Rachael Maskell
MP for York Central · Labour (Co-op) · United Kingdom
“I welcome today’s statement and I welcome the Secretary of State to her place. York hospital was heralded as a cheap build, but we are paying a heavy price today. We know that heat in that hospital will have an impact on clinical outcomes as well as on staffing.”
“The conflict is moving beyond traditional warfare; we are now seeing extensive drone use, mercenaries being brought from Colombia, and the exchange of money too. We also know that Russia has its own interests in weapons and gold. We must look at the minimal interest in Sudan and the developments in Port Sudan at this time.”
“When we think about the fact that 33.7 million of the Sudanese population are in need of humanitarian assistance, 13 million have been displaced, 19.5 million are at levels of food insecurity and need urgent attention, and there are 8 million children who are not in the safety of school every day, getting their education, which will fuel…”
“Will the Minister tell us what progress has been made in that area, how that money has been spent and its impact to date? As we see increasing brutalisation in war, we have to focus even more on how we use international law to hold actors to account, and on the pace of that process, because it takes forever and a day to bring people to ac…”
“In the assault on El Fasher in particular, we saw the systematic raping of women, the burning of people and places, and the escalation in the next chapter of the civil war that has raged since April 2023.”
“It is a pleasure to see you in the Chair, Dr Allin-Khan. I congratulate my hon. Friend the Member for Gillingham and Rainham (Naushabah Khan) on securing such an important debate.”
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“Q But the testing kit would have to come through you? Dr Squire: It would depend on what it was defined as. I think we could be going into the medical device regulations. I am thinking on my feet, but I would say that a testing kit to test a product would probably not be “for a medical purpose”. It probably would not be under the medical device regulations because the testing kit itself does not have a medical purpose, but it is quite a fine line. We would need to look at the actual testing kit and its purpose.”
“We find when we speak to young people that they associate vapes not with cessation, but with social vaping. It is important for the Bill to be mindful of all of the marketing mix, and I would put sponsorship in there as well. We know that there has recently been investment from tobacco companies in outdoor advertising for their vapes, and we are seeing a lot of sponsorship of nicotine products at music festivals and music events and in the sports sponsorship that I mentioned earlier. It is really important to be mindful of all those marketing avenues.”
“Q I want to come back to the point about advertising. Should the legislation bring tobacco advertising and vaping advertising into line so that the same standards are applied across all products? Professor Ford: That is something to consider. As I said in my previous answer, it is the whole marketing mix of the current vaping products that has led to the rapid rise in youth use. That includes not only the packaging, the retail displays, which we have spoken about, and the flavours, but the actual product design: the price, the promotion, the price promotion, the images on social media, the posters in the shop window—there are a lot of youth cues and messages in some of those—the accessibility, because of the wide variety of retailers that sell these products, and the user imagery.”
“Q You have talked about alternative products. We know that the industry is very adept at switching products to avoid regulation. Should we be creating a nicotine-free generation alongside a smoke-free generation, so that people who have never smoked will also not have access to nicotine products? Professor Ford: We do need nicotine products on the market, because we know that they can be helpful for adult smokers.”
“I am in touch with colleagues in the US to try to get any evidence from those measures as they emerge. You are right: nicotine, as I mentioned, is harmful to the developing brain, so ideally we should be aiming for smoke-free and nicotine-free generations in future, in line with the smoke-free generation legislation, while making sure that current smokers are able to quit using nicotine. But that is recreational nicotine, not pharmaceutical nicotine.”
“Q But these people have never smoked, because, having been born from 1 January 2009, they would not have been introduced to smoking. That would be unlawful. Professor Ford: Given the potential harm that nicotine can cause to young people, and the fact that generally everyone is in agreement that if you have never smoked, you should never vape, yes. I do not see an argument why we would need young people to use nicotine. That is my personal view. Professor Gilmore: I would support that. These measures have been put in place in some cities in the US in Massachusetts and California, where they have implemented both smoke-free and nicotine-free generations. They have not been evaluated yet, but I know that other cities are now implementing the same policies, so I think they must have been going reasonably well.”
“Certainly, in terms of de-normalising vaping and reducing addiction, there would be benefits.”
