Tag: Alex Cunningham

The speech made by Alex Cunningham, the Labour MP for Stockton North, in the House of Commons on 18 November 2022.

I beg to move, That the Bill be now read a Second time.

May I be the first to congratulate the hon. Member for Harrow East (Bob Blackman) on achieving a Second Reading for his Bill? Perhaps we could persuade him to organise a masterclass on how to achieve Government support for proposed legislation.

I am grateful to the Public Bill Office and, in particular, to Anne-Marie Griffiths, for their tremendous support in preparing this Bill and to the Minister who has taken the time to talk to me about what I am proposing today.

As I begin, I wish to thank the teams at both Marie Curie and the Trades Union Congress for all the vital work that they do in supporting those living with terminal illnesses. I also pay tribute to the many inspiring campaigners who work with these organisations, particularly Jacci Woodcock MBE who founded the TUC’s Dying to Work campaign, which I will talk about when I get to clause 3. I would also like to recognise the work of Mark and Cheryl whom I had the privilege of meeting a couple of months ago when I hosted Marie Curie’s Dying in Poverty parliamentary event. These campaigners and their families have been through one of the most difficult experiences that we can imagine—a terminal diagnosis—and yet they continue to use their voices to advocate to improve support for all people with terminal illnesses. Their work should inspire and humble us all—it certainly does me.

The first time I promoted a private Member’s Bill, to ban smoking in cars with children present, I am proud to say that the Government eventually implemented the measures, albeit three and a half years later. I am hoping they will make quicker progress this time. As the cost of living crisis deepens, people living with terminal illnesses will be disproportionately impacted. Indeed, they are already facing increasing financial precariousness. Between April and September of this year, almost one in five calls to Marie Curie’s support line were from people affected by terminal illness who were concerned about their finances—an increase of 38% on the same period last year. Therefore, I hope the Government take up the measures in my Bill quickly, and provide those living with terminal illnesses with much-needed additional financial support, without costing the Exchequer a penny.

Nobody should die in poverty, but, tragically, many of our constituents who should be able to spend the last stage of their lives enjoying the company of the people they love, are instead worrying about their finances, struggling to pay bills and incurring debts that will be passed on to their loved ones when they are gone. In 2021, Marie Curie commissioned Loughborough University to examine the number of people who die in poverty in the UK each year. The findings of the research are stark and horrifying: 90,000 people die in poverty every year in the UK, one in four people who die in working age are in poverty in their last year of life, and two in three working-age parents who die experience poverty in the last five years of life.

Being diagnosed with a terminal illness can lead to a number of additional costs, including travel to appointments, medication costs and higher energy bills, which I will come on to a little later. These costs all land on the doorstep just as people’s income is reduced, as they may be forced to stop work or at least reduce their working hours. As Marie Curie noted in its briefing ahead of the autumn statement:

“For many, this ‘double squeeze’ on household finances directly leads to a fall below the poverty line. Working age people living with a terminal illness are a third more likely to be in poverty than other working age people.

For those who die in working age the risks are even higher. Without the fixed income provided by the State Pension and other lifetime savings to rely on, people who die in working age are more than twice as likely to experience poverty at the end of life as those who die in pension age.

Working age families with children are particularly vulnerable to falling into poverty when hit by terminal illness. Childcare costs cannot be avoided and the impact of one or both parents leaving the workforce means that these families are more likely than any other group to fall below the poverty line when one parent is terminally ill.”

These statistics underline the urgent need for additional financial support for those living with a terminal illness, particularly those who are of working age.

There is a range of possible practical and impactful interventions that Marie Curie has worked up, such as placing elements of the National Institute for Health and Care Excellence guideline NG6, “Excess winter deaths and illness and the health risks associated with cold homes”, on a statutory footing and including people with terminal illnesses on the priority services register. That obliges providers to prioritise vulnerable customers for additional support, such as advance notice of planned power cuts or priority support in emergencies. It has also been energetically campaigning to give all dying people access to their state pension, no matter their age; to protect dying people from soaring energy bills, including by extending eligibility for the winter fuel payment; and to support dying parents with childcare costs. I urge the Minister to consider Marie Curie’s proposals that are wider than we are discussing today, and to meet it to discuss the full range of policies it has developed. For my part, the scope of this Bill is much narrower, so I hope she will be able to commit to advancing these limited but important proposals.

