Minister - No Khan do

Perhaps I had low expectations but I was pleasantly surprised by Neil O’Brien’s speech at Policy Exchange on Tuesday.

As I wrote in my previous post, I wasn’t 100 per cent confident that the public health minister wouldn’t make a further announcement - raising the age of sale of tobacco, for example - to complement the initiatives that had already been disclosed and widely reported.

But I needn’t have worried. The speech, which you can read here (or watch here), was pretty bland and lasted no more than 20 minutes before attendees, in the room and online, were invited to ask questions.

The big ideas - a task force to reduce the illegal sales of vapes to children, ‘free’ vape kits to be given to up to one million smokers to entice them to switch, and pregnant women to be offered up to £400 to quit smoking - had all been revealed in advance.

Not leaked, btw, but deliberately announced in two press releases ahead of the speech.

It had also been reported (by The Times) that the Government had rejected proposals ‘to ban smoking in parks and pub gardens or to stop people under a certain age from ever buying cigarettes’.

I was reasonably sure, therefore, when I walked into the Policy Exchange offices in Westminster, that no nasty surprises were in store, but you can never be certain, which is why I wanted to hear the minister's speech for myself.

Fair play, though, to O’Brien. Parts of his speech may have been lifted from the tobacco control template, but I was impressed by his short but firm answers to the questions that followed.

Gratifyingly he also emphasised the Government’s belief in personal responsibility which, together with freedom of choice, is the principal platform Forest has stood on for over 40 years.

If that can't be chalked up as a small victory, I don't know what can, and if Monday's post – 'Go on, minister, surprise me' – cast doubt on the Conservatives’ commitment to this important principle, I can only apologise!

O'Brien's speech and this week's announcements won’t be the end of it, though. In the room on Tuesday ASH and Cancer Research just about managed to keep their frustration in check, but I suspect they are rather more livid than they are letting on, and the pressure on government to go further will only increase over the coming months – right up to the election, in fact.

Labour too will no doubt try to get in on the act. Briefed by ASH, expect to hear 'Government not going far enough' in the coming weeks and months.

The Times, which seems to have replaced the Guardian as the most strident anti-smoking newspaper in Britain, has already demanded further action from government. In a leading article today, the paper argues that ‘ministers must do more to extinguish the country’s deadly habit’.

‘It is not too late for ministers to reconsider,’ thunders the paper, adding:

Conservatives are always squeamish about state intervention, often with good reason. But no government has ever regretted butting in to the private lives of smokers whose habit not only kills themselves but blights the lives of others, and costs the NHS billions of pounds. If ministers are truly serious about a smoke-free Britain, they should have the courage of their convictions, and act on them.

However, as I noted in January (How The Times has changed), the days when a leading article in The Times carried much weight are long gone, so I don't expect ministers to take much notice, nor should they.

To be clear, when answering questions on Tuesday, Neil O’Brien did not rule out further measures (and we know from the plain packaging debacle in 2015 how quickly government can change tack when it suits them politically), but it’s hard to make a case for the sort of measures advocated by Javed Khan, The Times and ASH when smoking rates are already at their lowest recorded levels across all age groups, including teenagers, and the Government has so many more important issues to deal with.

It was noticeable that despite the Khan review being commissioned by his predecessor Sajid Javid, the Secretary of State for Health Steve Barclay was nowhere near this week’s announcements. Instead he was up to his ears with the junior doctors’ pay dispute and left the issue of smoking to a junior minister.

The public has of course consistently signalled that the Government and the NHS have far more pressing priorities than tackling smoking, as confirmed by a series of polls commissioned by Forest over several years including, most recently, in February.

My own reaction to O'Brien's speech was principally one of relief because the announcements this week could have been so much worse.

I have some reservations when it comes to taxpayers paying for vape kits and other incentives to encourage smokers to quit. As I have said before, why should the public (the majority of whom are non-smokers) pay for smokers to switch or quit?

Nevertheless, of all the policies the Government could have announced this week, these are probably the least coercive so we should be grateful for that.

Likewise I don’t see how anyone could object to the proposal for inserts in cigarette packs that offer the consumer more information about vaping and how to switch. You either read them or you don’t, and if you read them it’s still your choice whether to switch or not.

I don’t have a problem with smokers being informed about alternative nicotine products. The important thing is that they are not forced to quit or switch, and their lives are not made even more unpleasant with the imposition of further petty regulations.

Consider some of the ideas recommended by Javed Khan in his now infamous report:

Increasing tobacco duty by more than 30 per cent, banning the sale of tobacco in supermarkets, radically rethinking how cigarette sticks and packets look, tackling portrayals of smoking in the media, banning smoking in more outdoor public spaces, banning smoking in social housing ...

The flagship recommendation was raising the age of sale of tobacco by one year every year until, eventually, no-one would be allowed to purchase tobacco any more.

Even ASH distanced themselves from that idea. Instead they urged the Government to raise the age of sale from 18 to 21, an issue we tackled head on during our recent panel discussion in London.

Thankfully the Government isn’t inclined to adopt any of these ideas. In fact, O'Brien's strongest answer on Tuesday was in response to Shaun Walsh, head of public affairs and campaigning at Cancer Research UK, who pushed the Government to raise the age of sale.

