Sharon Hodgson MP (Washington and Sunderland West)

It is an honour to serve under your chairmanship, Mr Howarth. I thank the hon. Member for Dartford (Gareth Johnson) for securing this debate. It is timely and important, especially because we have just seen the end of Stoptober, which vaping played a role in advertising. I thank all hon. Members for their thoughtful contributions, and I welcome the array of views and opinions they conveyed. It is clear that there is strong interest in the House in this topic. Although we are small in number here, the quality of the contributions made up for that.

E-cigarettes have been around since the mid-2000s, but in recent years we have seen them boom. Recent figures estimate that 2.9 million adults now use e-cigarettes, compared with only 700,000 in 2012. That increase is expected to grow as more people turn to e-cigarettes to reduce their tobacco consumption or to quit tobacco completely.

The interest in e-cigarettes can also been seen in the rapid growth in availability of such products and the advertising around them. In 2014, it was estimated that ​there were 460 brands and more than 7,500 flavour solutions. The BMJ highlighted that the advertising and promotion of the products had grown from £1.7 million in 2010 to £13.1 million in 2012—if we had the figures for 2017, they would obviously be a lot higher.

Labour Members welcome e-cigarettes as part of our drive towards a smoke-free society and because of the role they can play in the smoking-cessation landscape. What remains important, however, is that e-cigarettes are regulated correctly to ensure the health of our country is improved, not diminished—which, at the end of the day, is our main goal when it comes to smoking cessation. I will also use my contribution to this debate as an opportunity to further discuss smoking cessation, which is a crucial aspect of the debate around vaping, and the importance of continually looking at this market as we move towards a smoke-free society.

Smoking cessation is crucial. It improves the health of individuals and our nation significantly, and reduces the prevalence of cancer, lung disease and COPD—chronic obstructive pulmonary disease—diseases which we know are all too persistent. If smokers quit smoking when diagnosed with lung cancer, it is estimated that even at that late stage they will live nearly a year longer than if they continued to smoke. For those living with COPD, smoking cessation is the only treatment that can prevent the progression of the disease in smokers. It is also the most cost-effective one. The cost per QALY, or quality-adjusted life year, for smoking cessation in COPD patients is around £2,000 compared with between £7,000 and up to £187,000 per QALY for drugs to control the symptoms of COPD. The National Institute for Health and Care Excellence, NICE, has estimated that for every £1 invested in specialist stop smoking services, a return of £2.37 will be generated in savings on smoking-related diseases and in ending loss of productivity.

I hope that such issues will be addressed as the Government implement their recently published tobacco control plan, and it is welcome that e-cigarettes have been included as part of that work. E-cigarettes, however, must never be seen as a silver bullet to achieve our vision of a smoke-free society. E-cigarettes are a crucial player in the cessation landscape, but they are not the only player. It is important that we maintain the position set out by research and evidence from the World Health Organisation and in the tobacco control plan that nicotine replacement therapy is four times more effective when prescribed by a doctor and monitored than when simply bought over the counter, which is how e-cigarettes are acquired.

It is important that smoking cessation is a wide-ranging package that reduces smoking in society. Sadly, however, I have to say that the Government’s actions are undermining that approach. As the King’s Fund and the Royal Society for Public Health have identified, public health cuts will reach £800 million in the five years to 2021 and, in 2017-18, spending on tobacco control services faces cuts of 30%. That is concerning, because ASH has identified that a growing number of local authorities no longer have a specialist stop smoking service accessible to all smokers.

Even across the wider health service, it is clear that there are failures to implement NICE guidance on smoking cessation. An audit by the British Thoracic Society of 146 hospitals found that 27% of hospital patients were not even asked if they smoked, and provision ​of NRT and other smoking cessation treatments in hospitals was classed as poor. Is the Minister aware of that and is he ensuring that action is taken?

What is the Minister doing to address those genuine concerns? I would also welcome knowing his thoughts on promoting vaping and other smoking cessation treatments for in-patients during their stay in hospital, which is championed by Professor John Britton and chimes well with the position set out in the tobacco control plan:

“Promote links to ‘stop smoking’ services across the health and care system and full implementation of all relevant NICE guidelines by 2022”—

I am sure the Minister knows the quote well, as he published the plan, which I am pleased about.

That all shows the serious concerns within the smoking cessation landscape, and the worries for its future and for our move towards a smoke-free society. It is important to include vaping as part of the landscape, but it cannot detract from the other treatments available, which we cannot allow to wither on the vine because something new and shiny has come along. That is partly because the evidence for the impact of e-cigarettes on our health is still not definitive. Public Health England’s review of vaping products showed that they were 95% less harmful than tobacco products—which is excellent—because of the lack of carbon monoxide being inhaled and the reduction in the many other health implications that come with smoking tobacco, but that does not mean there are not concerns or split opinions over the health, harm and safety of such products.

It is paramount that such views are continually looked at and that we review our positions on the products regularly. That is why it is welcome that Public Health England will publish its update on vaping research and evidence by the end of this year. Will the Minister also outline plans to evaluate heat not burn? Although not vaping, such products are something else on the market seen as a way of limiting and reducing harm from smoking. The impact of those devices needs further research.

Gareth Johnson

I did not mention the available heat-not-burn products simply because I could not find any independent information on whether they were beneficial for health or still dangerous. I would be grateful if the hon. Lady enlarged on any information that she has found out about those products, because I found it difficult to find anything.

Mrs Hodgson

I do not think that I know much more than the hon. Gentleman, which is why I mentioned heat not burn. I have asked some questions about it because some independent research is needed. The manufacturers of heat-not-burn products have done their own research and make quite strong claims that although they are still tobacco products, they are far less harmful, but we need independent research to back that up before anyone can substantiate the claims. Will the Minister update us on when research into vaping and perhaps heat not burn will be happening?

As we come to the end of the year, the Minister will be aware that if we see any delays in publishing reports or plans, I will of course be on his case. I welcome the Science and Technology Committee also looking into this matter, and I will keep a close eye on the developments ​of that inquiry while looking forward to its findings. It is important that we take a pragmatic approach to e-cigarettes, which is reflected in Public Health England’s 2016 statement, which had the support of 12 health charities:

“We all agree that e-cigarettes are significantly less harmful than smoking…but we must continue to study the long term effects.”

The Opposition agree, as it is clear from the evidence so far that e-cigarettes are far less harmful than tobacco smoking, but the evidence remains inconclusive. That is why monitoring must be maintained to ensure that we fully understand the impact of such products in the short and long term.

The Minister has had a lot to think about during this short debate, and I am sure that in his response he will address each and every one of the points made. I implore him in that response to remember the wider smoking-cessation landscape and how important it is to ensure that vaping is included as part of that wider package, which is sustainable and effective in reducing smoking in society and thereby improving the health of the nation.