If implemented, my Bill would require utility companies to provide certain financial supports to customers with a terminal illness, and it would strengthen the employment rights of people with a terminal illness. Clauses 1 and 2 will enable people who are terminally ill to access financial support from their energy provider via the warm home discount and the energy company obligation. The measures will amend the eligibility criteria for these schemes in existing legislation, to give energy providers an obligation to provide such forms of support to customers who are thought to be in their last year of life.

In a 2021 report, “No place like home?”, the all-party parliamentary group for terminal illness concluded that the added costs of heating homes could drive many terminally ill people and their families into poverty and have a negative impact on their physical and mental health and wellbeing. That finding was confirmed by Marie Curie in the 2022 report “Dying in poverty”, which said that the energy bills of terminally ill people could increase significantly after their diagnosis. For example, some terminally ill people may need to heat their homes for longer than before, or to a higher temperature, as a result of their condition, while others will need to power medical equipment in the home, such as ventilators, respirators or monitors. Those higher energy needs can push households affected by terminal illness into fuel poverty.

The UK’s energy providers are required to make certain forms of support available to customers who may struggle to afford the cost of their bills, or who may be vulnerable and need support. They include the warm home discount—a £140 discount on electricity and gas bills over the winter period—and the energy company obligation, which obliges providers to deliver energy efficiency measures to homes in order to help households cut their heating bills. In some cases, eligibility for these schemes is set nationally: for example, low-income pensioners are automatically eligible for the warm home discount under the “core group” system, while customers in receipt of certain benefits are automatically eligible for support under the energy company obligation’s help to heat group. In other cases, energy providers set their own eligibility criteria—such as those for the warm home discount wider group—which are often based on receipt of certain means-tested benefits or other criteria.

Terminally ill people, especially those of working age, are not automatically eligible for support via these schemes despite their vulnerability to fuel poverty. They may be eligible to apply for support based on other criteria—for example, disability or receipt of means-tested benefits—but they will not necessarily be successful. Both the warm home discount and the energy company obligation require energy companies to make a limited pot of money available to support customers, and a provider’s criteria do not necessarily prioritise those who are terminally ill for support.

Legislation places obligations on UK energy providers to make support available to customers via the warm home discount and energy company obligation on the basis of eligibility criteria set out in legislation. Regulation 8(5)(c) of the Warm Home Discount (England and Wales) Regulations 2022 sets out the eligibility criteria for the core group, who are automatically eligible for the payment. At present, people are considered eligible for support under the core group system if they are in receipt of the “guarantee credit” element of pension credit. Article 2 of the Electricity and Gas (Energy Company Obligation) Order 2022 sets out the eligibility criteria under the energy company obligation for the help to heat group, who are eligible for interventions to improve the energy efficiency of their homes to help reduce their bills. At present, people are considered eligible for support under the help to heat group if they are in receipt of certain benefits outlined in schedule 1 to the order.

My Bill amends each of those items of legislation to introduce a new eligibility criterion based on the Social Security (Special Rules for End of Life) Act 2022, extending automatic eligibility for the warm home discount and energy company obligation to people who are thought to be in the last year of their lives. The Government have already demonstrated some commitment to improving financial support for those with terminal illnesses by amending the legal definition of terminal illness in benefits law to enable anyone who is thought to be in the last year of life to claim certain benefits on a fast-track basis. I welcome that, but I also hope that the Government can take this further step and provide necessary additional support for some of those who will need heating the most this winter as their energy bills climb.

The third and final clause of my Bill aims to put the demands of the TUC’s Dying to Work campaign on a statutory footing, ensuring that terminal illness is recognised as a protected characteristic, so that an employee with a terminal illness would enjoy a protected period during which they could not be dismissed as a result of their condition. This protection will provide those who have received a terminal diagnosis and are still of working age with the choice of how to spend their final months, and the peace of mind of knowing their job is protected and the future financial security of their family is supported. Losing one’s job following a terminal diagnosis can lead to reduced income, further exacerbating the issues with financial security that I have discussed. Sometimes, it leads to a deeply stressful and upsetting HR procedure, which should not have to be a concern for those in the final stages of their life. If a worker with a terminal illness loses their job, they may also lose any death-in-service payments that they have earned through a lifetime of work but which are payable only to those who die while still in employment.

