". After section 19 of the 1977 Act there shall be inserted—

19A.—(1) It is the duty of the Secretary of State to arrange, to such extent as he considers necessary to meet all reasonable requirements, for the provision of independent advocacy services.

(2) "Independent advocacy services" are services providing assistance (by way of representation or otherwise) to individuals making or intending to make—

1. (a) a complaint under a procedure operated by a health service body or independent provider,
2. (b) a complaint to the Health Service Commissioner for England or the Health Service Commissioner for Wales,
3. (c) a complaint of a prescribed description which relates to the provision of services as part of the health service and
1. (i) is made under a procedure of a prescribed description, or
2. (ii) gives rise, or may give rise, to proceedings of a prescribed description.

(3) In subsection (2)— health service body" mean a body which, under section 2(1) or (2) of the Health Service Commissioners Act 1993, is subject to investigation by the Health Service Commissioner for England c r the Health Service Commissioner for Wales;independent provider" means a person who, under section 2B(1) or (2) of that Act, is subject to such investigation.

(4) The Secretary of State may make such other arrangements as he thinks fit for the provision of assistance to individuals in connection with complaints relating to the provision of services as part of the health service.

(5) In making arrangements under this section the Secretary of State must have regard to the principle that the provision of services under the arrangements should, so far as practicable, be independent of any person who is the subject of a relevant complaint or is involved in investigating or adjudicating on such a complaint.

(6) Before making arrangements under this section in respect of complaints relating to the provision of any services, the Secretary of State shall consult—

1. (a) any relevant Patients' Council, and
2. (b) such other persons as he consit ers appropriate.

(7) A Patients' Council is, for the purposes of subsection (6)(a), a relevant Council if the services concerned are ones to which functions of a member Forum of the Council relate.

(8) The Secretary of State may make payments to any person in pursuance of arrangements under this section.".'.—[Mr. Jamieson.]

Brought up, and read the First time.

Motion made, and Question put, That the clauses be read a Second time:—

The House divided: Ayes 335, Noes 124.

Question accordingly agreed to.

Clauses read a Second time, and added to the Bill.

Question Put, That the remaining Government amendments and amendments Nos. 24 to 26 be made:—

The House divied: Ayes 338, Noes 118.

Question accordingly agreed to.

Order for Third Reading read.

Before I call the Minister to speak on Third Reading, I should announce that I have selected the Amendment in the name of the Liberal Democrat party.

On a point of order, Mr. Speaker Do you think it adequate for the mother of Parliaments to give a Third Reading of just 15 minutes to an important Bill?

Order. It must be adequate because I am proceeding according to the rules of the House. I call the Minister to speak.

I beg to move, That the Bill be now read the Third time.

Had the hon. Member for Gainsborough (Mr. Leigh) been here earlier, he would have heard his colleagues argue that an hour was far too long to spend on Third Reading of a Bill of this sort. The House would welcome a little bit of co-ordination by Opposition Members.

As we approach the end of the Commons stage on the Bill, I want to make a few points. The Bill is vital to implement the NHS plan. As a Government, we inherited a fragmented and under-resourced NHS; buildings were crumbling and there were too few staff. We have already acted to end the internal market, to get the biggest ever hospital building programme under way, to set up primary care groups and trusts and to expand the training of staff. We are now seeing unprecedented investment in the NHS which, however, must be investment for modernisation. The measures in the Bill make sure that that will happen.

First, it is a decentralising and devolving Bill, which underpins the principle of earned autonomy for the best run parts of the health service, together with the principles of less performance; management and greater financial freedom. It gives new powers to the NHS and local councils to work together at local level. They already have partnership powers; row they have the ability to create new joint organisations and a new level of partnership to provide a seamless care service for the elderly, the mentally ill and children. Those powers have been widely welcomed and sought. Unfortunately, not all right hon. and hon. Members have taken a close interest in the Bill, but it is no less important for that.

Will my right hon. Friend give way?

If my hon. Friend will forgive me, I should like to make a little progress.

As we have just discussed, the Bill provides more power for patients and increased democratic local scrutiny. It also enables us to tackle variations. The best of the NHS is extremely good, but the variations in the service are too wide. As we develop earned autonomy for the best parts of the system, we have more effective means to support and intervene in any part of the system in which performance is poor or trusts are failing. The Bill underlines the new performance management system and the performance fund that will be worth £250 million in two or three years' time. It gives us the power, if needed as a last resort, to tackle failing trusts.

