Tobacco and Vapes Bill

Written evidence submitted by the Royal College of Physicians (TVB67)

Tobacco and Vapes Bill Committee

Summary

1. The Royal College of Physicians (RCP) is the membership body for hospital doctors. We support physicians to deliver the best healthcare possible for patients and improve the standards of care. The RCP represents 41,000 members and fellows in the UK and internationally from over 30 medical specialties.

2. The RCP strongly supports the Tobacco and Vapes Bill and was pleased that the RCP Special Adviser on Tobacco Professor Sanjay Agrawal was invited to give oral evidence to the committee.

3. Smoking accounts for around 80,000 deaths annually in the UK – we know that two thirds of smokers will die from a smoking-related disease. Our members see first-hand the devastating effects of smoking on the health of their patients. In 2022-23, there were an estimated 408,700 hospital admissions due to smoking, an increase of 4.8% from the previous year. This Bill is a bold step forward for public health to protect future generations from the harms of tobacco smoking.

4. The rise is vaping among young people and non-smokers cannot be ignored. People who have never smoked, including children and young people, should never vape, as vapes are not risk or harm free. The RCP fully supports measures to reduce the appeal and availability of vaping to children and young people but given the devastating health effects of tobacco and smoking, e-cigarettes must remain available for adult smokers as a quit tool.

5. As set out in the RCP's 2024 report E-cigarettes and harm reduction: an evidence review, e-cigarettes are one of the most effective and most popular tools available to support smoking cessation. A Cochrane Review found that nicotine e-cigarettes and pharmacotherapies like Varenicline and Cystine appeared to be more effective than other interventions.

6. The government must swiftly publish the statutory consultations required by the legislation after the passage of the Bill to ensure there is no delay in bringing in new regulations that will deliver the ambitions of the Bill, including to regulate flavours of vapes, extending smokefree spaces and creating vapefree spaces.

Smokefree generation

7. The RCP fully supports the introduction of legislation to create a smokefree generation. We welcome the government’s additions to the Bill since the last Parliament, including the increased focus on smokefree spaces.

8. Smoking is not a choice; it is an addiction. Smoking remains a blight on health and society, with new figures from ASH in May 2024 showing the cost of smoking in England to be at least £21.8bn, largely as a result of the impacts of smoking on productivity.

9. Phasing out the sale of tobacco to everyone born after 2009 will protect future generations from tobacco addiction and pay a range of dividends, improving public health, reducing avoidable smoking-related demand on the NHS, tackling health inequalities and ultimately creating a healthier and more prosperous society. We fully support the mechanism in the Bill to phase out smoking in this way as the most effective intervention to make smoking obsolete. The tobacco industry has lobbied for the age of sale to be raised to 21 or 25, rather than indefinitely. We oppose raising the age of sale to only 21 or 25 as it would not protect a large proportion of young adults and undermine this world-leading public health legislation.

10. The RCP supports the Bill prohibiting proxy sales. According to an ASH Smokefree survey, prohibiting proxy sales directly through legislation is likely to have a similar impact as raising the age of sale. This is because most children initiate smoking by obtaining cigarettes through peers and family who are older to bypass legal age of sale requirements.

11. The RCP supports the Bill requiring warning notices to be prominently displayed in retail premises. Retailers and the public, including young people, will need to know what the law states.

12. In addition to warning notices, the RCP believes government should fund a far-reaching public information communications campaign, with an emphasis on reaching cohorts of the population who are more likely to smoke. This will be key to ensure that the public is made aware that new legislative changes mean nobody born on or after 1 January 2009 can legally buy cigarettes. We support ASH’s recommendation to amend the Bill to apply mandatory age verification for purchasing tobacco, vapes and non-medicinal nicotine products to all the nations in the UK, in line with the provisions set out for Scotland in the Bill.

13. A government-led mass-media campaign about the changes in law brought about by the Tobacco and Vapes Bill would also support retailers who will be responsible for verbally telling customers about the changes in law. It may reduce potential abuse that retailers could face from those who are unaware about the change in the law.

14. We note the inclusion of new clauses to strengthen existing regulations to ban the manufacture of snus in the UK and make it illegal to possess snus with the intent to supply. We believe the Bill takes the right approach – there are very low levels of consumption of snus in the UK, largely due to the existing legislation banning its sale which came into effect in 1992. Smokeless tobacco use does expose the user to a variety of carcinogenic chemicals - snus is much less hazardous than smoking tobacco, but it is more hazardous than medicinal nicotine.

