The report covers e-cigarette use among young people and adults, public attitudes, the impact on quitting smoking, an update on risks to health and the role of nicotine. It also reviews heated tobacco products.

The main findings of PHE’s evidence review are that:

• vaping poses only a small fraction of the risks of smoking and switching completely from smoking to vaping conveys substantial health benefits
• e-cigarettes could be contributing to at least 20,000 successful new quits per year and possibly many more
• e-cigarette use is associated with improved quit success rates over the last year and an accelerated drop in smoking rates across the country
• many thousands of smokers incorrectly believe that vaping is as harmful as smoking; around 40% of smokers have not even tried an e-cigarette
• there is much public misunderstanding about nicotine (less than 10% of adults understand that most of the harms to health from smoking are not caused by nicotine)
• the use of e-cigarettes in the UK has plateaued over the last few years at just under 3 million
• the evidence does not support the concern that e-cigarettes are a route into smoking among young people (youth smoking rates in the UK continue to decline, regular use is rare and is almost entirely confined to those who have smoked)

PHE’s evidence review comes just a few weeks after a US National Academies of Sciences, Engineering and Medicine report on e-cigarettes. Their conclusion on e-cigarette safety also finds that based on the available evidence ‘e-cigarettes are likely to be far less harmful than combustible tobacco cigarettes.’

Professor John Newton, Director for Health Improvement at PHE said:

Every minute someone is admitted to hospital from smoking, with around 79,000 deaths a year in England alone.

Our new review reinforces the finding that vaping is a fraction of the risk of smoking, at least 95% less harmful, and of negligible risk to bystanders. Yet over half of smokers either falsely believe that vaping is as harmful as smoking or just don’t know.

It would be tragic if thousands of smokers who could quit with the help of an e-cigarette are being put off due to false fears about their safety.

Professor Ann McNeill, lead author and Professor of Tobacco Addiction at King’s College London said:

It’s of great concern that smokers still have such a poor understanding about what causes the harm from smoking. When people smoke tobacco cigarettes, they inhale a lethal mix of 7,000 smoke constituents, 70 of which are known to cause cancer.

People smoke for the nicotine, but contrary to what the vast majority believe, nicotine causes little if any of the harm. The toxic smoke is the culprit and is the overwhelming cause of all the tobacco-related disease and death. There are now a greater variety of alternative ways of getting nicotine than ever before, including nicotine gum, nasal spray, lozenges and e-cigarettes.

Professor Linda Bauld, author and Professor of Health Policy, University of Stirling and Chair in Behavioural Research for Cancer Prevention, Cancer Research UK said:

Concern has been expressed that e-cigarette use will lead young people into smoking. But in the UK, research clearly shows that regular use of e-cigarettes among young people who have never smoked remains negligible, less than 1%, and youth smoking continues to decline at an encouraging rate. We need to keep closely monitoring these trends, but so far the data suggest that e-cigarettes are not acting as a route into regular smoking amongst young people.

PHE is calling on smokers and a number of bodies to act on the evidence.

Smokers

Anyone who has struggled to quit should try switching to an e-cigarette and get professional help. The greatest quit success is among those who combine using an e-cigarette with support from a local stop smoking service.

Local stop smoking services and healthcare professionals

These should provide behavioural support to those smokers wanting to quit with the help of an e-cigarette. A new training course on e-cigarettes for healthcare professionals by the National Centre for Smoking Cessation and Training is now live.

Medicines and Healthcare products Regulatory Agency (MHRA)

MHRA continue their work in regulating and licensing e-cigarette products and support manufacturers to expedite the licensing of e-cigarettes as medicinal quit aids. PHE believes there is compelling evidence that e-cigarettes be made available to NHS patients.

