PARLIAMENTARY DEBATE
Tobacco and Vapes Bill (First sitting) - 30 April 2024 (Commons/Public Bill Committees)

I chair the all-party parliamentary group on smoking and health.

I do not know whether it is an actual declaration, but I did the Cancer Research 10k fun run in February—the winter run.

I am an NHS consultant paediatrician, and a member of the Royal College of Paediatrics and Child Health.

I am a practising psychologist, and I also chair the all-party parliamentary health group.

Sir George, do we have to declare our memberships of any groups? I am a member of the all-party parliamentary group for responsible vaping.

I am, too.

Q You will have seen on Second Reading that there is almost universal agreement on the basic point that smoking is bad, and that we want to see smoking rates come down and to have a smoke-free future. A lot of Members of Parliament raised other issues, especially about raising the age of sale. Can you explain why you support a complete ban as the right way to deliver a smoke-free future?

Do you want me to ask the second question now as well?

My second question is on the point that Sheila raised. Clause 61 gives the Secretary of State powers to regulate on packaging, vaping or nicotine products. Clause 62 makes regulations for the Secretary of State to have powers on substances that may be included and the flavour of vaping. Do you believe that the measures in the Bill to prevent vapes appealing to children are likely to work, and where can we learn lessons to ensure their effectiveness?

Do you want me to ask both questions now?

Could you talk us through ASH’s assessment of the economic cost to the UK economy of smoking? Secondly, what is your view on the importance of restricting vaping for children?

Q Would you state your latest research for the record, though? Obviously, this Committee is here to provide the evidence on the record.

Deborah Arnott: I would rather not summarise it now, but it will come very quickly and we can provide it to the Committee in advance of publication, so the Committee will get the full details.

Q Public health messaging is most effective when it is simple. Should the restrictions on vaping being advertised on football shirts, for instance, be in line with those on tobacco advertising, and should there be similar restrictions on where people can vape as there are for smoking?

I want to ask about the passive effect of vaping. We know that if you are proximal to someone vaping you can smell the blueberry flavour, or whatever it is. Do you have any evidence on the passive health effects of vapes?

Q To expand on a point made earlier, I wonder what more is necessary in terms of promotion and advertising action. I am very concerned about the matter of football strips and, indeed, sports stadiums being sponsored by vaping companies. The messages that that sends to the young people who are taking up vaping in such numbers is hugely problematic. It strikes me that within your areas of expertise there are probably other areas where we could extend what we are seeking to do here, in order that we do the best job possible of trying to close these loopholes.

All three witnesses have given support for the Bill. You have already suggested one change that could be made in terms of age verification, similar to the system in Scotland. Are there any other changes that you think should be implemented that could make the Bill stronger? One of the concerns that many of us have is that we get only a limited number of chances to deal with this challenge in primary legislation, so we need to get in as much as we can to make sure that we achieve the smoke-free England that we all want to see.

Including where people can vape, yes.

Deborah Arnott: To go to that one first, I think it is really important—the chief medical officer has said this too—to make the distinction between smoking and vaping. Smoke-free laws were implemented after very strong evidence about second-hand smoke causing lung cancer and heart disease. We do not have that for vaping. It is important that regulations are in place, and we are seeing that—you cannot vape on public transport or aeroplanes or in most workplaces, and that is fine—but making it legislative implies that it is equivalent to smoking.

On the point about displays and promotion, our surveys show that children are most aware of the promotion of vapes in store and online, and that is where the priority has to be in strengthening the legislation. Restrictions on how products are displayed, and the packaging and labelling stuff that we have already talked about, are really important.

In terms of additional measures, on the vaping side, there is one thing that I would say is vital. At the moment, clause 63 does not allow for a change in the product requirements set out in the Tobacco and Related Products Regulations, following on from the EU tobacco products directive, which was designed in 2013, over 10 years ago. We need the Government to have powers to change the general product requirements, not just ones related to branding, and that is the other amendment on vaping that I think is really important. There are other things, but I have possibly run out of time, so we can share those with the Committee separately.

Q You will know that the Government have a clear target to narrow the gap in healthy life expectancy between the highest and lowest areas in the next five years. Do you think that smoking rates are particularly high in certain parts of the country, and are the health benefits following the ban therefore likely to be more prevalent in some places than in others? That is my first question. Secondly, I am concerned about the huge rise in youth vaping in recent years. Are you concerned about the increase in vaping even among groups who have not previously smoked cigarettes?

I am also interested in the impact of smoking and vaping on children’s hearts and lungs in particular. I would very much appreciate hearing the professional assessment of you both of the particular vulnerability of children’s lungs and hearts, as compared with adults. I know that the Opposition spokesman and I share that grave concern, as do a number of colleagues. My second question is: do you expect the smoke-free generation policy to stop young people starting smoking?

Q I asked a specific question about children’s asthma and children’s heart damage. Could I urge our witnesses to respond to that question?

Dr Griffiths: Thank you, and apologies if we did not cover that as clearly as we could have. Obviously, there is no such thing as a safe cigarette, there is no safe number of cigarettes to smoke, and there is no safe age to start smoking at all. We would emphasise our concern for children starting to smoke, because the damage starts as soon as you start smoking. There is no safe number of cigarettes to smoke. Combined with that, the fact that nicotine is so addictive that it leads to most people—over two thirds of those who start—becoming long-term smokers, worries us enormously. In terms of both the risk and the damage of starting smoking, the number of people who start and the fact that they go on to adopt a lifelong smoking habit caused by nicotine is of deep concern to us.

