The coalition’s U-turn on plain packaging for cigarettes is welcome, but it is a cynical move at the eleventh hour by an administration that has done little to truly tackle the long-term pressures that preventable ill health places on our National Health Service.

When Andy Burnham and Luciana Berger outlined Labour’s vision for public health last week, they captured the argument long missing from the national debate. The long-term survival of the NHS into the future will depend as much on securing a heathier nation as it will on squeezing even more efficiencies out of our health and care services.

The Tories may have thought that their ill-fated structural reforms could free up money to spend elsewhere, but the £3bn cost of the reorganisation, fragmentation of services and failure to tackle demand for NHS services has done precisely the opposite.

It is hard to think in today’s world that at the height of the ‘mad men’ era, half of the United Kingdom’s entire population were lighting up regularly. Placing products into the hands of television and movie stars, or co-opting doctors and dentists to attest to the benefits of smoking their particular brand, the tobacco industry was ingrained within the culture of society. It was not until the 1970s that the rate of smoking started is slow decline.

Today, around one and a half million hospital admissions each year are for smoking-related illnesses. It is estimated that smoking costs the NHS some £2bn annually. Add onto the financial pressure placed onto NHS the wider costs of smoking, like social care costs for older smokers or smoking-related sickness, and you can reasonably estimate £13bn is lost each year. For an economy facing sluggish growth those are figures not to be sniffed at.

We can continue to offer spending pledges to boost the supply of healthcare services, or we can sign up to the much harder, but much more effective, challenge of reducing the demand for NHS services through a revolution in healthy behaviour.

Under Labour since 1997, tough but necessary decisions like the ban in public reduced the number of people smoking by a third. Throughout the life of Labour’s three terms greater and gradual restrictions on tobacco advertising also shifted smoking culture.

With smoking prevalence now stuck at the 20 per cent mark, there are not many more ways we can ‘nudge’ people to change.

The introduction of health warnings from the 1970s onwards certainly encouraged people to think more consciously about the impact smoking was having on their health. But it is questionable whether other ‘nudges’, like smoking cessation campaigns, can bring that figure down much more.

We will never be able to beat the deep pockets and ingenuity of the tobacco industry, who will find new ways of making the irrational seem rational, and encourage people to smoke their products regardless.

If you cannot ‘nudge’ people much more, do you ‘push’ them a little harder? Or are you left with little choice but to ‘shove’ them to change?

‘Shoving’ ,too, probably will not get you the results you want. Britain has not banned tobacco and it is unlikely to do so in the future. For anyone who wants to proactively put their health at risk, exposing themselves to a later life of ill-heath, you will still be able to get hold of a cigarette.

Likewise, hiking tax on tobacco without securing a change in behaviour is more likely to punish low-income smokers, apportioning blame onto them despite the corrupting behaviour of the tobacco industry. The hysterical response therefore by those yelling ‘nanny state’ is without merit. We have never gone that far.

So we are left with little option but to ‘push’ a little harder. Plain packaging is the natural next step. If legislation is passed before the dissolution of parliament, the Tories will have set up the next Labour government for an almighty legal fight with the tobacco companies. That is a fight we should relish, and one we can and should win.

It will not be by any means the only way. The debate over what new measures can be put in place to reduce smoking rates will likely continue for quite some time.

But until we are willing to accept that only through collective better health can we reduce the pressure on the NHS, and be willing to take proactive and tough decisions, we will consign ourselves to an NHS that is constantly absorbing more money to firefight the growing pressures we place on it.

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Onkar Sahota AM is London assembly member for Ealing and Hillingdon and is the Labour assembly spokesperson for health. He is also a practising GP and tweets @dronkarsahota

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Photo: Sludge G