32 are aimed at children and child public health. I do not think we can wait.

We already have examples of vaping companies handing out free vaping products to 16 and 17-year-olds. There is an example of a 17-year-old woman on a market stall. A third party company came along and offered her vaping products in return for her email address, which was suspicious enough anyway. They do not tell the young person that the products have nicotine in them. There are already such examples.

I went online this morning to see whether I could purchase vaping products. The first one that came up was called the Breakfast Club, which tastes like marshmallow-flavoured breakfast charms. It is a shot of nicotine that goes into the refill of a vaping product. The refill is 15 ml, with a space left at the top for the shot. The Breakfast Club “charms”, which come in pink and yellow, are aimed at young people. When I went to buy some, I was asked if I was over 18; I would just have to click “Yes” for it to be delivered to my door tomorrow.

There is evidence that the longer we wait, the more young people will be hooked on nicotine through vaping products. I do not think we need further evidence. How many more young people will be addicted by the time the plan is introduced? I beg to ask leave to withdraw the motion, but I will divide the Committee on new clauses 31 and 32.

Clause, by leave, withdrawn.

New Clause 31

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.

--- Later in debate ---

[Edward Argar]

I entirely agree with the hon. Lady. There is a huge number of unpaid carers who we know about, and who recognise themselves as carers, but there will be a huge number who, as she says, do not see themselves in that way. They see caring for a loved one as part of their normal life, and as what they do; they do not recognise that they are providing care.

There is also a large, often unidentified, number of child carers. They care for their parents, grandparents and others, but they will not think of it in that way. They just think they are doing their bit to look after mum or dad, or granny or grandad. The hon. Lady is right to highlight the need for all of us—both in government and other Members—to make it as clear as possible that these people are carers and should be able to access support and help. There is support and help available, but people need to understand that they are in that category and are entitled to it. That is a long answer to basically say that I entirely agree with the hon. Lady.

We are not convinced that the provisions of new clause 39 are appropriate for the ICB, as a similar duty to that in the new clause is already held by and imposed on local authorities, so it risks causing duplication. The local authority will be part of the ICB and of the ICP, so we feel that the issue is captured.

Carers already have a legal right to an assessment of their needs from their local authority. Local authorities have a legal duty to meet needs identified through a carer’s assessment where the carer is deemed eligible. In 2019-20—the latest figures I have to hand—376,000 unpaid carers in England were assessed, reviewed, and/or supported. However, the number may well be a lot higher than that figure, which goes to the point made by the hon. Member for Central Ayrshire.

We continue to work closely with stakeholders, care organisations and the wider sector to support carers. We will work with care users, providers and other partners to co-develop more detail on our plans for the reform of adult social care. We will publish further detail of our plans for reform in a White Paper later this year, building of course on the strong foundations of integration we are setting in this legislation. The shadow Minister, the hon. Member for Ellesmere Port and Neston, would have been disappointed or concerned about me if I had not said that, and would have wondered what was going on.

New clause 40 introduces a definition of carer that includes—this goes to the point to which I have just responded—young carers, parent carers and adult carers. It seeks to bring clarity and to ensure that all carers, regardless of their age or their relationship with the person they care for, benefit from the measures in the Bill related to carers. The circumstances and needs of every unpaid carer are unique. Unpaid carers make a vital contribution to the lives of those they care for, and I know that every member of this Committee would want to put on record a tribute to them. It is important that we continue to work to understand carers’ needs and how to best support them, while reflecting the diversity of carers.

I have already discussed the measures in the Bill designed to promote the involvement of carers. “Carers” in this context should include anyone, child or adult, who cares, unpaid, for a friend or family member who, due to a lifelong condition, frailty, illness, disability, serious injury, mental health condition or even addiction, cannot cope without their support. In seeking clarity and inclusion, it is important that we do not inadvertently exclude groups of carers. The legislation as drafted is based on an everyday use of the term “carer”, and this allows for flexibility and the inclusion of all who provide unpaid care, in any shape or form, to a loved one or friend.