Sarah Sleet: It is worth thinking about children’s wider environment. Children who live in households where the adults smoke are four times more likely to smoke themselves, and find it much harder to give up. Children are getting into a cycle of deprivation and damage to their long-term health right from the very beginning. For children, stopping smoking availability is going to be profoundly helpful for their future lives, their ability to contribute to the economy and their overall prospects. This Bill, which tackles the issue from childhood up, will be one of the most profoundly important health interventions that you can make.

Q I think the Minister was referring to vapes and the evidence based around the impact on growing lungs and hearts. Is there anything you would like to say about that before we move on?

Dr Griffiths: As Deborah from ASH said, vapes are a fairly new product, so the research and evidence base, which we have in abundance for tobacco and smoking, is still forming for vaping. However, there are indications that it is not great for health. We are cautious and worried about the long-term implications. What we do know is that vaping can be an important cessation tool for those trying to quit smoking, and that many do want to quit, so we strongly encourage anything that stops smoking, but the people who are turning to vaping as an alternative to smoking for the first time is of deep concern to us. We do not understand the long-term health implications, but the addiction to nicotine deeply concerns us.

Sarah Sleet: We strongly agree. It is a very delicate balancing act between stopping the harm caused by smoking and looking to the long-term with regard to vaping. Quite clearly, smoking is far more damaging for adults and children. Anything that can steer people away from smoking will be healthier than continuing to smoke in the long run, but we do recognise that more attention and more research need to be put into vaping.

Q Clearly, smoking is far more harmful than vaping, but research by UCL has shown that there are DNA methylation changes linked to carcinogens from vaping in the oral cavity, which quite probably translates to the lungs as well. Should we be looking at this legislation not with the naiveté with which smoking was looked at in the past, but rather as taking advance steps to ensure that we do not see an inducement of lung disease in the future?

Sheila Duffy: As I said earlier, it is a delicate balancing act. We need to move people away from smoking, and anything that does that is a good thing, but we need to look at the long-term effects of vaping. The balancing act in the proposals around restricting access to vaping—making sure that nobody under-age gets access to vapes, denormalising them by taking them away behind the counter and so on—all of those are good measures to reduce the number of children moving on to vaping, but they need to be enforced. We need to make sure that we have the right enforcement action in place to make sure that that actually happens.

Dr Griffiths: You gave a great example of early science that causes us concern, and it perhaps will not surprise you to know that as a body that is based in science and evidence, we at the BHF take statistics incredibly seriously. We are worried that the body of evidence will grow. We would hugely support and welcome a position where vaping was available to people as a cessation tool, but absolutely would discourage anyone else from taking it up as a starting point for nicotine consumption.

Q Could you take us through the impact second-hand smoking has on health?

Dr Griffiths: It has a huge impact, and thanks to some of the previous legislation there have been some improvements that we can measure and track with great certainty. Second-hand smoke is undoubtedly a cause of cardiovascular disease, and for those people unfortunate enough to be exposed to it, it is a serious issue. Just over 15 years ago, there was a study that looked at coronary heart disease and cardiovascular disease in men. It showed a significant uplift for those exposed to second-hand smoke on a regular basis that was roughly the equivalent in risk of smoking nine cigarettes a day. So there is a very clear basis for saying that second-hand smoke causes heart and circulatory disease.

Sarah Sleet: I would add the legislation on smoking in closed places—there was of course the legislation back in 2015 about children and smoking in cars—was based on very good evidence and was introduced for very good reasons. It proved to be a popular measure. Second-hand smoke in this context as well is an important additional factor to consider in terms of the harms balanced against the need to restrict these particular products.

Q Thank you. While the harms of vaping are becoming better understood, what do we know about the behaviours around vaping? I ask as an MP who represents the northern constituency of Copeland, where smoking levels are above the national average, where health inequalities are more prevalent, and where deprivation is also a factor. Are we seeing the same kind of mapping of deprivation in areas where people are starting to vape? Are we aware of copycat behaviour—children mimicking their parents or other people in their households—and are we starting to see some patterns in age groups starting to vape? That statistic—350 young people starting to smoke every day—is shocking. What do we know about vaping?

Dr Griffiths: Not as much as we would like. That is the headline, but I do not think it will surprise any of us to know that people follow cues in their environment. That is partly what happens around them in their social environment, but I would like to draw attention to what happens in shops and convenience stores where people buy vapes. I was looking around my local convenience store, which is not far from a school, and thinking about today. It does not take a lot to look at what is happening behind the counter and see the packaging, the marketing and the highly, brightly coloured products that are clearly labelled, named and flavoured in a way to be attractive to children, whether it be cherry cola vapes or cotton candy vapes. They are things that are deliberately sweet and targeted at children, so it causes us great concern that that will be such a huge influence on so many children. We see that playing out in prevalence. I do not know if there is anything that you would add, Sarah.

Sarah Sleet: I think you are right that there is no real evidence base around this. That research should be done and we would very much like to look at. Where smoking is very prevalent—as you say, in more deprived areas—people take cues from the people around them in terms of their behaviour. I have no doubt that look to similar cues for vaping. Are people around them smoking? Is it easy to get hold of vapes? Is it completely normalised? I think we would find a very similar pattern, but we need to get that evidence.

