Ailsa Rutter gave evidence.

We now move on to our next witness, Ailsa Rutter, who is the director of Fresh and Balance North East. I am looking forward to find out what that is. We have 20 minutes for this session. Ailsa, could you kindly introduce yourself for the record? By all means, add some more if you wish to, but the Committee will have plenty of questions for you.

Ailsa Rutter:

Thank you so much. I am absolutely privileged to be here with you this afternoon, speaking on behalf of the north-east and the many partners in the region who will give you their overwhelming support for this absolutely crucial, complete once-in-a-lifetime opportunity to have the single biggest impact in addressing the biggest cause of cancer. For those of you who might not know what Fresh and Balance is, we are a regional tobacco and alcohol programme based in the north-east of England. We have been going for 20 years, we are funded by our local authorities and our NHS trusts, and we are doing a lot of work to drive down the harms on both tobacco and alcohol.

Q My first question to you is, what is the impact of tobacco smoking on public health? Secondly, do you think the Bill’s measures to prevent vaping products from being sold to children will be successful? That is essentially clauses 61 and 62.

Ailsa Rutter:

Tobacco is devastating. It is devastating to every individual who dies way too young, and to the family who lose their loved one. In my region alone, just since the turn of the millennium, 120,000 of our loved ones have died from smoking. It is not an adult choice, but a childhood addiction. The vast majority of those smokers reach a point where they deeply regret having got hooked in childhood, not thinking that first puff on a cigarette would be so addictive. It is really important that we remember the 6.4 million remaining smokers in the UK and the fact that 350 18 to 24-year-olds will get hooked on lethal tobacco smoking today.

I would like the Committee to imagine that cigarettes did not exist. It is 2024, and here we are discussing a product that is designed to hook, kill, maim, and be completely addictive. This discussion today needs to be about the future world we want to strive for. We can talk a lot about how we will enforce it, which is very important, but for me this is about imagining that in 20 years’ time we have created an entire new generation protected from this uniquely lethal product. That is why in the north-east, all 12 local authorities, all 10 NHS trusts, our integrated care board—the biggest in the country—and our Association of Directors of Public Health have given whole-hearted, unanimous support to the “stopping the start” proposal on the age of sale of tobacco.

We absolutely recognise that smoking is much more harmful than vaping, but vaping is not risk-free. Vaping is playing a pivotal role in our region—with our higher levels of deprivation and addiction—to get people off lethal smoking, but that is not to say that we do not absolutely agree that much more needs to be done to reduce the appeal of vaping to young people. We wholeheartedly believe that we must address the inappropriate packaging that is too youth-friendly. Some of the in-store promotions are completely inappropriate, where children are really noticing it. We must ensure that we recognise that children are growing up within a family context; children do not live in isolation. There is also the importance in our region of sending clear, evidenced-based messaging. We can also see the positive impact on children’s health if we can get the parents and carers off lethal tobacco smoking and if we can reduce second-hand smoke harm. Really important as well is more money in people’s pockets, because cigarette smoking has such a negative effect on your income.

Q Thank you so much for being here and for all you do in the north-east. It is fantastic.

As you will know, rates of smoking during pregnancy in the north-east are some of the highest in the country. Do you think this legislation will help to reduce those very high numbers? The rate is somewhere in the region of 14% in the north-east.

Ailsa Rutter:

We have made really good progress in the north-east in reducing maternal smoking; that has come through very good collaboration between our local maternity services and our local authorities, as well as the fantastic leadership from key people in the local maternity and neonatal system, the LMNS, and the direction from directors of public health.

As with anything, there is not one magic solution; it is about taking comprehensive measures. The tobacco age of sale increase will undoubtedly have a really positive impact on reducing maternal smoking. It needs to be coupled with important things that we must continue to do as well, so we also welcome the increased investment for stop-smoking services.

We hugely welcome—thank you—the reinvestment in the evidence-based health harms campaigns. We are thrilled that nationally you are using our fantastic “smoking survivors” TV advert featuring Sue Mountain. The role of financial incentives is also really important; we know that they have a very strong evidence base. This will have a positive impact on maternal smoking.

Q If there was one thing you could add to this Bill, what would it be?