“I think that having vape-free public places would go towards de-normalising vaping, which is also really important, particularly among younger people. The other thing, of course, is that the more you vape, the more nicotine you are taking in and the more you are addicted. If you can do it in public places and in workplaces, you can get more and more addicted; some ex-smokers have said to me that they find that a problem, because they can just keep vaping in some places, so they are now using more nicotine than ever before. I suppose it is theoretically possible that if they were not able to vape, they might shift back to smoking, but I do not think they would: we do not have any evidence for that and I do not think that that even really makes sense.”
“Q I would like to ask one further question, if time will allow, about the locations where people can vape. Smoking has now been banned in indoor places, cars travelling and cars with children present. Would the same impact around deterring people from vaping occur if the same statutory requirements were put in place? Professor Gilmore: Smoke-free legislation had a number of impacts. It was primarily there to protect non-smokers from the effects of second-hand smoke, which we know is harmful, and it was successful in that: we evaluated it and showed reductions in admissions to hospital for heart attacks, asthma and so on. We know far less about second-hand vape, if you like, but smoke-free legislation also de-normalised smoking.”
“One problem we have behind the perception about the relative risks of the two products is that, for example, fewer than one in 10 smokers knows that vaping is a lot less harmful than smoking, so I would be wary of putting them on exactly the same footing. It is important that we try to distinguish the relative risks through what we do. I think we can further reduce the advertising of e-cigarettes, particularly, as I have said, in shops, because that seems to be one area where young people can buy these products that are heavily promoted, and the branding is in itself a form of advertisement. Professor West: I agree. I think the key thing is the messaging in the advertising. It is already the case, if I understand it right, that you are not allowed to advertise e-cigarettes as a fashion item or leisure product.”
“Q I want to follow on from that theme on advertising and to take your opinion about advertising, promotion and sponsorship. We have seen the vaping industry very much following the lines of how the tobacco industry evolved in the way that it is very adept at promoting its products. Should there be a ban on advertising as there is for tobacco? First, for simplicity, so everyone knows what the rules are, and secondly, for effectiveness—that is, to discourage a new generation of vapers? Professor McNeill: My view is that there is a bit of a danger if we put smoking and vaping on exactly the same footing.”
“Obviously, there is a whole bunch of things going on, but it is a deterrent. Not only do we know this from the surveys, but I have been talking to a lot of people—intelligent academics even—who say, “Why would you switch to e-cigarettes? They are just as harmful as smoking.” We are not getting that message across. Whatever we do in relation to indirect messaging that might create a sense of equalisation or equality between e-cigarettes and smoking, we have a big comms job to do to make sure the message gets across that it is not the only method of stopping smoking, but it is an important one that a lot of people can use even if they do not, for example, use stop smoking services.”
“Q They are on football shirts. When we pressed a company that came to our Select Committee, they said, “This is a public health message.” They did not have “do not smoke” on the shirts, so I did not buy that, because they are trying the same tactics. Professor West: That, in a way, is a question of implementation. I agree with you. Just putting a brand on a shirt is not a message saying, “This can help you stop smoking.” If they had put, “Use this to help you stop smoking” on the football shirt, maybe it would be a different thing. Ann’s point is also a very important one. The weirdest sort of miscommunication that we have had over recent years is that as evidence has accrued that e-cigarettes are less harmful than smoking, the perception that they are more harmful than smoking has increased.”
“That is just unacceptable. The measures in the Bill will help deal with that and lead us, we hope, towards the nicotine-free generation that you talk about.”
“Personally, I think that there is merit in that, but we have to be careful, because some of the arguments are different. The arguments around smoke-free public places are based on passive smoking, but we do not have a lot of data on passive vaping; many people see it as a nuisance, but that is a very different argument. We need to be a little bit cautious about that, even though I would personally be in favour. The important thing is to remember that we really need to keep vapes as the quit tool. Your point about moving towards a nicotine-free next generation is absolutely right; that is really what we want to do. If we can make it less acceptable and less prevalent that children take up vaping, we should move towards that. The reality is that over the last three years we have seen a tripling of vaping among our children and young people.”
