Official Report: Minutes of Evidence

The Chairperson (Ms Kimmins): Apologies for the delay: we had a heavy agenda and overran on some of it, so we appreciate your patience. You are very welcome back on this issue. In attendance are Professor Sir Michael McBride, the Chief Medical Officer (CMO); Siobhan Broderick, director of population health; and Lesley Heaney from the population health directorate. We have limited time, but I will pass to you for opening remarks and then we will have some questions from members.

Professor Sir Michael McBride (Department of Health): I am delighted to be back, Chair. I will keep my comments brief, because I know that you are under time pressure. As you quite rightly said, I had the opportunity to meet the Committee on 14 March. As you know, a legislative consent motion (LCM) was subsequently agreed by the Executive on 21 March, but unfortunately the legislation fell with the dissolution of the UK Parliament for the general election. The new Bill was introduced on 5 November. I will briefly outline why I still feel that the Bill is crucial, notwithstanding the fact that I explained some of the issues in detail the last time we met. I will then hand over to Siobhan, who will take you through some of the key differences in the new Bill and how our approach compares with that in the Republic of Ireland.

I will start with the most important statement, which is that smoking kills. It remains the most preventable cause of death, disability and ill health in the UK, and it kills over 2,000 people in Northern Ireland every year. As you know, the effects are wide-ranging. It increases the risk of more than 50 serious health conditions, which I outlined in detail the last time I was before the Committee. Research has shown that, on average, those killed from smoking lose 10 to 15 years of their life. It is critical that we understand the human consequences of those statistics. The difference between the impact of smoking in the areas with the highest levels of deprivation in society and the least deprived is stark. Smoking rates where deprivation is highest are three times those in the least deprived areas, the lung cancer rate is two and a half times higher, and the smoking death rate is twice as high. The age at which a person starts smoking is crucial. Studies show that about two thirds of adult smokers report that they took up smoking before the age of 18 and over 80% report that they took it up before they were 20. We know that children of parents who smoke are about three times more likely to start smoking than others.

Those numbers — there are many more, as you know — represent the real human impact of smoking. It is compounded further by the impact of the cost on our already stretched health service. In 2019-20, Northern Ireland hospitals spent £218 million treating smoking-related conditions. In that same year, there were 38,617 smoking-attributable hospital admissions. The British Heart Foundation recently estimated that the cost of tobacco to society in Northern Ireland is £400 million annually.

Every single penny that we spend dealing with tobacco-related harms is entirely avoidable and represents a huge opportunity cost to our health service and financial cost to taxpayers. The facts are clear. We must act to address the harms that smoking causes: harms that are entirely preventable.

As we discussed last time, it is not just tobacco that we must consider; we have seen a significant rise in the prevalence of nicotine and non-nicotine-based vaping. Of particular concern is the increase among young people. Recent data shows that a fifth of young people have used an e-cigarette at least once. Current use in year 12 is particularly concerning. It has almost doubled since 2019, rising from 11·7% to 23·6%. We do not know the long-term harms, but the Institute of Public Health in Ireland (IPH), from which you previously took evidence, undertook a rapid review of the evidence on behalf of the Department and found high-quality evidence of an association between e-cigarette use and subsequent cigarette use, supporting a gateway effect. It also found some evidence, although less conclusive, recommending long-term studies to support the association between e-cigarette use and having asthma, increased coughing, marijuana use, alcohol use and mental ill health.

There are also health risks associated with other ingredients in the vapes, which I outlined previously. In the interests of time, I will not expand further. The long-term health harms of inhaling colours and flavours are unknown but are certainly very unlikely to be beneficial. There are growing concerns about the social and educational harms of vaping to increasing numbers of post-primary schoolchildren. All that substantiates our view, and my view and advice as CMO, that robust measures are required to address the appeal of these products.

The Bill provides us with a unique opportunity to save lives, create a smoke-free generation, gradually end the sale of tobacco products and break the cycle of addiction and disadvantage. There is absolutely no safe level of tobacco consumption; none. The prevalence of vaping, especially among children and young people is ever-growing, with unknown long-term effects. Chair, Deputy Chair and members, I respectfully urge you to grasp this opportunity and exercise our collective responsibility to take meaningful action and protect those who are vulnerable from the effects of that life-limiting addiction. Earlier this year, you provided your support for similar measures. I thank you all for that. I sincerely hope that you join us again in supporting the Bill.