NHS Trusts

To become truly smokefree, Trusts should ensure

• e-cigarettes, alongside nicotine replacement therapies are available for sale in hospital shops
• vaping policies support smokers to quit and stay smokefree
• smoking shelters be removed
• frontline staff take every opportunity to encourage and support patients to quit

The government’s new Tobacco Control Plan for England includes a commitment to ‘maximise the availability of safer alternatives to smoking’. It makes clear that e-cigarettes have an important part to play in achieving the ambition for a smokefree generation.

Background

1. McNeill A, Brose LS, Calder R, Bauld L & Robson D (2018). [Evidence review of e-cigarettes and heated tobacco products. A report commissioned by Public Health England. London: Public Health England. Read the report.
2. Over the past few years, e-cigarette use has hovered at just under 6% of the adult population in Britain. The most common reason for e-cigarette use continues to be to help with quitting and they are the most popular quitting tool in England. At the same time, quit success rates have been improving and we are also seeing an accelerated drop in smoking rates (currently 15.5% in England): smokinginengland.info/latest-statistics.
3. 79,000 people in England die every year as a result of smoking, and over half of long-term smokers will die from a smoking-related illness if they do not quit: digital.nhs.uk/catalogue/PUB24228.
4. PHE 2015 e-cigarettes evidence review: McNeill A., P. Hajek et al, E-cigarettes – an evidence update: A report commissioned by Public Health England, Public Health England, August.
5. Authors’note on evidence for ‘around 95% safer’ estimate.
6. Nicotine without smoke: tobacco harm reduction, Royal College of Physicians, April 2016.
7. Smoking Toolkit Study.
8. ASH (May 2017) Use of e-cigarettes (vapourisers) among adults in Great Britain.
9. Bauld, Linda, Anne Marie MacKintosh, Brian Eastwood, Allison Ford, Graham Moore, Martin Dockrell, Deborah Arnott, Hazel Cheeseman, and Ann McNeill. ‘Young people’s use of e-cigarettes across the United Kingdom: Findings from five surveys 2015–2017.’ International journal of environmental research and public health 14, no. 9 (2017): 973.
10. Towards a Smokefree Generation: A Tobacco Control Plan for England Department of Health, July 2017.
11. NHS Digital, Statistics on Smoking: England, 2017.
12. US National Academies of Sciences, Engineering, and Medicine (January 2018) Public Health Consequences of E-Cigarettes.

About Public Health England

Public Health England exists to protect and improve the nation’s health and wellbeing, and reduce health inequalities. We do this through world-leading science, knowledge and intelligence, advocacy, partnerships and providing specialist public health services. We are an executive agency of the Department of Health and Social Care, and a distinct organisation with operational autonomy. We provide government, local government, the NHS, Parliament, industry and the public with evidence-based professional, scientific expertise and support. Follow us on Twitter: @PHE_uk and Facebook: www.facebook.com/PublicHealthEngland.

Today’s (5 February) development by President Yameen to declare a state of emergency in Maldives follows an order by the Supreme Court on 1 February to immediately release nine convicted political leaders and retry their cases.

The Supreme Court also ordered that all MPs who have not been allowed to exercise their responsibilities should be permitted to sit in the People’s Majlis (Parliament) in accordance with the Constitution and the law, which has not been carried out by the Government of Maldives.

Foreign Secretary Boris Johnson said:

I am gravely concerned about the declaration of a state of emergency in Maldives, and the accompanying suspension of fundamental rights. The damage being done to democratic institutions in Maldives and the sustained misuse of process in Parliament is deeply worrying.

I call on President Yameen and the Government of Maldives to peacefully end the state of emergency, restore all articles of the constitution, take immediate steps to implement in full the order of the Supreme Court, and to permit and support the full, free and proper functioning of Parliament.

Further information

Thank you Mr President, and thank you also to High Representative Nakamitsu for your briefing.

