Amendment made: 39, page 68, line 18 , column 2, at end insert-

.- (Mary Creagh.)

Question agreed to.

On a point of order, Madam Deputy Speaker. I have waited until now to draw your attention to the fact that there was no call for a vote on my amendment-amendment 16-and, indeed, I was not called to speak to it. I seek your guidance on whether there is anything I can do to raise my concerns, given that the amendment represented the only compromise option on the table in terms of the display of cigarettes.

I do not seek to challenge your authority, Madam Deputy Speaker, but I know that this decision was worth hundreds of millions of pounds to the newsagents. I am in your hands when I ask whether there is any step that I can take to ensure that the matter is reviewed.

I understand the hon. Gentleman's concern, but he will not be surprised when I say that there is nothing I can do to assist him at this stage in the proceedings.

Third Reading

Motion made, and Question proposed, That the Bill be now read the Third time.- (Mary Creagh.)

Happily, the Secretary of State is now present for the debate on Third Reading- [ Interruption. ]

Order. Will Members who do not wish to stay for the debate please leave the Chamber as quickly and quietly as possible?

Thank you, Madam Deputy Speaker.

Notwithstanding the recent debates on tobacco, at the heart of the Bill was the intention that incorporating the NHS constitution and measures relating to quality and innovation in the Bill should drive forward an improvement in the quality of health care for the people of this country. We made it clear to Ministers from the outset-my right hon. Friend the Leader of the Opposition and I had made it clear for a considerable time-that we wanted an NHS constitution, and believed in the importance of incorporating the principles of that constitution and making clearer to the public the nature of their rights and entitlements and, indeed, the obligations they should have.

I am pleased that the Bill has enabled the NHS constitution to be referred to in legislation, but unfortunately, in these latter stages, Ministers have chosen not to incorporate its core principles directly in the legislation. I must confess that I find it astonishing that the Minister of State should have thought that expressing the core principles in legislation would, of itself, lead to litigation about those core principles, given that in any case the purpose of the NHS constitution is that every NHS body-or those contracted to provide services for the NHS-should have regard to those principles. If the Minister is suggesting that by leaving them out of the Bill, he leaves them out of the legal duties placed on NHS bodies and those NHS contractors, I am afraid that that simply serves to undermine his own argument.

As we know, the core principles of the NHS were stated by Ministers in the NHS plan in 2000. As Minister of State, the Secretary of State launched a consultation on the subject, and arbitrarily changed what he regarded as core principles. Perhaps he intends to change them once again. As I recall, when he introduced them he left out the principle that resources provided for the NHS should be used solely for the benefit of NHS patients.

I am afraid that the Bill does not drive forward reform and does not drive forward quality. We did not discuss this evening, but at an earlier stage, the obligation to produce quality accounts. I have to hand the quality report produced by the Wrightington, Wigan and Leigh NHS Foundation Trust, which is the Secretary of State's local hospital. As a result of it, he will know perfectly well that nothing prevents a requirement from being placed on hospital trusts, or prevents him from providing for such an obligation on primary care trusts, without it having to be written into legislation. We also learn that the publication of quality accounts will essentially be a self-justificatory exercise on the part of NHS bodies; they will choose what constitutes quality when they present them.

However, I do not want to be anything other than generous in approach at this late stage in the consideration of the Bill. It contains necessary and helpful measures, such as the incorporation of the NHS constitution, but we know that we will have to go further in future. The incorporation of direct payments into legislation is a good thing as well. I am delighted that, whereas the Government resisted our view that direct payments should be able to be extended to incorporate health and social care three and a half years ago, we have now arrived at the point of their having come round to that way of thinking.

I am also pleased that the Government have legislated for the investigation of complaints about privately arranged or funded adult social care. I just hope that when Ministers come to reply to this short debate, they will say that they will be able to make progress in the next few months on incorporating that. A lot of people whose social care is arranged privately will continue to be without that protection unless there is fast progress.

It was also important for the House to have an opportunity to look at the issues relating to tobacco, although I may not agree with all the conclusions that it reached. The amendment of Mr. McCartney has been passed, doubtless with discussions between him and the Government Front-Bench team, but there is a question that I need to ask if he does not: what is their intention in relation to these regulations? Our view is that to make regulations that would ban all vending machines would be disproportionate, but the Government seem to have acquiesced and voted for this power, so is it their intention to use such a power, or not? We shall see; perhaps Ministers will tell us.

