Cancer Strategy for England
Rachael Maskell Excerpts(1 year, 6 months ago)
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Clive Jones
I absolutely agree with my hon. Friend. This is why we need a national cancer strategy. So many cancers do not get the resources they need. Everything is a bit too general; a lot of cancers need the focused, targeted resources that will lead to better outcomes.
Rachael Maskell (York Central) (Lab/Co-op)
I am grateful to the hon. Member for hosting today’s debate. In the last Parliament, the Health and Social Care Committee carried out an inquiry into future cancer. From all the evidence we received, we came to the conclusion that a bespoke future cancer strategy was needed to support the NHS, and that it should not be combined in a major conditions strategy, which frankly went nowhere under the last Government. I congratulate the hon. Member on his advocacy; will he read the Committee’s report and our letter about all the interventions that this Government could make to drive forward cancer care?
Clive Jones
I am aware of that report and will refer to it later in my speech.
The challenges will only grow. Experts state that one in two of us will get cancer in our lifetime. An expanding and ageing population means that the number of cancer cases is only going to grow. Cancer Research UK projects that there will be about 2.2 million new cancer cases in the current five-year parliamentary term, a 21% increase on the previous term. Cancer services are struggling now, and they will continue to struggle to keep up with demand. We have a greater number of people being diagnosed, but we have services that are not working. The challenge is stark, but there is a diagnosis for the problem. We now need to deliver meaningful action to recover England’s cancer care to full health.
The Liberal Democrats have made cancer care one of our top priorities for health. There are many policies that we think are crucial to boosting cancer survival rates. We are calling for the introduction of a guarantee for 100% of patients to start treatment within 62 days of urgent referral. We cannot just be content with replacing old radiotherapy equipment; we need replacements, but we also need more equipment. We are calling for the recruitment of more cancer nurses so that every patient has a dedicated specialist supporting them throughout their treatment.
Those crucial policies all feed into the very first step we must take, which is to give England the dedicated cancer strategy that it needs. It beggars belief that we do not have one. A cancer strategy is the best route to delivering genuine improvements for patients, for their families and loved ones and for those who work in our health system to research, prevent, diagnose and treat cancer.
The recent announcement of a 10-year health plan for England and its aim to improve health outcomes for all is very welcome, but I fear that the plan for all could be a plan for none. For example, analysis from Bowel Cancer UK found that the existing NHS long-term plan failed to sufficiently address the barriers to early diagnosis for bowel cancer. That is the case for many cancers. The approach is just too broad. We need detail, we need political will to be focused and we need a rapid and urgent turnaround.
A dedicated cancer strategy would provide a huge opportunity to fix the entire system, not just for the present but for the future—for our children and our grandchildren. It will not be simple or easy: that is why a strategy requires political will and bold leadership to bring Whitehall together and make tackling cancer a priority.
It is clear that when there is strong, bold leadership, cancer strategies work. That is the case across the world. At present, internationally and across our four nations in the UK, England is an outlier in not having a cancer strategy. Comparable countries with a cancer strategy have seen greater improvements in survival rates. For example, having started from a similar position in the 1990s, countries such as Denmark have raced ahead of England in improving survival in recent decades. Denmark’s success is linked to a series of cancer strategies that successfully and strategically built on one another over a 20-year period to tackle critical issues facing cancer services.
Past cancer strategies in England have worked. The 2000 cancer plan for England set ambitious targets across research, prevention and care outcomes. A report by the National Audit Office found that that strategy had supported progress in most aspects of patient experience.
The last Conservative Government launched a consultation on a 10-year cancer plan for England in February 2022. They promised to wage a war on cancer, yet the then Health Secretary, the right hon. Member for North East Cambridgeshire (Steve Barclay), scrapped the dedicated cancer strategy, turning it into a broader major conditions strategy. Delays, delays and more delays meant that the strategy was never published. That is just another legacy of failure from the Conservatives.
In May 2024, the Health and Social Care Committee wrote to the Government and argued that it was a mistake for the Conservatives to abandon the 10-year cancer plan. The current Government have the opportunity to turn that around. Having a cancer strategy is very popular with the public. Almost eight in 10 people think that the Government need to develop a long-term and fully funded plan for cancer. Organisations ranging from Cancer Research UK and Breast Cancer Now to global biopharmaceutical companies and medical institutions support having a cancer strategy for England. Yes, this requires effort, cross-Government thinking and focus, and the ambition to make England and the UK a world leader in cancer outcomes and research. But that effort will mean that we have the chance to save tens of thousands of lives and that millions of people will not need to suffer the upset of losing a loved one or friend.
Last week, I tabled a private Member’s Bill—the National Cancer Strategy Bill—calling for the Government to implement a cancer strategy for England. But unlike other private Members’ Bills, mine does not need to be law for that to happen; the Government could make the decision tomorrow to kick-start the work to implement it. Indeed, if my interpretation of Hansard is correct, they may well be intending to do so. In response to a question from my hon. Friend the Member for North Shropshire (Helen Morgan), the Secretary of State for Health and Social Care recently said that the Government will
“work tirelessly through a national cancer plan to make sure that we deliver the cancer waiting time standards that the last Labour Government met”.—[Official Report, 15 October 2024; Vol. 754, c. 684.]
A national cancer plan sounds quite similar to a national cancer strategy, and I would like to use the final section of my speech to make some recommendations to the Secretary of State as to what his cancer plan could and probably should include, because if the Department is seriously considering doing this, it will need to get it right. Broadly, the plan needs to cover all aspects of cancer prevention, research and care. It requires political leadership to bring together stakeholders to develop a strategy and co-ordinate implementation. It requires dedicated governance. There must be a robust central oversight function with a mandate to bridge the gap between disconnected Government structures. It must clearly detail how it will implement the strategy, with measurable objectives and achievable timelines. It must have regular, robust and transparent reporting of implementation and, inevitably, it needs dedicated resources to enable the right change.
A cancer strategy also provides the opportunity for us to unlock innovation in the future. We are living in a golden age of cancer science. New types of cancer treatment, from immunotherapies to cell and gene therapies, are enabling clinicians to attack cancer from multiple angles. These advances are helping to improve cancer outcomes. Therefore, I implore the Government, if they do take up a cancer strategy, to look at how the National Institute for Health and Care Excellence can be reformed to unblock barriers to investment and to strengthen the current infrastructure to increase genomics and biomarker testing.
I could go on. We could discuss the historical lack of strategic direction in terms of having a national policy for blood cancer, or the fact that every day 12 children and young people hear the news that they have cancer. Sadly, 10 die every week, making cancer the biggest killer by disease of children and young people in the UK. Despite that, it remains overlooked in existing strategies and reviews. That reflects the scale of the challenge we face in English cancer services; it feels like a never-ending list of things that we need to fix.
I will use this opportunity to ask the Minister a few questions. Can he assure people living with cancer and cancer charities that the Government will address the current crisis facing cancer services and build long-term resilience through a dedicated cancer strategy? Will he give his support to my private Member’s Bill, which would put into legislation a requirement for the Government to establish a 10-year cancer strategy? Will he meet me and, more importantly, representatives of the cancer community to discuss the need for a cancer strategy? Finally, will he make the case to his colleague the Minister for Secondary Care that the Royal Berkshire hospital requires an urgent rebuild?