I appreciate, and to a large extent share, the shadow Minister’s intention of strengthening the legislation and seeking to bring clarity, so that those who are entitled to support know it, and can claim what they are entitled to. I want to reassure members of the Committee that we have today heard the concerns expressed about carers. I will take that away and carefully consider the issues, and see if we can continue to address them through the wider work of the Department on carers, and our ongoing discussions with organisations, many of which we deal with as constituency MPs, week in and week out, on their work in our constituencies.

For these reasons, I encourage the hon. Member for Ellesmere Port and Neston to consider not pressing his new clauses to a Division, but I look forward to hearing from him.

[Mary Kelly Foy]

For those who do not know, I should say that I was a carer for my severely disabled daughter for 27 years. Maria died six years ago; she suffered with cerebral palsy. I was very fortunate to be in a local authority that recognised the need for respite for carers. I was lucky enough to have a very generous package of six weeks, and that allowed me to engage with public life, have a social life and just recharge my batteries. However, other local authorities do not give such generous packages; it is a postcode lottery. When carers can no longer look after their loved one and that person has to be placed in social care, the cost to the public purse is huge.

On young carers, the issue is not just the caring role of young children. My children were classed as young carers, and the package they had was to enable them to enjoy social activities with other young people. They felt very left out of normal activities, because I was spending most of my time looking after Maria. It is very important that carers recognise that there is help out there, and help has to be consistent. As we know, local authorities have had their budgets cut massively, so what was once perhaps a gold star service for carers is down to a much lesser service.

A lot of carers I knew did not think they were carers and did not really want anything from the state. They said, “We’re just doing it because this is our loved one, and this is what we need to do.” However, the needs, health and wellbeing of unpaid carers are so important if we want them to continue doing the fantastic job that they do.

[Justin Madders]

I am grateful to my hon. Friend for relaying her family’s experience. She has articulated far better than I could why it is so important that we support carers, and young carers in particular.

I have listened to what the Minister said about the new clauses. I think he is keen to support this agenda, and there is clearly quite a lot of change happening in the Department over the next few months. We will keep an eye on how the issue of carers sits within that, and how ICPs work in practice, and will not push our new clauses to a vote. I beg to ask leave to withdraw the motion.

Clause, by leave, withdrawn.

New Clause 41

Review of implementation of NHS continuing healthcare by integrated care systems

“(1) Chapter 3 of Part 1 of the Health and Social Care Act 2008 (quality of health and social care) is amended as follows.

(2) After section 46A insert—

‘46B  Review and performance assessments: integrated care systems

The Commission must, each year—

(a) conduct a review of the implementation of NHS continuing healthcare by integrated care systems,

(b) assess the performance of these systems following the review, and

(c) publish a report of its assessment.’”—(Justin Madders.)

This new clause would require the review and assessment of NHS continuing healthcare systems.

Brought up, and read the First time.

Health and Care Bill (Fourth sitting)

Mary Kelly Foy Excerpts

Committee stage
Thursday 9th September 2021 Public Bill Committees

[The Chair]

Thank you. Mary Kelly Foy.

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

Q This is for Andy. It is noted that mental health provision has for far too long been seen as the Cinderella service of the health system. Indeed, there is very little in the Bill specifically around mental health. Given the growing number of people suffering with mental ill health and the shortage of services, is there enough in this Bill to satisfy you that mental health will be given parity of esteem alongside physical health?

Andy Bell: It is difficult to tell; the Bill is largely silent on mental health. If we had a system where there was genuinely equal regard for both mental and physical health, we would not have to worry about that, because we would know that the system would treat mental health fairly and equally, and there would be no disparity in the way it was thought about. Unfortunately, all our experience tells us that that is not what happens within many health systems at different levels, from very local to national, so we would like to see some assurances in the Bill.

From our point of view, that could happen in one of two ways. Legislation only gets you so far, but it could place specific duties on both NHS England and integrated care boards—I am being very careful in specifying integrated care boards here—that they must take action to ensure that mental and physical health are given equal regard in their decision making, particularly on resource allocation. We feel strongly that there needs to be a voice for mental health within integrated care boards. That is highly likely to happen within integrated care partnerships, but within integrated care boards we do not have confidence that mental health will be properly represented at the top table where important decisions about resource allocation are made.

