Nicotine Replacement Therapy (Hansard, 7 March 2000)

§ The Parliamentary Under-Secretary of State, Department of Health (Lord Hunt of Kings Heath)
My Lords, we welcome this report by the Tobacco Advisory Group of the Royal College of Physicians and will consider that recommendation carefully. We are aware of the important role of nicotine replacement therapy in helping smokers to give up, and are already investing substantial sums of money in NHS smoking cessation services, which include the provision of a week's free nicotine replacement therapy for poorer smokers.

§ Lord Rea
My Lords, I thank my noble friend for that Answer, which gave some detail of the Government's action. Is he aware that in terms of cost per life saved, nicotine replacement therapy is a great deal more economical than many other treatments that are available in the National Health Service for the prevention of coronary heart disease? Could NRT on the NHS be a welcome step to help the new heart tsar to work himself out of a job through prevention rather than cure? In the case of coronary heart disease, treatment is usually too late and never completely effective.

§ Lord Hunt of Kings Heath
My Lords, I am sure that we all hope that the heart tsar is put out of business soon because of the success of the programmes that we want to institute. However, I believe it will take a little time yet. I certainly agree that smoking cessation programmes are an important component of a preventative approach.
On the comparison between the cost-effectiveness of various preventative and treatment measures, it is important that one compares like with like. There is no doubt that nicotine replacement therapy, alongside advice to smokers who want to give up, can be an effective intervention measure.

§ Lord Clement-Jones
My Lords, in the National Service Framework for Coronary Heart Disease, published by the Government, smoking cessation clinics form an extremely important part. Does the limitation on the ability of those running such clinics to prescribe only one week's NRT to poorer smokers recognise the fact that every year smoking costs something like £1.5 billion to the NHS? In this millennium year, about 1.5 million are trying to give up smoking.

§ Lord Hunt of Kings Heath
Myself included, my Lords. I believe that smoking cessation programmes are an important part of our general drive in relation to improving health in this country. On nicotine replacement therapy, in the current financial year we have focused on health action zones. The zones are able to offer one week's free use of NRT. Next year we shall extend that one week's free use to the rest of the country. Of course, we shall consider carefully the 905 recommendations of the Royal College of Physicians, but I believe it would be better to evaluate the results obtained over the two years before making a firm decision about extending the use of NRT.

§ Baroness Massey of Darwen
My Lords, will the Minister comment on a recent article in the British Medical Journal which said that smokers usually start out as children who are addicted to nicotine by the time they are adults? Can he say what efforts the Government are making to encourage people not to start smoking as opposed to giving up?

§ Lord Hunt of Kings Heath
My Lords, that is the other side of the coin. We are taking a number of measures to dissuade young people from taking up smoking, including the banning of tobacco advertising as soon as legal action by the tobacco industry permits; toughening up on the enforcement of legislation outlawing the sale of tobacco products to children; and conducting a campaign targeted at young people as part of the tobacco education campaign later this year.

§ Lord Avebury
My Lords, first, I must declare an interest as a quadruple bypass alumnus, whose vascular disease was probably caused by heavy smoking before I gave up on 31st July 1976. Have the Government reached any conclusion on the recommendation referred to in the BMJ's article as perhaps the most important in the report? The recommendation was for an independent expert committee to examine the institutional options for nicotine regulation and to report to the Secretary of State for Health on future regulation of nicotine products and the management and prevention of nicotine addiction in Britain. Is not that a recommendation that the Government can accept at once?

§ Lord Hunt of Kings Heath
My Lords, first, I congratulate the noble Lord on giving up smoking such a long time ago; I am extremely envious of him. Nicotine addiction and the scientific basis for concluding that nicotine delivered through tobacco smoke should be regarded as an addictive drug was an issue raised by the report of the Royal College of Physicians. We shall give consideration to that issue and also to the suggestion that in the labelling of tobacco products reference should be made to nicotine addiction.
However, in terms of smoking prevention we need a concerted programme of developments, including the banning of tobacco advertising, strong programmes to discourage young people from taking up the habit, and ensuring that those who do smoke and want to give up—as the noble Lord rightfully said is the position with many people in this country—are given the strongest possible support.

§ Baroness O'Cathain
My Lords, in view of the Minister's admission, does he agree that many of those who do not smoke do not realise that it is an addiction? Yet some people have been known to say that heroin 906 and cocaine addiction are easier to crack—perhaps that is not the right word; to overcome—than nicotine addiction. Bearing in mind that this is a serious position and too often it is said that smoking is a lack of discipline rather than addiction, is not there a case for the Government to come down heavily in trying to cope with this addiction as they try to cope with the addiction of heroin and cocaine? In other words, cannot the therapy be made available to everybody and not just for one week?

§ Lord Hunt of Kings Heath
My Lords, in relation to the use of the word "addiction" one must draw a balance in making available to smokers the stark facts in relation to the risks of their smoking. For instance, there is a suggestion from the Irish Government in relation to the labelling of tobacco products that reference should be made to nicotine addiction. We will bear that suggestion in mind. More generally, we need to evaluate the results of the use of NRT over the next year or so. It is worth remembering that the cost of purchasing NRT for one week roughly equates to the cost of buying a packet of 20 cigarettes.
The aim of allowing one week's free use by those who can claim prescription exemption is to give them a kick start alongside the professional advice that can be given to help people cease smoking. It is worth making the point also that we are the only country in the world providing free NRT. We have the right programme, but should evaluate the use of NRT over the next year or so.