Rachael Maskell
The hon. Member is making an incredible and powerful speech. Will he add one more ask to his list: for the cancer strategy to be joined up with a life sciences strategy? The UK is fantastic at primary research around cancer, but there is work to be done in scaling that research and translating it into delivering a holistic product for the whole of cancer care, with the ensuing treatments and therapies.
Clive Jones
I thank the hon. Member for her very good intervention. We are lucky in this country to have many life science businesses, many of which would really like to work as part of a joined-up cancer strategy. I have several in my constituency that I know would really like to do that, so I thank her for making that very good point.
Let us utilise this crucial opportunity to fix our cancer services. Some 360 people will die of cancer in the Wokingham area in the next year, and there will be around 2,000 cancer deaths over the next five years of this Parliament. We need to do our best to ensure that that figure is not reached but comes down.
World Stroke Day
Rachael Maskell Excerpts(1 year, 6 months ago)
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Sarah Dyke
The hon. Member makes a very good point, and I also celebrate those people, who do such hard work within their communities.
The UK knows how to deliver world-class stroke care, and some parts of England are doing that as I speak. Stroke is one of the few conditions that takes patients through the entirety of the health and social care system, from emergency services and acute care to social care, specialist rehabilitation support and end-of-life care.
Rachael Maskell (York Central) (Lab/Co-op)
I am really grateful to the hon. Member for securing this debate. Time is everything with regards to a stroke, particularly around diagnosis, but also if treatment such as thrombectomy is needed. Does she agree that we should be looking at ambulance response times in particular, and perhaps at recategorising stroke as a category 1 call-out?
Sarah Dyke
I thank the hon. Member for her intervention and for all the work she has done in this area. I will come to the issue of ambulance response times a little later in my speech.
Delays in urgent care are currently leading to high mortality rates, and post-stroke services that provide crucial emotional, practical and social support are often treated as optional, rather than essential.
Stephen Kinnock
I am a little wary of generalising too much, because I know that so many decisions have to be made in real time by our skilled ambulance drivers and paramedics and the many others involved, but my hon. Friend makes a valid point. In a general sense, he is absolutely right that stroke needs to take priority. The red thread going through this entire debate is the need for speed. It is all about prioritising and acting quickly; he is absolutely right about that.
In the past year, we have seen a 30% increase in the number of thrombectomies delivered in England. Alongside that, our 20 integrated stroke delivery networks are looking to optimise care pathways. The General Medical Council is addressing critical workforce gaps through its thrombectomy credentialling programme, and our national optimal stroke imaging pathway is improving information sharing.
I am aware of the reconfiguration in the constituency of the hon. Member for Glastonbury and Somerton. NHS Somerset integrated care board has decided to close the hyper-acute stroke unit at Yeovil hospital and to establish a single hyper-acute stroke unit at Musgrove Park hospital in Taunton to provide 24/7 emergency treatment. All service changes should be based on clear evidence that they will deliver better outcomes for patients. A high bar is set out in guidance for intervening in contested reconfiguration cases, and the reconfiguration of services should be a matter for the local NHS. I would expect all avenues of local resolution to have been exhausted before a call-in request is made. The Department has received a formal request to call in NHS Somerset ICB’s decision, and Ministers will make a decision on whether to use their call-in powers in due course.
Unfortunately, there is still significant variation across the country in access and outcomes in relation to stroke. For example, the percentage of suspected stroke patients who received the necessary brain scan within an hour of arrival at hospital varies from 80% in Kent to only around 40% in Shropshire. That variation needs to change, and we need to bring the best of the NHS to the rest of the NHS. That will be one of the central challenges for the Government going forward.
The Government have a profound ambition to improve the lives and health outcomes of people who survive a stroke. At this point, I would like to pay tribute to my hon. Friend the Member for Stratford and Bow (Uma Kumaran) and to the man in the Public Gallery for what they have been through and for their fortitude. It was certainly not easy for my hon. Friend to come to this place and to have to go through the extremely difficult situation that she did. I also pay tribute to all the key partners and stakeholders who worked with her and her family to get through it. That really is a tribute to the immensely important work they do.
Rachael Maskell
As well as looking at acute triage to rapidly diagnose people who have had a stroke, it is important to invest in rehabilitation—something I did for 20 years in the NHS. I would be grateful if the Minister could set out how he proposes to have integrated rehabilitation teams that not only see people through the immediate aftercare, but continue to provide a top-up for them so that they do not backslide in their rehabilitation.
Stephen Kinnock
I can say a word about our national service model for an integrated community stroke service, which involves a number of specific projects aimed at improving delivery of psychological rehabilitation. The ICSS model is vital to support psychological recovery, return to work and improved quality of life, and I would be more than happy to discuss it further with my hon. Friend.
Before I close, I want to recognise the remarkable work of the charities that help people across the country to rebuild their lives after a stroke. Once again, I thank the hon. Member for Glastonbury and Somerton for this important debate, and I encourage every Member of the House to go to change.nhs.uk and to get involved in the biggest conversation about our health and care service since its foundation in 1948.
Question put and agreed to.
Oral Answers to Questions
Rachael Maskell Excerpts(1 year, 7 months ago)
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Wes Streeting
The decision on the winter fuel allowance is not one that the Government took lightly, but we inherited a £22 billion hole in the nation’s finances. We continue to stand behind vulnerable households by increasing the state pension with the triple lock, delivering the warm home discount and extending the household support fund to support the most vulnerable pensioners.
Rachael Maskell (York Central) (Lab/Co-op)
Andrew Gwynne
My hon. Friend is incredibly knowledgeable about public health matters both at national and local level. Lord Darzi’s investigation into the NHS set out the impact of past reductions in local government public health funding. We will confirm public health grant allocations for the next financial year as part of the forthcoming spending review, but the points she made have been made loudly and clearly.
Mental Health Support
Rachael Maskell Excerpts(1 year, 7 months ago)
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Rachael Maskell (York Central) (Lab/Co-op)
It is a pleasure to see you in the Chair, Mr Dowd. I think we all agree that, in introducing this debate, my hon. Friend the Member for Ashford (Sojan Joseph) gave an incredible speech, as all contributors have.
I want to talk a little bit about the transitional approach that we are taking in York, following the Trieste model. It is seeing a real transition, in the way the Health Secretary has described, from secondary care, which we know is just not able to cope with the capacity and demand that is placed on it, into a more primary-care and socialised setting. It is really transformative for the people in my city.
We are setting up community mental health hubs in my city. We have one, and we are going to have two more to follow, with one working 24/7. The model is co-produced and multi-agency, and is moving to provide open-access support to help people to manage their own mental health challenges, with interventions from health professionals, social prescribing and peer support, and to look at issues around welfare, debt and employment support.
Particularly in respect of community outreach, the hub is taking people who feel so neglected, because there just is not the capacity, into a space where they can get support and then progress on with their lives. It is centred around a café where people are encouraged to engage and talk. The café is run by service users, so it is a wholly-owned model, and it is incredibly successful.
The Trieste model is considered one of the best models of service provision in the world because of its emphasis on integration with the whole community and with the self, with professional support at hand if needed. In Trieste, very few depend on secondary care or acute psychiatric care, and residential placements are few and far between. We need to look at that, particularly in respect of the transitions and the Government’s ambition. Following a social model means we do not pathologise mental health but deal with it and help people to build on their strengths and to build resilience into the future.
