I remind Members that there have been some changes to normal practice in order to support the new hybrid arrangements, and timings of debates have been amended to allow technical arrangements to be made for the following debate. There will also be a suspension between each debate.
I remind Members participating virtually and physically that they must arrive at the start of the debate in Westminster Hall, and Members are expected to remain for the entire debate. I also remind Members participating virtually that they are visible at all times, both to each other and to us in the Boothroyd Room. If Members attending virtually have any technical problems, could they contact the Westminster Hall Clerks? Members attending physically should clean their spaces before they use them, and when they leave the room.
I also remind Members that Mr Speaker has stated that masks should be worn, except, of course, when speaking. Members attending physically who are in the later stage of the call list can use the seats at the back of the Gallery, but I think we are okay on space today.
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?
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.
It is a pleasure to serve under your chairmanship, Mrs Miller. I am the co-sponsor of the motion, so I crave your indulgence slightly because I have a rather longer speech than five minutes will allow. It is a pleasure to follow my co-sponsor, the hon. Member for City of Durham (Mary Kelly Foy). I chair the all-party parliamentary group on smoking and health, which published the report on the tobacco control plan yesterday.
We were delighted when my hon. Friend the Minister set out the need for a new control plan last December, and we commissioned Action on Smoking and Health and SPECTRUM, a widely acknowledged scientific research consortium, to put together a report for us on what needed to be done and why. The importance of the ambition is very clear: the chief medical officer, Professor Chris Whitty, recently said that smoking is likely to have killed more people in Britain than the covid-19 pandemic, with more than 70,000 people dying from smoking last year in England alone—and for every person killed by smoking, another 30 live with the serious consequences of smoking-related illnesses. Ending smoking is essential if we are to reduce health inequalities between rich and poor, level up the nation and increase healthy life expectancy by five years, in line with the Government’s manifesto commitments.
The smoking rate in my Harrow East constituency is lower than average for England, but there is no room for complacency. More than one in 10 of my constituents smoke, and smoking kills 250 of my constituents every year. In 2018, there were 1,566 smoking-attributable hospital admissions in Harrow alone. Research shows that smokers are likely to need social care a decade earlier than non-smokers because of the impact of smoking-related diseases and disability.
Inequalities in smoking have grown, not shrunk, in recent years. To be smoke free by 2030, we need to reduce smoking by two thirds in only a decade, and by three quarters for smokers in routine and manual occupations. Cancer Research UK has said that, at current rates of decline, we will miss the target by seven years, and by double that for the poorest in society, because there are still 6 million smokers in England. We will achieve a smoke-free 2030 only by motivating more smokers to attempt to quit using the most effective quitting aids, while reducing the number of children and young adults who start smoking.
It is an honour to serve under your chairmanship, Mrs Miller. I thank my hon. Friend the Member for City of Durham (Mary Kelly Foy) for having secured this important debate and speaking so eloquently, especially as the Department of Health and Social Care is looking to publish a new tobacco control plan later this year. The forthcoming plan is an enormous opportunity for the Government to cement the UK as a global leader in tobacco harm reduction. Having left the European Union, the Government must—alongside the post-implementation review of the Tobacco and Related Products Regulations 2016—set a clear direction for reducing smoking prevalence and improving public health.
However, if the Government are to achieve their ambition for a smoke-free society by 2030, their forthcoming tobacco control plan must champion the less harmful alternatives to combustible tobacco. In particular, a significant and growing body of scientific evidence shows vaping to be the most effective alternative for adult smokers looking to quit smoking. In their blueprint for better regulation, the UK Vaping Industry Association made a series of recommendations to the Department of Health for consideration when reviewing the tobacco and related products regulations—a process that is already under way. These recommendations, many of which I support, can also be applied to the Government’s tobacco control plan.