The Bill gives us the power to tackle variations in primary care. The new unified budget will make it easier for health authorities to determine the expansion of GP numbers, attract more GPs to deprived areas and enable them to work in better premises. The Bill makes possible a new partnership to invest £1 billion in primary care premises and one-stop primary centres, starting in deprived areas. It therefore helps our commitment to tackle health inequalities.

The Bill also enables us to protect the quality of patient services. All GPs will be on health authority lists; there will be a new system of suspension, removal and appeal which means that, in the small number of cases in which it is needed, there will be a faster and more effective system to safeguard patients and a fairer system for GPs. It enables us to hour the agreement with the British Medical Association that, as GPs move on to lists, all of them will be able to join the NHS pension scheme. It will take some months to get the lists into place, but our aim is to backdate them to April this year. We rightly extend the list system to other health professionals.

The Bill protects patients and improves the quality of care in other ways, for example, by ensuring tight controls over the use of patient information and by enabling patients to have more information about their own personal care. The Bill backs innovation: it provides for new ways of providing pharmaceutical services, establishes new groups of health professionals able to prescribe prescription drugs, and creates new powers to ensure that the NHS can benefit properly and fairly from its own research and innovation.

The Bill brings new fairness to health care for the elderly. For the first time ever, NHS nursing care will be free wherever it is delivered. It ends the means test of health care in nursing homes. That is a huge step forward, which goes with the investment by 2004–05 of £1 billion in new and improved health and social care services for the elderly.

That means turning our back on Tory privatisation, on the cuts that they promised in social care, and on the cuts that they promised in health care to make up for the money that they would not raise from tobacco, and the money that they would waste on subsidising private health insurance. It reverses Tory plans to make people pay for hip operations, knee operations, cataract operations and hernias. It is an important Bill, which underpins the Government's commitment to the long-term future and modernisation of the NHS.

I begin by correcting the first of a remarkable list of inaccuracies in the Minister's speech. He said that we did not want as much time as was allocated for Third Reading. The point that we made at the beginning of the day was that we had very little time for all the remaining stages of the Bill, including the Government's new clauses and more than 120 amendments. It is a sad reflection on the new procedure in the House that we have been able to give so little consideration to the remaining stages. The one correct thing that the Minister said was that the Bill was extremely important.

The Bill must be judged by whether it will improve the overall health care in this country and the running of the national health service. Almost any medical or nursing group that we speak to throughout the country speaks about morale in the NHS being at an all-time low, more people leaving the service than ever before, more doctors taking early retirement than ever before—

The hon. Gentleman is talking down the NHS again.

The hon. Lady says that I am talking the service down. Her Government have been in charge of the NHS for the past four years. More people are leaving the service than ever before. That is one thing for which she cannot blame the previous Government. This is the fourth winter that the Government have been in control of the health service, where morale among staff is clearly very poor. I wonder when the Government will take responsibility for anything that they are getting wrong.

Increased numbers of people are waiting to be treated in the service. The Government talk about the number by which they have reduced the in-patient waiting list. The Minister deprecates the private sector, but it is worth pointing out that since the Government came to office, 450,000 people have left the waiting list of their own volition to purchase treatment in the private sector with their savings. Had it not been for people being forced to use their savings by the waiting times overseen by the Government, the waiting lists would have risen by even more than they have.

Notwithstanding that huge reduction, as a result of the fact that people have been willing to pay, often for life-saving treatments, with their life savings, the total number of patients waiting in our system has gone up, if one adds together the in-patients and the waiting list for the waiting list, which has soared since the Government came to power.

Perhaps worse than that are the distorted priorities in the system. In the short time available to me, I will not go over the catalogue of horrors that we have heard in recent debates and which have been raised in the House during Question Time. When surgeons are asked to cancel waiting lists for surgery for cancer patients so that they can treat more minor cases, we must wonder about the ethical basis for our system. Under the Government's bizarre and distorted waiting list initiative, we have reached the point when we are debating whether to treat the sickest patients first. That is the background to the debate, and the level of distortion that now exists in the system.