Our programme is linked with the local university, York St John University, which runs the Converge programme that enables people to use education not only as a way to deal with their mental health issues but to learn new skills and feel included in our community. It contrasts so much with the traditional model, which we know just is not functioning given the demand on services. I therefore urge the Minister to have a look at what is happening in Trieste and to come and have a look at what is happening in York. Let us put this into a model in which people live with mental health as opposed to struggling with it.
NHS Performance: Darzi Investigation
Rachael Maskell Excerpts(1 year, 7 months ago)
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Victoria Atkins
I think the hon. Lady did not hear me; I said that cancer is the biggest killer of children under the age of 14, not 40. I know only too well how that terrible brain cancer has hurt her family, and the great loss that she has suffered. I know that she has ambitions for the work that we were doing to get cancer treatments, particularly new cancer treatments, as quickly as possible to patients who are getting towards the end of their life. We will of course support anything that the Government do to help people such as the hon. Lady’s sister; again, I come back to the fact that we all want this to work.
Victoria Atkins
I will make some progress, because I know that I am trying your patience, Madam Deputy Speaker.
Lord Darzi says that prevention is better than cure. We agree. The Government say that they are committed to prevention, but actions speak louder than words. Scrapping the winter fuel payment for millions of pensioners will undoubtedly come at a cost to the NHS. The equality analysis estimates that 780,000 of the most vulnerable pensioners who are eligible for pension credit will miss out this winter, and the cut will result in 262,000 pensioners needing NHS treatment because they are living in cold, damp homes, at an additional cost of £169 million in a year. How has the Secretary of State stood by as the Chancellor made that appalling decision, which will affect vulnerable pensioners in his constituency, as well as the NHS?
Finally, we have heard the words that the right hon. Gentleman has used about the NHS in England; it is surprising, to say the least, that he has not used those same words times 100 to describe the state of the NHS in Labour-run Wales. On almost every measure, the NHS performs the worst in Wales, where one in four people is on an NHS waiting list. Wales has the longest waiting times; Welsh patients wait on average seven weeks longer than in England. More than 23,000 people wait longer than two years, compared with just 120 people in England. Given the Secretary of State’s rhetoric about NHS England, why has he not asked Lord Darzi to take a cold, hard look at how Labour has run the NHS in Wales for 25 years?
In conclusion, we Conservatives want to support good reforms and good policies for the better health of the nation, but this backward-looking report will not improve productivity. Headlines will not drive better outcomes for patients, and speeches will not improve the life chances of our constituents. This Government need to move from words to action quickly.
Rachael Maskell (York Central) (Lab/Co-op)
Is a real pleasure to follow the new hon. Member for St Neots and Mid Cambridgeshire (Ian Sollom). I am sure that he will be a rising star on the Liberal Democrat Benches. It is a pleasure to follow all hon. Members who have made their maiden speech today.
I am really grateful for the analysis that Lord Darzi has set out for us. The NHS has never been under such duress, nor have its staff, but following a diagnosis, we need a prescription. That is what I want to talk about today. We live in an ageing society, and while we celebrate the medical advances since Labour was last in power—in diagnostics, treatments, digital and technology—we know the urgency with which we need to apply them. Transformation has to be central to the agenda. I congratulate the Secretary of State on his focus on the NHS bringing about the transformation that is needed.
However, before we can look at that, we need to look at the financial flows in the NHS, which are not working, and the governance structures. I am not talking about reorganisation; I am talking about having one controlling mind in the right place in the service, overseeing the system. At the moment, there is too much focus on secondary care. That is sucking resources and work into that part, and driving inefficiency. Moving services into primary care is the key to unlocking the productivity and savings that are needed. It will improve health as well.
In the short time that I have, let me point to two examples in my community. First, in mental health, 30 Clarence Street is set up to be open access, so that there are no more long queues to see mental health practitioners, and multidisciplinary, with the public sector and the voluntary sector working hand in hand to meet people’s needs. I invite the Secretary of State to come and see that service, because it is what we should be doing across our NHS. Two more hubs are to be set up in my constituency, leading the way on mental health. Then there is the work of Nimbuscare in primary care settings; it is pulling out from the NHS all the services that do not need to be in the secondary part. It is unplugging the backlog at the front door of the health service, while ensuring that we are looking after people at the back door. That is the transformation that our health service truly needs. I wanted to share those examples, and set out how they can be extended to build the NHS of the future.
Madam Deputy Speaker (Ms Nusrat Ghani)
I call Susan Murray to make her maiden speech.
NHS: Independent Investigation
Rachael Maskell Excerpts(1 year, 8 months ago)
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Wes Streeting
Of course we seek to work constructively with all trade unions representing staff across our health and care services, and also with the royal colleges. We want to work in a spirit of partnership, and we are only able to do so because people sent Labour MPs to Parliament to replace the Conservatives.
Rachael Maskell (York Central) (Lab/Co-op)
I agree with my right hon. Friend: this is the most devastating analysis that I have read of the NHS in over 30 years. It just shows the challenges that lie before him. Talking of challenges, will he challenge the integrated care boards to focus on moving resources into primary care? In particular, will he look at what is happening in York, where Nimbuscare has been able to pull out services from the acute sector and deliver work in the community?
Wes Streeting
I am really grateful to my hon. Friend for her question. She has a huge amount of expertise in health and care, and she is absolutely right about the need for that shift. I have made it very clear to ICB leaders and to trusts across the country that I want more focus on secondary prevention, which means much more activity in the neighbourhood. I know that she will keep on championing these causes. She is a good critical friend, and I know that she will hold my feet to the fire to ensure that I deliver.
Oral Answers to Questions
Rachael Maskell Excerpts(1 year, 9 months ago)
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Stephen Kinnock
The hon. Gentleman was doing so well at the start, and then he kind of blew it a bit towards the end. It is absolutely right that we put country before party, and we will work with whoever has the best interests of rebuilding our public services at heart. The issue that he raises specifically sounds interesting. What I would say is that unless we get the bigger picture sorted, and unless we make NHS work pay for dentists, we will not be able to rebuild the NHS dentistry system that we should be cherishing and seeking to reform. I am of course always open to conversations with him.
Rachael Maskell (York Central) (Lab/Co-op)
Just 39.2% of my constituents were able to access an NHS dentist over the past two years. That is an absolute disgrace, but the Health and Social Care Committee put together a report into NHS dentistry, setting out a blueprint for how to resolve the challenges, including access, looking at tie-ins and ensuring that we get more dentists registered. Will the Minister look at that report and follow its recommendations?
Stephen Kinnock
I congratulate my hon. Friend on her re-election; it is wonderful to see her back in her place. She is absolutely right that the tie-in consultation deadline was 18 July. We are considering those responses with an open mind. On the broader issues that she mentions, our rescue plan is 700,000 more appointments, incentives for new graduates to go to under-served areas, reform of the dental contract and making work pay for dentists. That plan is at the heart of the reforms that she mentioned and that is what we will be doing.
NHS
Rachael Maskell Excerpts(1 year, 11 months ago)
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Victoria Atkins
My goodness me. I thank my right hon. Friend. I have an inkling of the responsibilities and pressures that he bore during the pandemic. There will be many thoughts about how the Government and society handled the pandemic, but he devoted his absolute all to keeping people safe, and to moving our society out of the lockdowns. I thank him sincerely for all his work.
