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** 11 February 2020
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** UK
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** Opinion: Take NHS England’s power - but don’t give it to ministers (#1)
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** International
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** Netherlands: Ruling by Administrative Court in Rotterdam: end of ‘rigged’ cigarette in sight? (#2)
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** Europe: Outdated EU cigarette tax rules blamed for slow drop in smoking (#3)
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** Study: Raising taxes on e-cigarettes could encourage traditional smoking (#4)
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** Parliamentary Activity
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** Parliamentary Questions (#5)
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** UK
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**

Ministers need to work out how to curb NHS England’s power and responsibilities - but by devolving it, not taking it for themselves - writes HSJ deputy editor Dave West.

About a year ago HSJ asked: “What will the prospect of major health legislation unleash? … This is a long game and we could well see general elections and new prime ministers before it’s over…Starting to pull on one or two threads of the 2012 Health Act might lead unavoidably to unravelling the rest, and a major redisorganisation…There are already signs of how the exercise could snowball into something even more far reaching”.

Well we’ve seen a new prime minister and a general election, and reform of the Lansley Act now seems set to be carried out under this administration. According to The Times this weekend, the government is planning to use it to rein in NHS England, giving ministers more power to direct it. It is probably no coincidence that this story, which is light on detail of the plan, turned up in the middle of Budget negotiations – with NHSE pressing again for multi-year funding deals to back-up the prime minister’s promises of more NHS staff and buildings.

The truth is new laws would do little to ease ministers’ frustrations, which are mainly a product of Sir Simon Stevens’ personal abilities and positioning, and of the immovable reality that the service has not had the money, staff, or facilities needed in the face of spiralling health need, and failing social care and support. The government is onto one thing, however: The legislation does need to shrink NHSE, its responsibilities, and its power. But they shouldn’t go to ministers – they need to be devolved back to regional, system and local levels.

The default candidates for NHSE to devolve power to are integrated care systems — but what form do they take, and are they really able to take on the necessary roles? The NHS is still engaged in experimenting to find the answers. For ministers, the options range from adopting NHSE’s proposal from the autumn — in which ICSs start to adopt some statutory governance rules, but do not become legal entities; and risk that they might never fully take on devolved responsibility and power.

At the other end of the spectrum, government could establish ICSs as legal authorities — abolishing clinical commissioning groups and possibly subsuming trusts too, or at least giving ICS strong powers over them. Of the many dangers here are disrupting the current movement toward partnership and collaboration; and the political risk of what would be a wholesale restructure. In NHSE’s own words, it would “necessitate a major change to the NHS’s existing organisational and accountability structure… and would be an unwelcome disruption and distraction at this point”.
The most likely answer at the moment from the Department of Health and Social Care is closer to t
he existing NHSE proposal: perhaps creating an ICS committee named in law, mandatory nationwide, and with defined functions and membership — similar to health and wellbeing boards, and short of a “legal entity”. It would probably mean a mandated formal role for local government, which itself could be controversial.

Boris Johnson has described himself to cabinet as “basically a Brexity Hezza” — meaning that, leaving the EU aside, he favours the devolutionary philosophy famously championed by Michael Heseltine since the Thatcher years. Will the former mayor of London’s localising instincts triumph, or will he fall foul of the temptation experienced by so many prime ministers, to try and take greater control of the nation’s most beloved institution? In the long run, it could make Brexit look simple.

Source: HSJ, 10 February 2020

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** International
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On Friday 7th February, the Administrative Court in Rotterdam questioned whether the current legal method for measuring cigarette emissions leads to results that are in accordance with other legal regulations. The court ruled that the obligation of the EU and the Dutch state to protect public health had been seriously undermined. Consequently, the court has requested a ruling from the European Court of Justice.

European tobacco legislation determined that a cigarette may emit a maximum of 10 milligrams of tar, 1 milligram of nicotine and 10 milligrams of carbon monoxide. The legislation also specifies that cigarette emissions must be measured using the ISO method. However, according to the Netherlands National Institute for Public Health (RIVM), smokers actually inhale two to three times as much tar, nicotine and carbon monoxide as legally allowed. That is because smokers block holes in cigarette filters with their lips and fingers while smoking.

An alternative measurement method called the ‘Canadian Intense’ method, involves blocking the holes, thereby creating similar conditions as during ‘normal’ smoking. The RIVM takes the view that the Canadian Intense measurement method approximates the reality of smoking much more closely than the ISO method does, even though the latter is prescribed by law and propagated by the tobacco industry.

On appeal, the Administrative Court in Rotterdam has sided with the Youth Smoking Prevention Foundation (SJPR), which argues that the legal measurement method conflicts with the government’s obligation to protect the health of citizens, especially children, and that the Canadian Intense method should be used.

