19 August 2015

The arguments for NHS e-cigarettes are all smoke and mirrors


Roll up, roll up, it’s time to give away some more free stuff, folks!

This time it’s e-cigarettes, which public health officials want to hand out on NHS prescription to anyone who wants them.

This must be an excellent idea. After all, smoking real cigarettes is very bad for people’s health and most people who use e-cigarettes do so in a bid to kick their nasty habit. So, instead of spending billions of pounds treating smokers for lung cancer and heart disease, the NHS will instead spend a hundred million or so handing out free e-cigarettes to smokers instead.

It makes financial sense and it will improve public health at the same time so who could possibly argue with that?

Well, anyone with any common sense. Just because you believe in the NHS, its values and, crucially, in the health care it offers being free at the point of need, that doesn’t mean you shouldn’t, as a taxpayer, expect value for money for every pound you pay into Treasury coffers.

There is, quite simply, no need for the NHS to start handing out e-cigarettes on prescription to anyone. Yet the argument from Public Health England goes like this: smoking is harmful and we need people to give up the habit. E-cigarettes are 95 per cent less harmful than tobacco, so therefore if we offer e-cigarettes on prescription, we will encourage more people to give up.

Which sounds fine and dandy except, by the same logic, are we going to hand out free oranges to people who choose to spend all their money on chocolate? After all, oranges are much better for you, and if you fill up on oranges, you won’t have room to eat too many bars of Dairy Milk and will be healthier. Yet no one is offering free oranges out, last I heard anyway. Equally, cars are much safer than motorbikes. So shall we start handing out free cars to motorcycle owners in a bid to keep them safer on the roads? No, of course not.

In a free society, people are free to make their own choices and some people will make bad choices but, just because they have made those bad choices, it doesn’t logically follow that the rest of us should pick up the bill for them to be cajoled into the right choices. If you want the freedom to smoke, you also have to accept the responsibility for giving up. If you can afford to smoke, you can afford to pay the costs of kicking the habit too.

Ah, but don’t smokers contribute more than enough through tobacco taxes – £12.3bn annually – to cover the costs of their NHS treatment? Yes, but that’s beside the point. After all, we don’t offer extra NHS medicines or procedures to millionaires simply because they have paid more taxes than the low paid, so why should smokers, who have paid more in tobacco duties, be a special case?

Anyway, the biggest single contribution smokers make towards Treasury coffers isn’t the tobacco duty or the VAT they pay. That doesn’t quite cover all of the huge costs of treating smoking-related illnesses as well as the many years some smokers spend too sick to work, living on benefits and paying no income tax, which has been estimated at £14bn a year. No, the real contribution smokers make is that most of them will die prematurely of a smoking-related disease. 80,000 of them in England every year to be exact. That means that while the rest of us are likely to spend years, or even decades, claiming our state pensions, smokers won’t, thereby saving billions from the welfare budget – which is very generous of them.

But that still doesn’t justify handing out taxpayers’ hard earned cash through the NHS to people who simply don’t need it. If you can afford to spend £2,900 a year on a 20-a-day habit for years then you can definitely afford to buy your own, cheaper e-cigarettes to help you give up – or your own nicotine patches, nicotine gum for that matter.

We know that smokers who are genuinely motivated to kick the habit will happily spend their own money on e-cigarettes. How? Because most of the 2.6 million adults in the UK who use e-cigarettes are current or former smokers and bought their e-cigarettes using their own hard-earned cash. Does it really make sense to use taxpayers’ money to give away something that people don’t need, that they can readily afford and are already choosing to buy for themselves?

If Public Health England really believe that is a good way to spend scarce NHS resources, then their reasoning has disappeared in a puff of e-cigarette smoke.

Julia Hartley-Brewer is a journalist and broadcaster. A former political editor and LBC Radio presenter, she is a regular on TV shows such as Question Time and Have I Got News For You, and on Radio 4’s Any Questions.