True to his character, my right hon. Friend wants to talk about the future. Outside the pandemic, he had a particular focus, when he was Health Secretary and in previous Cabinet positions, on the role that technology can play in our lives. Our NHS app now has three quarters of adults in England signed up to it. That is a testament to him and to those in the NHS who helped to deliver it. There are more subscribers to the NHS app than to Netflix. The most common users of the NHS app are those over the age of 65. We can see just how powerful the app can be, and the role that it will play in prevention, but we need to invest in the technology. I view the long-term workforce plan as critical to building the next 75 years of the NHS, as is the tech plan that the Chancellor announced in the spring Budget, which provides £3.45 billion for technology to drive forward progress in the NHS—a plan that the Opposition has not supported.
Rachael Maskell (York Central) (Lab/Co-op)
May I take this opportunity to thank all NHS staff for their dedication, professionalism and care, which are really quite extraordinary in the light of the circumstances that they face? I spent 30 years working in and around the NHS, and I know that it was on its knees in 1996 and 1997, before the Labour Government made such a difference, but nothing compares to the state of it today. I am thinking particularly about NHS dentistry; my constituents are having to wait seven years for an appointment with an NHS dentist. I know that my hon. Friend the Member for Ilford North (Wes Streeting) will meet dentists on the first Monday after Labour come to office.
The Secretary of State has not adopted a plan that would have worked, the one produced by the Health and Social Care Committee. Can she tell us why she did not adopt that plan in full, and what she will say to my constituents, who will vote at the polls for a service that works, as opposed to one that is broken?
Victoria Atkins
I join the hon. Lady in thanking her local NHS staff, and, indeed, NHS staff throughout the country. The NHS employs more than 1.3 million people, and every single one of them contributes in their own way, from clinicians to nurses to hospital porters to administrative staff. All those people play a really important part in keeping us well and safe.
Notwithstanding the picture that the hon. Lady has sought to paint, I hope she will have the graciousness to acknowledge that we are diagnosing more cancer cases, and diagnosing them more quickly at stages 1 and 2. I hope she will acknowledge, for example, that some nine out of 10 cancer patients are treated within 31 days of a decision to treat them, and that the average waiting time in England—not Wales—is just under 15 weeks. Of course there is more to do, but we have plans in place.
I also urge the hon. Lady to look carefully at our dental recovery plan. We have seen more practices open up to provide more NHS appointments, and as the recovery plan is rolled out, we will see up to 2.5 million more appointments, roughly three times as many as will be seen under Labour’s dental recovery plans. Compare and contrast!
Tobacco and Vapes Bill (Sixth sitting)
Rachael Maskell ExcerptsThursday 9th May 2024
(2 years ago)
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Dr Caroline Johnson (Sleaford and North Hykeham) (Con)
I support clause 10. We heard compelling evidence from Professor Gilmore last week about the tactics the industry uses to try to get young people addicted to nicotine, so that it can continue to profit from their buying the products for the rest of their lives. We also heard from Professor Gilmore about emerging evidence showing that exposure to nicotine at a young age, particularly as a teenager, can rewire the brain, making it more difficult to quit. I therefore welcome the powers in clause 10 that allow the Government to be flexible and respond to changing techniques in the market in order to stop children becoming addicted to nicotine, but why do we not just make it illegal to sell nicotine of any kind to children?
Rachael Maskell (York Central) (Lab/Co-op)
I appreciate being called to speak to clause 10, which is a very important part of the Bill. As we have heard many times already, the industry will look at every possible mechanism to try to bring about a new generation of people who are addicted to nicotine and make it harder for them to quit. That goes not just for people under 18 but for those in later adolescence and adulthood.
My concern is with products already on the market that are being taken up quite readily. Next week, the Health and Social Care Committee will look at the public health measures being taken in Sweden. We will see how nicotine pouches—snus, as they are referred to there—are being used as an alternative to smoking, really quite extensively.
Dr Johnson
Does the hon. Lady agree that nicotine pouches are starting to be marketed to young people in a similar way to vapes, with an increasing amount of flavours, a relatively inexpensive price per unit and horrifyingly high levels of nicotine?
Rachael Maskell
I am grateful to the hon. Lady for making that point, which is certainly where I want to go with my speech. She is right: the industry will look at every single option to reformulate its products, including introducing nicotine pouches disguised with various flavours and colours—you name it, they will do it—to induce young people to engage with them. If we do not get ahead of the curve, the industry will be right there—I guarantee it.
We need to wise up to the tactics the industry has deployed over decades and recognise that, whether with pouches or something else further down the line, it is again on the move to sell its products in a reformulated way. I urge the Minister to look at whether this should be covered by secondary legislation—I know she is concerned about the amount of secondary legislation that will come through from the Bill—or in the Bill as vaping is.
Bob Blackman (Harrow East) (Con)
Does the hon. Lady not accept the counter-argument that putting things in the Bill means that we have to change primary legislation, but that by doing things via regulations, the Government can make changes in a speedy fashion and combat big tobacco’s fleetness of foot in bringing terribly addictive new products to the market?
Rachael Maskell
I am grateful to the hon. Member for that, and I agree that we want to be able to adapt as soon as the market does, but right now the industry is promoting nicotine pouches and we must ensure that we take the earliest opportunity to bring them into the scope of legislation, so that the industry does not just think, “Well, we’ve got six months now to promote our product.” Given the way the industry is behaving, this is a bit like a game of cat and mouse, and we need to do whatever we can to ensure that we are ahead of the curve, whether that is through primary or secondary legislation.
I ask the Minister to ensure that the regulations are brought forward expeditiously and that the first set—we may need further sets; I appreciate what the hon. Member for Harrow East says—is introduced in the shortest time possible. Can she tell the Committee what the timescale will be for that, so that we know how quickly these other products will be brought within the scope of the Bill, ensuring that young people are protected?
Dr Johnson
I agree with the hon. Lady and with my hon. Friend the Member for Harrow East. Clause 10 applies to clauses 7, 8 and 9, giving the Government flexibility on all three. As the hon. Lady said, it is great to have the flexibility to bring in regulations to amend clauses 8 and 9, but on clause 7, can she think of any good reason why we would want to be able to sell nicotine products to under-18s?
Rachael Maskell
The hon. Lady is following up on a theme that I probed at earlier stages of the Bill, notably on Second Reading. I believe that we need to look at stringent measures, so that people do not have their choices restricted by the addiction that they adopt. It is really important that young people today, or anyone else who engages with these products, do not get addicted at an early stage. We have to look at the issue of the impact of addiction in that wider realm, as we are doing on the Health and Social Care Committee, which is looking at products that are addictive and harmful to health in connection with the public health measures that we are scrutinising.
The hon. Member for Sleaford and North Hykeham makes an important point, and at a later stage of the legislative process I hope to examine how we address the drug nicotine and its harmful impacts on young people and more widely. Addiction has been utilised by people who exploit the lives of others for their own profit, and we need to ensure that they do not get the opportunity again with children, young people or adults. They plague those who live in the greatest deprivation in our country, driving them to more harmful addiction. I therefore welcome the legislation, but I believe that we can go further. Given the industry’s activities right at this moment in trying to find new ways around legislation before it is even on the statute book, the Committee needs to be wise about ensuring that it does not get that opportunity.