Clause 3 provides that employers must take into account an employee’s terminal illness when deciding whether it is a reasonable adjustment to retain in employment those who have terminal illnesses, rather than dismiss them in accordance with a sickness absence policy. This will provide people with a terminal illness who are still of working age and who wish to continue working with additional security at the end of their life, and remove some of the stress and fear that they face. Although in some cases the individual may wish to stop working and spend their remaining time outside of work, some workers decide to continue working as long as they can, either because they need the financial security or because they find that their work can be a helpful distraction from their illness. Those who decide to stay in work should not be having to stress about dismissal or salary reductions after any periods of sickness associated with their illness. The clause ensures that whatever choice a person makes, they can expect the appropriate help and support from their employer, because when a person receives a terminal diagnosis, their job should not be on their list of worries.

Thanks to the efforts of the TUC, over half a million workers in the UK are already covered by the Dying to Work charter. I hope that today the Government can commit to extending that to all workers. I desperately want these proposals to succeed, and would be more than happy to work with the Minister to amend the Bill if necessary ahead of implementation; I know that Marie Curie and the TUC would be pleased to meet officials in order to help in any way they can, too. I reiterate that these changes will not cost the Exchequer a penny, and the cost to energy companies is also very limited, especially when compared with their huge profits. The change to the warm home discount in clause 1 will not necessarily require additional funds, as all it does is widen the criteria of the core group who automatically receive it to include terminally ill people.

The cost per person of the energy company obligation will depend heavily on what steps are needed to make that person’s home more energy efficient: for example, they may need a new boiler, insulation or a smart meter, among other things. However, again, I am sure the Minister can recognise that those costs would be extremely modest. While these clauses will not be able to ensure that no one dies in poverty—which is what this House should be striving for—I believe they could have a significant impact on the lives of terminally ill people, particularly those of working age, when they are at their most vulnerable. I hope the Minister will support the Bill’s Second Reading today, and work with me in Committee to make it law.

The speech made by Alex Cunningham, the Labour MP for Stockton North, in the House of Commons on 3 November 2022.

I draw the attention of the House to my interests as a vice-chair of the all-party parliamentary group on smoking and health. I, too, welcome the Minister to his place and wish him well. I look forward to working with him. I congratulate the hon. Member for Harrow East (Bob Blackman) on an excellent and measured speech. I could make my shortest speech ever by simply saying, “I agree with Bob.” I won’t. [Laughter.] I will reiterate some of the points he made.

When I wander through parts of my constituency, particularly the areas of greater deprivation, I am struck by the number of people who still smoke, including children on their way home from school in school uniform. I know that in recent times rates of smoking have come down across the borough of Stockton-on-Tees, thanks to initiatives by the council, health staff and Fresh, the north-east charity that helped drive a reduction. Although the incidence of smoking has come down overall, it is still a major issue in areas such as the town centre ward, where it remains high, as does the number of young women smoking in pregnancy.

Sadly, public health is in a dire state after 12 years of Conservative rule and, in recent times, the promise to act on smoking does not align with what is being delivered. Time and again, Members from across the House have asked for the long-overdue tobacco control plan, but despite making commitments to introduce the necessary measures to further reduce tobacco harm in this country, the Government have not done so. We will never meet the Government’s targets if we do not have a plan, so I hope that the Minister will today give us a date for the plan and promise to make available the resources to make it work.