Q We have heard that this Bill covers tobacco and vaping, and we have talked quite a bit about the advertising and packaging of vapes. Do you think that we could go further in actually tackling tobacco, which is the biggest killer, around the advertising and packaging of tobacco and flavoured tobacco?

Dr Griffiths: We would welcome anything that stops people smoking or beginning to vape as a starting point for their addiction to nicotine. Given the scale of the devastation that that has on people personally as well as on our NHS in terms of cost burden and all the other impacts that it has, we fully support the Bill going through in full as it is now. If there are opportunities and support for strengthening it, I am sure that we would welcome that too.

The majority of people across the UK support the Bill and would love to see a smoke-free generation. The fact that you have 51% of retailers supporting it also speaks to how powerful a moment it is. We should do anything that we can to strengthen the Bill and prevent it from being diluted. We know that the tobacco industry will be campaigning in the opposite direction to limit any restrictions that would reduce its success, so we are really mindful of that. We urge the Committee and everyone who can to protect the Bill from dilution. It can save and improve lives. It is potentially a transformative piece of legislation.

Sarah Sleet: We asked our supporters who was in favour of the Bill. Bearing in mind that many of our supporters may still be smoking or are ex-smokers, 84% supported the Bill and really wanted to see it come through. Daily on our helplines we hear people saying, “I wish I had never taken up smoking.” They are completely addicted and find it almost impossible to get out of smoking, and their health is being slowly degraded over time. They are having to come out of the workforce and retire early and potentially face death as well.

Q I am grateful to you both for your comments so far. Would you say more about your thoughts on groups of people, particularly young people —this is a thing you will hear around the table—who are taking up vaping but have not previously smoked. Do the measures in the Bill go as far as you want in trying to prevent that from being the direction of travel?

Dr Griffiths: If the Committee is minded to strengthen anything that would prohibit people from starting vaping in the first instance, where they are not doing so as a cessation tool—I hope it is really clear that we believe that, as a cessation tool, this is a product that has its place that would help thousands of smokers give up and, ideally, prevent them from losing their quality of life or, tragically, their lives; I hope that is explicitly clear—I think that could have incredible impact. What we are worried about is people using vaping as a start and an entry point to nicotine. Nicotine is so highly addictive. You see that in the number of smokers who desperately want to give up. We have spoken to such people in abundance. Anything that helps us get to that point would be welcome.

Sarah Sleet: Nicotine, we know, is as addictive as heroin and cocaine. It is a terrible addiction. However, in terms of vaping, it is going to be quite tricky to get that balancing act right. We really need to have vaping as a cessation tool. We know it is more effective than just about anything else you can have in terms of cessation. For example, when it comes to flavouring, if you make that too difficult or make it problematic for people to switch, then there is a chance that we may have a real problem in terms of stopping smoking. On the other hand, we really do not want people to be attracted into vaping who have never smoked. I understand that that bit of the legislation is in secondary legislation and can be adapted over time; I think a lot of attention is going to need to be given to how people are actually responding and how they are behaving, and then adjusting that over time.

Q You have been quite clear that even though we do not yet have the evidence to understand the impacts of vaping, it is a very important cessation tool. Do you see a world in which it could be prescribed as a cessation tool, as opposed to being available as a retail product?

Sarah Sleet: I believe that is the system in Australia—it is prescribed. I think it is a possibility. It needs to be well researched. Would it still encourage people who need to stop smoking to use it as a tool, or would it put a barrier up to using that tool? Before we move to that system, we would need some really good behavioural evidence that it is not going to be a further barrier for people. If it is not, then that could be a really good option.

Q Some people say that the smoking generation does not need to be raised a year higher every single year. Can you say for the record what your view is of that? Does it need to keep lifting each year?

Dr Griffiths: We support the Bill exactly as it is written at the moment. It is really important to recognise that, as proposed, it does not inhibit anybody who is currently a smoker from purchasing tobacco, but it does take us on a really clear and, I believe, a transformative path to a smoke-free generation.

I understand that, but why?

Dr Griffiths: Because it is a really clear path to make sure that we move to a situation where we have a generation that is prohibited from buying cigarettes, and who are disincentivised from doing so.

Sarah Sleet: We have heard today the evidence about just how harmful and destructive smoking is, particularly for people in more deprived areas. If we really want to tackle that, we need to remove smoking as a normalised, available, legal option going forward. This seems to me a very measured and thoughtful way of introducing a smoking ban that will take hold. It is very important for our children going forward.

Q I want to ask about the information that is given to parents, especially if their children have never smoked but have taken up vaping. We know that a generation of children is becoming addicted to nicotine because products that have been classified as 0% nicotine do actually contain it. One of the parents that I spoke to asked, “Well, how many puffs are there in one vape? If my child has two or three of those in a day, what does that actually mean?” It is about the information on that sort of risk, and how we share that information with parents who are trying to address this issue with their children. Is there anything you want to say about that, and is there any research being done to look at that?

Dr Griffiths: I would observe that there is so much variation between products and how people are consuming them. I think it is quite difficult to give advice in a standard way, and that it is part of it being an emergent product and market. As we have discussed, there is no doubt that, with nicotine being so deeply addictive, it is an incredible worry that a child has a single puff on a vape, given the potency of nicotine and where we know it leads people, having seen that over generations with smoking.