“We need to support those individuals who currently smoke or are currently addicted to nicotine to gradually move away from that addiction. That includes supporting smokers who currently smoke to quit, but we are increasingly seeing individuals who wish to quit vaping and are finding it difficult. We are at the start of a journey. As Sir Chris has said, we do not want to delay this Bill and this important step change, in terms of making very significant progress. Sir Frank, do you want to add to that? Sir Francis Atherton: Very briefly. The principle of alignment is a positive one. Keeping it simple for the public is in the interest of messaging, as a general point. In Wales, we did try—in 2016, I think it was—to align smoke-free and vape-free public places.”
“We recognise that there are nicotine replacement products other than vapes that are very effective and that individuals successfully use, but for some individuals, as has been stated already and as is outlined in the relevant NICE guidance, vapes can be effective and are safer than smoking. It is about finding the sweet spot—hence the powers to consult. We need to get a balance to ensure that we are absolutely not creating circumstances in which vaping is attractive to young children, starts a lifetime of addiction to nicotine and is potentially a gateway to smoking tobacco, as I think your question is suggesting. But at this point in time, this is an important step to ensure that the next generation are protected from smoking tobacco.”
“Q Thank you to all the CMOs. I would like to press that point a little further. Should the advertising of vapes be in alignment with that of tobacco products, for simplicity and understanding? Should the rules on where people can vape be in alignment with those for tobacco products, so not in indoor spaces or in cars transporting children? Are we missing an opportunity, in the light of the opening comments about the addiction to nicotine, to create a nicotine-free generation, as opposed to a tobacco-free generation? Professor Sir Chris Whitty: I wonder whether Sir Michael might want to go first, and then Sir Frank. Professor Sir Michael McBride: We have to start somewhere. What we actively want to do, at this point in time, is encourage those individuals who smoke to quit smoking.”
“This is a golden opportunity for parliamentarians to step in early and to prevent further pressure building over time on the NHS, while recognising that the evidence is still emerging. I agree with the chief medical officers you heard earlier: I do not believe that vaping is safe. It is undoubtedly safer than smoking, which is why we support its use as a means of smoking cessation, but beyond that the evidence is building that it is not safe. Unquestionably, it will have a building impact on the NHS.”
“I have highlighted the number of admissions per year, but they have doubled over the past few years, so that impact is becoming apparent. For example, yellow card reporting to the MHRA is a mechanism for reporting harm, and again the number of incidents related to vaping is increasing, although still in relatively low numbers. As I said earlier, however, what is important here is that the evidence base, although emerging, is growing. This is an opportunity for us not to get into a position where, in years to come, we regret that we did not take the steps early on to change the trajectory. Instead of seeing rising impact on the NHS—small at the moment, but with the potential to be greater—that trajectory should be changed.”
“Q As you have just set out, we understand the harmful impact of tobacco, but I want to look at vaping. Is there any evidence of the impact on individuals who vape, or of a secondary impact, such as on triggering asthma or NHS admissions, or of an impact on admissions from the contents of vapes? We often talk about vapes, which are a delivery mechanism for substances. How should we regulate so that people understand what they are vaping, not least because it is now moving to an illicit market? Professor Sir Stephen Powis: As I outlined earlier, the impact on the NHS of vaping at the moment is relatively small compared with the impact of smoking. Nevertheless, there is an impact, and we are seeing growing numbers.”
“I see a smoke-free generation as the logical next step, and I really think we have to take it.”
“Professor Turner: Just to supplement that, as a user—if that is the right word—or a customer buying a vape, you can select the dose you want. There are doses that are equivalent to cigarettes and doses that you can wean yourself down on. You asked whether we would be missing an opportunity if we do not introduce a smoke-free generation. I think we would absolutely be missing an opportunity. If we look back, the legislation on smoke-free public spaces across the UK was landmark. We all remember the days when you went on a plane and there was a smoking bit up front and a non-smoking bit at the back. If we were to go back and say there would be no smoking areas, we would think, “Wow, that would be transformational.” We have come on a journey, and the legislation has been part of it.”
“Q We have already heard how addictive nicotine is, but do we have an understanding of the dosage of nicotine that people inhale through vaping versus through smoking? Secondly, are we missing an opportunity not to introduce a nicotine-free generation? Professor Hawthorne: I am not a nicotine expert, but my understanding is that there is a risk from vaping, but it is about 5% of the risk from smoking. That is the best I can do in comparing the two. When I talk to patients about stopping smoking, vaping is one of the things we talk about as an alternative, with a view to eventually stopping vaping as well. Of course, there are all the other products: we use patches and chewing gum—all the usual things. It is difficult to quantify exactly how much less dangerous vaping is than smoking.”
