The next item is the statement by the Minister for Social Services and Public Health on the tobacco control delivery plan. Therefore I call on the Minister, Rebecca Evans.

Thank you. I am pleased to launch our tobacco control delivery plan for Wales 2017-20. The actions contained in this plan have been developed to address tobacco use in Wales, and will ensure our work remains on track to reduce smoking prevalence levels to 16 per cent by 2020.

Cigarette smoking is the greatest single cause of premature death in Wales, causing around 5,450 deaths a year. Smoking-related disease is preventable, and costs the NHS in Wales an estimated £302 million every year. Smoking is also one of the main causes of inequalities in health, with smoking rates in poorer areas more than double those in affluent areas.

The Deputy Presiding Officer took the Chair.

Reducing smoking levels in Wales remains a priority for our Government. In 2012, we published our tobacco control action plan for Wales. The plan set a target to reduce smoking levels from 23 per cent in 2010 to 16 per cent by 2020. It also expressed a vision of a smoke-free society for Wales in which the harm from tobacco is eradicated. I am pleased to say that our 2012 plan has resulted in a range of health improvements for the people of Wales. These include a reduction in exposure to second-hand smoke, increased support for those wanting to quit smoking, and action to help prevent the uptake of smoking amongst young people. The smoking prevalence rate has fallen to 19 per cent. This is encouraging, but our work does not end there. We need to ensure that we take the steps we need to take if we are to maintain this momentum if we are to achieve our 16 per cent target in just three years’ time.

With that in mind, a tobacco control strategic board was established last year. The board, chaired by the chief medical officer, and its sub-groups for cessation, prevention and reducing exposure to smoking, have worked hard to develop and finalise this delivery plan, which will guide action up to 2020, and I would like to thank them for that work.

The plan I am launching today sets out the individual actions the Welsh Government and our stakeholders will take to invigorate activity and help us achieve the target and vision set out in the 2012 plan. It builds on the progress to date and will be supported by new powers contained in the Public Health (Wales) Act 2017 to enable us to extend the smoking ban to certain outdoor settings such as hospital grounds and places where children play. It will also enable us to introduce other measures to discourage tobacco use and improve health outcomes, such as the introduction of a register of retailers of tobacco and nicotine products. It will also make it an offence to hand over tobacco or nicotine products to those under 18 when using home delivery and collection services.

The actions in the delivery plan will support people to give up smoking and help to prevent people from taking up smoking in the first place. There are also a number of actions included to reduce exposure to smoking so that it’s not perceived as a normal, everyday behaviour. These actions and the new regulations to extend the smoking ban to areas that children frequent are intended to protect children and young people. This will help give them the best start in life.

Our intention is for people to choose smoke-free living as their aspirational goal and the plan is launched today under our overarching brand Choose Smokefree. The brand has been developed as one that will be recognised and used for all strands of tobacco control work in Wales. Its name is very clear about what it stands for. This will ensure consistency and signposting to cessation services for those who seek it. Earlier this year, I was pleased to launch our Help Me Quit cessation service, which is the first service to sit under our new brand. The service is designed to make it easier for smokers to access help to quit smoking. Over 40 per cent of smokers make at least one quit attempt every year, so it’s important that as many of those as possible seek help to quit as this significantly increases their chances of a successful quit attempt.

This delivery plan is consistent with the goals of the Well-being of Future Generations (Wales) Act 2015 and was developed by adopting the ways of working underpinning the Act. It’s also one of the responses to our national strategy, ‘Prosperity for All’. It aims to improve the health and well-being of people in Wales and to provide a greater emphasis on prevention.

During the lifetime of the plan, our tobacco control strategic board and its sub-groups will remain focused on progress and be alive to new and emerging tobacco products that threaten what we have worked so hard to successfully achieve in Wales since the introduction of the smoking ban 10 years ago. The board will ensure that we continue to plan beyond 2020 and will set further goals to achieve a smoke-free society.

Minister, thank you for your statement today. I welcome the delivery plan. I’m pleased that it continues to set out a number of ambitious targets to cut smoking rates. I think it does remain shocking that up to two thirds of long-term smokers will die from smoking-related diseases, and I think it is worth reminding ourselves that the US Food and Drug Administration actually summed it up by saying cigarettes are

‘the only legal consumer product that, when used as intended, will kill half of all long-term users’.

