Paul Farmer gave evidence.

Q We will now hear evidence from Paul Farmer, who is the chief executive of Age UK. This brief session will last only until 11.25 am, so the time will need to be snappily used. Mr Farmer, this seems unnecessary, but for the record can you simply state your name and title?

Paul Farmer:

Good morning, everyone. I am Paul Farmer and I am chief executive of Age UK, the charity supporting older people.

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—

Very briefly.

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.

I will attempt one final question from Dr Lisa Cameron. I simply make the point that the briefer the question, the more possibility there is that she will get an answer.

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.

I thank the witness for his answers to the questions from Members, which were really helpful. They gave us not only the perspective of those who his organisation represents, but the intergenerational nature of their role in the world. That brings us to the end of this morning’s sitting. The Committee will meet again at 2 pm here in the Boothroyd room to continue taking oral evidence.

Ordered, That further consideration be now adjourned. —(Aaron Bell.)

Adjourned till this day at Two o’clock.