Achieving a smoke-free country – a best buy for the UK chancellor
Open letter to the Chancellor
Achieving a smoke-free country – a best buy for the UK chancellor
The UK government has set out a bold mission to improve the nation’s health. This is an urgent and essential task, not just to improve individual wellbeing, but because poor health is a huge drain on the economy. The mission will require action across all arms of government. Unless smoking is addressed, there is no prospect of delivering on Labour’s manifesto commitment to halve the gap in HLE between the richest and poorest regions.[1] We therefore urge the Chancellor to use the budget on 30th October to invest in creating a smoke-free UK as quickly as possible, and make the tobacco industry pay.
The rationale for investing to end the tobacco epidemic could not be stronger. The annual cost of smoking to individuals, public services and the wider UK economy is £93 billion. The direct cost of smoking to the UK public finances in 2023 was £21.9 billion, with a net cost of £13.5 billion.[2]
We understand that there are acute constraints on spending. However, investing to address tobacco use is not merely fiscally neutral, it will actually improve public finances. Smoking cessation treatment is one of the only interventions that can reduce in year NHS costs, saving £2.37 for every £1 invested,[3] while improving health improves economic productivity. For example, currently new support to inpatients to quit smoking is helping the NHS to avoid ~£65m in costs. However, if services were being funded at the levels intended following the NHS Long Term Plan [4], it would be avoiding an additional £33m. The gap in investment is estimated to be around £15m. [5]
Moreover, introducing a ‘polluter pays’ levy on tobacco manufacturers, as recommended in the Khan review and by the APPG on Smoking and Health, would raise around 5 times the sum needed to fund comprehensive tobacco control.[6] [7] Capping tobacco industry prices and hence profits could raise £700 million a year for vital tobacco control activity in a way that would prevent companies from simply passing the cost on to consumers.[8]
The previous government committed five-year funding for stop smoking services and mass media campaigns in England, along with UK-wide enforcement activity.[9] This was in addition to England-only funding for a national vaping ‘swap to stop’ scheme and financial incentives to help pregnant smokers quit. The new government needs to go further but has not yet committed to maintaining this funding and appears to have scaled back funding for tackling illicit tobacco from £30 million a year to “more than £20 million.” [10]
The smokefree generation proposal in the Tobacco and Vapes Bill will be crucial for protecting future generations from tobacco addiction. However, we also need to support the 6.4 million adult smokers in the UK to quit. Dedicated long term funding is vital to deliver stop smoking support in hospitals and the community, national marketing campaigns, a robust illicit tobacco strategy, and targeted measures to reduce smoking rates in priority groups.
Finally, the UK must now reestablish its global leadership in tobacco control. The last Labour government was instrumental in the development and adoption of the first WHO health treaty, the Framework Convention on Tobacco Control (FCTC). The UK has supported implementation of the Treaty in low-and middle-income countries by co-funding the FCTC 2030 project. This has been a small investment with a big impact, but UK funding for it is set to expire at the end of 2024/25. Committing the UK to contribute at least £2 million a year for a further five years will cement our place as a world leader in tobacco control.
Professor Nick Hopkinson
Chair, Action on Smoking and Health
Professor of Respiratory Medicine, National Heart and Lung Institute, Imperial College, Royal Brompton Hospital Campus, London SW3 6NP
Professor Sanjay Agrawal
Special Adviser on Tobacco, Royal College of Physicians, London NW1 4LE
Dr Ranee Thakar
President, Royal College of Obstetricians and Gynaecologists, London SE1 1GH
Dr Charmaine Griffiths
Chief Executive, British Heart Foundation, London NW1 7AW
Dr Ian Walker
Executive Director of Policy, Information and Communications, Cancer Research UK, London E20 1JQ
Dr J Robert Branston
Associate Professor in Business Economics, University of Bath School of Management, Bath BA2 7AY
[3] Pokhrel S. Owen L. Coyle K. Lester-George A. Leng G. West R. Coyle D. Costs of disinvesting from stop smoking services: an economic evaluation based on the NICE Tobacco Return on Investment model. The Lancet. Volume 388, Supplement 2, November 2016, Page S95. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)32331-5/fulltext
[5] These estimates are based on cost savings found in Ottawa when they implemented a similar model. ASH Inpatient Tobacco Dependence Treatment Services Impact Calculator 2024 https://ashresources.shinyapps.io/TDTS_Impact/
Competing interests:
JRB: I receive funding from receive funding from Bloomberg Philanthropies, as part of the Bloomberg Initiative to Reduce Tobacco Use. I also own 10 shares in Imperial Brands for research purposes. The shares were a gift from a public health campaigner and are not held for financial gain or benefit. All dividends received are donated to health related charities, and proceeds from any future share sale or takeover will be similarly donated.