So, I do congratulate you on achieving the target of getting down to 19 per cent. I would like to understand, Minister, a realistic assessment from you as to whether or not you believe the 16 per cent target will be met by 2020, because I do note in your plan that you say that it’s going to be a very challenging target. And off the back of that, I’d be very interested to hear your opinion as to whether you consider the Cancer Research UK aim of seeing a less than 5 per cent smoking rate across all socioeconomic groups by 2035 in Wales achievable, because there’s no point in setting a wholly unachievable target, but maybe it’s something we can get towards.

You talk in your statement of the Help Me Quit programme, and yet in 2016-17 only 2.9 per cent of the smoking population was seen by a smoking cessation service and no health board met the target. Indeed, in Cardiff and Vale university health board, only 1.3 per cent of the smoking population made a quit attempt. Minister, I would be interested to know why you think it has taken so long for the health boards to get on side with this. Do you have any plans again to look at the targets or to provide extra resources to ensure they are achievable?

I understand that mass media campaigns are very effective and you talk about it quite a lot in the delivery, but with figures from the Public Health Wales Observatory showing significant differences in smoking rates across Welsh counties, can you tell us what is being done to ensure that the resource is targeted at the areas where it can make the most difference? Whilst it’s very fashionable, and I know some of the population are very much into social media, a huge number of the people who smoke are not social media savvy, they’re not necessarily having access to computers, or they live in areas of poor internet connection. So, I wonder if you can let us know how you’re going to ensure that those sections are not being ignored.

Two final areas. People with mental health issues smoke significantly more than the general population. What plans do you have in place—because I couldn’t spot it in the delivery plan—to try to educate those people as to the need to give up smoking or to try to cut down on their smoking? Because it is a significantly higher number of people who smoke who have mental health issues. And the other figures that really shocked me were the figures available for expectant mothers who smoke during pregnancy. The delivery plan says that the data isn’t available for this sub-group, but the Public Health Wales Observatory did publish data last year that showed over 18 per cent of mothers smoked during pregnancy, and there were disparities across the health boards and across the socioeconomic boundary. So, I wondered, Minister, what plans you might have to tackle those two groups.

And finally, Deputy Presiding Officer, over the summer, Minister, I backed calls for UK health officials to consider new rules enforcing a reduction of nicotine in tobacco products to non-addictive levels following an announcement of a landmark consultation in the United States by the US Food and Drug Administration. I think we have to do something radical to try to stop the curse of smoking, and I would like to ask for your thoughts on that kind of initiative. If you think it is worth taking forward, would you be able to try and liaise with the health department officials at Westminster to see if we can actually look at some comprehensive legislation that might try to make some of these toxic products less toxic to those who do choose to use them? Thank you.

Thank you very much. I thank you very much for your welcome for the plan, but also for those important questions as well. You began by talking about how shocking it is that so many people are still smoking and the impact that has on families. In my statement, I said that smoking kills over 5,000 individuals every year. So, that’s 5,000 families impacted terribly by smoking. It is the main cause of preventable death and, of course, that keeps driving us forward to reach our targets. Actually, one of the facts that drives me forward on this particularly is that it really is an issue of health inequalities as well, because we know that people in poorer communities are much more likely to smoke, and, as a result, are much more likely to have those poor health impacts as a result of it. So, it really is an equalities and a social justice issue as well. So, this really does drive us forward in pursuit of those targets.

You asked about the 16 per cent target. I will put my neck on the line and say that, yes, I think we will be able to achieve that target with the help of the various new actions set out in our plan, and also with the help of our public health Bill—or public health Act now—which was passed recently by this Assembly. It is a challenging target; there’s absolutely no doubt about that. But, equally, I think that there is the drive to get there. You asked about future targets, and, of course, our ultimate ambition is for a smoke-free Wales. It will be something that I will be asking the tobacco control delivery board to look at setting new targets when we look to review things in 2020, when this plan comes to an end. So, I would certainly want to have continuous targets to take us to our smoke-free place where we want to be.