Kirsten Oswald (East Renfrewshire) (SNP)
Everything that the hon. Member for York Central just said is worth reflecting on. Clause 43 applies to Scotland, and we are also talking about clause 10.
I spent a little time looking at nicotine pouches, which suddenly seem to be everywhere—or perhaps it is just that I am finding them advertised to me. I am definitely not the right person to advertise them to, but whenever I go on to social media, I inexplicably find them appearing before my eyes. There are a whole lot of questions around that. I will not be taking them, so that is fine, but other people will. We have heard about the uptake among young men in particular, which is concerning, because we heard some powerful evidence from health experts about the real harms that can be caused and the addiction that will follow people throughout their lives.
All the time, industry is finding new ways to hook young people. Some of the websites that I have looked at suggest that the pouches are a way to “avoid the health risk”. That is obviously not true—it is patent nonsense, actually. They also suggest that, for a sportsperson, “according to some reports”—that is me quoting again—there are “performance” benefits. Again, that is patent nonsense. It is obviously absolute rubbish, but I think it speaks to the narrative that surrounds pouches, as if they are somehow okay—a good thing—and they are not going to cause the harms that other nicotine-based products do. But of course these things will cause harm, and the addiction risk and health challenges are still there, too. The social normality, acceptability and prevalence of these things is deeply depressing. Their use by sportspeople in particular puts them across with some kind of veneer of being okay. They are not okay; they are deeply damaging to health.
Unsurprisingly, I am always keen to hear from the Minister about advertising and football strips, but to take that a step further, because we are talking about the same sports-based area, will she say how we can use legislation to keep ahead of companies that are so fleet of foot in hooking into things that people are interested in to promote these products directly or, more concerningly, indirectly?
Dame Andrea Leadsom
I wholeheartedly endorse almost everything I have heard. I share hon. Members’ concerns and applaud them for their commitment to solving the issue of nicotine pouches. As my hon. Friend the Member for Harrow East rightly pointed out, should the industry find a way around something in the Bill, we would have to legislate again with primary legislation. The right thing to do, therefore, is to take powers to make secondary legislation that gets on top of the issue and future-proofs us, so that right across the United Kingdom we can tackle this appalling scourge: the tobacco industry’s determination to get our children addicted.
Extraordinarily, the tobacco industry dominates the UK nicotine pouches market, and it claims to self-regulate—that is, it claims not to sell to under-18s. That is absolutely extraordinary. A recent study suggests that although nicotine pouch use is low among adults, with roughly one in 400 adults in Great Britain using them, nicotine pouches are increasingly popular with younger, largely male audiences. The Committee on Toxicity of Chemicals in Food, Consumer Products and the Environment has identified gaps in research and flagged that the long-term health harms are not known, but use by non-smokers is likely to be associated with some adverse health effects due to the nicotine.
We all know that other nicotine products need to be clamped down on. We will not need to consult on age of sale restrictions on nicotine products; we will be able to use regulations, hopefully in this Parliament, with implementation from 2025. It is certainly our plan to consult on all of this regulation to get ahead of nicotine pouches and other nicotine products with a view to implementing the regulations in 2025.
Rachael Maskell
I do not know whether the Minister is aware that the strength of the nicotine in these products is excessively high—much higher than in other products—and so they rapidly bring about addiction. When the Government brought forward measures to try to educate the country about alcohol use, they did a comparison. Perhaps it would be helpful to do a comparison about the amount of nicotine that individuals are taking through a nicotine pouch, because the public would be alarmed to know that we are talking about their taking multiple factors of nicotine into their bodies.
Dame Andrea Leadsom
The hon. Lady is absolutely right; they vary from 2 mg to 150 mg per pouch. I imagine that that variation would make it hard to provide a complete comparison, but she is quite right that education will be a big part of the implementation.
Dame Andrea Leadsom
My hon. Friend makes a good point. The Bill takes powers to bring forward the age of sale restriction, and that in itself will not require further consultation. It is my expectation that, if possible, that will be brought forward in this Parliament. However, as has been explained, if we put something in the Bill, the industry will get around it by saying, for example, “This doesn’t contain nicotine”—except it does, as we have already seen.
The other thing I want to raise with hon. Members is that clauses 61 to 63, which will grant the ability to restrict flavours, packaging and location in store, will also apply to nicotine products. Those measures are clearly designed to reduce their attractiveness to children.
Rachael Maskell
In response to my questions and accepting the clause as it is written, can the Minister give the Committee an assurance about when the regulations will be brought forward to ensure that products such as nicotine pouches will come within scope of the Bill?
Dame Andrea Leadsom
All I can say to the hon. Lady is that she has heard me, and I am determined to bring that forward as soon as possible. There are good reasons for not putting the provision on the face of the Bill, which are to do with future-proofing. I can only give her my absolute assurance that, as soon as humanly possible, I will bring the regulations forward for consultation where necessary and for implementation where not.
Rachael Maskell
If I might be so bold, I think the Minister is making life slightly complicated for herself. We know the impact that taking smoking products out of the line of sight of people who go into shops or supermarkets has had. Putting them in closed cabinets has very much had the effect that we would want. People do not see the products, but they have to request them; they are not on display for people to just glance an eye over. They are simply not there in the line of sight.
If the same legislation applied to all vaping and nicotine products, that would make things simpler for shopkeepers and supermarkets. They already have the shelving and the shutters; it is not as if they would have to make a financial investment in new shelving. They would not have to do anything different—just pick up the vapes and put them into a contained, enclosed space. I do not see any reason why that could not be in primary legislation, because it would be so simple, and I believe the expectation of the public is already there.
I walked down a street in York just the other day, and almost every shop had their little vape display. Putting them behind the counter, behind screens, behind shutters, would be the simplest method of dealing with that. We know it is effective for smoking. There is no reason why tobacco products should be dealt with at a different standard than vaping products when people go to purchase them, and we would get the effect of “out of sight, out of mind”. We know how much the industry spends on packaging to draw the eye to products, and how powerful that is. Putting them out of sight would have the required effect of reducing people’s thinking about those products.
Simplifying and bringing the legislation into line, for shopkeepers, the public and for us as legislators would meet the public expectation that this is what will happen. I do not think we need separate legislation to deal with vapes one way and smoking products another. Let us just pool it together, make it simple and say that this is about protecting the public. I do not think anyone will bat an eyelid.
Dr Johnson
I rise in support of clause 11 on restricting the display of vaping and nicotine products. I have been horrified to see that after the Government, with good intentions, made it difficult for children to see sweets at the counter, to reduce pester power and help protect them from obesity, the sweets were in many cases replaced by vapes. The Government are doing exactly the right thing in taking the powers to look at displays. As has been mentioned, the ability and flexibility of doing so through regulations means that we can move swiftly when the industry seeks to get round the latest rules. I think that is great.
I have two examples for the Minister. Would they be covered by paragraph (1)(c)? The first is a mini-mart in Grantham. The entire shop window is covered in pictures of things such as Kinder chocolate, Haribos, fruit and very large-size vape devices in bright colours. I was in WH Smith in Nottingham last weekend; this is a shop that sells children’s books, children’s toys, sweets and children’s stationery, yet at the till there is a very large video display of vape adverts immediately behind the shopkeeper’s head. Will these two types of advertising and display be covered by the regulations?