Finally, I am disappointed at this late stage in what the Government have demonstrated in their reaction in the past two months to the Mid Staffs situation. We debated that earlier so I will not return to all the issues, but I am afraid that their inclusion of the de-authorisation provisions is a further indication that they have given up on the reform process they were pursuing a few years ago. According to former Prime Minister Tony Blair, foundation trusts were integral to that reform process, yet Ministers have not only stalled on the process of creating foundation trusts but are now actively seeking to de-authorise them and are looking for opportunities to do so. We know that they have abandoned "any willing provider" as a basis for introducing competition into the provision of NHS services, and we know that measures to do with patient choice and practice-based commissioning have also been stalled, so some measures that would best deliver improved quality in the NHS through reform processes in the service have been undermined by decisions that are now being taken by the Government.

Therefore, this Bill is not a flagship for reform; rather, it is a portmanteau Bill. It contains measures that we welcome, and others that will be good or bad depending on how they are used, such as pharmaceutical needs assessments; but it will not, in itself, achieve a substantial shift forward in quality, innovation and performance across the NHS, because it is no more than a collection of modest changes. To that extent, although there are measures that the Government have included in the Bill-not least today-to which we object, we will not resist it at this stage. However, I encourage those who have yet to consider it in another place to look very hard and critically, not least at the de-authorisation of NHS foundation trusts.

May I conclude by thanking my colleagues my hon. Friends the Members for Eddisbury (Mr. O'Brien) and for Hemel Hempstead (Mike Penning), who have done all the heavy lifting in relation to this debate? As today's debate has served to illustrate, they have done so magnificently.

This is a bit of a mish-mash Bill, containing a lot of fairly worthy things. Most of today's discussion has been about tobacco, but we also heard detailed discussion of the NHS constitution and direct payments. I shall be particularly interested in the results of the pilots on that when they emerge, because this represents an interesting way forward in respect of people taking more control over their own health care. We also looked into things such as quality accounts, innovation and the provision of pharmaceutical services. What was fairly obvious throughout was that a mish-mash of things had been thrown together and there was no coherent sense of direction in the Bill.

The big disappointment was the Government's timidity, in some respects, on the tobacco legislation. An attempt was made to produce something simple that people could instinctively understand, but the solid evidence base remains relatively poor. An opportunity to be bolder and to deal with the smuggling of, and proxy sales of, tobacco products and all the other things that constitute the problem we face was missed. However, we are where we are and some welcome moves have been made.

I wish to thank my hon. Friend Dr. Pugh for his support during the long hours in Committee and to thank the Clerks and the Department of Health officials, who were also very helpful. My one criticism is not of any particular individual involved with the Bill; it is of the procedures of the House, which meant that although the Government amendments had been tabled for some time, we did not see the wording on the amendment paper until Friday. That was because of the recess, throughout which amendments are not published, and we need to change that situation. The procedures resulted in a lot of last-minute activity in trying to understand the amendments. I particularly wish to thank my researcher, Joe Moran, who gave up much of his weekend to have a look at some of this material and prepare my briefing notes. Often our researchers do not get mentioned, and the fact that he did a lot of this work in his own time is very much appreciated.

I shall not detain the House for too long; I rise just to support the Third Reading of the Bill. Opposition Members have said that it is something of an omnibus Bill, but I wish to comment on the small parts relating to tobacco. When the Bill has passed through all its stages, it will finish off some of this House's unfinished business on the advertising and promotion of tobacco in this country. The Bill containing the "ad ban", as it was popularly called, went through the House a number of years ago. We can assume that most of it was implemented to good effect, because the level of smoking is decreasing in all categories, although among teenage girls and young women the situation is a bit difficult.

The ad ban legislation introduced by this Government was supposed to eliminate anything

"(a) whose purpose is to promote a tobacco product, or

(b) whose effect is to do so".

I submit to the House that for years we have been banning the advertising and promotion of tobacco, but the tobacco companies have been using the point of sale to promote tobacco. That loophole, which has existed since that legislation was put through, has been closed by tonight's decisions. I say that because of the evidence I have in front of me, which includes a quote from Geoff Good, the global brand director of Imperial Tobacco, concerning the limited edition Lambert & Butler celebration packs, which increased sales by £60 million. He said that

"the pack design was the only part of the mix that was changed, and therefore we knew the cause and effect".

Packs have been used to promote tobacco since the advertising ban came in.

The Benson & Hedges Silver slide-the neat package that slides open as opposed to flipping open at the top, for example-was described as follows:

"Slide is all about packaging".

It

"appeals to young adult smokers and research shows they will buy into innovations such as unique packs".

The Benson and Hedges Silver slide pack increased market share by 57.5 per cent.-that is worth about £120 million-within 18 months of its introduction. A Gallaher spokesman stated that

"marketing restrictions make the pack the hero".

It is clear that that has been the case for many years.

If this legislation is brought in, packs will be brought for their outside covers, they will be taken around and people will have them in their pocket, but they will not be seen when people go into a tobacco retailer. The test will be whether the holograms and everything else that attract young people in particular disappear from these packs in a few years' time.

