Neil O’Brien – 2023 Speech at Policy Exchange on Smokefree 2030
The speech made by Neil O’Brien, the Minister for Primary Care and Public Health, at Policy Exchange in London on 11 April 2023.
It’s an enormous pleasure to be here today at Policy Exchange to set out the government’s next steps on vaping and smoking.
Everybody agrees that we must do more to prevent ill health in the first place – not just treat it afterwards.
Cutting smoking is one of the most evidence-based and effective interventions that we can make.
That’s why in 2019, this government set the bold ambition for England to be Smokefree by 2030 – reducing smoking rates to 5% or less.
Everyone knows about the health impact of smoking.
It’s still the sadly the single biggest cause of preventable illness and death in England.
Up to two out of three lifelong smokers will die from smoking.
Cigarettes are the only product which will kill you if used correctly.
The positive impact of stopping smoking is immediate. For those who quit, after just a few weeks lung function increases by up to 10% and circulation improves, and the risk of heart attack is half that of a smoker after one year of quitting.
The person who quits today is the person who isn’t in a hospital bed next year. So, cutting smoking will help us hit the fourth of the PM’s five priorities – to cut waiting lists.
But as well as the health impact, the economic impact of smoking is also huge.
The excellent 2010 Policy Exchange paper ‘Cough Up’ noted that – “it is a popular myth that smoking is a net contributor to the economy”
In fact new analysis from ASH on the costs of smoking in the UK in 2022 found that smoking has a £21 billion total cost to the public purse.
To talk you through that – people used to argue that although there was a cost to the NHS from smoking, the taxes paid offset this.
But this ignores the fact that smokers are more likely than non-smokers to become sick and be out of work, and more likely to stay unwell for longer. Smokers are absent for an average of 2.7 more days per year than non-smokers.
Reducing smoking rates not only improves health outcomes and reduces the burden on the NHS, it also boosts productivity and economic growth too.
Current smokers are 7.5% less likely to be employed compared to never smokers and ex-smokers are 5% more likely to be employed than current smokers.
In places like Birmingham, an additional 6,000 people are out of work because of smoking. Quitting could help to put that right.
As well as the productivity impact, quitting smoking would save the average person around £2,000 a year.
In poorer parts of the country going smokefree could mean far more money circulating in the local economy. There is a positive productivity benefit but also helps to level up across the nation.
Today, as well as tackling smoking, I also want to start to address a new threat… the growth of vaping among children.
There has been a very sharp increase in children vaping – particularly disposable vapes. NHS figures for 2021 showed that 9% of 11- to 15-year-old children used e-cigarettes, up from 6% in 2018. That’s a rapidly rising trend we need to stop.
Whether it’s disposable vapes marketed to kids with bright colours, or low prices, or cartoon characters or child-friendly flavours…
…Or indeed products being sold that don’t meet our rules on content.
Today we step up our efforts to stop kids getting hooked on vaping. My message is this: if your business plan relies on getting kids hooked on nicotine, we are coming for you.
So today I will set out
- What we will do to stop children and non-smokers from starting vaping…
- How we will exploit the potential of vaping as a powerful tool to stop smoking.
- … And how we will help more people quit smoking, particularly where rates are highest.
I’d like to thank Javed Khan for his independent review which has helped inform many of our next steps.
And I’d also like to thank Bob Blackman in his role as the Chair of the All-Party Parliamentary Group (APPG) on Smoking and Health, who has been a hugely positive advocate for keeping smoking on the public health agenda.
Let me start with vaping.
We need to do two things:
On the one hand, stop children taking up vaping.
On the other, exploit the huge potential of vaping to help adult smokers to quit…
NHS figures for 2021 as I mentioned showed that 9% of 11- to 15-year-old children used e-cigarettes in 2021 – that’s a rising trend.
Dr Mike McKean, vice-president of policy for the Royal College of Paediatricians and Child Health, has estimated that prevalence may well be even higher now.
I think many of us as parents worry about our kids’ health, about them getting addicted to nicotine. The Chief Medical Officer who is here today has also raised concerns about children vaping. I also pay tribute to my colleague Caroline Johnson who highlighted this issue.
That’s why today, as part of work on stopping people starting smoking and vaping, we are opening a specific call for evidence on youth vaping to identify opportunities to reduce the number of children accessing and using vape products – and explore where the government can go further. We will look at where we can go beyond what the EU’s Tobacco Products Directive allowed us to.
This will explore a range of issues including how we ensure regulatory compliance, look at the appearance and characteristics of vapes, about their marketing and promotion of vapes, and the role of social media which is crucial. It will also seek to better understand the vape market, looking at issues such as the price of low cost products and disposables.
We are also working closely with colleagues at the Department for Environment, Food and Rural Affairs (Defra) to consider the environmental impact of vapes – particularly disposable vapes which have become so appealing to young people. In 2022, 52% of young people who vaped were using disposable products, compared to just 8% in 2021.
Over 1.3 million disposable vapes are thrown away each week. This accumulates to 10 tonnes of lithium a year, equivalent to the lithium batteries of a staggering 1,200 electric vehicles.