Bob Blackman
I want to put one issue to the Minister before she sums up these clauses. Obviously, the overwhelming number of retailers will wish to conform to the rules and regulations under which they exist. On re-reading the Bill, I notice that it does not cover the contents of products. For example, we have cited the issue of so-called nicotine-free products that contain nicotine and, indeed, many other products that may have different amounts of nicotine from what is stated. We hear anecdotally of some suppliers wanting to reduce the amount of nicotine in vapes to get people to buy more of them because the nicotine hit is insufficient. Under these powers, will trading standards officers have the opportunity to look at those products and take action against retailers who are clearly selling products whose contents clearly do not accord with what should be in them?
Rachael Maskell
I want to pick up on this point as well because it is incredibly important, and we cannot put the responsibilities on to trading standards if they do not have the tools to do the job. Clearly, this is a new field and, as we have discussed throughout the Bill, new products will come out and be marketed if we do not get ahead of the curve. It is therefore important that we ensure that new testing kits are made available and that we look at how they can be brought into play.
We heard strong evidence last week about the benefits of introducing a track and trace system, which would simplify the work of trading standards. If a product has not been through that process, and there is therefore not an authoritative basis on which to say that it can be sold, it would clearly be an illicit product. If a proper track and trace process was put in place, that could aid the work of trading standards, and addressing the real challenges we are trying to deal with through these clauses would not require such extensive resourcing.
Will the Minister therefore comment on her appetite for bringing in a track and trace system for vaping and other nicotine products to get ahead of the curve? That would ensure that the illicit trade is suppressed and does not rear its ugly head and that it is as easy as possible for trading standards to uphold every part of the Bill.
Dame Andrea Leadsom
This is obviously an incredibly important area of enforcement, and successful enforcement is integral to the success of this policy.
To the question from the hon. Member for Birmingham, Edgbaston about Operation Joseph, in the year before the operation—2022-23—2.1 million illicit vapes were seized by trading standards across England. In the same year, 1,199 test purchases were carried out by trading standards in England, with 27.3% resulting in an illegal sale. Those are the numbers. As the hon. Lady says, Operation Joseph has had £3 million of investment over two years, led by National Trading Standards. It conducts a range of illicit vape enforcement activities, including data collection and analysis of the scale of illegal products and under-age sales; market surveillance; under-age sales testing; court enforcement action; and upskilling of trading standards staff. A further operation—Operation CeCe —was established in January 2021 as a joint venture between National Trading Standards and His Majesty’s Revenue and Customs to tackle illicit tobacco sales.
So those individual measures are in place. As hon. Members will know, the Medicines and Healthcare products Regulatory Agency looks at the product notifications for legal products, which have to meet the compliance standards of the MHRA. It is then for trading standards to enforce, and they have had a significant increase in resources to tackle enforcement, as I have set out. I am obviously happy to write to Members with more detail should they wish.
Question put and agreed to.
Clause 19 accordingly ordered to stand part of the Bill.
Clauses 20 and 21 ordered to stand part of the Bill.
Clause 22
Power of ministers to take over enforcement functions
Question proposed, That the clause stand part of the Bill.
Preet Kaur Gill
The amendment is very simple: it would amend clause 24, which introduces fixed penalty notices for retailers that breach age of sale, proxy purchasing and free distribution restrictions on tobacco, vapes and nicotine products, by doubling the fixed penalty notice from £100 to £200.
The need for the amendment is clear. In 2022-23, national trading standards identified that 20% of the 1,000 vape test purchases carried out with retailers resulted in an illegal sale. In 2019-20, 50% of councils that undertook test purchasing reported that cigarettes or tobacco products were sold to under-age people in at least one premises. Despite existing regulations, there is a big and widespread problem, which suggests that the current penalties and fines, which can end up as high as £2,500, are an insufficient deterrent. I strongly support giving trading standards officers the power to issue on-the-spot fines to retailers doing the wrong thing, but the current level of the fine is too low.
My amendment would increase fines to £200, precisely doubling the deterrent in the Bill. Under the Bill as drafted by the Government, offenders can be forced to pay only £50 if they pay off their fixed penalty notice within 14 days, and it is surely too easy for those breaching the law to factor that in as the cost of doing business. Stakeholders including the Association of Convenience Stores and the Local Government Association agree that £100 is too low and that £200 makes logical sense as the level at which to set fines, equalising it with the level for other, similar offences, such as that proposed in the draft regulations for the disposable vapes ban. In the Government’s consultation, £200 was also the most popular response—three times as many respondents supported £200 over £100.
The other reason why my amendment is important is that the penalties from fixed penalty notices can be retained by the local authority. I have raised my concerns, as others have, about the decline of local trading standards, and the amendment would increase the funds they have available to enforce other aspects of the Bill, including regulations yet to be made under it. All of that comes with a cost, and anything that we can do to give local authorities the tools they need to enforce the regulations, the better. I note that clause 26 would provide the power to amend the level of the fixed penalty notice by way of regulations, so the issue could be revisited if needed.
I urge other Committee members to support my amendment in order to strengthen enforcement and provide a proper deterrent to rogue retailers that choose to sell addictive and dangerous products to children.
Rachael Maskell
I rise to support my hon. Friend the Member for Birmingham, Edgbaston. I completely agree that when we set these figures, we often forget that the economy has moved on so much, and that the rise in inflation has meant that so many things cost so much more. Just £100 is a very small amount to many shops, which take their cut from these products. It is therefore essential that we move into the realms of reality, not least because the consultation advised the Government that £200 would be an appropriate starting point and would have public support.
Clause 26 says that the figure can be amended by the Secretary of State, should they choose to do so. So the amendment would not place a limit in primary legislation, but it would make this a more realistic deterrent to ensure that shopkeepers abide by the law. It is also really important to have an incentive for them to ensure that they are fully up to speed with their obligations. This change would focus their minds as regulations are introduced, as the Minister alluded to, and ensure that they keep themselves up to date, because they know that the penalty makes it worth doing that. I therefore urge the Committee to adopt my hon. Friend’s amendment. It is a simple measure that would not cause the Minister any grief as the Bill passes through its later stages.
Dame Andrea Leadsom
I am grateful to the hon. Member for Birmingham, Edgbaston for bringing this discussion to the Committee, and I fully appreciate the sentiment behind the amendment. I completely understand why it is attractive to raise the fixed penalty notice and make it more material to the individual, but I urge hon. Members to take into account the fact that local trading standards take a proportionate approach to tobacco and vape enforcement. The Bill proposes fixed penalty notices of £100 to enable trading standards to take swifter action by issuing on-the-spot fines, rather than needing to go through lengthy court processes. Littering, parking or under-age alcohol sales attract on-the-spot fines. The proposal in the Bill is for £100, or £50 if it is paid within two weeks. That avoids people thinking, “I can’t pay this, so you’ll have to pursue me through the courts.” That creates an incentive for these issues never to come to court, and it can clog up court time and so on. I fully appreciate the hon. Lady’s point, but this is about practicality.