“Q Just to come back on that, I said a nicotine-free generation. Professor Turner: To me, smoking and nicotine are two sides of the same coin. Nicotine addiction is smoking.”
“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?”
“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.”
“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.”
“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.”
“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.”
“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.”
“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.”
“The ADPH does not have an official position on the passive inhalation of vapes, but my personal view is that in open spaces I am not too worried about it. In enclosed spaces, I might be, particularly for people who have pre-existing respiratory conditions, but I do not think that the evidence supports it being as big an issue as people think. However, that is definitely a question for Prof McNeill, who is the expert on such matters.”
“Q My question is for Greg Fell. The clarity and simplicity of knowing where you can smoke has meant that the universal principle of that bar has largely been applied, but it has not applied to vaping to date. Given that vapes contain not just nicotine but cannabis, Spice and other illicit substances, should the same restrictions be applied to vaping? Greg Fell: Hopefully only illegal vapes contain cannabis or Spice, and not legally produced ones—I sincerely hope that is the case. I have mixed views on vaping in public. I think that Prof McNeill will talk later this afternoon. It is worth reading her evidence review for the Office for Health Improvement and Disparities, which has a whole chapter on the passive inhalation of vapes.”
“It might be something that you want to test them on later, but I do not know that there is lots of evidence of that. Nobody thinks it would be a good thing to do. I think it is fair to say that there is widespread misunderstanding, and occasionally misinformation, about the dangers of vaping in much of the popular press. When we read a study about immensely high doses of vape in the lungs of mice, that leads to awfully lurid headlines, and that causes people to have misunderstandings and misinformation about the relative risks and benefits of vaping compared with smoking. Sadly, I cannot stop that, but it is a problem and I do not think there is an easy solution, because the media like to publish good headlines. I get that; I understand it, but it often skews us away from what the science is actually telling us.”
“Q Again, the question is to Greg Fell. We know that there is a risk around a transition between vaping and smoking. I understand that a paper will soon be published on that in Sweden. A York schools survey has shown that 42% of children think that vaping is as dangerous as smoking and that 17% think that vaping is more harmful than smoking. How are we going to avoid future risk around young people taking up smoking, even if that is in later life? They are young people, obviously, today, but I am talking about young people outside the age group for the year-on-year increase. Greg Fell: I do not know that there is a lot of evidence on the gateway effect of switching from vaping to smoking. Again, there are proper experts, some of whom are sitting behind me.”
“But there is a huge amount of enforcement around illegal drugs in this country, with the police, and the public health approach, about ensuring that people do not use illegal drugs. However they consume them, it is really important that they are on board—”
“Q My big concern is the illicit trade around vapes. What further measures would be helpful in the legislation to enable you to do your job? Vapes are clearly a delivery mechanism. We have particularly focused on lung health; I am more concerned about the use of vapes for synthetic drugs, which are available in my community and, I am sure, elsewhere. What more can be done to ensure that we do not see the growth of illicit vapes on our street corners or in our shops? Kate Pike: Illegal drugs are not a trading standards issue. If drugs are consumed via vape or by injection or rolled up in a roll-up, that is not our issue; that is a police issue. We can only enforce the law around the products where the enforcement is given to trading standards. We have no role whatsoever in illegal drugs in vapes.”
“I was walking down Hackney high street with trading standards just a couple of weeks ago. About every third or fourth shop, regardless of whatever the main thing it sold was, was also selling vapes on visible display. It is about making sure that we are aware of the level of vapes being sold, and that we therefore take the appropriate action, which is what the Bill should enable us to do.”
“Q But a vape product looks like a vape product, in all its various kinds. That is really what I am getting at. Kate Pike: If you have intelligence around a vape seller selling an illegal drug in a vape, or in any other sort of format, that should be reported to the police. The police will take action against illegal drug sales, or Border Force at the ports and borders. There is a huge enforcement body around illegal drugs. John Herriman: It is the market surveillance point again. If you have the right level of market surveillance, which is down to capacity, you will have trading standards officers, as well as those from other agencies, out and about who will detect the stuff. Then you can take the appropriate enforcement activity by whichever agency is appropriate at that particular point. I take the point that was made earlier.”