We think that would help. There are no 100% safeguards in legislation, but one positive thing we have seen with the 2012 Act is that a clause at the very top of the Act talked about mental and physical health as one of the key purposes of the NHS, and that has been used positively and helpfully to make the case for parity in health systems up and down the country. A few simple words can sometimes make quite a big difference.

[Edward Timpson]

Q This is a question for Ed, building on the fact that you have, I think, fairly extensive experience of working with local authorities and supporting them on governance and scrutiny. Having direct involvement in NHS decision making on funding and so on is a fairly new role for local authorities, and different ICSs will have different sizes and geography; for instance, mine is Cheshire and Merseyside, which is one of the largest—I think it is three or four times the size of some other ICSs. Over and above being involved in the board, for local authorities in larger ICSs, where the emphasis on place could be lost if they are not more fused into the system, how do you think the Bill could help to ensure that that is the case, so that we get the right balance between their involvement in the decisions, based on their knowledge of their own population, and the wider regional decisions?

Ed Hammond: For me it starts with an understanding of what decisions are best made at system level and what decisions are best made at place level. Certainly, I would imagine one of the first things that ICBs and ICPs would need to do, once established, would be to determine how to set up a system-wide framework for ensuring equality and equity in terms of how its health and care service is delivered, and then determine how and where it is most appropriate that more detailed decisions come to be made at place level. Otherwise, the system simply becomes too unwieldy.

There are risks that those partners sitting at that system level will draw decision making into those spaces, rather than pushing it back out to localities, because it is the simplest, in many ways the most efficient and apparently the most co-ordinated way of doing it, but in practice it will not serve the interests of local accountability or better outcomes. That raises the prospect of certain services being delivered in different ways in different localities, depending on the political priorities of different councils, but that is local democracy—that is local government bringing its understanding of the demographics of the populations it serves into the conversation.

I think this can all be made to work if there is sufficient transparency in the system, so that those within and those outside it understand how decisions are being made, on what subjects, and by whom. When you have that clarity, it becomes easier to unpick what is happening at place level. Are decisions being made at system level that would be more appropriately made at a lower level? Is there consistency across the entire system? What does the geography mean for decision making and commissioning, and these kinds of things? It provides assurance, and it provides everybody with more confidence that decisions are being made properly in the interests of local people.

Going back to the point I made before, that is also why some external local accountability is so important, because effective local external accountability can challenge the system on whether the right decisions are being made at the right level, and whether they reflect and are responsive to what the local needs are. Local scrutiny committees are, at the moment, anchored at place level within local authorities. They are well able to publicly draw in the voice and concerns of the public about those kinds of issues, and transmit them to health and care partners so that there is a clear way for those concerns and issues to be responded to.

Health and Care Bill (Third sitting)

Mary Kelly Foy Excerpts

Committee stage
Thursday 9th September 2021 Public Bill Committees

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

I remain a member of the BMA.

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

I am a member of Unison.

[The Chair]

Welcome Sara and Chaand. Will you kindly introduce yourselves, please?

Sara Gorton: Good morning. I am Sara—it is pronounced as if it is spelled with an h at the end. I am head of health at the trade union Unison.

Dr Chaand Nagpaul: My name is Dr Chaand Nagpaul. I am a GP in north London. I have been a GP for more than 30 years. I am chair of the BMA UK council. We represent doctors across the UK—more than 160,000. I represent all doctors of all types, working in hospitals, public health, general practice—you name it.

Health and Care Bill (Second sitting)

Mary Kelly Foy Excerpts

Committee stage
Tuesday 7th September 2021 Public Bill Committees

[Dr Davies]

Q Very good. Thank you. As a follow-up question to both panellists, could you comment on the benefits arising from the preventive measures in the Bill on the fluoridation of tap water and obesity?

