A quick update on developments that may or may not have a bearing on the Government’s tobacco control strategy.
We have a new Secretary of State for Health, a new minister for public health and a new chair of the Social Care and Health Committee.
It barely seems credible but so far this year there have been three health secretaries, one of whom is now in his second term of office in 2022.
The year began with Sajid Javid in post. Appointed in June 2021 following the resignation of Matt Hancock, it was Javid who commissioned Javed Khan, a former CEO at Barnardo's, to conduct a review of the Government's tobacco control policies.
Published in June, The Khan Review: making smoking obsolete featured 14 recommendations including a proposal to raise the age of sale of tobacco by one year every year until no-one will be allowed to buy tobacco legally.
Welcomed by tobacco control campaigners, it was derided by critics including Clive Bates, the former director of ASH, who commented:
Too much of Khan’s proposed agenda involves measures to hurt, restrict or humiliate smokers and to press them to stop smoking in response.
We'll never know whether Sajid Javid would have embraced any of Khan’s ”crackpot” ideas because on July 5, the day of the Forest Summer Lunch at Boisdale of Belgravia (which is why I remember it so clearly), Javid resigned as health secretary followed minutes later by Rishi Sunak. Together they dealt Boris a blow from which his premiership never recovered.
Stephen Barclay, Javid’s replacement, but had barely got his feet under the table before Boris was announcing his own resignation and after Liz Truss won the leadership battle, defeating Sunak, Barclay was immediately replaced by Thérèse Coffey.
Six weeks later, following Truss’s resignation (keep up!), Sunak succeeded her as PM and in another reshuffle Coffey was moved to the Department for Environment, Food and Rural Affairs (Defra) with her old job being given to … Stephen Barclay.
Although I expected Coffey to lose her job as Secretary of State for Health, I was nevertheless disappointed. As I wrote here she seemed like a breath of fresh air.
Her appointment as health secretary hinted at a new, less bossy direction for government and in her brief period at the DHSC it was clear that the puritanical health lobby was getting impatient and twitchy.
At the very least, as an interview with Nick Ferrari on LBC suggested, a new tobacco control plan was unlikely to be top of her agenda.
Again, we’ll never know what would have happened had she remained at the DHSC but it would have been interesting to find out.
So what now?
Well, unlike Coffey - who voted FOR an amendment to the smoking ban (in 2010) and AGAINST the ban on smoking in cars with children (in 2015) - Stephen Barclay did the exact opposite.
Barclay said he felt children deserved the “same protection” as pub goers – who benefited from a ban in 2007 – and went as far as to praise the last Labour government for introducing it …
“The last Labour Government deserve credit for banning smoking in pubs, which as a non smoker I have benefited from. It is overdue that we now ensure children in cars receive the same protection.”
Unlike Coffey, he also supported plain packaging. (See The Tory MPs who sided with Labour to support the theft of intellectual property.)
Not a good look for any Conservative, let alone one who prefaced his support for banning smoking in cars with children by saying, “As a general rule … the Government should try to avoid interfering in people’s lives.”
Meanwhile, what of the new Minister for Primary Care and Public Health, Neil O’Brien?
Elected in 2017, O’Brien is a former director of Policy Exchange, the conservative think tank founded in 2002 by, among others, Nick Boles and Michael Gove.
I wouldn’t read too much into it - not yet anyway - but O’Brien was director when Policy Exchange published a report, Cough Up: Balancing tobacco income and costs in society.
Published in March 2010, it is summarised on the think tank’s website as follows:
Smoking is the single, largest preventable cause of serious ill health and kills tens of thousands of people in England every year. It is a popular myth that smoking is a net contributor to the economy – our research finds that every single cigarette smoked costs the country 6.5 pence. In order to balance income and costs, tobacco duty should be progressively increased until the full societal cost of smoking is met through taxation.