I should perhaps take a moment to emphasise that we also really support the £70 million investment being allocated to public health campaigning and cessation services, as well as enforcement. You are right that we need to be really clear with the messaging of the Bill to encourage support from parents and others around children in particular. We really applaud the decision to put resourcing behind this as well. We know that effective public campaigning can be an incredibly powerful tool. We were really proud to run the “Give Up Before You Clog Up” fatty cigarette campaign way back 20 years ago, and we know even that campaign led to 14,000 smokers seeking to quit. We know public campaigning works, and it was a great thought to allocate that resource as part of this work—it will be needed.

Sarah Sleet: The variation in nicotine levels and the method of delivery, which affects the uptake of the nicotine, is undoubtedly very concerning in vapes. I am a mother of three adult children who all vape, and I am very concerned about how often they are doing that and what impact that is having. We must also remember that, from what we know at the moment, it would appear that smoking is far and away the most damaging activity, compared with vaping. There is a little bit of concern that we overemphasise the harms of vaping to the extent that people say, “Well, I might as well smoke then. I’ll do that instead.” We need to be very careful about how we have this conversation.

Q I want to follow up on something that both of you alluded to earlier in the evidence you have given. Is there any research beginning to form that suggests that, while vaping can be helpful for cessation, it might also be a gateway to smoking itself for young people?

Dr Griffiths: That is an interesting question, and I can see the clear linkage you have described, but I am not able to provide any evidence. I am very happy to go back and provide that as a follow-up.

Sarah Sleet: I am not aware of any evidence around that either.

Dr Griffiths: It is a great question.

Q In the Health Committee, of which I am a member, we heard evidence that some schoolchildren with lung diseases, such as asthma, were not able to visit school toilets during the day because the overwhelming smell of people vaping in there was triggering their asthma. Have you heard anything about that? Do you have any evidence about asthma in children or adults being triggered by vaping?

Sarah Sleet: We have heard anecdotally that people have had issues with being around vaping, but there is not any robust evidence as to whether it genuinely triggers asthma for some of those people. It is an area we want to look into a bit further, but I would say that here is a clear case of where the law is that children should not be vaping. We need to ensure that enforcement is in place, as far as possible, to prevent that from happening.

Q Is that an absence of evidence, or does evidence exist but is inconclusive?

Sarah Sleet: I am not aware of any serious evidence that has been gathered around this at this stage. It probably needs to be looked at.

Q Thank you, Chair, and I thank the witnesses for giving evidence today. First, is under-age smoking or vaping the bigger issue in schools today, and what is the impact on education, behaviour and so on? Secondly, will the measures in the Bill to restrict sales of vaping products to children under 18 work, in your opinion?

Matthew Shanks: It is an interesting question, whether vaping or smoking is more popular among children in schools. All I can say is that it has increased in the past three or four years. We see evidence of vaping; it is more difficult to catch children vaping, because of the size of the vapes, the fact that the smell is slightly different and does not set off smoke alarms in the same way, and so on. I think it is fair to say that smoking and vaping are still as popular as they were among younger children in certain areas, and vaping is being seen to be a safe alternative.

The marketing of vapes in different flavours and colours makes them akin to a progression from chewing gum for some families—with bubble gum flavours and so on. There is also anecdotal evidence of parents talking about, “If it’s grapefruit, it must be safe.” There is that evidence around it as well out there—because of the way in which vapes are marketed, and if you see them in shops, they seem safe and okay.

With behaviour, the size of vapes makes it very difficult to admonish children, because they can hide them very easily. They can look like mini hard drive sticks—I think that is deliberate targeting in how they are marketed, with the cleverness of it. Certainly in terms of behaviour, it is something else that we are dealing with, when we say to a child, a teenager, “You’ve been vaping”, but they say, “No, I haven’t”—there is nowhere for us then to go, which immediately sets up an issue.

The earlier question about toilets was interesting, because children tend to vape in toilets. It is easier for them to vape in toilets than it was for them to smoke in toilets. You just need to see people on public transport vaping—it is easy for it to dissipate and disappear quickly. So, yes, I would say that vaping is a real issue in schools for children.

Patrick Roach: I support fully what Matthew has just said. I do not think that it is an either/or; the reality is that smoking is a threat to children and young people, in terms of their health and wellbeing and their ability to participate and progress educationally, but so too is vaping.

The NASUWT, at the start of this academic year, published our own research into vaping in schools from the perspective of teachers and school leaders, and it very much reinforces what Matthew has just said, in that vaping is pretty much predominant as an activity taking place among secondary-aged pupils. But we are also seeing teachers reporting pupils vaping from as early as 10 years of age, so the primary phase is also impacted. Three quarters of teachers report a significant increase in the participation in vaping by pupils in their schools, so we are seeing an upward curve in respect of vaping activity within schools.

On the issues that have just been mentioned about the difficulty that schools have in detecting and controlling this kind of behaviour, the way in which vape products are available to pupils is that they are masquerading as hard drives, as highlighter sticks or as other things that it would be legitimate for a pupil to bring into school. This is not like a situation in which you catch a pupil with a packet of cigarettes and you confiscate it; first, you have to identify what on earth it is that that pupil has. At the end of the day, good order in schools is dependent upon there being trust and respectful relationships between teachers and students. You cannot go around every moment of every day asking pupils to turn out their pockets and then inspecting what is in them.