Ms Siobhan Broderick (Department of Health): Thank you for the opportunity to speak to you this afternoon. I will take a few minutes to highlight the key changes from the previous Tobacco and Vapes Bill that you considered earlier this year and how our approach compares with that of the Republic.

The Bill's aim remains the creation of a smoke-free generation. As such, the provisions in the new Bill are broadly in line with those in the previous version. Consequently, the Bill makes it an offence to sell tobacco products, herbal smoking products and cigarette papers to anyone born on or after 1 January 2009. It provides measures to regulate vaping products — nicotine and non-nicotine vapes — including age of sale, product requirements, displays, flavours and notification requirements.

The key differences from the previous version that members considered earlier this year are as follows. A number of the previous provisions relating to a ban on free distribution of vapes and nicotine products and sale of non-nicotine vapes to those under 18 years old were dealt with through regulation-making powers. They are now included in the Bill, at Part 3. I can provide you with the clauses if you want. The Bill also extends the tobacco vending machine ban to include cigarette papers, vapes and other nicotine products. That is new. The Bill will extend the tobacco retailers register to include vapes and other nicotine products. Again, that is in Part 3. The Bill will introduce retail licensing provisions that will be commenced in the longer term following consultation. There are wider powers to allow for more significant changes to the tobacco and vapes notification scheme in Part 5. The Bill extends the existing robust tobacco advertising rules to cigarette papers, herbal smoking products, vaping products and other nicotine products. That is in Part 6. The Bill's powers will allow regulations to be made to extend smoke-free provisions to public outdoor places and workplaces, and to allow for regulations making smoke-free places also vape-free places and heated-tobacco-free places. That is in Part 7.

I will look at some of those new provisions. In relation to additional smoke-free places, members will be aware that those provisions attracted some attention in the media over the summer. Specifically, the Bill provides the Department with powers to make additional places smoke-free. It specifies that those must be workplaces or places that are open to the public, which can obviously include outdoor spaces. Such spaces may only be prescribed as smoke-free places during the times that they are open to the public or used as a place of work. The Bill also provides powers to designate places or vehicles as vape-free and/or heated-tobacco-free, but only when those places are already smoke-free. When the UK Government announced the Bill, they clarified that their intention is not to extend smoke-free places in England to the hospitality sector. Rather, they are considering plans to designate places such as children's playgrounds and areas outside schools and hospitals as smoke-free. In Northern Ireland, any regulations would be subject to consultation and to the draft affirmative resolution procedure. As such, I assure Members that the appropriate mechanisms will be put in place to ensure scrutiny of any proposed regulations in relation to that matter.

A new part of the provisions that are provided in the Bill relates to licensing. With regard to licensing and registration in Northern Ireland, I can clarify that, in the first instance, the Bill extends our existing tobacco retailer register to include vapes and other nicotine products. I think that the Committee discussed that issue the previous time we were here. The Bill also provides powers to introduce a future licensing scheme that will cover tobacco products, other smoking products, nicotine products and vapes. The Bill sets out the broad shape of that licensing scheme and the criminal and financial penalties, but the details will be brought in through regulations. The Bill provides the framework, and the detail will be in the regulations. That will allow time for a considered approach to be taken, including appropriate consultation, before introducing a new licensing scheme. While Northern Ireland's current tobacco retailer register is a helpful enforcement tool, it has limitations. I think that the Committee touched on those last time. Introducing a licensing scheme will allow us to strengthen enforcement and support legitimate businesses, and it will act as a deterrent to rogue retailers. In turn, that will support the Department's strategic aim of improving public health.