I find it slightly odd that the hon. Lady says £100 is affordable but £200 is not. I would be shocked to get a £100 on-the-spot fine, and I am sure she would, too. Most retail workers would find a £100 fine to be quite devastating vis-à-vis their daily cost of living. I fully understand the sentiment behind the amendment, but £100 is in line with the precedent set by penalties for comparable offences. The fixed penalty notice for under-age alcohol sales is £90. If the penalty were raised to £200, as the amendment suggests, trading standards could issue higher on-the-spot fines, but how many of us have that kind of money on us? It would push a person into severe difficulty. As we have discussed, there is a very swift escalation—it is a “two strikes and you are out” policy—and there is the ability to take the business to task, too, so I think the current penalty is actually quite stringent.
Dame Andrea Leadsom
I completely agree; the hon. Lady makes a good point. What people would see as a deterrent is an open question. I would see a £100 fine as a deterrent; I do not have £100 in my purse, so I would have to go to the cash point. I would not be keen to do that, and Members of Parliament earn quite a bit more than most retail workers. That is the truth of it. I actually think that setting the fine in line with the £90 fine for the offence of selling alcohol to someone under age is quite a material deterrent.
Rachael Maskell
I think the Minister is making slightly the wrong comparison. A retail outlet will have a till, and that till will have money in it. Therefore, it will be the business, not the shop worker, paying the fine. She makes the point that for one person, £100 could be incredibly steep, but for someone working in a venue that sells products out of the scope of the legislation, paying £200 out of a till is not really out of the ordinary, and these businesses make extortionate profits out of these things. I wonder if she could address that point.
Dame Andrea Leadsom
The hon. Lady makes a good point. There is an open question as to what the right level is, but it is for trading standards to decide whether the individual member of staff or the business pays the fine. So this is a very relevant point, but it is not just about taking the money out of the till. That is not necessarily the choice that trading standards would make; the fine may well be imposed on the individual.
Tobacco and Vapes Bill (Fifth sitting)
Rachael Maskell ExcerptsThursday 9th May 2024
(2 years ago)
Public Bill CommitteesRead Full debate Tobacco and Vapes Bill 2023-24 View all Tobacco and Vapes Bill 2023-24 Debates Read Hansard Text Read Debate Ministerial Extracts Amendment Paper: Public Bill Committee Amendments as at 9 May 2024 - (9 May 2024)
Bob Blackman
It is a pleasure to serve under your chairmanship, Dame Siobhain. I rise to support the proposals outlined by the Minister. It came as quite a shock that one of the recommendations of the Khan review was that the age-of-sale be raised by a year every year. We on the all-party group on smoking and health —I declare my interest—thought that we would end up simply raising the age from 18 to 21, but I am delighted that we have moved from that position to one of literally creating a smoke-free generation.
The key point will always be free choice—the free choice that is made is to smoke that first cigarette; after that, the individual is addicted. To colleagues of mine who may be listening or considering this as an issue of freedom of choice, I say that one only makes one choice. After that, there is no choice because one is addicted and therefore required to continue to fuel that addiction. It is vital that we create this smoke-free generation.
One of the fundamental issues is enforcement rules and premises—I know we will come to that, so I will not pre-judge it, but this will be key. One of my concerns —I ask the Minister to think about this—is what will happen about duty-free sales and provisions that, at the moment, are outside the scope of the Bill. There will be temptations for young people on trips abroad to buy cigarettes, either abroad or at duty-free, and bring them back, or for others to do so and provide them to young people. Clearly, we would all want that to be an offence, but as I read the Bill, the provisions do not cover that. We need to think about strengthening the legislation in that area.
I do not want to go on for a long time; I am delighted with the Bill. I have been campaigning for this sort of action for many years, so it is a delight to see. We need to get it on the statute book as fast as possible.
Rachael Maskell (York Central) (Lab/Co-op)
It is a pleasure to see you in the Chair, Dame Siobhan. Let me open by welcoming the Bill. I think the Government have taken a brave and bold step in introducing such a significant public health intervention. I worked in respiratory medicine for 20 years, and I saw the devastating impact of smoking on so many of my patients.
We must remember that the industry exists in order to ensure that its customers become addicted to their product: nicotine. It profits as a result, as we learned in the evidence sessions, from some of the poorest communities in our country. The Bill will address not only that gross inequality, but the behaviours of the industry and, in particular, it will ensure that we have a healthier future going forward. The tobacco-free generation measures will have such an impact on young people as they grow up.
We also need to ensure that the public health messages are really driven home. As colleagues have said, there is no liberty once someone has started smoking. There is no liberation because they become enslaved to addiction—to the highly addictive product, nicotine. It is therefore important that the Bill is passed to give that liberty to so many people who regret having commenced the journey of smoking. We need to remind everybody that once they start smoking, it is incredibly difficult to give up. Smoking is a product that kills two thirds of its customers. Therefore, the only people who benefit from smoking are the industry, which profits extensively from the misery of others.
I will certainly support the Bill through its passage, but I believe that there are areas where it can be strengthened. One, in particular, is advertising. We know that this pernicious industry has learned so well how to get around legislation at every turn. It has been incredibly difficult to ensure that the legislation encapsulates the safeguards needed to prevent the industry from doing that, but I do think that there are some loopholes in the Bill that need to be addressed around promotion, advertising, sponsorship and ensuring that retailers are supported in relation to age verification.
Simplifying things in the Bill will help everybody when it is fully implemented. We have Challenge 25; it is easily understood, and young people are used to showing their ID. Introducing that here would be a logical step in being able to see those restraints, and it will also mean that there is no variation in how shopkeepers will apply the law. It will take out inequality for their sake, too. I hope that the Minister reflects on that as we get to those points in the Bill.
Dame Andrea Leadsom
My hon. Friend makes an extremely good point. She will be interested to know that I have recently written to the Advertising Standards Authority to ask about how well it considers enforcement to be working, and what more it can do to enforce the already strict regulations. I am happy to share its response, when it comes, with all members of the Committee.
Dame Andrea Leadsom
I will give way to the hon. Member for York Central and then to the hon. Member for East Renfrewshire.
Rachael Maskell
I am really grateful to the Minister for the work that she is doing in this area, but clearly, for vaping, there is not equality with smoking in terms of an advertising ban. For simplicity’s sake, equalising the law would make a significant difference. We often think about packaging in shops, but today, the social media space is an incredibly powerful tool that young people are exposed to on a continuous basis. Therefore, extending the advertising, promotion and sponsorship ban could have such a significant impact, and it could be legislated for simply. As we have got so accustomed to the advertising ban for tobacco products, it can simply be translated for vapes. Will the Minister look into that?
Dame Andrea Leadsom
With your permission, Dame Siobhain, I will take the intervention on the same subject from the hon. Member for East Renfrewshire.
Bob Blackman
We have to consider the various tactics used by big tobacco. I campaigned long and hard for the standardised packaging of tobacco products, which was finally achieved, and one of my concerns then was the way that packaging is used to attract young people to start smoking. I support the provisions, but one concern might be that big tobacco will respond by reducing the number of cigarettes in a pack and selling them at a cheaper price. Will there be regulations to ensure that, for example, companies cannot sell them in single packs? We have to think about what these evil people will do to sell and push their product. Very simply, can we look at something to ensure that they cannot do that?
Rachael Maskell
I support the points that have already been made, but I will not repeat them, because they have been made eloquently.