Professor Maggie Rae: Obviously, from my position as president of faculty, I want more emphasis on prevention, so I am very pleased to see that focus on it, but I do not think it is quite enough yet. I think we would all recognise that part of the reason why we seemed to take the biggest hit on covid in terms of deaths and the effects of the virus was the ill health of our population. We are recognised as having one of the most unhealthy populations in Europe now, and that was not always the case. Yes, it is very pleasing to see the measures on obesity, but we need to recognise that most of the influence could come from the very local level.

I am sorry to say to colleagues and this eminent Committee that we could probably spend the whole meeting talking about fluoridation. I recognise the attempt to tackle the problems of oral health. Children’s teeth being extracted under general anaesthetic is a national disgrace; that money is so wasted in the NHS when we desperately need it to be spent on other health matters, and the time it takes for that operation is so dangerous for children. It is good to have this recognised, but I think it will be quite a slow burn, even with the legislation.

Some areas have tried to implement fluoridation. It has taken them years and they still have not succeeded. Could we perhaps persuade people? As well as focusing on fluoridation, could we have just a small investment in other methods to tackle oral health? One that is really effective, which I used myself as DPH, is simple toothbrushes and toothpaste. Sometimes we think public health measures take a long time, but I can guarantee that if that measure were implemented effectively you could see the changes within 12 months and would also end up saving the NHS a lot of money. I work closely with Councillor Jamieson in his role at the LGA and I hope that he would agree with me.

Cllr James Jamieson: I am going to agree with Maggie. I think that that is a general point we would make. Better healthcare does not start in a hospital; it starts in the community and it starts before you are born. It is about prevention, early intervention, public health, good food and all those things. We welcome measures to support that.

On the point about obesity, I would particularly say that although, yes, it is nice to be able to produce advertising, there is so much more we would like to do. This is not necessarily within the scope of the Bill, so I am not suggesting that, but, for instance, in licensing legislation, being able to take account of public health, which at the moment is specifically excluded, as well as being able to do so in planning legislation as regards where fast food places are and so forth, would be immensely helpful. This is a start; it is a small but positive step.

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

Q One of our earlier witnesses touched on the social determinants of health—housing, green spaces, good jobs—being the greatest factor in a person’s healthy life and life expectancy. I am disappointed that there is nothing in the Bill that addresses those fundamental issues. Do you think that there is scope for them to be touched on, as well as in working with local authorities?

Even more remarkable as regards reducing health inequalities is the absence of any detail, duty or provision to tackle alcohol harm and tobacco control, which of course are the greatest factor in determining a person’s life expectancy—and further down the line they have the greatest impact on local authorities’ social care bills. Do you think they should be included in more detail in the Bill, with a duty to reduce health inequalities rather than just having “regard” to reducing them?

Cllr James Jamieson: I think we need to be cognisant of the fact that this is a Bill providing a framework. I completely agree with the comments made about health inequalities, good housing, green space and all those things—absolutely. I am a full advocate of the idea that health is three quarters determined by somebody’s environment and choices, and probably only a quarter by what the NHS does. That is really important. My slight concern is that if we get very prescriptive in legislation, it limits the ability to do the right thing.

The really important thing about this legislation is all the guidance and so forth that will come out of it, and where the funding goes. Our preference is to say, “Try not be too prescriptive in the legislation, but really engage with local government and public health on the guidance that comes out of this legislation.” A real priority has to be better places, better communities, better jobs, less pollution and all those things, but I do not think that that is something for legislation; I think it is very much about getting the guidelines right, and they will be different in different parts of the country. The issues that might be faced in a rural area are very different from those faced in an urban area. I do worry that if legislation is too prescriptive, it hampers rather than helps.

Professor Maggie Rae: Would you mind if I added some comments please, Chair?

[The Chair]

Please do.

Professor Maggie Rae: Just building on those comments from Councillor Jamieson on what I think is a very important question, there is a line in the Bill saying that the ICSs have to take note of advice from directors of public health. If we want ICSs to be population health organisations, we have to make sure that the legislation is strong enough to ensure that the advice is acted on. Our directors of public health have been highly trained and are able professionally to identify the needs of the population, identify where the health inequalities are and make sure that they can provide the ICSs, in terms of both the NHS-side board and the partnership board, with all the evidence they need about what will make a difference. It is the action that will make a difference and improve those outcomes that we all want. It would be very helpful to ensure that the Bill, if possible, is more explicit about that advice and which source it is coming from. We have worked very closely with the legislative team and the Bill team. I do not think anyone could fault the amount of hours they have spent discussing with stakeholders the details of the Bill, and Councillor Jamieson is also right that we cannot have everything in the Bill, but we want a true population-focused organisation.