The first recommendation involves effectively tackling the increasing levels of misinformation, as well as the increasing misperception of the relative harm of e-cigarettes versus combustible tobacco. Action on Smoking and Health data suggests that millions of smokers—more than half of the 6.9 million remaining in the UK—could now be dissuaded from exploring switching to e-cigarettes because of incorrect views or confusion about the harm of e-cigarettes. To combat increasing misinformation, the UKVIA recommends that the Department of Health launch an effective communication strategy. This should include the introduction of approved health claims and switching messages that can be displayed on vape device and e-liquid packaging alongside nicotine health warnings, a proposal similar to those explored by the Governments of Canada and New Zealand.
It is good to serve under your chairmanship, Mrs Miller. I congratulate the hon. Member for City of Durham (Mary Kelly Foy) and the APPG on securing this debate. I declare an interest: I am an honorary life governor of Cancer Research UK.
Smoking is, of course, a significant cause of ill health and death in this country, and the Government should be congratulated on the progress they have made to reduce the incidence of smoking, but the rate of reduction is sadly still not enough. A recent Cancer Research UK report found that, at current quit rates, the UK will not reach its smoke-free target until 2037 at the earliest—seven years late. To meet the target, quit rates will need to increase by some 40% over the next 10 years. In other words, we are at risk of enduring several more years of heartbreak for families, strain on the NHS and avoidable deaths—a pattern that can, and of course should, be broken.
Three months ago, I was fortunate enough to be selected for a Westminster Hall debate on this issue. I made the point then that the tobacco control plan was our chance to break that pattern. Now is our opportunity, and if we are to seize it, the control plan must be ambitious. I would like briefly to propose three courses that I believe should form part of the plan’s recommendations.
First, the key issue with smoking is, of course, the smoke. An evidence-based policy that seeks to assist the 7 million cigarette smokers in the UK must put forward alternative products to combustible tobacco. Continuing to raise awareness of those products is key, so I suggest that the plan should facilitate the use of cigarette pack inserts and online communications as ways of reaching smokers directly. E-cigarettes and other alternatives to combustible tobacco save lives, and we should make sure that that message reaches every smoker in Britain.
My second point is about access to those alternative products. E-cigarettes have been hugely important in the fight against smoking, and I commend NHS England for promoting them to smokers. The strategy is based on evidence, and has a proven positive effect on the health of the nation. In 2017, more than 50,000 smokers who would otherwise have carried on smoking stopped with the aid of a vaping product.
It is an honour to serve under your chairmanship, Mrs Miller, and lovely to see you in the Chair. I refer Members to my registered interests. I am the chairman of the Gallaher charitable trust, which was formed after the closure of a tobacco company in Northern Ireland.
Let me turn to the subject of the debate. Facts are stubborn things. We all appreciate that, and we must ensure that any actions we take to address facts are based on evidence. I am a non-smoker. I do not encourage people to smoke. I do not want people to smoke, and I recognise the impact that smoking has on people’s lives, but like many substances, tobacco is a lawful product, and I will not tell other adults what they should do or not do with lawful products.
Tobacco is one of the most highly regulated products and the most highly taxed product in the UK—about 90% of the cost of an average packet of cigarettes is taxation. That tax disadvantages poorer households in my constituency and across this country more than the most affluent. The UK tax regime is designed to control tobacco and the sale of tobacco, but it has had the opposite impact. It has driven up the price of the product and encouraged smuggling of illicit product. Many people have made the wrong choice to purchase that illegal product. Therefore, under the current mechanism, everyone is a loser. It is not working.
On 2 June—just nine days ago—the Northern Ireland Border Force, at the real border in Northern Ireland, which is the land border, seized 4.4 tonnes of illegal tobacco, which, if sold, would have stolen from you, Mrs Miller, and me and our taxpaying constituents £7.24 million in unpaid duty. Tobacco control measures ought not to be about trophy taxation or gimmicks, but should be primarily about reducing consumption by good education and good enforcement, and secondly about minimising crime by directing resources to the tackling of criminality associated with activities related to illegal tobacco.