The reality is that we are seeing the impact of vaping not just on pupils’ health, because we are seeing pupils who are presenting as ill as a result of the overuse of vaping products—although, in fact, all of it is overuse—and therefore becoming ill in schools, but on educational participation, progression and achievement. When pupils are diving off into the toilets to vape, that interrupts teaching and learning. When pupils are late arriving at school, perhaps because they have been vaping en route, that impacts on pupils’ learning. We are also seeing bullying behaviours within schools because, quite often, vaping products are being informally circulated, exchanged or acquired. Therefore, it becomes another source of behavioural challenges for teachers and head teachers. So, from a teacher’s perspective, vaping is a serious issue within schools, and one that we are pleased that this Bill is seeking to address.

Q Thank you so much for being here, and also particularly for the work that the NASUWT has done in terms of the impact on schools. Could you expand on that a bit further? I have done a couple of visits ahead of this Bill. I met enforcement officers, for example, who gave me anecdotal evidence that teachers say that pupils will return to the classroom with their eyes spinning and unable to concentrate because of the heady nature of whatever it is they have just been vaping or smoking. There was another anecdote about a school where children decided to drink the vape fluid and the school actually had to have a sort of emergency evacuation as a result of that.

Could you therefore expand on that, in terms of the specific health impacts and, at the one end, the ability of children to concentrate on the class when they are spaced out on vapes, and, at the other end, the very real risk to children from doing something stupid with a vape that was entirely unintended, with disastrous consequences?

Patrick Roach: I very much appreciate your remarks about the research that the NASUWT has undertaken. We come at the problem of vaping from the point of view of our members in classrooms, in schools the length and breadth of the country. What do teachers need in order to be able to teach effectively and what do they believe that pupils need in order to learn effectively? They need good order in the classroom.

My perspective is not that of a medical practitioner or of someone wanting to assume that I have the knowledge about the impact of vaping on a child’s physical development. Our concern is the impact on a child’s educational development, participation and achievement. The reality is that everything you have mentioned there is absolutely right, whether it is about the way in which vaping products might be unintentionally used by pupils; or about how they seek to conceal them about their person; or, indeed, the drinking of vaping fluids, as if somehow that will get the high without necessarily being detected; or about the use of vaping products as a stimulant, which impacts not only on concentration but on behaviour and, indeed, on a child’s wellbeing in the classroom.

Matthew has already referenced the difficulty of detecting vapes sometimes, because they can dissipate very quickly; and they can also trigger fire alarms in schools. We have had plenty of examples of teachers and headteachers reporting that their school has had to evacuate the building not just on one or two occasions in a day but multiple times—five or six occasions. That is a loss of learning not just for one pupil or class of pupils but the entire school. We are really concerned about the impact of all that.

Teachers are not just concerned about a child’s educational development, though; they are also concerned about a child’s wellbeing in the round. Teachers are reporting the very damaging impact that vaping can have on a child’s mental and physical development, just as smoking can. That is one of the reasons we have spoken out—and we are pleased that the Government have responded—to say that we need to be doing more to strengthen the enforcement of rules around vaping, access to it and the availability for school-age pupils. We need to do as much as we possibly can to prevent any school-age pupil from getting access to vaping products, whether in or outside school. We are pleased that the Bill seeks to do just that.

Matthew Shanks: I absolutely echo and reinforce what Patrick has said. Also, as school leaders we are looking after teachers, but we are caring for families as well. The Bill will help families to understand that it is not okay for their children to vape. Anecdotally we have parents saying to us that they let children vape at home, because it is better than them smoking or being out on the streets; parents do not see the harm in it. It is really important that that is recognised. The banning of tobacco sale was interesting in terms of the prescription of it; I would posit that at the moment vaping is seen as safe by the general public.

Q I wonder if you can develop some of the points you have made, which have been very useful. I am hearing anecdotally about issues in schools where the addiction of children to these vapes is itself causing a problem, because the children are unable to sit in the classroom and have to go out to vape, with whatever excuse is made, so that they then feel able to come back to the classroom, such is the level of their addiction to these products. If I may go beyond that slightly, what are your views on the way these things are promoted—for instance, on our particular concern about vape companies advertising on sports strips and in sports stadiums, and the impact on the same young people who are so addicted?

Matthew Shanks: I completely agree. The way in which vapes are marketed—the colours, flavours and so on—and the places where they are marketed suggest to people that they are safe. The fact that they are put forward as a “safe” alternative to cigarettes, the fact that parents use them and the fact that there are lots of colourful vape shops open in high streets: all those aspects promote the idea that vaping is okay.

At the same time, getting into a child’s mindset—we have all been there, as children—we like to break the rules and feel like we are pushing at boundaries. We know that it is not okay, but it is made okay. I would suggest that more children engage in vaping than in cigarette smoking, because they are not sure what the harmful effects are. That is the danger in it. I do think it leads on, because the younger children vape, but by the time they are 16 or 17, vaping might not be cool any more, so they go on to cigarettes or other things.

Anecdotally, we have heard of schools down in the south-west where people are putting cannabis into the vapes, so the addiction grows from that point of view as well. It leads to children coming out of lessons agitated. If I did not have three coffees in the morning, my agitation would be quite high. If children are not getting nicotine, as well as going through all the other things they are going through, they really do present as confrontational to staff, which makes it difficult to deal with them in classrooms and engage them in their learning. At the same time, to repeat a point I made earlier, you have parents at home who are saying, “Well, it’s okay to do.” I absolutely concur about the way it is marketed and so on.