That has to be the change that this legislation brings; it has to be an enabling legislative framework. We then need to ensure that the guidance, and, most importantly, the assurance process, allow some of the public health expertise to determine whether it is fit for purpose. It is possible that these organisations, and the excitement of the changes, could result in our having a more place-based population focus, but that will only be the case if we get it right and take account of those wider determinants such as education and housing—all the things that contribute to good health.

Social Care Reform

Mary Kelly Foy Excerpts

Wednesday 23rd June 2021 Commons Chamber

[Helen Whately]

I thank my hon. Friend, and I recognise the situation right now. That is one reason why we are providing £3.8 billion in grants for adult and children’s social care this financial year, which has gone up from £3.5 billion in the previous financial year. Of course, looking ahead in our reforms, we do have to make sure that the way social care is paid for is fair across the country.

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

I was a carer for my daughter Maria for almost 27 years, so I know the demands that carers face every single day caring for those they love. Does the Minister really believe that £67 a week carer’s allowance is a fair amount for round-the-clock care, and will this amount be raised under the Prime Minister’s “prepared” plan for social care?

[Helen Whately]

I pay tribute to the hon. Member for the hours, the love and the effort that she has put into caring herself. She knows, from her own experience, the experience of carers across the country and what it takes in time, physical effort and emotional effort.

Carer’s allowance is not intended to be somebody’s income; it is intended to support people with some of the costs of caring. It is primarily led by the Department for Work and Pensions, but I can say that I am committed to ensuring that there is support for unpaid carers and family carers, and, as I said earlier, ensuring that, as well as caring for and looking after others, those individuals should be able to have time for themselves to lead their own lives.

Tobacco Control Plan

Mary Kelly Foy Excerpts

Thursday 10th June 2021 Westminster Hall

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

I beg to move,

That this House has considered recommendations for the forthcoming Tobacco Control Plan.

It is a pleasure to serve under your chairmanship, Mrs Miller. In December, the Minister confirmed to Parliament that the Government will publish a new tobacco control plan this year, setting out measures to deliver the smoke-free 2030 ambition in the 2019 prevention Green Paper. I welcome this announcement: as a former chair of the Gateshead tobacco control alliance, this issue is close to my heart. In my own area of County Durham, adult smoking prevalence is 17%, compared with 13.9% nationally, and rising to 27% among people in routine and manual occupations. Some 16.8% of mothers smoke during pregnancy, compared with 10.4% in England, and smoking in County Durham has an annual cost to society of approximately £122 million.

The Secretary of State himself stated that the “extremely challenging ambition” of a smoke-free 2030 will not be delivered by business as usual. The new report from the all-party parliamentary group on smoking and health sets out the evidence-based recommendations needed to achieve that ambition. Smoking is responsible for half the difference in life expectancy between rich and poor, and the impact is passed down through generations, with those who grow up in smoking households far more likely to become smokers. With 1,500 people dying from smoking-related diseases every week, and less than a decade to go to achieve a smoke-free 2030, there is no time to waste.

However, this will not happen without investment. That is why the key recommendation of the APPG’s report is for a smoke-free 2030 fund, requiring the tobacco industry to pay for tobacco control. This is the “polluters pay” approach that the Government committed to considering in the 2019 prevention Green Paper. As such, can the Minister assure me that the proposals put forward by the APPG on smoking and health will be considered as part of the forthcoming control plan? In particular, will the Government deliver on their commitment to consider a US-style “polluter pays” approach to fund the tobacco control measures needed to deliver a smoke-free 2030?