We are holding this session in the open Chamber today after a series of reported chemical attacks in Eastern Ghouta within the last month, as the Assad regime continues its merciless bombing and killing of civilians. Over the weekend, there was a further allegation of use of chemical weapons in Idlib, as well as airstrikes by pro-regime forces which reportedly hit three hospitals, leaving doctors scrambling to remove premature babies from their incubators to move them. I cannot say move them to safety because the reality is that, for the citizens of Idlib and Eastern Ghouta, nowhere is safe. Mr President, we are appalled by this violence and the reported deliberate targeting of civilians and civilian infrastructure and call upon all parties to the conflict to uphold International Humanitarian Law and protect civilians.

The OPCW is already investigating reports of chemical weapons use in recent weeks, but establishing who was responsible for such use will be much more difficult, because Russia three times vetoed continuation of the independent, expert Joint Investigative Mechanism, in order to protect the Assad regime.

We would welcome any serious attempt to re-establish a properly independent investigation and attribution mechanism to continue the meticulous work of the JIM.

Sadly, we do not yet see that in the Russian proposal.

Any successor investigation must be empowered to investigate all use of chemical weapons, whoever the perpetrator may be. Yet the Russian proposal focuses only on non-state actors. We have repeatedly condemned Daesh for its use of chemical weapons, which the JIM clearly reported. But given Assad’s track record of chemical weapons use and his failure to comply with the Chemical Weapons Convention, it is imperative that any new mechanism also investigate chemical weapons use by the Syrian regime.

A second objection is the proposal that experts would merely gather evidence, leaving this Council to decide what it meant. No other UN expert panel that I know of is specifically prohibited from reaching conclusions and reporting its findings to the Council on what has happened. We are not specialists on chemical weapons at this table; we rely on independent, UN-selected expert panels. The entire purpose of the JIM was that an independent panel reached conclusions on the basis of the evidence, taking it out of the hands of us, the Member States, the Council Members, because we had been unable to agree. Russia’s proposal looks designed to avoid the political embarrassment of having to use its veto power to defend the indefensible, when independent bodies report on what has truly happened. The underlying intent seems to be to ensure there are no clear conclusions in future reports.

Thirdly, we object to the proposal’s demands that the standard of proof should be ‘beyond reasonable doubt’. This standard is not used in any other comparable past or present UN investigation. It is used in relation to criminal prosecutions in courts of law, which have significantly greater investigative powers and independence than Russia’s text proposes.

And finally, Mr President, this proposal insists on site visits. This is despite the explicit provision in the Chemical Weapons Convention for other ways to gather relevant evidence, recognising the difficulty of safe and timely visits. There is no scientific basis for this proposal. It is simply an attempt to hamstring future investigations and to discredit the JIM. Russia, of course, made much of the absence of a site visit to Khan Sheikhoun, despite the fact that the Assad regime handed over to the UN samples from the site, which contained chemical signatures unique to regime sarin, obviating the need for such a visit.

It is for these reasons that the text is unacceptable. The JIM set a high standard of impartiality and expertise; we expect that standard from any future mechanism.

Mr President,

The Syrian regime of course claims not to have used chemical weapons.

Yet over the years, two separate reports from the JIM under separate leadership panels, drawing on a broad range of respected independent international experts, concluded that the regime used chlorine at least three times – in Talmenes in April 2014, and in Sarmin and Qmenas in March 2015, and used sarin to attack Khan Sheikhoun in April 2017.

And let us remember, too, that infamous attack in Eastern Ghouta in August 2013, when a separate UN investigation found that sarin was used to kill hundreds and injure thousands.

That attack brought near universal international condemnation. And, following our concerted international pressure, Syria joined the Chemical Weapons Convention.

Syria promised – as it was legally obliged to do – to destroy and abandon its chemical weapons programme. Yet they have been unable to satisfy inspectors that they have done so. We have to ask ourselves: why not?

In 2013, Russia promised to act as a guarantor for the Assad regime’s compliance with the Chemical Weapons Convention. Yet month after month we all sit here and we hear that Assad has not done so. So why does Russia not compel the Syrian regime to comply with its obligations and make it impossible for them to use chemical weapons?