Ministers have failed to tackle the most important thing of all—not the number of patients waiting, but what the service does. There is nothing in the Bill about outcome-based targets for a system and a country that has just slipped behind Turkey in life expectancy—down to 19th place in the world. In many priority areas, the NHS fails to deliver outcomes that we might rightfully expect for the fourth wealthiest nation in the world, yet patients with in-growing toe nails and impacted wisdom teeth are being removed from the waiting list simply to make the figures look better for Ministers. That is a disgraceful way to run a service.

Against that background, we are faced with the NHS plan and the Bill. The NHS plan is not a plan in the sense in which most people would understand that word. It is more of a wish list, as we see when we consider some of its particular aspects and scrutinise them in detail. Such aspects include the number of staff required. Medical bodies such as the British Medical Association and the royal colleges tell us not only that the Bill does nothing for the provision of staff, but that the numbers are greatly underestimated in the first place.

The Minister tells us that the Bill is a decentralising measure. He has many talents, but he has only recently turned his hand to comedy. The Bill could not be described as decentralising by any stretch of the imagination. It will reinforce all the micro-management tendencies of the current Government, who genuinely believe that a service that employs a million people can be managed from behind a single Minister's desk in Whitehall. There is constant interference with management and the Department is continually distributing circulars that make it impossible for anyone to set budgets for any length of time and which force those in NHS management to go chasing after packets of money for which they must compete by investing huge amounts of their time and energy. We need depoliticisation and decentralisation, but the Bill gives us increased centralisation.

That is not to say that the Opposition do not welcome some parts of the Bill. We welcome the extension of nursing care, which the Minister mentioned. We also welcome proper control of locums. From my personal experience, I think that that is long overdue in the NHS. We do not pretend for a minute that every aspect of the Bill is undesirable, but three major issues make it completely unpalatable.

The first issue is the abolition of community health councils, which we have recently addressed. Let me make the Opposition's position perfectly clear. We think that the new clauses introduced on Report will reduce the damage caused by the abolition of CHCs, but we do not accept them because we do not accept that policy. We will continue to press for retention and reform of CHCs as the Bill proceeds through the House of Lords. I believe that we will have the support of Liberal Democrats in the other place in carrying that process forward. There is no doubt that the abolition of CHCs is a completely unacceptable policy, as it removes an independent voice for patients, as well as their ability to use a single point of access into the system.

None of the questions that we asked earlier were answered. We had no answer about cost or about what would happen to the staff or to confidential information. We have debated the ownership and confidentiality of patient information, and have considered where it should rest. A huge volume of information about patients is contained in the records of CHCs throughout the country. Having spent time debating those matters, however, we have reached Third Reading and we do not yet know where that information will go. As it may contain complaints about specific doctors or hospitals, it could potentially return to those doctors or hospitals.

My hon. Friend's point about CHCs worries us all, but what concerns the doctors and surgeons in my Constituency and those of other Opposition Members is the fact that the Government are taking away their clinical freedom. Will he give an absolute assurance that after the election, when he is in charge of health policy and the Conservative party is in government, the distorted priorities imposed from the centre by Labour Ministers will be swept away and doctors will have the freedom to treat the sickest first?

On a point of order, Mr. Speaker. I beg to move the Amendment standing in the name of Liberal Democrat Members.

I cannot allow that on a point of order. The hon. Member for Woodspring (Dr. Fox) is on his feet and has the Floor.

At least two hon. Members who have spoken today would benefit from reading "Erskine May". You mentioned one earlier, Mr. Speaker; I offer you another candidate.

I give my right hon. Friend the Member for Penrith and The Border (Mr. Maclean) the assurance that he seeks. In a few months, when the electorate have decided that they need a change of Government, we shall return to a system of proper clinical priorities that treats the sickest patients first.

Another unacceptable aspect of the Bill is the interventionism in hiring and firing trust board members, and the ability of the Secretary of State to set terms and conditions of employment. That will allow greater manipulation of and further controls over information for which Clause 62 provides. The Secretary of State will be able to perform unacceptable actions, including publishing patient information if he chooses to do that.

It being Ten o'clock, MR. SPEAKER put the Question already proposed from the Chair, pursuant to Order [7 November and this day].

Question put, That the Bill be now read the Third time:—

The House divided: Ayes 310, Noes 168.

Question accordingly agreed to.

Bill read the Third time, and passed.