Why is the fine in clause 4(2) only at level 3, whereas elsewhere in the legislation the fines are at level 4? We know that cigarettes being sold as single items, and packs being broken up and sold in that way, encourages people to smoke. We also know that they will be targeted at children and young people, as well as people in greater deprivation.
There are 14.5 million people in our country who are living in poverty, and there is a much higher prevalence of smoking in that population. The increase in the price of tobacco products has been a major determinant of how much people smoke and whether people smoke at all. It therefore seems perverse that the fine applied to breaking up cigarette packs is less than that applied elsewhere in the Bill, where there is a level 4 fine. Can the Minister explain the reasoning behind dropping the level of fine? Why is it not in line with the other measures in the Bill?
Dame Andrea Leadsom
I do not have all the answers to hon. Members’ questions. The purpose of the clause is to restate and clarify the statute book, so the answer to many of the “Why haven’t you done this or that?” questions is that the intention was to tidy up the statute book rather than address all the other potential issues that could be solved. I will certainly come back to hon. Members with the answers to their questions.
As colleagues will appreciate, there are thousands of potential add-ons to the legislation, but it is important to remember that the core purpose of the Bill is to create the smoke-free generation. On those well-made points and suggestions, I do not know whether they were considered and ruled out or whether they were not considered, but I will come back to hon. Members with answers.
Question put and agreed to.
Clause 4 accordingly ordered to stand part of the Bill.
Clause 5
Age of sale notice at point of sale: England
Question proposed, That the clause stand part of the Bill.
Rachael Maskell
I, too, welcome the fact that legislation is at last being supported by the Government and is before us today. I have deep concern about the impacts of vaping—and not just on physical health, although much research clearly needs to be done to understand the extent of that. In the Health Committee, we saw a paper on the DNA methylation changes that take place in the oral cavity. We have not seen the impact on the lungs, because that would require more invasive sampling, but the evidence shows that much research needs to be done to understand the implications of vaping on physical health.
I am also concerned that we are looking only at the age of 18. I understand the Government’s reasons—clearly, young people can readily become addicted to the nicotine in these products, and I welcome the measures to restrain that—but I have serious concerns about those over 18 who commence vaping. I understand that a paper will be coming out in Sweden showing that people move from vaping to smoking, so I am concerned that there could be unintended consequences if we do not take more extensive measures on vaping.
I absolutely understand that the Government are using the Bill to send a clear public health message that vaping is safer than smoking and that smoking kills, so if people can move from smoking to vaping, that is a positive health change. However, we do not yet know the extent of the harm that can be done by vaping, so we could well be back here again if we do not put proper measures in the Bill to facilitate more action more rapidly, should evidence come forward on the impacts of vaping.
I have talked about physical health, but we know that vaping involves an addictive product, and we do not want to see another generation of people becoming addicted to a nicotine product. We must recall that the vaping industry, like the tobacco industry of old—well, it is still in existence—has the sole interest of bringing forward another generation of people who are addicted to a substance, to ensure that those people buy its products and it profits. Leaving individuals with that dependency means that they are in bondage not only financially but in terms of their health. We must ensure that we properly examine the scope of the challenges involved in leaving over-18s exposed.
Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (Con)
The hon. Lady is making a very informed speech, but I want to pick up on one thing. She said that the sole purpose of the vaping industry is to get people addicted to vaping, but does she acknowledge that many people across the UK, and particularly adults, as we heard in evidence, have reduced their addiction through vaping? They are tapering down the amount of nicotine they are using, as opposed to when they were smoking. We also heard that there were some health benefits from people moving from smoking to vaping.
Rachael Maskell
I am grateful to the hon. Lady for the point she made. Certainly, I did highlight that transitional benefit of moving from smoking to vaping to, hopefully, stopping altogether. However, we must also highlight that vaping is not without risk, and we need to give that serious consideration. I am just concerned that the Government are slightly light, shall I say, in terms of their concern about vaping, in order to drive down the smoking. I absolutely understand that, because smoking kills, but I just think that we could be on the “too light” side. I know that it is about balance, but I hope that we can reflect on that during the course of the Bill.
I want to draw out one question that I have about clause 9 and giving away vapes. I certainly understand why the measures would be applied to industry, but I want to ask about public health measures that could be deployed. I recognise that the clause is about under-18s, but unfortunately, despite the current legislation, we know that many people under 18 smoke, and we obviously need to ensure that they stop and move into a safer space. The Government have been very much pressing the idea that vaping is a route out of smoking. Does the Public Health Minister see vaping as a means to help people under the age of 18 to stop smoking, or will they have no access to vapes? I would just like some clarity around that. Clearly, there are other smoking-cessation programmes and products available, but it would be useful to know the answer to that question. If vaping is to be used in that way, and clinicians are to be able in future to prescribe or indeed provide vapes for young people to stop smoking—if that was the only tool—we need to understand whether we are to have a blanket ban in the Bill. It would be very useful to understand that.
Dame Andrea Leadsom
Once again, I thank all hon. Members for their thoughtful and considered remarks —I really do appreciate them. Essentially, the questions are pretty much around the product notification and the availability of quit aids to under-18s. Hon. Members may not have spotted this, but the notification of vapes to the MHRA is something on which we are taking powers. There will be a further consultation on that point because it did not come under the scope of the original consultation. We will have the powers to require notification of vapes to the MHRA.
The other point that has been raised by a few colleagues is, “How do we help under-18s to stop smoking?” Under the MHRA, there is licensed nicotine replacement therapy, which is licensed for 12 to 18-year-olds. Of course, all under-18s can go to their local stop-smoking services.
To the point from the hon. Member for York Central about whether young people should be able to access vaping as a quit aid, my instinct would be, “No, absolutely not,” and I think that that would be her instinct also. However, I must slightly correct the record: it is certainly not the Government’s position that vaping is in any way safe; it is merely less harmful than smoking. I would reiterate that if you don’t smoke, don’t vape. And children should never vape, so they should not be turning to vaping, even as a quit aid. In my view, that would also be the thin end of the wedge, because people would simply say, “Well, I am only vaping because I am trying to stop smoking.” I cannot imagine that ever being a suitable way to help children to stop.
Dame Andrea Leadsom
As the hon. Lady will know, the MHRA is not an enforcement body; enforcement is for trading standards. As I mentioned earlier, there will be new resources for trading standards, as well as new training and guidelines. Also, fines will go direct to local authorities, which employ enforcement officers, so there will be a huge ramping-up of enforcement on illicit vapes, non-compliant vapes and so on. That is the place for enforcement.
On the MHRA and notification of other types of vapes, there will be powers, and the consultation will take place in due course.
Rachael Maskell
While the Minister is doing the work on vapes, will she also look at nicotine pouches, which are incredibly concerning? We have heard that the strength of the nicotine in pouches far exceeds that in vapes. People are therefore getting a very high dose of nicotine and are sometimes not aware of the level they are getting.
Dame Andrea Leadsom
I am frantically looking through my pack here. Clause 10 covers nicotine pouches, so we will come on to that—[Interruption.] The Whip is saying it will be after lunch, if that is not too much of a sneaky “get out of jail” card. With the hon. Lady’s acceptance, I will defer that until later.
Question put and agreed to.
Clause 7 accordingly ordered to stand part of the Bill.
Clauses 8 and 9 ordered to stand part of the Bill.
Ordered, That further consideration be now adjourned. —(Aaron Bell.)