Mr President,

Tragically, for the people of Syria, the regime continues to use chemical weapons with impunity. If it is confirmed that Assad has again used chemical weapons on his own people, it would not only be another entry in the catalogue of his war crimes.

It would also be another attack on us all: members of the United Nations who have worked for decades – in the words of the Chemical Weapons Convention – “for the sake of all mankind, to exclude completely the possibility of the use of chemical weapons”.

Through history, our peoples have said “never again”: among others from the First World War battlefields; in Ethiopia; in Manchuria; in Saddam Hussein’s attacks on Iran, and on Iraqi Kurds.

Let us on this Council stand up for the peoples of the United Nations, determined that these abhorrent chemical weapons should never be used.

Let us stand up for the people of Syria and give them a real investigation into those responsible for the use of chemical weapons, an investigation which pursues justice for the horrific crimes committed against them.

Let us signal our determination to pursue accountability through all means available, even if one member of the Security Council is currently preventing us from taking action here.

Thank you Mr President.

On 10 January I informed the House that my department was preparing contingency plans for running train services on the East Coast in the event of the existing franchise failing. Despite delivering significant returns to the taxpayer and having some of the highest passenger satisfaction scores in the country, the lead operator of the franchise, Stagecoach, has been incurring significant losses.

In that debate I promised to return to the House to provide an update statement on the situation, and I am doing so today (5 February 2018).

Since 2015 the franchise has met all its financial commitments to the taxpayer, returning nearly £1 billion to the public purse. But this has come at a substantial cost of nearly £200 million to Stagecoach.

I have already informed the House that the franchise will in due course run out of money and will not last until 2020. But it has now been confirmed the situation is much more urgent. It is now clear that this franchise will only be able to continue in its current form for a matter of a very small number of months and no more.

Last week, following detailed analysis, my department issued the franchisee with notification that the franchise had breached a key financial covenant.

Now, it’s important to be clear with the House, this will not impact on the railway’s day-to-day operations. The business will continue to operate as usual with no impact on services or staff on the East Coast.

But it does mean I will need to – in the very near future – end the contract and put in place a successor arrangement to operate this railway.

Given the imminent financial pressure the existing franchise is under, I am taking action now to protect passengers who depend on these train services and ensure continued value for money for taxpayers.

And, given the urgency of the situation, I would like to take this opportunity to update the House on my plans.

Our franchising system as a whole has delivered great benefits to passenger:

• new private investment totalling £6.4 billion over the last 11 years
• passenger journeys on the rail network have more than doubled

The private sector is paying for new trains all round the country.

There has been much misinformation about this franchise so it is worth stressing again at the outset that – because payments to the government have been subsidised by Stagecoach – the taxpayer has still profited financially from this franchise. Passenger satisfaction is high and preparations are well under way to deliver state-of-the-art new trains on the route.

The problem is that Stagecoach got its numbers wrong. It overbid and is now paying a price.

Contrary to widespread speculation, no deal has been done and I have not yet made a decision on the successor operator to run the East Coast railway until the long-term plans for the integration of track and train can begin in 2020. There is no question of anyone receiving a bailout. Stagecoach will be held to all of its contractual obligations in full.

As the Brown Review said 5 years ago, this is what you would expect in a competitive franchise system – private businesses risk substantial amounts of their own capital, and if they fail to live up to their stretching targets they lose out, not the taxpayer.

To anyone who thinks that the nearly £200 million that Stagecoach will lose is insignificant, let me put it into some context. The combined profit of every single train operator in the country was only £271 million last year. The loss equates to over 20% of Stagecoach’s total market value. So it is a significant amount of money by any measure, and it should also act as a stark warning to any company tempted to over-bid in future. Moreover the franchising system has been adjusted to further deter over optimism when bidding.

The priority now is to ensure the continued smooth running of the East Coast franchise for its passengers.