More investment is needed, because the huge gap in smoking prevalence between those in routine and manual occupations and those in other occupations is stubbornly persistent. Ending smoking would lift around 450,000 households out of poverty, including more than 250,000 million children and 140,000 pensioners, concentrated in the most disadvantaged parts of the country. That would not only benefit the health and wellbeing of individuals but inject money into local economies, which would show just how serious the Government are about the levelling-up agenda.

Smoking is linked to almost every indicator of disadvantage, and those indicators overlap different communities. Smokers in routine and manual occupations or who are unemployed are also more likely to live in social housing and to be diagnosed with mental health conditions. The Government have been unsuccessful so far in reducing the inequality gap in smoking and need to redouble their efforts to achieve a smoke-free 2030 for all. There is a clear need for a national strategy that targets investment and enhanced support at disadvantaged smokers.

Unfortunately, smokers from deprived communities with higher smoking rates tend to be more heavily addicted than those from more affluent areas. Analysis of Government data shows that in 2019 nearly half of England’s smokers were in routine and manual occupations or were long-term unemployed. They are just as motivated to quit as other smokers, but it is harder to succeed when smoking is more commonplace and cheap, illicit tobacco is widely available.

Regional tobacco control programmes have been effective in tackling these disparities, as shown by the example of Fresh in the north-east, which is the longest-running—indeed, the only surviving—regional office of tobacco control. When Fresh was founded in 2005, smoking prevalence in the north-east was over 20% higher than the national average for England, and the disparity was growing. Since then, the north-east has seen the greatest decline in smoking prevalence of any region: smoking prevalence in the north-east is now only 10% higher than the England average. However, the regional work done in the north-east and elsewhere has been limited by cuts to the public health grant for local authorities since 2015-16. This led to the closure of the regional offices in the north-west and the south-west, and funding in the north-east has been significantly reduced. New funding streams are needed.

Smokers can successfully quit only if they are motivated to make an attempt to quit. Sustained mass multimedia behaviour change campaigns are the most impactful and cost-effective way to provide that motivation. The US Government’s “Tips From Former Smokers” campaign was funded by tobacco manufacturers through the USA’s user-free scheme, which raises $711 million annually from the tobacco industry. The Food and Drug Administration campaign led to over half a million sustained quits in three years, and it was associated with healthcare cost savings of $11,400 per lifetime quit.

Such campaigns have an immediate impact and can be targeted with precision at disadvantaged smokers, yet investment in behaviour change campaigns has fallen year on year in England. This has coincided with a significant decline in the number of adult smokers who have tried to quit. In 2008, 40% of adult smokers in England had tried to quit within the previous year; by 2018, that had fallen to just 30%. Over the same period, funding for mass media campaigns fell by over £20 million.

Behaviour change campaigns need to be targeted at key groups and communities to reduce socioeconomic inequalities. The effectiveness of national campaigns can be significantly enhanced when they are supplemented by targeted regional campaigns. Regional funding for stop-smoking behaviour change campaigns in the north and midlands would support the levelling up of some of the more deprived regions of England. These are the regions with the highest rates of smoking, combined with the lowest gross disposable household income. Supporting smokers in these regions to quit will prevent people’s hard-earned incomes from going up in smoke, lifting thousands of households out of poverty and providing a boost to local economies.

Modelling by University College London for the all-party parliamentary group on smoking and health estimates that a sustained national behaviour change campaign aimed at deprived smokers, combined with regional campaigns in the north and midlands, would result in an additional 1 million quit attempts, 179,000 successful quit attempts and 45,000 more ex-smokers in C2/DE occupations in England by 2030. The investment required is estimated to be about £28 million a year, which the tobacco manufacturers could easily afford to pay from their £900 million profits in the UK—and more than three quarters of the public want the tobacco manufacturers to pay for those measures. Does the Minister agree that targeted investment to tackle high rates of smoking among our most deprived communities is vital to delivering the Government’s levelling-up agenda?

Sadly, illicit tobacco is more accessible to children, and as it is cheaper than legally sold tobacco it reduces the incentive for adult smokers to quit. In 2018-19, the total tax revenue lost because of illicit tobacco was estimated by Her Majesty’s Revenue and Customs to be £1.9 billion. The illicit trade is heavily concentrated in the more deprived communities, contributing to higher smoking rates. Addressing that disparity requires tackling both the supply and demand for illicit tobacco in communities where it is endemic.