10 October 2024
Nick Hopkinson
Chair, Action on Smoking and Health, and Professor of Respiratory Medicine, National Heart and Lung Institute, Imperial College
Professor Sanjay Agrawal, Special Adviser on Tobacco, Royal College of Physicians; Dr Ranee Thakar, President, Royal College of Obstetricians and Gynaecologists; Dr Charmaine Griffiths, Chief Executive, British Heart Foundation; Dr Ian Walker, Executive Director of Policy, Information and Communications, Cancer Research UK; Dr J Robert Branston, Associate Professor in Business Economics, University of Bath School of Management; on behalf of a further 203 organisations and individuals
Rapid Response:
Achieving a smoke-free country – a best buy for the UK chancellor
Open letter to the Chancellor
Achieving a smoke-free country – a best buy for the UK chancellor
The UK government has set out a bold mission to improve the nation’s health. This is an urgent and essential task, not just to improve individual wellbeing, but because poor health is a huge drain on the economy. The mission will require action across all arms of government. Unless smoking is addressed, there is no prospect of delivering on Labour’s manifesto commitment to halve the gap in HLE between the richest and poorest regions.[1] We therefore urge the Chancellor to use the budget on 30th October to invest in creating a smoke-free UK as quickly as possible, and make the tobacco industry pay.
The rationale for investing to end the tobacco epidemic could not be stronger. The annual cost of smoking to individuals, public services and the wider UK economy is £93 billion. The direct cost of smoking to the UK public finances in 2023 was £21.9 billion, with a net cost of £13.5 billion.[2]
We understand that there are acute constraints on spending. However, investing to address tobacco use is not merely fiscally neutral, it will actually improve public finances. Smoking cessation treatment is one of the only interventions that can reduce in year NHS costs, saving £2.37 for every £1 invested,[3] while improving health improves economic productivity. For example, currently new support to inpatients to quit smoking is helping the NHS to avoid ~£65m in costs. However, if services were being funded at the levels intended following the NHS Long Term Plan [4], it would be avoiding an additional £33m. The gap in investment is estimated to be around £15m. [5]
Moreover, introducing a ‘polluter pays’ levy on tobacco manufacturers, as recommended in the Khan review and by the APPG on Smoking and Health, would raise around 5 times the sum needed to fund comprehensive tobacco control.[6] [7] Capping tobacco industry prices and hence profits could raise £700 million a year for vital tobacco control activity in a way that would prevent companies from simply passing the cost on to consumers.[8]
The previous government committed five-year funding for stop smoking services and mass media campaigns in England, along with UK-wide enforcement activity.[9] This was in addition to England-only funding for a national vaping ‘swap to stop’ scheme and financial incentives to help pregnant smokers quit. The new government needs to go further but has not yet committed to maintaining this funding and appears to have scaled back funding for tackling illicit tobacco from £30 million a year to “more than £20 million.” [10]
The smokefree generation proposal in the Tobacco and Vapes Bill will be crucial for protecting future generations from tobacco addiction. However, we also need to support the 6.4 million adult smokers in the UK to quit. Dedicated long term funding is vital to deliver stop smoking support in hospitals and the community, national marketing campaigns, a robust illicit tobacco strategy, and targeted measures to reduce smoking rates in priority groups.