The Chairman of the Select Committee said that that change increased that tobacco company's market share. Does he agree that there is a world of difference between increasing sales of tobacco in general and a company's increasing its market share? Surely that is a perfectly legitimate thing for it to seek to do?

For years, the tobacco industry has been saying that advertising is all about market share and that has not been true. In this case, it is, but it was not true when there was general advertising of tobacco products in this country. It was a case for the defence and it was a very weak one. Since we brought a general advertising ban into this country there has been a decrease in smoking, which I think is directly related to the fact that the companies cannot promote tobacco. The fact that this means of promoting tobacco when one walks into a shop is no longer available-the displays had got very sophisticated, with tobacco next to shelves of chocolate and so on-will further restrict the attraction of tobacco when people, young or old, go into tobacco outlets. This is a progressive move. I think we agreed to ban vending machines, too, in the last few minutes.

The Government should be complimented on what they have done over the past 10 years in attacking this scourge of ill health in this country. Tobacco causes 50 per cent. of our health inequalities; 50 per cent. of people who smoke will die prematurely because of tobacco. We have probably gone as far as we can at this stage in stopping the promotion of tobacco. The Government's smoking cessation programmes and targets for smoking cessation over the past few years have been very good, too; they have helped to reduce tobacco's attack on the health of the nation and we are making progress. I thank the Government for eventually doing the things that people were arguing for in this House 20 or 30 years ago. They were done through gritted teeth as far as the tobacco companies were concerned, but they were done none the less.

I am delighted to follow my predecessor as chair of the all-party group on smoking and health. In 1998, the Government published their seminal White Paper, "Smoking Kills", and so brought to an end the lost decade of tobacco control. Smoking rates have been falling fast. From 1978 to 1988 the adult smoking rate in England fell from 40 per cent. to 30 per cent. Between 1988 and 1998, it snaked within the 25 to 30 per cent. range.

The White Paper set out a plan to help those smokers who wanted to quit and to restrict the industry's capacity to recruit new young smokers. Across the country, a network of local cessation services was established. Tobacco advertisements on billboards came down and the disgrace of tobacco industry sponsorship was put to a stop. No longer were the makers of this deadly product free to buy a link with sporting achievement in the minds of our young people. As a result, we have seen a return to year-on-year reductions in smoking rates so that now only two adults in every 10 smoke.

"Smoking Kills" did what it was supposed to do, but a new strategy is needed. The main challenges of a tobacco control strategy remain to help smokers who want to quit and to constrain the industry's capacity to ensnare young people. The Bill takes up those challenges but it is not enough on its own. The whole House awaits the publication of a new tobacco control plan, of which this Bill is only a part, that will build on the success of "Smoking Kills" and help make smoking history for our children. I strongly support the Government's proposal to do away with the power walls of tobacco promotion at the point of sale.

I am puzzled about advertising at the point of sale. People may wander into a shop, look around and say, "Does this shop sell tobacco?" Will the shop be able to display a list showing that it sells tobacco and what products its sells? Otherwise there will be some very confused people in some very confused shops, wondering whether they are in places that sell tobacco.

If the hon. Gentleman had been here throughout the debate he would have heard that answered adequately. I am pleased that the amendment tabled by my right hon. Friend Mr. McCartney, which puts cigarette vending machines out of the reach of our children, has been accepted, and that we can uphold the World Health Organisation framework convention on tobacco control to protect health policy from the vested interests of the tobacco industry. I would have liked to have seen new clause 7 on plain packaging go further-I would have liked the Lib Dems to have put it to the vote-but that is for another day. I would like proxy sales to be banned, too, but I voted against the Tories' proposal, because what they suggested was not enforceable. However, I would like more action on that.

Someone dies prematurely every four minutes from the effects of smoking-15 people an hour, or 75 in the five hours of this debate, which would empty the Public Gallery steadily. This is a valuable step forward, and I congratulate the Government on taking it.

I will take only a minute of the House's time, because the Secretary of State needs to respond to the debate.

First, I thank the British Heart Foundation, Smoke & Mirrors, and Smokefree Northwest for the past year of non-partisan support, advice and help, as well as my colleagues in the House, and people in each Department I have spoken to. A boyhood hero of mine, Denis Law, once said of his first goal for Scotland that he scored it with his bottom or backside, or words to that effect, but it did not matter because it was a goal. We won the vote tonight nem. con., and it does not matter, because it is going to change history. I hope that my right hon. Friend the Secretary of State will indicate clearly in his contribution that, when the Bill reaches the Lords, there will be absolute clarity and that the amendment accepted tonight will ensure that in England, Wales and Northern Ireland, vending machines will be banned once and for all.