Raising the age of sale, said O'Brien, was "too big a departure" and the Government wasn't going to pursue it.

Impressed though I was by O'Brien during the Q&A part of the event, the role of the Treasury can't be underestimated. As I wrote last week, intel suggested that the Treasury had been pushing back against Khan's invasion of 'their' territory, and this was clear from several of O'Brien's answers.

As for the author of ‘The Khan review’, O’Brien may have thanked him in his speech but the reality is that most of his recommendations have been ignored or rejected by the Government.

Significantly, Khan himself was nowhere to be seen on Tuesday. To the best of my knowledge he hasn’t commented on the Government’s proposals, nor has he posted a single tweet referencing them, which tells its own story.

Last year I noted that he had been invited to speak at a new tobacco harm reduction conference in New York. A few weeks before the event, in a post entitled ‘Javed takes Manhattan’, I wrote:

I had hoped the author of The Khan review: making smoking obsolete would quietly exit the stage, especially after the resignation of health secretary Sajid Javid who commissioned the ill-conceived report.

Instead Dr Khan is one of several UK-based speakers who have been invited to address a new conference – 'New Approaches to Tobacco Control' – at the Harvard Club of New York next month.

Given that Dr Khan's recommendations are no more than that and the UK Government has given no hint that it will adopt any of them, it seems a bit presumptuous for his 'keynote' address ('The Khan Review in a Global Perspective - The UK as Case Study on Tobacco Control') to be given such a grand title but it must be very flattering for someone who was unheard of as a tobacco control influencer only six months ago.

He's also taking part in a panel discussion ('How Can the Best Practices from the UK and the US FDA be Globalized to End Smoking in All Countries'?) so it looks like we'll never hear the end of it, or him.

Fingers crossed, this week may be the last we hear of the Khan review.

To be clear, I have nothing personal against Dr Khan who seems a decent man driven by good intentions. I do however think he was poorly advised and unwisely ‘protected’ by the Department of Health and Social Care (DHSC) who made sure he wasn’t exposed to heretical opinions from the likes of Forest.

To this day I still don’t know if he saw or even read our submission to his review, or whether he was even aware of our request for a meeting to balance similar meetings he was having with the anti-smoking lobby.

Either way we never got to present our case to him with the result that his ‘independent’ review came across as very one-sided, and rather naive.

The fact that we were then barred from attending, in person, the launch of his report merely added fuel to the fire but, again, I blame the DHSC more than Javed Khan.

I can imagine this has been a bruising experience for him, and I would be surprised if he returned to this particular battlefield any time soon.

I wish the same could be said of the tobacco control industry but we know they will regroup and come again because that’s what they always do.

Before the vaping industry is tempted to get further into bed with ASH et al, it’s worth noting another comment by O’Brien in response to a question from someone who wanted to know what measures the Government was taking to help people quit, not smoking, but vaping.

The minister's reaction was the same message we’ve heard many times from tobacco control. "In an ideal world, it's best not to do either," he said.

And that, ultimately, is the direction of travel. It may take decades but the long-term goal of the stop smoking brigade is the eradication of all recreational nicotine products and they will never be happy until that goal has been accomplished.

Nevertheless, credit where credit’s due. Knowing it would be criticised in some quarters, the Government held its nerve this week and announced smoking cessation policies that, for once, put the carrot before the stick.

After two decades of anti-smoking legislation that has frequently put bullying and coercion ahead of information and education, that’s a significant step forward.

So I take back part of what I wrote on Monday.

Minister, you DID surprise me!

PS. As an aside, while I was waiting for the lift to take me to the Policy Exchange offices on the third floor of the building at 1 Old Queen Street, I saw a familiar figure scurry past the main entrance.

It was Deborah Arnott, CEO of ASH, and she appeared not to know where the Policy Exchange office was. (I had just had a similar experience so I was sympathetic.)

Being a decent chap I wandered outside, through the automatic door, hoping to catch and direct her inside.

When I got to the street however she was too far away, with her back to me and still walking, so I went back inside and made my way to the conference room.

Ten minutes later, having finally got her bearings, she appeared in the room, made a beeline for O’Brien, and spent the next ten minutes chewing the poor man’s ear off, her voice ringing across the room.

I'm in awe – what a woman!

Comments

[Pat Nurse]

As long as political lobby group ASH is exclusively close to government decision making we can never be sure the persecution will end. Ministers change, but anti smoker zealots stay in office.

I agree that O'Brien could have done worse. Chris Snowden also wrote a good review of the announcement and reported O'Brien mentioned some figure from the anti smoker industry suggesting smokers are less likely to get employment than non smokers.

If that is the case, forcing smokers to quit is not the answer to ending discrimination but ensuring smokers are treated as fairly in the employment market as non smokers is. There should be laws to protect people who smoke from the prejudicial discrimination of potential employers who currently refuse to employ, or sack, smokers based on nothing more than their identity.

Discrimination against smokers in the workplace is something I have raised previously with ministers going back as far as Gillian Merron. Now Govt recognises it is happening, and O'Brien's speech seems to suggest it does even though the blame is put on those discriminated against rather than those employing the discrimination, surely there now needs to be employment protection for people who smoke to end discrimination and level up their prospects of employment with those of people who do not smoke and ensuring they have same rights as other minority groups from workplace discrimination.