Ailsa Rutter:

Gosh! There are already some fantastic elements in the Bill. The key thing for me is to make sure that we can get the Bill through—particularly the focus on tobacco. It is really good to think that there is going to be subsequent consultation on the important elements around vaping. Factoring in what colleagues said previously, we need a simple mandatory age verification scheme. That is already in place in Scotland, and I would certainly welcome its introduction in England.

Thank you, Ailsa, for all the work that you do up north in the north-east. I represent the north-west, Cumbria, which also has higher than national average rates of mothers saying that they are smoking at the point of birth—about 12.3%. I am told by our authority in Cumbria that about 3,500 hospital admissions, 74,000 GP appointments and 80,000 sick days are caused by smoking-related illnesses. But why not just do more of what you are doing in the north-east? Do you really need this Bill to tackle the problem?Q

Ailsa Rutter:

I think we are doing some really good work in the north-east but I absolutely think that this Bill is required. I go back to the uniquely lethal nature of tobacco smoking; that is the one key argument that we need to think about. This is guaranteed to kill. For me, this is about a societal shift.

I am really pleased with the huge shift in the north-east on the social norms of smoking. We talk to people who smoke every single day, and you have their backing because they desperately do not want their own children to fall into the same trap. As I mentioned before, this is about aspiring into the future. We are all conscious of the pressure and strain on our NHS. Think about the impact—one in four beds in the north-east and elsewhere with somebody suffering from a smoking-related condition. I think our NHS colleagues in particular really welcome this.

There is another important aspect when it comes to the economic costs. We all get the healthcare costs and we also really understand the strain on social care, but actually it is business that bears the brunt of this. That can surprise people. It is about the lost productivity and people having to retire early and dying early. I would like to think about who these people are. I have mentioned the pivotal role of Sue Mountain and the showing of her TV advert, but so many other people have come forward who sadly were diagnosed in their late 40s—women in the north-east who are desperate to tell their stories. Cathy Hunt, diagnosed with lung cancer at 49; Claire Oldfield, diagnosed with lung cancer at 49. Their real appeal to you today is to think about taking this seismic leap forward and about the leadership the UK can show globally by recognising that smoking had a beginning and a middle, and it is down to us to say that it can have an end.

Q Thanks to Ailsa for everything that Fresh does in the north-east and for the wonderful results we have seen in the north-east, which is a very deprived area in places. I want to follow up on the question on evidence in vaping. Although there are still a few grey areas and unknowns about vapes, we know that vaping is much less harmful than tobacco. Crucially, it is a really important tool for those people who do smoke. What evidence does Fresh use to back up this argument? Do you feel there is a worry that if we focus too much in the Bill on youth vaping, we will leave behind those dependent, addicted and, very often, deprived smokers?

Ailsa Rutter:

I think we are really fortunate in the UK. The UK has shown great leadership by commissioning evidence-based reviews that are completely independent of Government; we have had eight of those now since 2014. That has been incredibly important. Fresh is not complacent. We have been monitoring the evidence around the rise in vaping and how this is positioned in terms of public health for the last 20 years—since we were set up. I would strongly recommend that many of the really useful questions we have had today could be answered by looking at those systematic reviews from the Office for Health Improvement and Disparities. In particular, when people say, “We don’t know what’s in vaping,” there is a significant chapter on the constituent chemicals and so on in vaping, and the magnitude of potential harm.

I have forgotten the second bit of your question, Mary.

It was about the use of vapes by heavily dependent smokers.

Ailsa Rutter:

Yes. In the north-east, vapes have been a “game changer” for some of our heavily addicted smokers. I have permission to share with you the fantastic role that vapes have played in our biggest mental health trust, Cumbria, Northumberland, Tyne and Wear. We are talking about people who have been smoking 40 or 50 cigarettes a day, often for decades, who have really struggled to imagine that they could ever get off lethal smoking. Being able to give them something that still gives them their nicotine, but in a much purer, safer and cleaner form, has been a game changer.

Vapes are being used successfully in our drug and alcohol treatment services—on the point about alcohol, the two often go hand in hand. If we are really intent on ending smoking, we must do more on alcohol. Wearing my Balance hat—Balance is the alcohol bit—it is really important that we do not think of risk-taking behaviour in youth as just vaping. Last week, the World Health Organisation published a report that shows that across 44 countries, the UK sadly has the highest use of alcohol among 11-year-olds. I hope nobody thinks that the amount of alcohol promotion, advertising, marketing and so on is okay. I think it is quite important that we look at risk-taking behaviours in the round.