I want to be a little parochial and make it clear again why I have always focused on this health issue, in particular, during my 12 years in Parliament. In my patch of Stockton, 13.2% of adults smoked in 2019 compared with 13.9% in England. That rises to 19.1% among those in routine and manual occupations. When we look at the proportion of women who smoked during pregnancy in 2021, it is worrying that the figure for Stockton was 14.1% compared with 9.6% nationally. The fact that one in 10 expectant mothers smoke across the country is bad enough, but the proportion is 50% higher in my patch and much higher, again, in deprived communities. Smoking can be a family issue. Any expectant mother committed to quitting will struggle if their partner or others in their household smoke. We need a plan to work with whole families to discourage smoking and end the dangers to the unborn child.

There is, of course, an economic argument to invest in smoking cessation. At the local level, smoking costs £62.3 million every year. That includes £47.2 million in lost productivity and costs of £9.2 million to the NHS and £5 million to social care. It is particularly distressing that 7.4% of our Stockton North population suffer from asthma—higher than the 6.5% across England. Furthermore, the level of COPD—chronic obstructive pulmonary disease—in my constituency is 3.1%, which again, is 50% higher than the rate of 1.9% across England. In England, 14.1% of people have high blood pressure, but the proportion is 16.2% in my constituency. It is therefore no surprise that 75% of adults in the north-east support the ambition to reduce smoking prevalence to less than 5%—fewer than one in 20 people—by 2030, with just 9% opposed. Along those lines, 76% of adults in the north-east support activities to limit smoking or think that the Government should do more.

We can all celebrate the fact that, in the past five years, the fastest decline in smoking rates in England has been in the north-east, although that was from a very high starting point. That is due to highly effective regional collaboration between local authorities and the NHS, supported by Fresh, to which I referred earlier, but they cannot do that alone. Government action could have a fast impact if they were to bring in legislation introducing the further regulation of tobacco products, as the hon. Member for Harrow East mentioned.

Liz Twist

My hon. Friend is speaking powerfully about the experience in the north-east and nationally. He will be aware that, between 2007 and 2019, when the Government led the way in introducing tough new regulations, our smoking rates declined far faster than in the rest of Europe and most of the world, but that has dropped off, so we need to take further action. Is he aware of this recent research into smoking habits? University College London’s smoking toolkit study has surveyed smokers’ behaviour monthly since 2006. After years of steady decline in adult smoking—the proportion went from 24.1% in 2006, as he said, to 14.8% in 2020—smoking rates have stagnated, standing at 14.9% as we reach the end of 2022. Worse still, although the uptake of smoking among young adults declined year on year from 2007, that started rising again after 2019.

Alex Cunningham

I am grateful to my hon. Friend; I was not aware of some of the research to which she referred. However, the reduction in smoking has plateaued in recent times, and that is lamentable. I have a big enough heart to say that the Conservative Government have done much over the years to reduce smoking, building on much of what the Labour Government did between 1997 and 2010, but we cannot allow ourselves to stop there. We need to do so much more.

There are often arguments—many of which are put forward by front organisations funded by the tobacco industry—that further smoking regulation would be the “nail in the coffin” for small businesses, but that is not so. As the hon. Member for Harrow East mentioned, a recent survey commissioned by Action on Smoking and Health found that small tobacco retailers in the UK support further measures to reduce the harm of tobacco, including increasing the age of sale from 18 to 21, mandating a licence to sell tobacco and requiring tobacco companies to pay for services to help smokers to quit. John McClurey, a retired local retailer from Newcastle said, “Tobacco is a burden” to small businesses. The Government could help to lift that burden and charge the tobacco companies to do so.

In my last speech on smoking in Westminster Hall, I again stressed the need for a levy on the tobacco companies, but Ministers were reluctant. The new Minister will want to take action in this space. As we all know, cash will be tight and the Budget in two weeks’ time will be difficult, so he can earn himself brownie points by requiring the industry that makes billions in profits while killing our people to pay up instead. It needs to pay, because more than 4,000 people died prematurely from smoking in the north-east alone last year, with 30 times as many suffering disease and disability caused by smoking.

Going hand in hand with the personal suffering caused by smoking is the economic cost to our already disadvantaged communities. In their election manifesto, the Government claimed:

“We are committed to reducing health inequality.”

