Health in Focus: Tobacco and Vapes Act & Devolved Elections

Last week, the elections dominated proceedings, and this week, focus will centre on the crucial King’s Speech, a chance for Starmer to swing the seemingly insurmountable tsunami of pressure he faces currently.

As this blog is posted, more information on Catherine West MP’s challenge to the Prime Minister will develop, and May could prove to be the straw that broke the camel’s back on Starmer’s tenure in the top office. Multiple takeaways can be drawn from an explosive election period which saw Labour under pressure from all sides: a resurgent Green Party, taking over key councils in London, and the poll-dominating Reform UK, who have firmly positioned themselves as a major party, controlling swathes of local government. Overall, Labour lost 1,496 councillors, with Reform UK the biggest ‘winners’ of the elections, gaining full control of 14 councils. Notably, wins in Barnsley, Sunderland, and Wakefield signal Reform UK coming for the Red Wall, while wins in Suffolk, Essex, and Havering show Reform UK usurping the right-wing vote and replacing the Conservatives. As a result, following the elections, Reform UK have proclaimed themselves as the only ‘national’ party which is competitive across the country. Meanwhile, the Greens took key wins in London, notably winning the mayoralty and council control in Hackney and Lewisham, two Labour stalwarts over recent decades.

In both Scotland and Wales, the pro-independence Scottish National Party and Plaid Cymru took home the most votes. While the SNP lost 6 seats from 2021, they still emerged the dominant party with Labour and Reform UK coming joint second with 17 seats each. In Wales, Plaid Cymru surged to victory, taking 20 more seats than in 2021, considerably outperforming expectations with most polls placing them in the lower- to mid-thirties range. Meanwhile, Labour slumped, losing 35 seats, and First Minister Eluned Morgan will likely head back to the Lords after dramatically losing her seat with only 7.3% of the vote in her constituency. Plaid Cymru Leader Rhun Ap Iorwerth has said Plaid Cymru will ‘move forward as a minority government in a co-operative way’, moving away from the previous expectation of a coalition between parties. No doubt, they will need support from somewhere to move forward proposals such as the Welsh budget. Plaid Cymru’s health policy is centred around two key pledges: to recruit 100 additional salaried GPs and establish 10 new surgical hubs to tackle regional ‘postcode lotteries’. Their manifesto also presents a decentralised governance model, seeking to remove political influence by transferring responsibility, notably through a reformed NHS Executive.

The proposed health policy for the new SNP government is driven by a ‘Once for Scotland’ approach, aiming to streamline corporate activity and protect a strictly publicly owned NHS that is free at the point of delivery. A cornerstone of this vision is a £10bn investment over ten years in infrastructure and Community Health and Care Centre (CHCC) hubs, ensuring that all health budgets are spent directly on care. A defining feature of the SNP’s workforce approach is the introduction of an NHS Job Guarantee, providing all graduates in medicine, nursing, and dentistry with a guaranteed three-year contract. The manifesto also boasts a £530m investment to recruit more family doctors and a revised Golden Hellos initiative to attract specialists to rural and island communities. To tackle waiting lists, the SNP sets a strict mandate that no patient waits longer than 26 weeks for treatment, supported by a minimum annual investment of £200m to expand elective capacity. Access to healthcare will be improved through 30 new seven-day walk-in GP clinics to eliminate the ‘8am rush’ and the rollout of the MyCare.scot app for digital bookings and prescriptions.

The SNP’s manifesto also places an emphasis on drug and alcohol harms, providing 1,000 residential rehab beds and new Alcohol Care Teams in hospitals. There is also reference towards new health MOT ‘one-stop shops’ to tackle poor health indicators, and a range of testing, screening, and diagnostic initiatives to drive early detection. Women’s Health is elevated strongly in the manifesto, including through a £13bn National Plan for Gynaecology and a commitment to recognise endometriosis as a chronic condition. Palliative care is also addressed, with NHS pay parity for hospice staff and a ‘Molly’s Suite’ for paediatric care. Furthermore, by legislating a legal right to breaks for unpaid carers and introducing a strengthened Power of Attorney system, the SNP aims to ensure a stronger and fairer social care service.

It is expected that the Government will use the King’s Speech to formally announce the legislation to abolish NHS England and merge some of its functions into the Department of Health and Social Care. The move has a deadline of April 2027, and was potentially a surprise omission from the first parliamentary session, given its magnitude. The move will look to improve productivity and efficiency, reduce bureaucracy, and cut running costs, most notably through a large reduction in overall headcount of both NHSE and DHSC by 50%. Importantly, not all functions will be merged into DHSC, with key responsibilities, including specialty and strategic commissioning, being reformed in the process.

The 10 Year Health Plan, published in July 2025, lays out key measures which will also require legislation. This includes the merger of the Health Services Safety Investigation Board into the Care Quality Commission and the abolition of Healthwatch, two decisions that have been proposed by the Government to simplify the regulatory landscape, but criticised for reducing transparency and accountability. Legislation to set the parameters and requirements of the Single Patient Record, which will place a duty on every health and care provider to make the information they record about a patient available to that patient, and changes to the patient safety landscape, including a patient safety commissioner, are also expected. Labour are likely to go heavy on policy in an attempt to push back on political pressure and convey a working Government committed to a stronger and fairer country and pushing forward progress amidst the political chaos.