It is a pleasure to serve under your strong and stable chairmanship, Mrs Miller. It is a great privilege to speak in the debate, and I thank the hon. Member for City of Durham (Mary Kelly Foy) for introducing it.
We are debating a vital issue, and the UK can be No. 1 in the world for its approach on reducing smoking and the harm it causes. I commend my hon. Friend the Member for Harrow East (Bob Blackman) for his input into the report and his earlier contribution, and my right hon. Friend the Member for Clwyd West (Mr Jones) for his apposite remarks, which I am sure the Minister took on board. I also commend the Minister herself, and the Government, for their approach. I would say that she is mistress of the brief, as we have had many conversations and interactions through correspondence, and there is no doubt that she gets all the issues to do with smoking cessation devices and the tobacco control plan.
The industry in the UK seems to be aligned with the Government’s objectives on reducing smoking, as Philip Morris, British American Tobacco and many of the other firms recognise that this is the end of the game—it is the end of smoking in the United Kingdom, even if that might not be the case in certain far eastern countries, in Africa or elsewhere. The companies accept their responsibilities, and it would be of no surprise to them—they would not be disappointed about this—that they needed to make contributions to a fund to help to secure the goal of a smoke-free Britain, which should certainly be firmly on the table.
I speak as chair of the Parliamentary Office of Science and Technology and a member of the all-party group on e-cigarettes, and it seems to me that we are in an era in which we must be driven by data and evidence. There can be no doubt that the data is completely one way on vaping devices, electronic nicotine delivery systems and all sorts of other technologies to help smoking cessation. Vaping, using an electronic device or even using snus is so much safer than smoking. Smoke is the killer; tobacco is the killer. I urge the Minister not to do what the European Union has done, or what the World Health Organisation seems to be doing, by mangling the two issues. Tobacco is one thing; smoking cessation devices, which in most cases contain nicotine, are a completely different thing, with a completely different scale of harm and risk.
It is a pleasure to serve with you in the Chair, Mrs Miller. I thank my hon. Friend the Member for City of Durham (Mary Kelly Foy) and the hon. Member for Harrow East (Bob Blackman) for securing this important debate to consider smoking cessation.
I will start with a few figures, just to show why this issue is important to me. It is very difficult to get constituency figures, as I am sure colleagues have found, so we are looking at local authority areas. The covid-19 pandemic recovery makes it particularly important to set out an ambitious national strategy to tackle smoking and to address, once and for all, the tragic health inequalities that smoking causes.
In Gateshead, 17.1% of the population smokes, compared with 15.3% across the north-east. That figure is well above the England average of 13.9%. It is estimated that smoking costs Gateshead around £48.3 million a year through smoking-related health and care needs, lost productivity and premature death. Between 2016 and 2018, there were 1,227 deaths attributable to smoking in Gateshead, which is significantly higher than the per population average for England. Between 2016 and 2018 in Gateshead, there were 515 deaths from lung cancer and 412 deaths from chronic obstructive pulmonary disease. More than 80% of those disease cases were caused by smoking. Between 2016 and 2018, there were, sadly, 29 stillbirths in Gateshead, which is above the per population average for England. Smoking during pregnancy has been shown to double the risk of stillbirth.
Although adult smoking rates have declined in recent years, inequalities in smoking rates between different groups have remained stubbornly high. The next tobacco control plan must go further in providing additional quick support for smokers in communities and groups with high rates of smoking. That is essential if we are to tackle the health inequalities in our society after covid-19, and indeed before that time comes.
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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.
It is right that the Government brought forward the ambition of the prevention Green Paper, and we need to ensure that bold action is implemented, with appropriate investment. The Health Foundation estimates that a minimum of £1.2 billion is needed to restore public health funding to 2015 levels, and that a further £2.6 billion is needed to level up public health across the country.