The court in Rotterdam has agreed with the SRPJ’s request to seek a ruling from the highest court in the European Union, the Court of Justice in Luxembourg. That court has the power to overturn European legislation and can also instruct the European Commission to solve the problem through legislation. The Administrative Court has also asked the Court of Justice whether the Netherlands can decide to replace the measurement method, until the issue has been settled at EU level. If the Court of Justice in Luxembourg agrees, this ruling would mean that the Netherlands Food and Consumer Product Safety Authority (NVWA) could impose an immediate ban on the sale of filter cigarettes.

Wanda de Kanter, chairperson of the Youth Smoking Prevention Foundation, is delighted with the ruling: “At last, the end of the scandalous ‘rigged’ cigarette is in sight. That does not mean that cigarettes will immediately disappear, and smoking remains unhealthy, but it is definitely an important step in the right direction.”

Source: Stichting Rookpreventie Jeugd, 10 February 2020
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A pack of cigarettes still costs little more than £2 in parts of the EU, according to a European commission report that warns of a disappointing rate of reduction in smoking in recent years. It says the level of the EU’s minimum excise duty on cigarettes is outdated and higher taxes are required to deter young people from taking up smoking.

Countries with a strong public health agenda increased the costs for smokers far beyond the terms of the 2011 EU tobacco directive harmonising tax levels, but with the result that smuggling has been encouraged. In Bulgaria, a pack of 20 cigarettes costs on average €2.57 (£2.17), compared with £7.41 (€8.76) in the UK and €11.37 (£9.61) in the Republic of Ireland. The report says Denmark (€5.38 a pack), Austria (€4.74) and Luxembourg (€4.63) also feature among the least expensive countries for buying cigarettes, after purchasing power is taken into consideration. The disparity has created huge financial incentives for smugglers, whose illicit products account for 8% of all cigarettes consumed, the report says.

The rate of reduction in smoking predicted in a 2008 impact assessment has not been met. Across the EU, about 27.9% of adults (defined as over-15s) smoked in 2012 and 25.9% in 2017. A 10% reduction had been predicted, the report says.

“The study confirms that taxation has proved to be a main driver for the reduction of smoking prevalence,” it adds. The Brussels directive is estimated to be responsible for only 250,000 fewer smokers in the 2011-17 period.

The minimum excise level set by the 2011 directive – at least €90 per 1,000 cigarettes and at least 60% of the average retail selling price of a pack – has also been undermined by fine-cut tobacco remaining comparatively cheap.

Source: The Guardian, 10 February 2020
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A new study, funded by the National Institutes of Health in the US, has suggested that raising taxes on e-cigarettes to curb vaping causes people to purchase more traditional cigarettes. A team of researchers from six universities examined the effect of e-cigarette taxes enacted in eight states and two large counties on e-cigarette prices, e-cigarette sales, and sales of other tobacco products. Using data from 35,000 national retailers from 2011 to 2017, researchers found that for every 10% increase in e-cigarette prices, e-cigarette sales dropped 26%. But the same 10% increase in e-cigarette prices caused traditional cigarette sales to jump by 11%.

Currently, nearly half of the fifty states in the US have an e-cigarette tax, which has significantly raised the price of e-cigarettes. Congress is considering enacting a federal tax of its own on e-cigarettes. That concerns study co-author Michael Pesko, an economist from Georgia State University. "We estimate that for every e-cigarette pod no longer purchased as a result of an e-cigarette tax, 6.2 extra packs of cigarettes are purchased instead," he said.

"Although vaping-related illnesses are a public health concern, cigarettes continue to kill nearly 480,000 Americans each year, and several reviews support the conclusion that e-cigarettes contain fewer toxicants and are safer for non-pregnant adults," said Erik Nesson, an economics professor in the Miller College of Business at Ball State, and a member of the research team.

If raising taxes on e-cigarettes simply chases smokers to traditional cigarettes, which the CDC has determined to be "the leading cause of preventable death", is it worth it? The research team believes that the issue will continue to be important for policymakers to consider as they develop e-cigarette related tobacco control policies.

Source: Forbes, 10 February 2020

See also:
National Bureau of Economic Research. The Effects of E-Cigarette Taxes on E-Cigarette Prices and Consumption: Evidence from Retail Panel Data. ([link removed]) 2020.

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** Parliamentary Activity
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**

Asked by Mr Gregory Campbell, East Londonderry
To ask the Secretary of State for Health and Social Care, whether the Tobacco Control Plan 2017-2022 is making adequate progress to reduce adult smoking prevalence to 12 per cent by 2022.

Answered by Jo Churchill, the Parliamentary Under-Secretary for Health and Social Care
Adult smoking rates in England are at their lowest level recorded at 14.4% of the population. The Government continues to make progress towards delivering the ambition of 12% or less by the end of 2022. As announced in the Prevention Green Paper the Government has set out a further ambition to go ‘smoke-free’ in England by 2030. Proposals for this will be set out at a later date.

Source: Hansard, 10 February 2020
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ASH Daily News is a digest of published news on smoking-related topics. ASH is not responsible for the content of external websites. ASH does not necessarily endorse the material contained in this bulletin.

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