“Perhaps the savings I have put aside could be better spent by them than on me.” It is not necessarily coercion, but the way that people feel in a society that changes the law. We have much to address, including the physical, psychological and spiritual needs of people in our country, and that must be our first consideration.”
“We should move on from the embarrassment and inconvenience and look at how quality of life can be given to everyone, no matter their impairment. Loneliness and isolation are also cited, but that is a societal failure that must be addressed. If we improve our NHS care, our social care and civil society, many of those reasons will be dismissed. The reason why we are debating this issue is not lost on me: the NHS is in tatters, social care is in a dire condition and so much funding has been withdrawn from civil society. There is much for the Government to do, and they must address those reasons in order to ensure that everyone has the opportunity for a good end-of-life experience. I am worried about the person who says, “I’m just getting in the way. My children will have a better future without me.”
“Not only should there be more investment in palliative care, but we should push on with the opportunity for more research in that area. Of course, we should also address the social factors that are cited as reasons why people want to access palliative care. It is often about poor death literacy. Certainly, I am disappointed that the Government do not have a plan to improve that, so I urge them to consider it. We must also look at the reasons why people have opted for end of life in other jurisdictions, as set out in the petition, including the loss of meaningful daily activities, the loss of dignity and incontinence. For many people, perhaps those with an impairment, that is their daily experience, and yet it would be wrong to say that that dehumanises them as individuals.”
“It is a pleasure to follow the Chair of the Health and Social Care Committee, having also travelled to take evidence over the last 18 months and really engaged with everything people have written to us about in sharing their opinions and life experiences. I really do commend the report to the House. We learned especially about the need to have a better death, and there are lots of opportunities for that, through improvements in palliative care and listening to clinicians about the extent to which that can be brought about. We also heard very clearly that if the law were to change, it would fundamentally change the relationship between the physician and the patient, and the House must take that into consideration.”
“The inequality in the funding formula is driving inequality for children with SEN. In York, we are seeing not only the lack of placements that are needed, but staff being laid off because of an inadequacy of funding. We know that the number of children with SEND is growing exponentially in York, so will the Minister not only review the funding formula to ensure that it is fair, but give local authorities the power and provision to provide for the future needs of our city?”
“What discussions has the Minister had regarding UN security forces accompanying trucks to enable them to move into Gaza in the light of the impediments they are facing, and also rebuilding infrastructure so that trucks can travel across the country to deliver crucial medical and other humanitarian aid?”
“York has one of the worst housing crises in the country, yet we have not had a local plan to restrain developers for 68 years. Why has it taken this Tory Government more than 14 years to deliver a local plan for York?”
“The children’s sector, yes, has received a grant, but what comes next? We cannot just run our hospices by running marathons and running charity shops. It is driving inequality. In areas of greater deprivation, fundraising is even harder and therefore the hospices are getting even less money.”
“With a total income of £8.6 million, it had a £1.3 million deficit. Only 18% of its funding came from the statutory sources, £1.1 million came from the national children’s hospice grant and £700,000 came from the ICB. Hospice UK estimates a £77 million deficit for the financial year just past—the worst for 20 years. As demand and costs are rising, the funding is not rising to match. As of 12 April 2024, St Leonard’s hospice in York did not know how much money it was getting from the ICB: left to carry all the risk and left to depend on its reserves, and that, of course, not guaranteed for the future. Martin House, which is also using its reserves to expand its services, knows that it will have only six months of reserves. It certainly does not know what is happening with its funding after this financial year.”
“Currently, however, we know that many people—Hospice UK says one in four—are not accessing palliative care. That is 150,000 people every year who die without the support they require. That number is set to rise 25% by 2048 and, according to Marie Curie, by 13% in the next decade. This debate cannot just be about what happens now, but what happens in the future. In York, the hospice ran an £800,000 deficit last year. The hospice at home funding has remained static for the past seven years, while demand has doubled and the ICB has provided just a 1.2% increase. Sue Ryder believes that the real cost increase over the past year was 10%. Hospice UK figures released say there has been an 11% increase for the payroll this year to around £130 million. Martin House, the local children’s hospice, costs £9.9 million to run.”