I have therefore asked my officials to conduct a full appraisal of the options available to the government to ensure continuity of service until we implement the East Coast Partnership on the route from 2020.

My decision on which option to choose will be made in accordance with the key principles set out in the statement on how I use my rail franchising powers. This includes:

• protecting the interests of passengers
• preserving the interests of taxpayers, by ensuring value for money
• supporting investment and improvement in the railway, including the deployment of the new Intercity Express trains on the East Coast

In order to inform this decision, the department will assess the extent to which each option performs against these principles. Our value for money assessment will be based on a number of criteria, including which option returns most money to the taxpayer, the risks attached to each, and the value of any improvements in passenger services.

I will also have regard to the effect of my decision on other franchises.

This decision will be taken in a transparent way. The department’s assessment of the options will be published and will include be properly validated.

At this stage, one of the options is to consider the possibility of Stagecoach continuing to operate services on the East Coast under a very strictly designed and short-term arrangement. The current management has a strong record of customer service and to rule out their involvement now would go against the principles I set out above.

However, given the circumstances in which the government is having to step in to protect passengers on this line, I am only prepared to consider this option on the basis that the franchise would be operated on a short-term, not-for-profit basis. The only acceptable financial reward for Stagecoach would be received at the end of the contract and only in return for clearly specified passenger benefits being delivered. The company cannot be allowed to continue running this franchise and making a profit given what has happened. They got their sums wrong and they will pay the price for that – not the taxpayer.

The alternative option is that the East Coast franchise would be directly operated by the Department for Transport through an Operator of Last Resort. My department will subject this option to the same rigorous assessment to establish whether it will deliver value for money for taxpayers and protect the interests of passengers. This option is currently on the table and will be selected if the assessment that I have set out determines that it offers a better deal for passengers and taxpayers than the alternative.

In either scenario, the East Coast Mainline is expected to deliver substantial revenue to the taxpayer. The line will also continue to deliver premium payments to the government once the East Coast Partnership is in place from 2020. Let me be absolutely clear: the East Coast franchise will deliver a healthy operating profit for taxpayers. It has over the course of this franchise so far and it will in the future.

Mr Speaker, there will be those who claim that because Stagecoach overbid, it should be excluded from bidding for future franchises. The legal advice on this is clear.

As Stagecoach is meeting its financial obligations to support the franchise, including with the full parent company support, and because it has operated the services on the East Coast successfully, the department has concluded that there are no adequate legal grounds to restrict it from bidding on current and future franchise competitions on this basis.

I will therefore follow that legal advice. But let me be clear – we will keep its eligibility for current and future bids under close scrutiny and constant review.

Mr Speaker, it is vital that we continue to focus our attention on delivering benefits for passengers across the network and secure the benefits of privatisation.

So, in addition to the transparent, rigorous process I have set out for the East Coast, I am making some additional franchising announcements that will deliver benefits to passengers on the West Coast and East Midlands routes.

In December 2016, we set out our plans to award the West Coast Partnership – the franchise that will deliver the first passenger services on HS2. In that announcement, we made clear our intention to agree a short direct award with the incumbent to allow us the time necessary to design the West Coast Partnership.

These negotiations have been completed and we have agreed a direct award with the existing operator, Virgin Trains West Coast.

Let me be clear, the East Coast and West Coast franchises should not be confused. As with the East Coast, the operator is meeting all its financial obligations, but the West Coast franchise has a completely different corporate structure, where Virgin Trains is the majority shareholder.

As set out 14 months ago, this is a sensible bridge between the existing contract and the West Coast Partnership – and once that partnership is ready this direct award will cease to exist.

Virgin has transformed the West Coast from a poorly-performing service requiring a subsidy of over £75 million a year to the franchise with one of the highest passenger satisfaction rates, at 91%, and returning over £200 million per year to the taxpayer.