Q In answer to my colleague, Nickie Aiken, you raised the primary issue of age verification. We get an opportunity to change the law on tobacco and vaping only once every 10 years or so, so it is quite important that we get as much in as we can. What other improvements would you like to make to the Bill to strengthen the argument you are putting, to get people to quit smoking or not even start in the first place?

Ailsa Rutter:

That is a really good point. I think it goes back to not wanting to delay the progress of the Bill. It is not necessarily for legislation, but it is important that we have a very clear communications strategy. Reflecting on previous legislation, much of the high levels of compliance we have seen in this country have come from very proactive communications in advance. We need to be really careful that the narrative does not get overly confused. It worries me enormously that too many people are staying on smoking because they are scared of even trying to switch over to a significantly less harmful product. I worry enormously about scaring people. It is absolutely right that we have evidence-based messaging to children and young people, but they are messengers who go back to their parents, and we know that it is very important that they are sending clear messages back. So, I will defer on your question about additional amendment—sorry.

Q May I prompt you? We have heard from previous witnesses about licensing. The Minister has talked about warning messages in packs and individual cigarette papers. Would you support those measures?

Ailsa Rutter:

I absolutely would. Fresh has been advocating a tobacco licensing scheme for many years. I do not know whether it is in the parameters of the Bill, but it is wrong that anybody can set up their car boot and sell a lethal consumer product. I would also strongly recommend that previous consultations on things such as pack inserts are looked at again: there is a strong rationale for that. Canada is leading the way with a clear message on the cigarette stick itself. Those are called dissuasive cigarettes. There are certainly other things within that realm. I would also be really willing in the future to discuss the role of a “polluter pays” levy; that is something worth considering.

Thank you. There are four minutes left and three people have already caught my eye, so short questions and short answers please, colleagues.

It is always great to see youQ and your enthusiasm shows through. We are very grateful for what you do in the north-east with Fresh and Balance. Does there need to be some kind of balance—no pun intended—between education and enforcement in order to make this a successful campaign, and to make the Bill as successful as we all want it to be?

Ailsa Rutter:

We have a really good track record over the last two decades of collaboration and cross-party working, with fantastic support from civil society, the NHS and local authorities. The previous legislation has gone through really well, overall, because we have worked together to build up public awareness and support. It is really important that we have adequate resourcing for our important professional groups, such as trading standards.

For me, it is about the communication, the vision and the narrative that we can set. Undoubtedly, if we can get this through, it will not just stop a whole new generation starting; we also know that it will trigger many people to think, “You know what? I am going to give it another go. I am going to try to quit.” We know that it can take people many attempts to quit for good. That is why it is really good that this is being backed up by additional investment in the important stop-smoking support systems and in our NHS trusts.

We heardQ this morning that some individuals and families had misinformation about vaping. We were given the example that, where the flavour is grapefruit or another fruity flavour, people might think that it is actually beneficial for children to be using vapes. Should we tackle those types of flavours and do more in terms of education, to make sure that families are aware that just because something has a fruity flavour, that does not necessarily mean that it is good for their health?

Ailsa Rutter:

I note the aspects of the Bill that deal with flavours. We absolutely think that more should be done on the descriptors. We wholeheartedly agree that some of the description is completely inappropriate. However, flavours play a really important role. For example, in our mental health trust, it is the fruit flavours that have got addicted smokers to stop. I genuinely have not heard that come up in the north-east—parents thinking that it is somehow healthy for a young person if it has a fruit flavour. What is wrong, though, is when it is in a packet called “Unicorn bubbly shake” or whatever, with a cartoon image on it. Those are things that we should look at addressing.

On vaping by young people in the north east, I want to make the point that we need to be careful about the data. Sometimes people say that all young people are vaping, but the evidence does not stack up. All of our local authorities do health behaviour questionnaires and, across the board, around 10% occasionally vape. I am not at all saying that we should be happy with that, but the risk of a public narrative that all young people are vaping is that we inadvertently promote it as a norm. Schools North East—

Order. I am sorry, but we have hit 2.50 pm. Caroline, I am sorry to you, too. We are not allowed to go over the time limit. Ailsa, thank you so much for your evidence; it has been absolutely first-class. We wish you well with all the important work.