The APPG’s view is that when it comes to ending smoking, the industry that makes excess profits from the sale of tobacco should pay, as it does in the US. The US’s user fee legislation raises $711 million annually from the tobacco industry; a similar approach could be introduced in the UK, with a statutory smoke-free 2030 fund imposing a targeted tobacco manufacturer profit cap and utility-style price controls in order to raise funds from the industry through a charge-based mechanism on sales volumes. It would not apply just to tobacco, because obviously this is about incentivising the industry to deliver on making smoking obsolete by 2030. It is quite clear that this is more than demonstrated by the market failure that has happened, and we need to get on with it. Will the Minister commit that the APPG recommendations for a “polluter pays” approach will be considered as a funding mechanism for the forthcoming tobacco control plan?
We also need to look at raising the age at which young people can buy cigarettes. Clearly, young people who start smoking continue to smoke into adulthood, so one of the areas that we have explored is raising the age of sale. It was raised from 16 to 18, which produced a 30% reduction in smokers aged 16 to 17 years old. It would be helpful if we could get to a position whereby 18 to 20-year-olds were prevented from smoking, so will the Minister commit to conducting a consultation on raising the age of sale from 18 to 21 and to coming to a decision about whether to go ahead by the end of 2021?
We have been a leader in the tobacco control plan, but obviously the position is that we have set the record. Now that we are free from the European Union, we can make decisions on our own. Will the Minister investigate extending official development assistance funding for the framework convention on tobacco control 2030 project for a further five years?
Finally, the Minister is the lead for the World Health Organisation’s FCTC in the Department of Health and Social Care, so will she commit to provide the leadership in other Government Departments and public authorities that we need to fulfil their legal obligations to prevent tobacco policy from being influenced by the tobacco industry?
I have been able to touch on only four of the recommendations that we have made, and there are 12 in the report. I urge all Members to read the full report and the recommendations. The recommendations are supported not just by the APPG, but by leading health organisations too numerous for me to mention. There is good evidence that the recommendations will work in synergy to drive down smoking rates, and the forthcoming tobacco control plan offers the perfect opportunity to put them in place. I commend our recommendations to the House, and look forward to the reply of my hon. Friend the Minister.
In addition, it is important that medical professionals at local stop smoking services are sufficiently supported, with clinicians signposted to the latest clinical guidance and evidence on e-cigarettes. An evidence-based approach to smoking cessation must be adopted consistently by local stop smoking services to support patients in their harm reduction journey. This is critical, considering the upcoming trials in NHS A&E departments. The forthcoming tobacco control plan should also make provisions for a review of the regulation of nicotine in e-cigarettes, to better understand the role nicotine plays in allowing e-cigarettes to be a satisfying alternative for adult smokers wishing to make the switch away from smoking. For them to compete with combustible cigarettes and provide a satisfactory alternative for those looking to switch, they must provide a comparably satisfying nicotine experience. It is the toxic by-products of combustion, not the nicotine, that are responsible for smoking-related death and disease.
Understanding the alternatives to combustible cigarettes and making a clear distinction between smoking and vaping is critical to our smoke-free ambitions and changing misconceptions. Our all-party parliamentary group for vaping made several recommendations in our report on vaping in workplaces and public places. These are endorsed by the UKVIA and, if implemented, would support adult smokers in their transition to less harmful alternatives and give those who have already made the switch the best chance of sticking at it. I can provide the Minister with a copy of that report, if she so wishes. My late husband, Ray, is an example of such a switcher: having smoked from the age of nine with a couple of interludes, he made the switch to vaping several years ago, and was never separated from what he called his “pipe”. I might add that he did not die of a smoking-related illness.