In the previous King’s Speech, and as outlined in their 2024 manifesto, Labour committed to ensuring ‘the next generation can never legally buy cigarettes’. This led to the Tobacco and Vapes Act 2026, which passed at the end of the last parliamentary session, an emulated version of Rishi Sunak’s attempt at the legislation just prior to the ousting of his Government. As such, this policy was no surprise in the 2024 King’s Speech, and was widely supported by many health charities including the Smokefree Action Coalition, which is a group of over 300 organisations across the UK committed to ending smoking.

The Act is set on the backdrop of a strong push from charities for further smoking restrictions and prevention techniques, backed by scientific evidence. It is widely understood that tobacco is strongly correlated with worse health outcomes, with smoking remaining the most preventable cause of ill health, disability, and death in the UK. These harms have a detrimental impact on the NHS, costing the country an estimated £43.7bn a year in England. Tobacco use is also scientifically considered to cause ill health for non-consumers through secondhand smoke. This is particularly dangerous for medically vulnerable people like children, pregnant women, and those with pre-existing conditions. On top of the immediate health risk, smoking is also strongly linked to exacerbated geographic inequalities, poverty, and poor mental health. Vaping, whiledeemed a successful route out of smoking, has seen a sharp rise in prevalence among children. In 2025, 20% of children (11-17-year-olds) had tried vaping, up from 11% in 2021. Rates of children currently vaping have also risen from 3% in 2021 to 7% in 2025. In addition, vapes, particularly single-use, are an environmental hazard and a health risk, with toxic components such as propylene glycol and glycerine carrying health risks upon consumption. A previous call for evidence found that display and packaging of vapes was enticing for children and a strong factor in youth consumption and wider evidence shows that increased youth vaping is strongly caused by marketing strategies, as well as the attraction of sweet and fruit flavours, alongside exotic names and descriptors.

Previous Acts, Orders, and Regulations have amended legislation to increase: the age of sale of tobacco and vaping products, requirements around age verification and vaping ingredients, control measures relating to public spaces, packaging, display of products, advertising restrictions, and restrictions on smoking around children. Despite these changes, and in reaction to increased pressure, in 2022, Dr Javed Khan OBE undertook a significant independent review into smoking and came to four ‘critical’ recommendations: increase investment into stop smoking services, increase the age of sale from 18 by one year every year, promote vaping (as an effective tool to help people to quit smoking tobacco), and improve prevention through direct advice via healthcare services such as pharmacies, GPs, and hospitals. The 2022 Khan review also recommended banning cartoons or imagery on vape packaging. Public consensus over vaping and smoking restrictions is also overwhelming. A poll conducted by Action on Smoking and Health in 2025 found 68% of the public supported the ‘smokefree generation’ policy to ban the sale of tobacco for anyone born after 2009. The poll also found 65% of people want to live in a country where no one smokes, and 45% believe the Government is not doing enough on the issue.

The Act, while extensive in its number of clauses, is centred around Clause 1 which creates a ‘generational’ age of sale restriction for tobacco products, herbal smoking products, and cigarette papers to anyone born on or after 1 January 2009. Tobacco products include any product consisting wholly or partly of tobacco intended to be smoked, sniffed, sucked, chewed, or consumed in any other way. The Act also sets sale restrictions of vaping and nicotine products to under 18s, as well as granting powers to the Secretary of State, and devolved ministers, to introduce licensing schemes for the sale or possession of relevant tobacco products.

The Secretary of State can also legislate, following consultation, to set standards on relevant products, including on: appearance, information, texture, colour, images, shape, physical appearance, technological features, ingredients or flavourings, substances released into the body, and emissions. The Secretary of State is also granted powers to label any public space or workplace as ‘smoke-free’ which removes the existing threshold of a place needing to be at ‘significant risk’. The Act also clarifies restrictions on advertising and sponsorship of relevant products, replacing the Tobacco Advertising and Promotion Act 2002. This excludes the promotion of vapes and nicotine products where agreed for public health purposes with a public authority.

While reforms to tobacco and vaping regulations have been lobbied against strongly by tobacco companies, the overwhelming pressure, led by science, and pushed by a wide array of health charities has been firm in moving these reforms forward. Despite this, some policy experts have criticised the implementation of the Act, including the ‘generational age’ element where in decades’ time 50-year-olds may be turned away from buying cigarettes, whilst 51-year-olds can smoke freely. This raises the question of fairness, appropriateness, and logistical implementation. The argument also points back to the ongoing debate on individual responsibility and the ‘nanny state’. Nevertheless, the ‘nanny state’ debate is not one that multiple Governments have been shy to act on, with the UK ranking 7th in the 2025 Nanny State Index. This Government is no different and measures on new junk food restrictions, energy drinks, and alcohol pricing compound this. Whilst tobacco has been tackled progressively over many decades, recent scientific discoveries, increased public use, and business innovation has placed vaping firmly under the microscope. As such, the Tobacco and Vapes Act represents the wider cultural shift against tobacco and vaping, tackling both in tandem. In doing so, the Act symbolises the power of public health prevention and the role the state can play in supporting people to live healthier lives.