The call for evidence will be open for the next 8 weeks.
We hope that everyone concerned will take this opportunity to share their views to help shape our future approach particularly for our young people.
We are already taking action to enforce the current rules.
I was extremely concerned to hear of certain disposable vaping products that don’t adhere to our regulatory standards. There has been a particular issue about the Chinese-made “Elf Bar”.
Working closely with the MHRA and Trading Standards we have agreed a voluntary withdrawal of some of these products from the UK market. Some large supermarkets like Tesco are setting a good example by working across their distribution network and ensuring all their products meet the requirements.
I urge the rest of the retail sector and vape manufacturers to follow suit and to our vaping product rules. If they do not do this, it could result in an unlimited fine. Companies failing to comply with the law will be held accountable.
To that end today I can announce that we will go further to enforce the rules.
Working hand in glove with our enforcement agencies and learning from our work with Trading Standards on illicit tobacco, we will provide £3m of new funding to create a specialised “flying squad” to enforce the rules on vaping and tackle illicit vapes and underage sales.
This national programme will help share knowledge and intelligence across regional networks – including on organised crime gangs.
It will bolster training and enforcement capacity in Trading Standards and undertake specific projects such as test purchasing in convenience stores and vape shops. We will produce guidance to help build regulatory compliance. We will remove illegal products from shelves and at our borders, and we will undertake more testing to ensure compliance with our rules.
But while we want to make sure children don’t take up vaping, vaping can play an important role in helping the government achieve its Smokefree 2030 ambition.
Vaping is effectively a double edged sword. On the one hand, we do not want children to develop an addiction to any substance at a young age.
But on the other hand for adults, vaping is substantially less harmful than smoking and we now have high quality evidence from Oxford University that compared to nicotine gum or patches vapes are significantly more effective as a quit tool, but not more hazardous.
This is particularly true when they are combined with additional behavioural support from local stop smoking services.
Vaping is already estimated to contribute to about 50 – 70k additional smoking quits per year in England.
However, vapes are not yet being used widely enough to reach their full potential as smoking quit aids, showing the potential power of it as a tool.
A “swap to stop” partnership is a scheme where smokers are provided with a vape starter kit alongside behavioural support to help them completely stop smoking.
There have already been successful local pilots of ‘swap to stop’ schemes in many areas, such as in Bath, Southampton, Sheffield, and Plymouth…
Learning from these proven effective pilots, today, I am delighted to announce that we will be funding a new national ‘swap to stop’ scheme – the first of its kind in the world.
We will work with councils and others to offer a million smokers across England a free vaping starter kit. Smokers who join this scheme which will run initially over the next two years must join on one condition – they commit to quit smoking with support. For our part we will make it as easy as possible, referring people to stop smoking services and developing a digital approach to help people quit smoking. Once that is done, we will offer support to those who want to go on to quit vaping too.
We will target the most at-risk communities first – focusing on settings such as job centres, homeless centres, and social housing providers. And we want to work with retailers on this journey too.
Among the first of these exciting projects will be in the North East. I have already been working with local councils in Northumberland, Gateshead, South Tyneside and Hartlepool to start a joined-up delivery of a ‘swap to stop’ scheme in their most deprived neighbourhoods.
This scheme represents an exciting opportunity to capitalise on the potential of vaping as a tool to help smokers quit.
The latest international research shows that smokers who use a vape every day are three times more likely to quit smoking, interestingly, even if they didn’t actually intend to quit smoking.
So we will offer a million smokers new help to quit.
Let me now turn to other steps we will take to stop smoking and start quitting.
And let me start with our next steps to tackle illicit and underage sales.
Taking action against those who break the rules firstly protects legitimate shops from being undercut.
But we also know that this is very important to stop underage people starting smoking, because illicit tobacco and underage sales are strongly linked.
We’ve already implemented a successful new UK-wide system of track and trace for cigarettes and hand rolling tobacco to deter illicit sales.
This system requires all cigarettes and hand rolling tobacco to be tracked right from the manufacturer to the first retailer using unique ID codes applied to the products.
Track and Trace will be extended to all tobacco products in May 2024. This means not only will we track cigarettes and hand rolling tobacco but also cigars, cigarillos, shisha and other tobacco.
‘Operation CeCe’, a UK-wide intelligence hub between HMRC and National Trading Standards, has also bolstered our efforts against illicit tobacco, and we have given it long term funding.
Operation CeCe resulted in more than £7 million worth of illegal tobacco products being removed from sale in its first year, and prevented far more illegal activity.
HMRC are also introducing tougher additional sanctions to track and trace to deter repeat offending, including a new civil penalty of up to £10,000 for more serious offences.
I can also announce that this year, HMRC and Border Force will be publishing an updated strategy to tackle illicit tobacco.
It will lay out strategically how we continue to target, catch and punish those involved in the illicit tobacco market.
If you supply tobacco for sale in the UK you must be registered for Tobacco Track and Trace and also obtain an Economic Operator ID.
We want to start using this existing system in a new way – to help strengthen enforcement and target the illicit market.