Patrick Roach: To add to that, because those are important points: vape producers and manufacturers, and indeed those supplying vapes, are advertising freely in ways that make their products increasingly attractive to children and young people, with the way vapes are advertised and the marketing descriptors used for them. All the evidence we have, and certainly what our members tell us—our survey was of 4,000 teachers, so this is not anecdotal; it has an impact right across the system— suggests that the way those products are marketed and described deliberately seeks to entice young people to make use of them.

We believe that this is a strong Bill that very clearly sets out the societal expectations in this space, but as with any legislation, there is always scope for loopholes. If there are areas in the Bill where there is potential to further strengthen the legislation, I think the enticing way products are described, before an individual understands what they are getting themselves into, is something that needs to be considered and addressed.

From our point of view, it is about advertising, but it is also about access to these products. With the best will in the world, and no matter how they are advertised, if the products are easily available at the point of sale it makes things incredibly difficult. I remember that when I was bringing up my own children I worried about going to the supermarket with them, because they would be surrounded by candy and sweet products at the checkouts. You could not navigate your way through the checkouts. Thankfully, things have moved on: that has changed, and many parents are benefiting from those changes.

Young people are very much interacting with many of these products at the point of sale. They are in the shops that are in the vicinity of or on the route to and from school. They are being marketed in places that young people will frequent, whether that be a local café, the hairdressers or the barbers. They are in places where young people will be. They are also immediately available. The more we can do to stop the immediacy of marketing of these products and that easy availability, no matter how they are described, the better.

Q I have been hearing from parents and schools in my constituency that they are very concerned that children are going out at lunchtime and spending their lunch money on vapes, so they are not having anything nutritious during the day. Is there any evidence that indicates that there might be a pattern developing in that respect that will have an impact on children’s physical health and wellbeing?

Matthew Shanks: Absolutely: children will find any which way they can to do what they want to do. At the moment, while this is not illegal, they will gather more people to follow the crowd and go out. In my experience, the majority of children want to do as they are instructed—probably about 85%, anecdotally, over the years—but they will follow the herd. At the moment, there is a greater herd growing because of all the things we have talked about, with the marketing and colour of vapes. I can absolutely see children going out at lunchtime and spending their money on that, instead of on food. There is peer pressure to do that as well—it is taking more people with them. As Patrick said, you can see these products in the barbers, in the shops and so on.

Patrick Roach: To add to that, there are also bullying behaviours that manifest themselves. Whether a pupil is making the choice to go out at lunchtime to acquire vapes or is feeling coerced to do so, there is an issue either way. The availability of those products in the proximity of schools needs to be considered. That is a point that we would make.

Increasingly, schools have introduced systems to seek to ensure that children are being fed at lunch times, for example. We should not lose sight of that, but in some instances these products—particularly disposable vapes —are cheap as chips. I know that that is an issue of concern to the Government, and it is of concern to us and our members.

It is really important that we look at how we can ban the sale of disposable vapes entirely, because frankly no one knows what is in them, and they are incredibly cheap to acquire. Even if your parent can see what you had on Tuesday lunchtime because it comes up on their phone, how will they know if you have spent 10 minutes popping out to the local shop to acquire some vapes, particularly if they are of the disposable variety? More can be done not only to limit appeal, but to reduce the availability and accessibility of those products to young people. The more that can be done on that, the better.

Q There is nothing magical about your 18th birthday, but the legislation clearly talks about 18 being a cut-off age. Would it assist if that age were heightened—for instance, it is 20 in Japan and 21 in California—not least because of the impact of nicotine and cannabis, which have been mentioned? I have been hearing about synthetic drugs as well.

Matthew Shanks: Yes. I absolutely agree.

Q You talked about the escalation whereby young people, possibly as young as 10, start by vaping and then go on to other tobacco substances. What further measures would be required, in your view? What further support would teachers need to explain the harm that young people are doing to themselves as a result of vaping and smoking?

Matthew Shanks: There are lots of campaigns that explain the harms of vaping and smoking. Sometimes people do not listen and do not engage with them. The only thing that I would say is that more people vape and smoke than take drugs, because drugs are illegal. If we are saying that tobacco is dangerous and harmful to people in our society, and our role is to protect them and educate them to see what is better, why is tobacco not illegal as well? Vaping started as an alternative to tobacco, but it is now catching on with young people. Is there a similar thing to be done with vapes? That is the view within schools on how we can help children to engage in what they should be doing at school, which is working at their education. There will be other things that have come along, but 15 years ago it was chewing gum everywhere—nicotine chewing gum was a big thing.

Patrick Roach: The reality is that schools are doing an awful lot to inform, to educate and indeed to regulate the conduct of children and young people, as well as to engage with parents and carers, but schools by themselves cannot change society. They can have a tremendous influence over wider society, but by themselves they cannot change it.

Anything that we can continue to do to educate young people about the harms and dangers of smoking and vaping, we should continue to do. Notwithstanding this legislation, that is essential, because no legislation is going to eliminate illegality. We have to continue to strive to eradicate those behaviours wherever they manifest themselves.

What other practical measures could the Bill include? I have mentioned the way in which vape products are described. We think that something could be done there. On availability—this is potentially outwith the scope of the Bill, but it could happen through other legislation and regulation—we think that the prohibition of disposable vapes is an issue that needs to be addressed.