You’re absolutely right to say that we need to redouble our efforts within the NHS in terms of the support that’s offered through the NHS to people to quit smoking. There are some really important actions within this particular delivery plan, one of which, actually, is improvement against those cessation services by the design and development of an integrated ‘stop smoking’ service. Now, we’ve started that with our new brand, and the new service that I described that has been launched, Help Me Quit. But actually, there’s a lot more that we need to be doing there. One of the things we’re doing will be strengthening the referral pathway for maternity services to include referrals for all women who smoke to cessation services—who are pregnant—and also strengthening referral pathways to include referral to smoking cessation services for all smokers who are either preoperative patients, because we know the impact that that will have on the likelihood of a positive outcome after surgery, people with lung disease, and also people who have mental health conditions as well. So, that’s a specific action here. There are also actions in here for primary health care clusters in terms of defining how many referrals they will need to make in order to see a year-on-year reduction in smoking as well. So, we know primary care has a very important part to play in this. And actions for pharmacy as well. So, we’ll be looking to ensure that all pharmacists are able to offer smoking cessation services as part of their training pre-registration. So, this would be a new development as well. And, again, we’ll be looking to enhance the role that dentists play in terms of offering smoking cessation services as well. So, lots of work in development and lots of new approaches within the NHS as well.

You referred specifically to the fact that social media is fantastic in terms of getting the message out, but not everybody is able to access social media. So, as part of our Help Me Quit campaign we did have some television advertising and also some billboards as well. Going on a visit to stand by a billboard was one of the strangest things I’ve done as a Minister, but that’s where we launched the campaign because we felt it was important to have a very, very public and visible presence in communities as well.

We will be consulting with mental health service users, staff and stakeholders on the removal of the exemption in spring 2018 for those smoke-free places within mental health units. And I’m really keen that we have the views of people who have experience of stays in mental health units for that. Those are the people who more than anyone else I need to be listening to in these circumstances as well.

Lastly, and I did refer to it briefly, but you did mention support for pregnant women. The results from our smoking in pregnancy pilot, models for access to maternal smoking cessation support, which rather conveniently can be shortened to MAMSS, has shown that pregnant women are more likely to engage with smoking cessation services when using support that is embedded within those maternity services. And it’s also important to know that children are 70 per cent more likely to smoke if their mother smokes and actually three times more likely to smoke if both parents smoke as well. So, these are the kind of short interventions that healthcare professionals, both midwives and healthcare workers, can be having with families through the work that they are doing as part of the Healthy Child Wales and 10 Steps to a Healthy Weight schemes as well.

I’d like to welcome the publication of this delivery plan, and I’m sure that we can all welcome any commitment to continue to try to reduce the smoking rates, and especially those steps to try to prevent people from starting smoking in the first instance, because I do believe that that is the most significant element of the battle to reduce smoking rates in the long term.

If I can look specifically at some points that arise in step 2 in this new strategy—it talks about looking at the use of technology, for example, social media, in steps taken to prevent smoking amongst the young, and also looks at international evidence with regard to targeting younger people and people who are at risk of starting smoking. In both examples there, it is talking about starting this work by April or March of next year. I wonder whether the Minister would agree with me that there’s no time to waste here and that those kinds of steps should perhaps already be being taken.

In terms of this new brand, ‘choose smoke-free’, I look forward to seeing whether that does reach its aim. I hope that it very much does that. I wonder how much funding—. Are there any details about how much funding will be available to market that scheme and the new steps that are part of that strategy?

I was also eager to make the point about smoking rates amongst those who have mental health issues. I understand that 36 per cent of people who have mental health issues smoke, as compared to 19 per cent of the general population. The evidence shows that smoking cessation can be a very effective part of treatment for those conditions. So, even though the Minister has made comments on this already, I would encourage the Government to do more work in that particular area.

Finally, targets. I welcome the comments that the Minister made in response to Angela Burns’s questions with regard to her willingness to look at adapting and strengthening the long-term targets for the reduction of smoking rates. She mentioned this target that Cancer Research UK has of aiming for 5 per cent of the population by the year 2035. Has the Minister considered already, even though she’ll be looking at this further, whether this could be a target that she would be willing to adopt, because it is a target that Cancer Research UK certainly hopes that we can consider as a realistic one, and an ambitious one? And that other target then of treating 5 per cent or offering services for 5 per cent of those who do smoke, whilst we reach less than 3 per cent at the moment—by when is the Government confident that it can hit that target?