In the north-east, there have been dedicated multi-stranded programmes of work in place since 2007 to reduce the supply and demand as part of a broader activity to reduce smoking prevalence and improve the population’s health. Such programmes drive a strategic approach to tackling illicit tobacco at local, regional and national level. One programme was described as follows:

“an exemplar of partnership working…and…deserves to be widely disseminated”—

a recommendation supported by the National Audit Office. Unfortunately, that has not yet been possible owing to lack of funding, and the funding in the regions where it does exist is under threat because of cuts to public health budgets. Fresh and the Greater Manchester health and social care partnership have estimated that it would cost approximately £5 million annually to roll it out across England.

As the Minister said at the launch of our report, we need to get HMRC to do more to tackle illicit tobacco. Just £5 million for a highly effective regional programme is peanuts and would return far more in lost revenue than it costs. Will the Minister commit to discussing with HMRC how funding can be found for the illicit tobacco partnership to extend cover to all the regions of England to reduce the use of illicit tobacco, which is endemic in poorer communities in every part of England?

We are delighted that the Minister was able to attend the launch of the report by the APPG. I know how passionate she is about the issue. I look forward to hearing her response to our report and recommendations. I am confident that if the Government can embrace our recommendations in the forthcoming tobacco control plan, we will be well on the way to a smoke-free England by 2030.

[Mrs Maria Miller (in the Chair)]

Before I call the next speaker, I should say that I shall be moving to Front-Bench contributions at 2.35 pm. I suggest an informal five-minute time limit to enable all colleagues to make their contributions. I call Bob Blackman.

--- Later in debate ---

[Mary Kelly Foy]

I thank you, Mrs Miller, the Minister and right hon. and hon. Members for their contributions to the debate. I am so pleased that there is cross-party support. I just want to reiterate that in order to go some way towards reducing inequalities, levelling up and increasing healthy life expectancy—especially in poorer communities—we must implement this plan.

Motion lapsed (Standing Order No. 10(6)).

A Plan for the NHS and Social Care

Mary Kelly Foy Excerpts

Wednesday 19th May 2021 Commons Chamber

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

I must admit that I greatly enjoyed the Health Secretary appearing to argue that our health and care sectors need to recover after a decade of Tory government—I could not agree more. The covid-19 pandemic has served to expose the damage done by Tory austerity and privatisation to our NHS and social care sectors. They are understaffed and underfunded, while existing staff are overworked and underpaid. However, unlike the Health Secretary, I do not think that further privatisation is the answer, even if he and his pals are already drooling at the thought of selling off the NHS to every Tom, Dick and Tory donor.

It is clear that our health and social care sectors are in crisis. Before the pandemic, there were over 100,000 NHS vacancies, while a quarter of staff were more likely to leave than in the year before. The Government’s plan to address that is to give NHS staff another real-terms pay cut. Added to that, there are an estimated 112,000 social care staff vacancies. Again, with zero-hours contracts and median pay of just £8.50 an hour, I do not think there is any great mystery behind that shortage. However, the social care crisis goes beyond staffing. Age UK estimates that there are 1.5 million older people not receiving the social care support they need. Councils have had their budgets slashed by nearly 50% on average since the Tories came to power, with around £8 billion taken out of social care budgets since 2010, so is it any surprise?

We desperately need a plan for social care that relieves the pressure on unpaid carers and widens access to adult social care where it is needed, yet the Government appear clueless. This crisis requires a dynamic Government: a Government who are ready to accept the ideological failures of austerity and privatisation, who are willing to invest in publicly-run health and social care services, and who reward the workers who staff them. Instead, the promised plan for social care is still missing, private healthcare firms are being welcomed with open arms, and workers face pay cuts and poverty wages.