There is also the issue of enforcement measures. There is no point in passing legislation if it is not enforced in practice. We need to ensure that the enforcement measures are absolutely robust. The proximity to schools of any retailer selling vaping products also needs to be looked at.

Q Following on from Bob’s question, you are in a position to educate young people about the harms of tobacco. Is there a point here about educating young people about the harms, about the unscrupulous measures that the tobacco industry takes and about the horrific products that it is making? Young people are often interested in climate change and wider issues. These industries and organisations are having an impact across the whole world. It could be something that young people are interested in—not just for their health, but for the wider impact on their local communities and across the world. If we had more funding for education, maybe with a payer levy, those types of measures could be looked at. Is there any opportunity for that type of education in schools?

Matthew Shanks: That is happening at the moment within education, in curriculums and so on, but there is a lack of messaging around vaping, its harmful effects and its cheapness compared with tobacco. Even with the teaching of the harmful effects and the messaging compared with tobacco, there are still some families who smoke and you still see celebrities smoking. You are fighting that all the time.

It is good that we are educating young children about the harmful effects of things and the need to change, and we will continue to do that. We talk about big tobacco companies, big pharma, the global environment and so on, all within the curriculum.

Patrick Roach: The reality is that we need more space in the curriculum to do all that and to make the connections between vaping, the impact on a child’s health, and how these companies are profiteering, often from the most vulnerable. The producers of vaping products, the degradation of the environment, the way products are manufactured—all of this is very rich territory.

I would like to see more by way of permission for teachers and school leaders to engage with their pupils about the real everyday concerns that young people have. There should be more scope and space in the curriculum to do that. That is not to argue against the teaching of maths, science and languages; it is about saying that we want to produce well-rounded individuals. For us, that is the purpose of education. This is an area where educators have an important role to play.

Matthew Shanks: I would just add to that by encouraging you to visit your local schools and see what they are doing.

Q This morning, in evidence from previous witnesses, we heard a lot about how vaping is a great smoking cessation tool, but there is not enough evidence about the harms of vaping. You have described social harms; you probably see health harms as well. You have surveyed people, and you have come to give evidence this morning. Have you been asked, outside this, for evidence of the harm from vaping to the young people you look after? Do you believe that the evidence gathering on whether vaping is harmful is going at a fast enough pace?

Matthew Shanks: No, prior to now. This is very welcome, which is why we have both given our time because this is important. There was something in the papers this morning about evidence of harms of vaping for children, but it is not the headline; it is seven or eight pages in, so people will not read it.

I absolutely think that there should be more about the harm of vaping or just the unknown. You do not know necessarily what the dangers are, so therefore why would you engage in it? We talk a lot when we are doing drug prevention with children about—apologies if this offends—where the drugs come from, what the base of them is and what they contain. In the same way, you do not know what is in a disposable vape or another type of vape, so why would you put that in your body? Those are the lessons we are talking about, so we would certainly welcome more evidence to support that.

Patrick Roach: We know, from the feedback we have had from teachers as part of the research we have done, which includes both quantitative and qualitative feedback, that children are getting ill as a result of using vaping products. That is the daily reality that school leaders and teachers have to deal with.

The more that we can systematically collect and collate that data and evidence—whether that is a child who ended up being rushed into hospital because they became very ill on the school premises or, indeed, a near miss within the school—the better we will be. But the reality is, on an everyday basis, that teachers are experiencing this and having to deal with these issues and to intervene on and support pupils who are impacted physiologically by other harms of vaping products.

Q I want to ask about flavourings because we have heard that flavourings may encourage some adults to switch. We know that where adults stop smoking using vapes, flavourings might prolong their addiction to vapes, and we know that flavourings entice children to vape. Some people say that we need to keep the flavours for the adults; some people say no flavours because they entice children. To govern is to choose, so which do you think is the most important—supporting adults to stop smoking or protecting children from starting vaping?

Matthew Shanks: A simple question to finish with—thank you! I think you can have both, because I would. If you look at the way cigarettes are marketed—behind a shelf with the pictures of the damage they cause—that is different from the way vapes are marketed, with their colourful packaging and excellent flavours that appeal to children. If you change the way they are marketed, you could have both, because you could still help adults with the flavourings but not make them appealing to children.

Patrick Roach: A simple answer: protect children from harm.

Q Welcome, Paul. It is good to have you here. My first question is simple and straightforward: what is Age UK’s view on the Bill?

My second question is this. I know that over-65s are much less likely to smoke. I have a constituent, Eric, who has suffered from a stroke and has suffered with chronic obstructive pulmonary disease and is now a tobacco campaigner in his 80s. Why is this Bill important to the people Age UK works with?

Paul Farmer: Age UK fully supports the proposed legislation, and we have been working alongside the Richmond Group of Charities to highlight the significant health benefits of phasing out smoking, which will help individuals and have a wider impact on society. It will have particular benefits for the NHS, which as we know faces significant challenges at the moment.

Our job at Age UK is to think about not just the health and wellbeing of older people as they are now—I will come to your second question in a moment—but issues affecting future generations of older people. This is quite a rare opportunity for us to have a significant impact on those future generations for reasons we will look at later.