In an email to supporters, O’Brien wrote:
Dear Friend
Whilst tax on tobacco contributes £10 billion annually to the Treasury coffers, the true costs to society from smoking are far higher, at £13.74 billion, think thank Policy Exchange’s latest report finds. This cost is made up of the cost of treating smokers on the NHS (£2.7 billion) but also the loss in productivity from smoking breaks (£2.9 billion) and increased absenteeism (£2.5 billion); the cost of cleaning up cigarette butts (£342 million); the cost of fires (£507 million), and also the loss in economic output from the deaths of smokers (£4.1 billion) and passive smokers (£713 million).
The report, Cough Up, calculates that of this £13.74 billion, cigarettes – which comprise 93.3% of the tobacco market - cost us £12.82 billion a year. Currently, a pack of cigarettes costs just £6.13. But this would need to be increased to at least £7.42 for cigarettes to be revenue neutral to society and their true cost reflected by their price.
Tobacco control campaigners quoted these estimates and calculations for years but the backlash from more sceptical observers was immediate, prompting me to write:
I wonder if Neil O'Brien, director of Policy Exchange, is aware of the terrible damage a report like this has done to Policy Exchange's reputation in centre right circles. I won't forget it in a hurry, and nor will a lot of other people.
Needless to say ASH wasted no time welcoming O’Brien to his new role at the DHSC, tweeting:
Congratulations @NeilDotObrien. As Levelling Up Minister you rightly said govt needed to “think extremely radically and really floor it” on prevention and public health. We look forward to seeing you deliver #smokefree2030
For a so-called ‘charity’ you have to admire the speed with which they rushed to lobby the new minister. Ditto local authority-funded Fresh North East who tweeted:
Welcome to @NeilDotObrien and we look forward to meeting you to discuss vital role of tobacco control to address health inequalities and also levelling up.
Finally I’m sure you’ll want to congratulate the new chair of the cross-party Social Care and Health Committee whose role is to ‘scrutinise the work of the Department of Health and Social Care and its associated public bodies’.
Formerly chaired by Jeremy Hunt, who now has more important things on his plate, his replacement is Steve Brine who was public health minister from June 2017 to March 2019.
Within weeks of his appointment (by Theresa May) he had not only published a new Tobacco Control Plan but received public support from ASH who gushed:
ASH congratulates Steve Brine for showing his commitment to tobacco control by getting the new Plan published only weeks after taking over as Public Health Minister. The vision of a “smokefree generation” it sets out is a welcome step change in ambition from the last Tobacco Control Plan for England and should be achievable by 2030.
Since stepping down as public health minister (he resigned in protest against a possible no deal withdrawal from the EU) Brine has continued to actively engage in tobacco control.
In March this year he ‘joined colleagues from across Parliament at a parliamentary event to celebrate No Smoking Day’ (MP commits to a smokefree future), saying:
“I worked closely with ASH when I was at the Department of Health and they have a fine pedigree of informing Government and helping us transition towards smoke free. We’ve done a lot in 50 years but, as ASK (sic) are well aware, we have a lot more to do starting with a new ambitious and deliverable SmokeFree England plan this Spring."
Most recently he responded to reports that (former) health secretary Thérèse Coffey might abandon the Government’s smoke-free target by arguing that it would be a “massive own goal”.
PS. As an aside and nothing to do with tobacco control, Nick Boles, a co-founder of Policy Exchange, was a staunch Remainer who quit the party in April 2019 and didn’t stand at the 2019 general election.
Now a footnote in history, Boles’ Wikipedia entry is worth reading if only for this:
He endorsed the Liberal Democrats in the 2019 election but then revealed that he had in fact voted for the Greens. During the 2022 local elections, he announced that he would be voted Labour and said that he had also done so in 1997.
Ladies and gentlemen, a thoroughly modern ‘Conservative’!
Update: Today’s business in the House of Commons includes a ‘debate’ on tobacco control:
Independent review of smokefree 2030 policies
Bob Blackman
Mary Kelly Foy
That this House has considered the recommendations of the Khan review: Making smoking obsolete, the independent review into smokefree 2030 policies, by Dr Javed Khan, published on 9 June 2022; and calls upon His Majesty’s Government to publish a new Tobacco Control Plan by the end of 2022, in order to deliver the smokefree 2030 ambition.