The Health Secretary speaks about the prevention agenda, but the main cause of ill health is not obesity alone; it is poverty. He can talk about levelling up, building back better and the rest of their buzzword bingo, but until the Government address insecure work, low wages and welfare reform, health inequalities will continue to grow. The Government need to wake up to the health and social care crisis, because the effects are already being felt by real people—the people this Government promised to help.

Health and Social Care Update

Mary Kelly Foy Excerpts

Thursday 18th March 2021 Commons Chamber

[Matt Hancock]

Yes. We did fund the science from the start, and we worked collegiately to make that happen. I can confirm that there is no impact on the road map timetable from the news on supply, because we remain on track in terms of the targets that we have set out.

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

If there are indeed issues with vaccine supply, it does not make sense that countless manufacturers across the world are unable to produce covid-19 vaccines, treatments, diagnostics and other health technologies because of intellectual property restrictions and pharmaceutical monopolies that prevent open technology sharing. Will the Government now commit to supporting a waiver of covid-19-related patents at the World Trade Organisation, or is artificially limiting vaccine supply official Government policy?

[Matt Hancock]

I am very happy to provide the hon. Lady with a briefing, because she should be very proud of her country. AstraZeneca is providing the Oxford vaccine free of charge—it is not charging for any intellectual property rights—right around the world. That is not true, as she implies, for all the vaccine companies, but she should be really, really proud of ours.

Maternal Mental Health

Mary Kelly Foy Excerpts

Wednesday 10th March 2021 Westminster Hall

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

I thank the hon. Member for Richmond Park (Sarah Olney) for introducing this debate. I declare an interest as co-chair of the all-party parliamentary group on cerebral palsy

Maternal mental health has been one of the hidden impacts of the pandemic. Being a new mam is a special time for any woman. However, it can also be overwhelming and generally challenging. In normal times, many women receive support from their family and friends, who are there to offer invaluable guidance. However, for the past year, the public health restrictions needed to tackle covid-19 have meant that many women have had to make this journey on their own.

I had my first child, Maria, at 21. The advice from my mam was crucial in spotting the missed stages in her early development, which enabled her cerebral palsy diagnosis to come much sooner than it otherwise would have. I cannot put into words how valuable her support was following such heart-rending news. It was thanks to my family and friends that I felt confident enough to go on and have two more children.

It strikes me that if Maria had been born during this pandemic, the personal support I received from my mam and health visitors would have been much more limited. My heart truly goes out to those who have become mothers during the pandemic. I cannot imagine the impact that isolation is having on their mental health. I worry that sadly some may choose not to extend their families in future.

The pandemic has particularly affected those whose babies have received neonatal care, with more than 90% of parents who responded to a Bliss survey saying that they felt more isolated due to having a baby in neonatal care during the pandemic, and 70% saying that their mental health was negatively impacted as a result of their experience. The situation has not been helped by the fact that Bliss research also found that psychological support for parents experiencing neonatal care was inconsistent at best. Around half the parents said they were not offered mental health support during or after this care.

The impact of negative maternal mental health goes beyond the parent and is not limited to the short term. As we have heard, the first 18 to 24 months of a baby’s life are critical in their development, and the stress and trauma of poor maternal mental health has the potential severely to impact a child’s life chances.

In parts of the north-east, where my constituency is located, existing health inequalities mean that some children begin their lives with inferior life chances to those from less deprived regions. We simply cannot afford to place further obstacles in the way of their development and risk losing a whole generation. As a result of the pandemic, we are facing a potential mental health crisis in Britain and maternal mental health is significant.

It is unreasonable to suggest that, as a society, we could experience a collective trauma on this scale without it impacting on mental health. Inevitably, that will be challenging, especially when the existing foundations of mental health care in the country are already weak. It was therefore incredibly disappointing that health services were absent from the Chancellor’s Budget last week. He could do with learning that the damage to public health from the pandemic will not fix itself.

It seems fitting that the debate is happening in the week in which International Women’s Day falls. Not only have women consistently stepped up to the plate during the pandemic, with little to no reward, but they have shown resilience in coping with one of life’s toughest challenges—becoming a mam. We owe it to the women in our constituencies to have the best mental health support out there, for what is undoubtedly one of the most beautiful yet challenging life experiences they will face.