Why, then, are there such pronounced inequalities? In the north-east, 42% of smoking households are in poverty and tobacco spending accounts for a higher share of gross disposable household income per head than in any other UK region or nation. Please do not give me the argument that if people are poor, they should give up their fags. Smoking is an addiction and they need help to quit. Ending smoking in such communities would not just benefit the health and wellbeing of individuals but inject money into local economies that was previously going up in smoke.

The Minister will know that, at the current rate of decline, poorer communities risk being left behind as we move towards the hoped-for smokefree 2030. It will not happen in the communities to which I have referred without robust action. Most of the quitting has been done by people from better-off communities, and the benefits have largely accrued to those communities. In 2019, fewer than one in 10 professional and managerial workers smoked—well on the way to the smoke-free target of less than 5%—compared with nearly one in four workers in routine and manual occupations.

Half the difference in life expectancy between rich and poor is due to smoking, which means that the scope for reducing health inequalities related to social position is limited, unless the many smokers in lower social positions can succeed in stopping smoking. Smoking is linked to almost every indicator of disadvantage. Those overlap different communities, so smokers in routine and manual occupations, or who are unemployed, are also more likely to be living in social housing and to be diagnosed with mental health conditions.

There is a clear need for a new tobacco control plan that targets investment and enhanced support at disadvantaged smokers, wherever they are. As long as smoking remains the norm in some communities, not only will it be harder for smokers to quit, but smoking will continue to be transmitted from one generation to the next. The evidence shows that most people who smoke started as children. Prevention is key, so what will the Government do to reduce the appeal of cigarettes?

Liz Twist

Does my hon. Friend agree that raising the age of sale, as the APPG proposes, would reduce youth uptake? According to the UCL modelling that I spoke about, it would reduce smoking among 18 to 20-year-olds by a third. It would narrow the inequalities in uptake: as my hon. Friend has powerfully explained, children from more disadvantaged backgrounds are more likely to take up smoking.

Alex Cunningham

I have no doubt that everything my hon. Friend says is totally on the money. We can take action, and it need not cost the Government a fortune either. My hon. Friend raises the issue of age. Some parts of the UK have a Check 25 policy—would it not be wonderful if we could introduce such a check on the sales of cigarettes? It might help to put an end to smoking among younger people.

High smoking rates among people with mental health conditions are a leading cause of premature death and disease. Smoking accounts for two thirds of the reduction in life expectancy for people with a serious mental illness. The smoking rate among people with serious mental illnesses is more than three times that of the general population. The rate among people with depression and anxiety is just under twice that of the general population, but they account for 1.6 million smokers. There is now good evidence that smoking exacerbates levels of poor mental health, whereas stopping smoking contributes to improvements in mental health. Tobacco remains the biggest cause of cancer and death in the UK, so Cancer Research would like to see the ambition to make England smoke free by 2030 implemented. I ask the Minister whether we can expect to see that ambition realised.

I would like to say a little about “The Alternative Smoke-Free 2030 Plan” published by the Institute of Economic Affairs, which the hon. Member for Harrow East has also received. After the disastrous free-market policies promoted by the IEA and adopted by the last Prime Minister and Chancellor, I find it hard to believe that any current Minister would give any credence to the IEA’s recommendations on anything. However, the hon. Member makes an important point: as a party to the World Health Organisation framework convention on tobacco control, the Government and all public authorities are required to protect

“their public health policies…from commercial and other vested interests of the tobacco industry”.

If the Minister is in any doubt about the role played by the IEA, he should take note of the leaked documents that show that during the passage of the tobacco products directive, Philip Morris International described the IEA as a “media messenger” on its behalf, able to assist in “policy outreach” to “pro-actively relay our positions”, while British American Tobacco described it as a “vehicle for delivery” of its UK reputation initiatives. I would like the Minister to restate for the record, on the Floor of the House, the Government’s commitment to complying with paragraph 3 of article 5 of the convention and to preventing tobacco industry-funded organisations from influencing tobacco control policy.

The arguments for bringing tobacco regulation forward are multifaceted and can no longer be ignored. As a member of the APPG, I look forward to working with a new Minister who can do the maths to realise the cash value of a tobacco control plan, especially if we make the polluters pay, and—better still—who can help us to ensure that we have healthier people in all our communities.