Another issue on which members may want some information is how we compare North and South. We share a common goal of reducing smoking prevalence and the level of tobacco harm. That aligns with the aims of the World Health Organization and the EU. The EU goal is for less than 5% of the population to be tobacco users by 2040. We engage regularly with colleagues in Dublin, and we met them only last week to update them on the Bill and hear in turn about the Public Health (Tobacco) (Amendment) Bill 2024, which is known as Tobacco 21 or T21. Tobacco 21 aims to accelerate the decline in adult smoking prevalence, which had plateaued at 18% in the South. It is one of a series of measures designed to reduce the smoking prevalence among children to zero. The Bill is before the Oireachtas, and it completed the Seanad Éireann Fifth Stage on 7 November. It is awaiting enactment, and it will make Ireland the first EU country to raise the minimum age of sale of tobacco products to 21. Tobacco 21 will not impact on the minimum legal age of sale of nicotine inhaling products. Since December 2023, the sale of nicotine inhaling products, including vapes, to under-18s has been banned in the South. You will know that that was introduced earlier here. There is currently no proposal to extend that to the age of 21.

How do we align? The adoption of Tobacco 21 in Ireland will create a cross-border divergence. However, in time, it will still mean that no one on the island of Ireland under the age of 21 will be able to legally buy cigarettes. Tobacco 21 and smoke-free generation measures aim to achieve the same end, acting on the same population group — the young — over the same period to protect children and young people from ever becoming addicted. Beyond the age of 21, the chances of becoming a regular smoker are significantly reduced, as the CMO mentioned. The statistics are quite stark: over 80% of smokers start before they are 20. Cross-border divergence in this area is not unusual. Until recently, the age of sale for nicotine vapes — I think that I mentioned this — was restricted to 18 in the North, and recently it became that in the South. Other measures have been introduced at different times. In both jurisdictions, the introduction of new laws on the legal age of sale is likely to result in more vigilance on age verification. With regard to enforcement, the Institute of Public Health in Ireland — I think that you heard from them last time — concluded that the potential disruption in enforcement occasioned by having different legislative approaches would be minor and should be considered carefully in the context of the known negative impacts of delaying legislation aimed at reducing the use of tobacco and, as the CMO has already mentioned, the dire impact that tobacco has on lives. Doing nothing is the worst option.

The tobacco industry has lobbied intensively against a number of progressive tobacco control measures by raising fears of black-market and criminal activity. IPH has advised that evaluations of the impact of tobacco control measures have repeatedly concluded that they did not contribute to increasing rates of out-of-country purchases, illicit tobacco or cross-border purchases of tobacco products. Despite the differences in legislation in the South and the North, the resulting increased vigilance and restrictions will benefit us all.

I understand that JTI has shared with members a letter that it sent to the First Minister and deputy First Minister raising concerns that the generational age of sale provisions were not consistent with EU provisions that apply to Northern Ireland via the Windsor framework. As noted in our paper that we shared with the Committee, consideration of that issue is a matter for the UK Government, and the UK Government's advice is that the provisions in the Bill are consistent with the Windsor framework. In this context, I will mention that the UK Government and the EU are parties to the World Health Organization's framework convention on tobacco control, which encourages every country to take steps to protect its citizens from the harm caused by tobacco. Guidance provided to public health bodies under the auspices of WHO and that convention says:

It adds that we should seek to protect the formulation and implementation of:

Consequently, there are limitations on how we engage with the tobacco industry to ensure accountability and transparency. I thank members for their time, and we are open to any questions.

The Chairperson (Ms Kimmins): Thank you. You have covered a lot of what I would probably have asked, Siobhan, which is useful. The only question that I have is in relation to North/South engagement and implementation around tobacco products, which you covered. As part of those discussions, has there been anything in relation to banning single-use vapes? We are heading in that direction in the North, but does the South have any plans for that that you are aware of?

Ms Broderick: I think that they are planning to ban single-use vapes. DAERA is leading that proposal in Northern Ireland with a view to the ban coming into effect next June.

The Chairperson (Ms Kimmins): I am conscious that a general election is imminent in the South and things could change, but it is good that that is part of their plan.

Ms Broderick: I think that they issued a structure framework of the proposals in respect of nicotine vapes, and I think that it was in that, but I can check for you.

The Chairperson (Ms Kimmins): OK, thank you.