Finally, I turn to another opportunity to enact the meaningful regulatory change to support smoking cessation. The Government are currently considering the submissions made to the consultation on the review of the Tobacco and Related Products Regulations 2016. Like many others, I eagerly await the publication of the Department’s response, which has already been delayed from May 2021 until later this year. It is hoped that the Department of Health and Social Care will continue to take an evidence-based approach to the regulations and listen to the experts. The TRPR review can help shape the UK’s approach to tobacco harm reduction considerably and can significantly support the next tobacco control plan. I look forward to the Government’s response to the tobacco and related products regulations review and the publication of the tobacco control plan. I hope that they make the most of these unique opportunities to support adult smokers in their transition to a less harmful alternative.
The tobacco control plan should advise what else can and should be used to assist smokers to quit, in addition to e-cigarettes. That is crucial when we consider that, for all the impact vaping has had, 50% of people who have tried e-cigarettes go back to smoking. We should not limit our response to one weapon. Nicotine pouches, heated tobacco and other emerging products are there to be used, and their efficacy and utility should be the subject of urgent study. The tobacco control plan should embrace the new products and allow for more measures for companies to promote.
Thirdly—this relates to my previous point—the plan should contemplate legislation for a new robust regulatory framework that can cover all the products within the market. We should not allow our focus to be narrowed to e-cigarettes alone. New products are entering the market, and the UK must be open to the kinds of innovations that save lives.
I have two brief final points that I wish to make, to which I hope the Minister will respond. First, there is a slight lack of clarity about whether the new plan will take account of the conclusions of the post-implementation review of the Tobacco and Related Products Regulations 2016 and the Standardised Packaging of Tobacco Products Regulations 2015. On Monday, I received a written reply from the Minister, in answer to a written question, which said:
“Evidence gathered from this Review will be considered as part of the development of the new TCP.”
I hope the Minister will confirm that all the evidence from the review will be fully reflected in the plan.
Secondly, I return to a point I made in the previous Westminster Hall debate—that is, the opposition of the World Health Organisation, which has called for a ban on reduced risk alternatives to combustible tobacco. To listen to that call would run counter to the success in smoking reduction that has been achieved in the UK, and I strongly urge the Government to stand up to the WHO at COP9 and to advocate a change in policy from it.
None of the control measures addresses that issue seriously. Government policy has failed to do that, and I believe that today’s proposals fail to do it. Instead, they are about unnecessary tax and minor tinkering such as putting another written warning on the cigarette stick. When the cigarette is in a person’s mouth, it is too late to put such a warning to them.
HMRC already generates £11.8 billion in tax on tobacco, yet it loses almost £2 billion in revenue annually in illegal sales of tobacco product. That is because the control plan is one-dimensional and, frankly, stupid. It does not work. Since 2000, tobacco smuggling has stolen from you, Mrs Miller, and me and our taxpaying constituents revenue of—wait for it—£47.2 billion. That has been stolen from us by tobacco smugglers. Surely we can have a plan that, instead of punitively taxing a lawful product more, lets consumers see that money being spent on tackling this international, multibillion-pound crime of racketeering. Imagine a control plan that, over the next 10 years, would deliver £40 billion in revenue to hon. Members’ constituencies. Imagine what we could do for hospitals, schools and the defence budget. Imagine what we could do with the overseas aid budget.
I want the Government to be creative and to stand up to people who say, “Just put on more tax,” because clearly that does not work. Frankly, the control plan will not save one life from the effects of smoking, will not stop one smoker smoking, and will not stop one smuggler bringing in illegal products. If the Government want, unintentionally, to fill the pockets of organised crime gangs, undermine legitimate businesses and ruin small shops throughout the country, they should stick with the plan, but they should not be smug about it, because the plan is not working.
I recognise that other hon. Members will talk about various recommendations from the all-party group on smoking and health, so let me briefly focus on three. Recommendation 5 says that smokers should be advised annually of their options for quitting. Reminding people that they can choose an alternative to smoking is an important step forward. If we ask any smoker—I was a smoker for a few years, some time ago—“Would you like your children to smoke?” they all say no. It is clear that no one really wants to smoke, no matter what their brain says about dopamine levels. In that scenario, I think it a good idea to remind people annually that there are alternatives. Nicotine patches are not the only alternatives. Those have some efficacy, but, to be frank, very little for the money that is paid for them. People should certainly consider vaping devices.