Finally, the UK must now reestablish its global leadership in tobacco control. The last Labour government was instrumental in the development and adoption of the first WHO health treaty, the Framework Convention on Tobacco Control (FCTC). The UK has supported implementation of the Treaty in low-and middle-income countries by co-funding the FCTC 2030 project. This has been a small investment with a big impact, but UK funding for it is set to expire at the end of 2024/25. Committing the UK to contribute at least £2 million a year for a further five years will cement our place as a world leader in tobacco control.
Professor Nick Hopkinson
Chair, Action on Smoking and Health
Professor of Respiratory Medicine, National Heart and Lung Institute, Imperial College, Royal Brompton Hospital Campus, London SW3 6NP
Professor Sanjay Agrawal
Special Adviser on Tobacco, Royal College of Physicians, London NW1 4LE
Dr Ranee Thakar
President, Royal College of Obstetricians and Gynaecologists, London SE1 1GH
Dr Charmaine Griffiths
Chief Executive, British Heart Foundation, London NW1 7AW
Dr Ian Walker
Executive Director of Policy, Information and Communications, Cancer Research UK, London E20 1JQ
Dr J Robert Branston
Associate Professor in Business Economics, University of Bath School of Management, Bath BA2 7AY
This letter has been signed by a further 203 organisations and individuals. Full list here: https://ash.org.uk/uploads/Endorsees-letter-of-support-for-investing-in-...
References
[1] Labour Party. Change: Labour manifesto 2024. https://labour.org.uk/wp-content/uploads/2024/06/Labour-Party-manifesto-...
[2] Reed H. Cost Benefit and Public Finance Model of Smoking, Version 2.2. May 2024 https://ash.org.uk/uploads/CBPF-model-May-2024.pdf?v=1715163422
[3] Pokhrel S. Owen L. Coyle K. Lester-George A. Leng G. West R. Coyle D. Costs of disinvesting from stop smoking services: an economic evaluation based on the NICE Tobacco Return on Investment model. The Lancet. Volume 388, Supplement 2, November 2016, Page S95. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)32331-5/fulltext
[4] NHS England. NHS Long Term Plan. Chapter 2: More NHS action on prevention and health inequalities. Smoking. January 2019
https://www.longtermplan.nhs.uk/online-version/chapter-2-more-nhs-action...
[5] These estimates are based on cost savings found in Ottawa when they implemented a similar model. ASH Inpatient Tobacco Dependence Treatment Services Impact Calculator 2024 https://ashresources.shinyapps.io/TDTS_Impact/
[6] OHID. The Khan review: making smoking obsolete. June 2022 https://www.gov.uk/government/publications/the-khan-review-making-smokin...
[7] APPG on Smoking and Health. APPG on Smoking and Health Manifesto for a Smokefree Future. November 2023 https://ash.org.uk/resources/view/appg-on-smoking-and-health-manifesto-f...
[8] ASH. ASH policy paper for the APPG on Smoking and Health: Establishing a Smokefree Fund. November 2023 https://ash.org.uk/uploads/ASH-policy-paper-for-the-APPG-on-Smoking-and-...
[9] ASH and ADPH. On the path to ending smoking: using new funding. March 2024 https://ash.org.uk/uploads/On-the-path-to-ending-smoking-DPH-briefing.pdf
[10] Hansard. House of Lords. Vaping Products: Usage by Children. 2 September 2024. https://hansard.parliament.uk/lords/2024-09-02/debates/E9ACDB3F-29B6-47C...
Competing interests: JRB: I receive funding from receive funding from Bloomberg Philanthropies, as part of the Bloomberg Initiative to Reduce Tobacco Use. I also own 10 shares in Imperial Brands for research purposes. The shares were a gift from a public health campaigner and are not held for financial gain or benefit. All dividends received are donated to health related charities, and proceeds from any future share sale or takeover will be similarly donated.