Mr Donnelly: Thank you very much for the presentation. I appreciate how powerful the Bill will be; it will change lives and save lives. Will the new regulation of vapes associated with the Bill mean that vapes will be sold in a cupboard in the same way as tobacco is sold? What we see now when we go into a shop are mountains of vapes in brightly coloured packages. Will those be put behind doors?

Ms Broderick: There is a power in the Bill that provides for the Department to make regulations to make provisions similar to tobacco with regard to display and pricing to address that issue.

Professor Sir Michael McBride: Including nicotine and non-nicotine vapes. As you say, they are deliberately marketed in bright colours and flavours etc to target children, so that will be taken into account.

Mr Donnelly: You mentioned the tobacco industry lobbying strongly on this. Is the tobacco industry the vapes industry? Are the same people involved in this, and is the vapes industry now involved in lobbying as well?

Professor Sir Michael McBride: That is my understanding. The tobacco industry has seen the writing on the wall and has moved into the vapes industry. I do not know all the details of that, but there is a broad overlap between the two.

Mr Donnelly: Do you see lobbying to keep vapes unregulated?

Professor Sir Michael McBride: Yes. The retail sector is very strongly supportive of the move to regulation and licensing in the Bill, given the rogue traders that Siobhan described. Certainly, my own view has always been that, whilst vapes are a useful tool for those who want to quit smoking and then stop vaping, I was always concerned about the long-term gateway effect. The research evidence from the Institute of Public Health is very compelling in that respect. Promoting vapes and blatantly marketing them at children is an attempt to recruit children into a life-limiting addiction that is going to kill two thirds of them. Clearly, we have to take action on tobacco use in all its forms and on vaping.

Miss McAllister: Will the Bill include the advertising bollards that are outside?

Ms Broderick: The powers should be wide enough to allow us to address that.

Miss McAllister: That is what you see outside those shops now. We have not carried out any official surveys, but, anecdotally, those have been seen close to schools. There have been instances when MLAs have confronted shop owners after watching them sell vapes to children in school uniforms. They are advertising on those bollards, so if we could ban those, that would be important.

Ms Broderick: The other provision is the licensing provision. That will allow for a framework within which you can set conditions, which might include, subject to consultation, limiting the sale of vapes or tobacco in the vicinity of a geographical location, which might be a school.

Miss McAllister: If there is anything that we can do, that will be worthwhile. I recognise that resources are an issue, but education and awareness in schools needs to be a part of all of this.

Ms Broderick: The Public Health Agency (PHA) did a bit of proactive engagement on awareness raising with health professionals and education sector colleagues. It put fact sheets and other resources online, which are shared across schools via the Council for the Curriculum, Examinations and Assessment.

Professor Sir Michael McBride: The PHA also did a piece of work to engage with post-primary schoolchildren in Northern Ireland. Over 7,500 of them responded to an online survey and to group sessions. Some 77% of them said that the colours and the flavours were the things that attracted them to use vapes. Young people themselves are telling us that there is a problem here. It is a problem that we need to do something about, given the exponential growth in their use.

Miss McAllister: We heard from the Youth Assembly, whose Members shared some of their views. Any powers to change the situation would be good.

Mrs Dodds: Thank you for explaining the issues around licensing. That is important, and it addresses a gap in the original proposals. Do you have any projected data on the impact of banning the sale of vapes after 21 and the proposals in the Bill?

Ms Broderick: I think that modelling was done, Michael.

Professor Sir Michael McBride: There was, but I do not have it to hand.

Ms Broderick: I believe that IPH is updating it at the moment. The Tobacco 21 proposals may have a later start date, so there was some modelling done, and we are getting that updated. I know that you may want to hear from IPH again, but we can follow that up and share it with you.

Mrs Dodds: It would be interesting to see that.

Professor Sir Michael McBride: We could provide a written update on that, if that would be helpful to the Committee. I strongly agree with you. The limitations of the registration scheme and the importance of the licensing scheme were issues that you flagged when we last met. I am pleased that those provisions and powers will be in the new Bill, should the Assembly wish to include them.

Mrs Dodds: That is the issue here.

The Chairperson (Ms Kimmins): OK. Thank you all for coming in. Even being able to compare the differences between the previous Bill and this one has been very useful. We appreciate your time. Thank you.