Thank you very much for those questions, and particularly for the focus that you gave at the start in terms of what we can do to prevent children and young people from taking up smoking in the first place. And our recent public health Act, as you know, extends the smoking ban to places where children and young people often frequent. And there’s a commitment within that Act that Ministers will be able to add other places to the list of smoke-free settings in due course as well. So, there’s a commitment within our plan to consider what other settings can be added to that as well, and I’ll be looking in the first instance at the tobacco control delivery group and its sub-groups to advise, although I was very aware that there were lots of ideas that came forward during the scrutiny of the Act. And, of course, we talked a lot about how we’re essentially banning a legal act in a public place, so there are lots of human rights considerations to be taken into account. But, of course, this is about the health of the children and young people of Wales.

There are some actions that have already started in terms of our action plan that we launched today, one of which is reviewing the tobacco criteria within the national quality award for the Welsh network of healthy schools scheme, and that’s to ensure that it does reflect the best practice and the best evidence that we have about young people and tobacco. That also includes other tobacco products such as e-cigarettes as well. We know that we have to be very responsive and agile in terms of the new ways in which tobacco is able to be administered to people, and we’re very clear within the action plan that our tobacco control delivery board and its sub-groups are going to be very active in terms of monitoring the latest trends, the latest technologies and the latest use and so on.

We’re also keen to be using the curriculum to see what we can do to further ensure that correct messages are getting through to young people about the dangers of smoking. And also within our action plan we have actions for further education and higher education settings because these are times when young people might think about starting smoking, but also times when it’s actually a good opportunity to reach out to them and provide the information that they need and the support that they need in a different setting to give up smoking as well.

I share your concerns about the high level of smoking amongst people who are experiencing mental ill health, and again this comes back to that social justice issue that we shouldn’t be accepting worse for people who are suffering from mental ill health, we shouldn’t be accepting worse for people who are living in poorer communities—we should be expecting good health and good services for all of these people. So, I’m pleased that this is addressed in the plan but, again, I would say the tobacco control delivery board as well is very open to any further ideas that people might have in terms of how we can strengthen our approach, and I’m keen to talk, as we go about looking again at the regulations on smoking in mental health units, to have a wider discussion, really, with people with mental ill health and the organisations who represent them as well.

And on that, I should have at the end of my comments in response to Angela mentioned the issue of the nicotine levels. And I’d be keen to have a meeting with you to further discuss that, if that would be helpful as well.

There are lots of targets and lots of opportunities to monitor the delivery of the plan. You’ll see that within it we have indicators from the national survey of health behaviour in school-age children, School Health Research Network studies, Public Health Wales’s maternity indicators, other Public Health Wales indicators, and other performance targets as well. So, it should be very clear to people as to what extent we are meeting our targets and our aspirations within the plan.

In terms of that longer term plan and that longer term aspiration for a smoke-free Wales, I’m aware of the Cancer Research UK and World Health Organization aspiration for a smoke-free society by 2035, and this will certainly be something that the tobacco control delivery board thinks about when advising on the next targets. Although, I would imagine that they would want to set a closer target. So, if we were republishing a new plan in 2020, then I imagine that we’d be looking towards, say, a 2025 target and so on. But, ultimately, obviously, our vision is for a smoke-free Wales.

Thank you for your statement, Minister. I welcome the delivery plan. Since the implementation of the smoking ban, it is good news that smoking in the home has reduced from 80 per cent to 46 per cent. ASH Wales says that this suggests that there is a better understanding of the dangers of second-hand smoke, especially around children and families. Therefore, although we look at this as a 34 per cent decrease in smoking in the home, we must remember that the other people in the home are benefitting from not being exposed to this second-hand smoke also.

As mentioned, smoking is one of the main causes of inequalities in health, and smoking rates in poorer areas are more than double those in affluent areas. So, I wonder how we are going to deal with this inequality aspect.

Whilst visiting hospitals within my region, I was alarmed by the amount of people outside of the hospital, but in the public area, who are still smoking. So, I am pleased that the statement acknowledges this and plans to extend the ban to include areas such as these. It would seem that all the information in the world would not help some people beat this addiction, and I’m not criticising, but trying to understand that when people become hooked on cigarettes, it must be awful if you cannot beat the addiction. Despite knowing the dangers of smoking, and that, in Wales, it contributes to 5,450 deaths per annum, people are still smoking. So, this is a concern and we must do all that we can to combat this and help people more.