From now on where people are found selling illicit tobacco, we will seize their products, we will remove their Economic Operator ID and they will no longer be able to buy or sell tobacco.
We are also exploring how to share information with local partners about who is registered on the Track and Trace system, so they know who is and who isn’t legally entitled to sell tobacco in their local areas, helping to drive enforcement.
Now of course some would go further to stop people to start smoking in the first place. The Khan Review last year advocated the New Zealand approach – a full phase out of smoking, with the age of sale increasing over time to cover all adults.
This would be a major departure from the policy pursued over recent decades which has emphasised personal responsibility and help for people to quit. And it is the help for current smokers to quit that we want to focus on.
And, there is much more we can do to help people quit smoking.
Over half of all smokers – that’s 3 million people – want to quit smoking. One million of these people want to quit in the next three months.
But nicotine is highly addictive. We know that 95% of unsupported quit attempts relapse within a year.
So we will do more to help people quit.
First, we will use the latest treatments – proven to give smokers a much greater chance of quitting.
Some of the most cost-effective treatments that we have are not currently available in England. We are working closely with suppliers to give access to prescribers, to put licensed medications in the hands of those who would benefit the most from them. For example, ensuring the availability of proven smoking cessation medicines such as Varenicline and Cytisine. We have been working urgently with business to unblock supply chain problems to support more people who want to quit.
Second, we’ll join up services through the new Integrated Care Systems, to make the NHS more like a national prevention service.
The pioneering work being done by the Humber and North Yorkshire Integrated Care Board – is leading the way in devoting local health service resources, organising the local system to have a local voice in driving down smoking rates in their most deprived communities. In April – this month – they will ‘go live’ with their comprehensive tobacco control program. They will go first in implementing many of our national plans, including the provision of incentives for pregnant women to stop smoking, providing vapes as a first line quit aid in local stop smoking services, lung health screening and joining up local services to tackle illicit tobacco.
I encourage all other ICBs to follow their example and develop similar partnerships with local authorities to create effective tobacco control programs. This is a really good example of integrated care systems working together to drive prevention.
Third, we’ll help pregnant women quit. Nationally 9% women still smoke in pregnancy – but it affects as many as nearly one in four births in some areas. Of course smoking in pregnancy increases the risk of stillbirth, miscarriage, and sudden infant death.
All maternity services in England are establishing pathways to ensure rapid access to stop smoking support for all pregnant women. We’ve already rolled out carbon monoxide testing widely to mothers.
Recently financial incentive schemes have been proven effective to increase the number of pregnant women successfully quitting. In trials women receiving financial incentives are more than twice as likely to quit. The return on investment for these schemes is £4 for every £1 invested.
These schemes have been effective in a number of local areas, including Greater Manchester, which has seen the biggest drop-in maternal smoking rates over the last two years.
So today we build on that local evidence and I’m announcing that we will offer a financial incentive scheme to all pregnant women who smoke by the end of next year.
This will unlock a lifetime of benefits for the child and the mother.
Fourth, we will provide further help for people with mental health conditions to quit.
Smoking is more than twice as high in people living with mental health issues. They will die 10 to 20 years earlier, and the biggest factor in this is smoking.
It is a common misconception that smoking helps anxiety. Actually smoking exacerbates anxiety and depression. Quitting smoking has been proven to be as effective as taking anti-depressants.
So we will work with mental health services to improve the signposting to evidence based support for smokers. At a minimum, all mental health practitioners will be able to provide signposting to specially developed, evidence based, digital quit resources.
Fifth, to help people quit, we will use a new approach to health warnings.
The front of cigarette packs has contained ‘smoking kills’ warnings since 1991. We will continue this, but we also want to give people hope and connect them in a hassle-free way to the best offer of support.
We will consult this year on introducing mandatory cigarette pack inserts with positive messages and information to help people quit. In Canada, health promoting inserts are required by law and have been in place since 2000. Evidence from the experience in Canada shows pack inserts are an effective measure to increase the number of people attempting to quit smoking.
We have commissioned the University of Stirling to undertake testing with UK adult smokers and young people to help get this right.
We are exploring how best we can use innovative approaches within this, such as the use of QR codes to make it as easy as possible for people to get help to quit. You could take a pic with your phone and be taken straight to stop smoking support, the kind I’ve been talking about in this speech.
In conclusion, the evidence is overwhelming that stopping smoking not only has major health and economic benefits.
It is crucial to extending healthy life expectancy, particularly levelling up the places it is lowest.
That’s why today we’re:
- Stopping the growth of vaping among children
- Introducing new help for a million smokers to quit.
- Increasing enforcement of illicit sales
- Expanding access to new treatments.
- Backing joined-up, integrated approaches
- Rolling out a national incentive scheme to help pregnant women quit,
- Consulting on new pack inserts using modern technology
All these are ways we will help people quit.
These proposals to reach our goal of a Smokefree 2030 are some of the most innovative in the world.
They will give more people the help that they need to quit smoking for good.
So thank you to all of the experts in the room today that have fed in ideas to inform the speech today – and I look forward to your questions.