The second recommendation I draw to hon. Members’ attention is No. 6, which is support for those with mental health challenges. It also says
“for those living in social housing”,
but I will broaden that slightly to those on lower incomes and in lower-paid jobs, among whom there is a far higher incidence of smoking than in the general population. There is work to be done to focus the efforts in those areas.
Recommendation 11 is also important, because there is still an ambiguity about whether vaping is a smoking cessation device or just another way of inhaling nicotine. It is clear from the evidence that it is a smoking cessation device that works, and it is twice as effective—if not more—at helping smokers to cease smoking as the other available treatments. Let us dig into the pockets of the tobacco companies—they are actually happy for their pockets to be dug into—and use that money to publish the relative health benefits of vaping, e-cigarettes and other alternatives to smoking.
Windsor is a lovely seat, and thankfully we have slightly lower smoking rates than the rest of the country, but we still have perhaps 200 or 300 people a year dying of smoking-related diseases, as well as all sorts of other challenges.
In conclusion, we are first in the world for genomics, for the vaccine roll-out, and for FinTech and financial services. Let us make this another one: let us be the first in the world to implement a tobacco control plan that completely takes on board the wonderful innovation of vaping devices, e-cigarettes and all the other technology, and let us not mangle it together in a tobacco directive.
I support wholeheartedly the recommendation of the APPG that tobacco manufacturers should pay the costs—on the “polluter pays” principle—of creating a smoke-free 2030 fund and helping to meet that target. Indeed, it is absolutely essential that we achieve that target.
Smoking during pregnancy is the leading modifiable risk factor for poor birth outcomes, including stillbirth, miscarriage and pre-term birth. The Government’s ambition is to reduce smoking in pregnancy to 6% by 2022, but with a rate of 10.4% in 2019-20, that target is unlikely to be met. National rates of smoking in pregnancy have only declined by 0.6 percentage points since 2015, although some regions—such as the north-east, I am glad to say—have seen much larger declines. Clearly, there is much to be done.
Ensuring that pregnancies are smoke-free and that there is greater consistency across the country must be a major focus of the next tobacco control plan, if we are to deliver a smoke-free start for every child by 2030 and give them the best start in life. The highest rates of smoking among pregnant women are in young pregnant women. Nearly a third of pregnant women in England under the age of 20 are smoking during early pregnancy and at delivery, compared to around one in 10 pregnant women overall. As well as being more likely to smoke in the first place, younger mothers are less likely to quit prior to conception, whereas older mothers are more likely to have quit when planning a pregnancy. As such, driving down rates of smoking in the younger population should have a rapid impact on rates of smoking in pregnancy.
A woman’s circumstances also greatly affect the likelihood that she will smoke in pregnancy, with smoking in pregnancy concentrated among those who live in an area of deprivation or high smoking prevalence, those who live with a smoker, those who smoked through a previous pregnancy, and younger women.
There is so much more we could say on this issue, but the key thing is that we need to consider ideas such as financial incentive schemes. Those that have been implemented in Greater Manchester and south Tyneside are highly effective at reducing rates of smoking in pregnancy among women from deprived backgrounds. They are also cost-effective, with an estimated return on investment of £4 for every £1 invested.
To finish, can the Minister assure me that the next tobacco control plan will include a national strategy for reducing rates of smoking in pregnancy, learning the lessons from the areas where the greatest declines in smoking in pregnancy have occurred? Will she commit to introducing a national financial incentive scheme to achieve the aim set out in the tobacco control plan? Will she also commit to consulting on raising the age for the sale of tobacco to 21, to reduce the number of young people who become addicted to smoking?