15. We welcome that the government will consult on extending smokefree legislation to public outdoor spaces. We support the intention of extending the outdoor smoking ban to playgrounds, school grounds, and hospitals to make these spaces safer for children, patients, and the wider public –many of whom live with 'invisible' vulnerabilities such as asthma, heart disease, or are pregnant - from the dangers of second-hand smoke. The RCP looks forward to engaging with the government’s consultation to develop these new regulations. We support ASH in its call for this consultation to go wider and cover all outdoor spaces, including hospitality settings and ensure that government policy on smokefree spaces is guided by the evidence. There is no safe level of exposure to tobacco smoke. It is vitally important to tackle the impacts of secondhand smoke. We also support ASH’s call that if national comprehensive action is not taken, then the legislation is amended to allow local authorities to decide what additional spaces, beyond those regulated nationally, they want to make smokefree.

16. While the Bill is a significant step forward in protecting future generations from the harms of tobacco, government must continue to prioritise action to support existing smokers to quit. This is a central part of delivering a smokefree generation – we know that children growing up in households that smoke are significantly more likely to smoke themselves. As recommended in the RCP’s Smoking & Health 2021 report, government must restore mass media campaign funding for campaigns about quitting smoking and offer opt-out tobacco treatment services at any point of contact with the NHS. We welcomed government confirming additional £70 million for stop smoking services in England for 2025 to 2026 for stop-smoking services. Additionally, government should consider introducing on-cigarette warnings (‘dissuasive cigarettes’) to warn people about the harms of smoking.

Measures to address youth vaping

17. We support the measures proposed in this Bill and wider government action to tackle the concerning rise in vaping among children and young people. E-cigarettes are a vital tool to treat tobacco dependency in adults, and must remain available for adult smokers to help them quit smoking – but the RCP is clear that those who have never smoked should not vape. We welcome the provisions in the Bill to reduce the availability and appeal of vapes to children, young people and never-smokers.

18. The majority of adults who vape are using vapes to quit smoking. With around 6 million smokers in the UK, we must take action to stop them smoking given its significant impacts on health, health inequalities and the economy.

19. As outlined in our 2024 report ‘E-cigarettes and harm reduction: an evidence review’, the RCP supports the introduction of standardised packaging for vaping products to reduce the appeal to children and young people.  Research among young people aged 11–18 in England has found that compared to branded and standardised packaging, youth interest in trying e-cigarettes is lowest when standardised packaging is combined with reduced flavour and brand descriptors.

20. The RCP is supportive of the provisions in the Bill to regulate the display of vaping and nicotine products in retail outlets, which was recommended in our 2024 report ‘E-cigarettes and harm reduction: an evidence review’ as a way to limit advertising of e-cigarette products to young people. There are currently too many inappropriate examples of point-of-sale displays of vape products in shops, such as displays and promotions that are designed to catch the eye of children and young people in particular. Data from the 2024 ASH Smokefree GB Youth Survey shows that 55% of 11-17-year-olds reported awareness of e-cigarette promotion in shops. Government must urgently publish this consultation after the passage of the Bill.

21. We welcome that government will consult on regulations regarding the flavour of vapes. We must be careful to avoid unintended consequences for adults using vapes to quit smoking given the harms of tobacco. There is evidence from the US that severe flavour restriction can have the unintended consequence of people switching back to smoking.

22. While we know flavours can attract young people to vaping, the use of flavours by adults trying to quit smoking is an integral part of the effectiveness of vaping as a quit aid. We know that many adult smokers report wanting to move away from the taste of tobacco. Other nicotine replacement therapy (NRT) products, such as gums and lozenges, also have fruit flavours. The RCP supports limiting the number of flavours available and recommends restricting flavour descriptors. Bland descriptors, alongside limiting the number of flavours and removing those most popular with young people non-smokers from vaping without the unintended consequences of perpetuating smoking for adults.

23. Depictions of tobacco and vapes on social media should be considered by the government in the Bill as part of measures to reduce the appeal of vapes to children and young people.

24. The introduction of vape-free places in the UK must reflect the difference in health harms between smoking and vaping. We welcome that government will consult on new powers to restrict vaping in public places to ensure careful implementation that does not result in unintended consequences for adults using vaping as a quit aid. There must be exemptions to the regulations to ensure there are specific vape-free places, such as mental health hospitals where inpatients have been prescribed a vape and preventing the use of e-cigarettes within hospital grounds could risk a relapse to tobacco use.

25. We welcome new powers to establish a registration system for tobacco and vaping products. In our 2024 report, the RCP recommended the introduction of a retail licensing scheme to limit access of e-cigarettes to children and young people. The RCP looks forward to the consultation to develop the structure and details of this scheme.

January 2025