It is worth noting, however, that this Bill is heavily supported by older people. Polling shows that 69% of over-65s support it. Why is that? That goes to your second question. We know from older people and the work we are currently doing that health and wellbeing in later life is pretty much the top priority for older people. Age UK has recently published our blueprint for older people for the next few years, as we enter an election year. It is very clear from the work we have done with older people that health and wellbeing is right at the heart of what is most important for people.

Of course, that is logical: the ability to feel well, remain active and maintain our independence is a major determinant of the quality of life that we aspire to in later life. We also know that there is a huge gulf in life expectancy and life experiences between those who have the opportunity to age well and those who do not. I will not go into the points your earlier witnesses made about the importance of healthy life expectancy in detail, but that is right at the heart of older people’s considerations. It is important that we do something about the fact that healthy life expectancy for those who are most disadvantaged is quite so stark.

How does that affect smoking? As you know, smoking is a leading cause of death and disability. It is responsible for half the difference in healthy life expectancy between the most and the least affluent communities. People living in the areas with the lowest healthy life expectancy are 1.7 times more likely to smoke than those living in the highest healthy life expectancy areas. These are fundamental reasons why the intervention of this legislation will make a difference.

Q I really appreciate your being here—thank you. I would like to tackle the fact that young people tend not to consider either their own mortality or their health and wellbeing. The majority of young people tend to take those for granted, and yet there is a complete correlation: the age at which you take up smoking—or, indeed, vaping—is when you are young and feel pretty immortal, or are at least not concerned about later life.

Could you give us a view, as an Age UK representative, of the sort of advice that older people who have smoked all their lives and are now bearing the brunt of the decisions they took would give to those who argue, “It’s a matter of personal choice. Everyone should be free to smoke if they want”? What would an older person say to that young person?

Paul Farmer: I think a lot of people would say that they wish they had never started. Those are certainly the conversations we have been having with older people in preparation for this session. The reason for that is that, as you enter into your later life, you start to understand the consequences of smoking through your personal experience. The list is frightening.

Q For the record, can you outline some of those experiences? Obviously this is a public evidence session and we are looking to make the strong case for this Bill.

Paul Farmer: Very clearly, there is the relationship between smoking and multiple forms of cancer, COPD, pneumonia, heart disease, aortic aneurysm and stroke, vascular diseases, diabetes, rheumatoid arthritis, hip fracture, cataract and macular degeneration—and dementia. In a society where we are increasingly debating dementia’s impact, I think the relationship between smoking and dementia is a really important context.

These are in and of themselves very challenging physical health conditions, but we can also see the correlation with people who experience multiple long-term conditions. I think many older people who experience those multiple long-term conditions—who have to live with the impact of them often because they smoked in their early life—would say this impacts on the individual being able to do the things they want to do in their later life. There is a severe detriment on pursuing their ambitions of later life as a result of having smoked in earlier years.

My last point: may I just pursue that—

Q Thank you. Would that older person suffering those consequences say: “Yes, it was all a matter of free choice”?

Paul Farmer: I think different people will have different opinions about choice, and whether it was as a result of choice. I think what many older people have been telling us is that if they had known about the damaging consequences of smoking, they would not have started in the first place and would certainly have considered it in a greater way.

I want to pay huge tribute to colleagues at British Heart Foundation, who I know you have just heard from, who I think have taken the best way of trying to campaign over a long term on this issue. This is a long-term issue. Sadly today’s generation of older people is seeing the consequences of what has not happened.

Q Could you explain who “older people” are? Sadly, I recently recognised that that might include more of us than we might like to believe. We need to take that on board. What I am really interested in are the different demographic groups, and where you think there might be disproportionate levels of harm from tobacco and vaping within the groups of older people that you support.

Paul Farmer: We work with people over the age of 50, which may be news to some of you here. One of the reasons why we have recently chosen to drop the age group that we increasingly work with is precisely for prevention and early intervention.

This is not the earliest intervention; you can, of course, argue that many health interventions need to take place among children and younger people. However, from an Age UK point of view, we know that there is potential to intervene in people’s lives and support them to live healthier lives—it is not just about health, but in this context it is mainly about health—which means that your healthy life expectancy can improve and, as I mentioned earlier, you can fulfil some of the ambitions of your later life. The burden on the NHS of unhealthy life expectancy is a big issue.

The bulk of our direct work is with people over pensionable age, if you like. In each of those generations, you see the differences in experiences of smoking. Somebody now in their 80s or 90s almost certainly will not be alive if they are a heavier smoker, because they probably will not have benefited from any of the public health information that has taken place under previous Governments, so that is obviously the major difference.

In terms of the different health conditions, we know that certain health conditions will increase with age. Dementia is the greatest example of that, where we know that the older you are, the more likely you are to develop dementia. In a sense, as our population as a whole has gotten healthier and lived longer, it has become increasingly apparent where those health inequalities are at their most acute.

Q Thank you; I will be very brief. Do you think it is fair to describe older adults as having made a choice, when perhaps it was not an informed choice, given the misinformation and lack of evidence at the time that they made the choice to start smoking?

Paul Farmer: I think a lot of people made a choice without having the information in front of them. I suppose my parting thought to this Committee is that the consequences of failing to intervene in previous generations are now seen by the older people of today. If this legislation is implemented, the first generation of people will not reach 65 until 2074, but I can tell you that that generation of 65-year-olds will look back and recognise the contribution that the Government have made to changing and impacting on their long-term health in the same way that this generation looks back on the contribution of other Governments in other health initiatives.