This has included introducing trains every 20 minutes between London and Manchester and London and Birmingham, hourly services between London and Scotland, installing wifi on all trains, lengthening Pendolinos from 9 to 11 carriages to accommodate growing passenger numbers, and introducing a free at-seat entertainment service.

My decision is also in keeping with the 3 key principles I set out earlier in protecting passengers, ensuring value for money and supporting investment. I look forward to the release of the invitation to tender for the West Coast Partnership in due course and I am confident we will see strong competition for this exciting new franchise, which will help transform rail travel in this country through the delivery of the first HS2 services.

We are also transforming the East Midlands franchise in the coming years, with the biggest investment in the Midland Mainline since it was completed in 1870.

Passengers will benefit from more seats, new trains and dramatically reduced journey times from Nottingham and Sheffield to London. Once complete, there will be almost twice as many seats into London St Pancras in the peak compared to today.

The next operator will be required to deliver many of these improvements so I am today setting out the next step of the competition that will award this new contract.

Abellio, Arriva, Stagecoach (the current incumbent) and a joint venture between First and Trenitalia have all been shortlisted to run the East Midlands franchise that will deliver these improved services.

As I have previously said, the government has no adequate legal grounds to restrict Stagecoach from bidding. But the competition will be run on a fair, transparent basis, including new safeguards against overbidding. Ultimately, the winner will be the firm that offers the best service to passengers and best value to the taxpayer.

Mr Speaker, in a competitive market, franchises will sometimes fail. When that happens my duty is to protect passengers and taxpayers and ensure continued investment in the railway. Stagecoach has paid the price for failure as stipulated in its contract. Passengers on the East Coast Mainline can be assured that services will continue as normal. This government will undertake a transparent appraisal of the options available to ensure passengers and taxpayers are protected.

Passenger numbers have doubled.

We have one of the safest railways in Europe.

Passenger satisfaction is high across the network.

And other countries are now adopting Britain’s model for running the railways.

The plans I have set out today will allow the British public to continue to benefit from an ever improving railway into the future.

Prime Minister Theresa May today chaired the inaugural meeting of the Housing Implementation Taskforce – a cross-government working group attended by, among others, the Chancellor, the Housing Secretary, the Transport Secretary and several other Cabinet Ministers, to discuss the progress Government is making and further actions needed to increase housing supply.

A Downing Street spokesperson said:

Today the Prime Minister chaired the first meeting of the Housing Implementation Taskforce at Downing Street.

She stressed the integral role all Government departments have in helping to fix the broken housing market and deliver 300,000 additional homes by the mid-2020s.

The taskforce discussed the steps Government has already taken, including further investment at the Budget, planning reform, releasing land faster, the Housing White Paper and building more affordable housing. They emphasised the key role of Homes England in driving forward change, and also focused on the supply of new housing, public sector land sales, land banking, house-building skills and building the infrastructure needed for new housing developments.

The Prime Minister reiterated that a step change was needed right across Government and that all departments needed to think creatively about how they can contribute to building the homes the country needs.

Ministers who attended the meeting included:

• Rt Hon Philip Hammond MP, Chancellor of the Exchequer
• Rt Hon Sajid Javid MP, Secretary of State for Housing, Communities and Local Government
• Rt Hon Greg Clark MP, Secretary of State for Business, Energy and Industrial Strategy
• Rt Hon David Lidington CBE MP, Minister for the Cabinet Office and Chancellor of the Duchy of Lancaster
• Rt Hon Damian Hinds, Secretary of State for Education
• Rt Hon Michael Gove MP, Secretary of State for Environment, Food and Rural Affairs
• Rt Hon Chris Grayling, Secretary of State for Transport
• Rt Hon Tobias Ellwood MP, Parliamentary Under Secretary of State at the Ministry of Defence
• Baroness Buscombe, Parliamentary Under Secretary of State for the Department for Work and Pensions
• Oliver Dowden CBE MP, Parliamentary Secretary at the Cabinet