My concern is the second-hand smoking surrounding babies and children. I have watched programmes on television about how an unborn baby reacts to smoke, and this is very disturbing to watch, but I’d like to, sort of, see more of it advertised. Parents who smoke are highly likely to influence the children who live with them, so it’s disturbing to read that 64 per cent of secondary school pupils reported being exposed to second-hand smoke. So, I wonder if you agree with me that this area does need consideration.

As 19 per cent of Welsh adults are still smoking, what research and information has the Welsh Government undertaken to assist with reducing this number? Also, ASH has stated that in prisons the ban has been 100 per cent successful, but I understand that since this ban, the number of self-harm incidents in prison has increased among prisoners, as has violence, prisoner on prisoner and prisoner on staff. Is this due to frustration—the improvisation of a cigarette through trying to smoke teabags in order to make up for the non-access to a cigarette? So, these people have mental health issues, and, coupled with being locked up, it is adding stress. So, I wonder if we could ask that some research is undertaken regarding the above statement—that ASH states a 100 per cent compliance to this—and whether we can re-evaluate, if necessary, the success claims regarding these prisons.

The banning of smoking anywhere near playgrounds and children’s areas is a must, and I’m pleased to see that the plan is making provisions to stop this. I’m pleased that the statement acknowledges the harm that second-hand smoking has caused and the plans to deal with it. Also, I’d like to ask about the collaboration with other services, such as Cancer Research, ASH and other areas. Thank you very much.

Thank you very much for those questions. I’ll begin where you finished in terms of talking about collaboration with other organisations with a keen interest in this area. ASH Wales have been funded for three years to support us in the delivery of our plan, but they play a really important role as well in terms of having wider discussions with all of those people with an interest in tobacco control in Wales—across the third sector as well. So, there is good dialogue, I think, in terms of all of those organisations who have an interest. And also, at the back of the delivery plan you’ll be able to see a list of all of the members of the tobacco control delivery board, and also the sub-groups that support that work, and I hope that you’d agree that they are a diverse section who do capture the views of our society in that regard.

You were right to remind us, actually, that smoking is an awful addiction because, I think, as a non-smoker it’s often quite easy to forget that actually it is a real addiction. It’s an extremely expensive addiction, and six out of 10 smokers actually at the moment, today, would like to give up. So we need to be there to support those six out of 10 and also to provide the right messages and education for the other four in terms of helping them understand the damage and then make choices in that regard.

You did mention the work that’s going on in prisons; it has been very successful in terms of the fact that prisons now in Wales are all smoke free. I’m really keen to ensure that, when Welsh-domiciled prisoners are released from prison back into the community, that they actually still have support to stay on that smoke-free journey, and that’s reflected in our action plan as well.

You mentioned, as others have done, the importance of supporting parents to give up smoking. We know that, as I mentioned earlier, children who see their parents smoke are much more likely to take up smoking themselves, and the latest research shows that most adult smokers actually start smoking before the age of 18. So, the parental role and the parental role models are a really important factor in this as well.

Second-hand smoke is an extremely important issue as well, and you did talk about the danger that that can pose to children and young people. One of the big successes, I think, has been the ban on smoking in cars with children. I think it has been well observed as a ban because it’s a difficult thing, as you can imagine, in terms of policing that ban, but it has been well observed. And I suppose those kinds of culture changes, you know, it takes a while to change culture, but actually I think we are getting there now with a multipronged approach, with many partners working together.

And if you can just ask a question very quickly and the Minister can answer it very quickly, I’ll allow it. Russell George.

Thank you. Minister, can I ask: have you given any consideration, and if not will you, to banning smoking in all hotel rooms in Wales?

I thank you for that question. Under the current smoke-free premises regulations 2007, managers of hotels, guest houses, bed and breakfasts, inns and members’ clubs with residential accommodation are allowed to designate bedrooms for smoking. There’s no legal obligation for them to do so, as it’s up to the manager to decide whether or not smoking rooms are to be allocated. But, when taking forward regulations under the Public Health (Wales) Act 2017, all of the smoke-free provisions will be reviewed in line with good practice, and a full consultation will be held on those draft regulations. So, in terms of what does that mean for hotels, bed and breakfasts and so on, as I say—I think I’ve done a written answer to you very recently on this issue as well—currently it is a choice for the hotel or the business manager, but they have to be absolutely confident, and it has to be demonstrated, that the smoking room doesn’t have any effect on the surrounding rooms, for example, from vents and so on as well.

Okay, thank you very much, Minister, for that.