Briefly, as we seem to have had a round of congratulations on the Bill, I want to say that this is a very sad day for the House, which once again shows that the Government are one of the most intolerant, authoritarian and illiberal Governments that we have ever seen. It is yet another triumph for the nanny state. It will not make any difference at all to smoking rates. Cigarettes are not an impulse purchase. As someone who worked in retail for many years before coming to the House, I can assure people that they are not an impulse purchase like cream cakes. People walk past cream cakes, think that they look nice, and decide to buy them, but they do not buy cigarettes on the same premise.

This is just another authoritarian victory for a Government who want to thrash around looking as if they have done something. It will have a devastating effect on many, many small retailers, small newsagents and pubs. I hope that we will not see crocodile tears from Ministers when many more small shops and pubs go to the wall as a result of the Government's policies.

It says here, "I beg to move, that the Bill be now read the Third time." However, I gather that someone moved the motion in my absence, so I shall move on and say something about the Bill.

This important Bill paves the way for the next stage of reform in our national health service while, at the same time, cementing its founding values in a new NHS constitution. I am grateful for the constructive approach from Members on both sides of the House to improving the Bill, and I believe that it leaves the House better and stronger as a result of our deliberations. It builds on the consensus established by Lord Darzi's next stage review that the next decade in the NHS must be characterised by a relentless focus on improving the quality of services. In the past decade, the NHS has done the heavy lifting, tackling the big challenges such as waiting and infections. Today it is in a position where it can focus more on the quality of the individual patient experience.

In that regard, the introduction of quality accounts marks a significant step forward for the NHS. Those new accounts will give patients and the public clearer information when exercising their right to choose health care services, setting out for clinicians and managers valuable information about the quality of the services that are provided. Equally, the provisions allowing for the introduction of direct payments for health care will further empower patients to take greater control of their care. These measures are evidence of how, in the next decade, we are placing the power to drive reform in the hands of patients and staff, not from the top down.

The Bill also reaffirms our commitment to the pursuit of excellence in the foundation trust regime and across the NHS. We have listened to calls from another place for mental health trusts to be given more flexibility in respect of the operation of the private patient cap, and will expect that to be used to improve NHS services.

The pressing requirement to act in the wake of the events at Mid Staffordshire NHS Foundation Trust led to late amendments to the Bill. I am grateful to the House for its patience and consideration of those amendments at this late stage. I was particularly pleased to hear the comments today of my hon. Friend Dr. Wright and the hon. Members for Stone (Mr. Cash) and for South Staffordshire (Sir Patrick Cormack), and to see on the Front Bench my hon. Friend Mr. Kidney, all of whom had spoken to me and my right hon. and learned Friend the Minister of State for Health to convey to us the strength of feeling in Staffordshire about the appalling failure at their local hospital.

The House has shown today its commitment to the foundation trust ideal that freedom must be continually earned through high performance. It is important that foundation trust status continues to represent a badge of excellence and high standards in the NHS, and the amendments that we have passed today will help secure that. I noted that the Conservative Members from Staffordshire were asking us to go even further than we had proposed. We had constructed an amendment that kept Monitor as the decision maker but gave the Secretary of State a role to ask Monitor to take a view on whether a trust should be de-authorised. In opposing that approach, Mr. O'Brien is somewhat out of touch with his own Back Benchers and local opinion on the matter.

There was another late amendment on help with costs of spectacles for over-60s, or rather, to correct a loophole in the law whereby eligibility for help with those costs was more widely drawn than was ever intended. That had lain on the statute book for some time. I am pleased to say that that loophole has now been closed. Perhaps in time the amendment will come to be known as the "should have gone to Specsavers" amendment.

The Bill includes new protections to ensure that future generations are less likely to suffer from tobacco-related disease. For many hon. Members, the central issue in the Bill has been deciding how best to protect our children from the dangers of smoking. We heard today passionate contributions, most recently from the Chair of the Select Committee on Health, my right hon. Friend Mr. Barron, and from my right hon. Friends the Members for Holborn and St. Pancras (Frank Dobson) and for Makerfield (Mr. McCartney). There is consensus in the House that smoking has devastating consequences for our society and that more needs to be done to protect children from those harms. As my Minister of State, my hon. Friend Gillian Merron pointed out, there is direct evidence that tobacco point of sale has a direct impact on young people smoking. I am pleased that the important clauses on the subject remain in the Bill.

It is clear that although Opposition Members were not able to conduct a proper whipping operation, hon. Members have made their views on tobacco vending machines clear this evening. I note in particular the efforts of my right hon. Friend the Member for Makerfield. His passion and resolve have been rightly rewarded by the House today. We appreciate that as a result of certain amendments being withdrawn, the remaining amendments that have been voted through today go to the other place in a well drafted and legally workable form. I will watch with interest how my right hon. Friend's proposals are received in another place. The Government will not seek to overturn them but, respecting this House, will consider how best to put its will into effect.

My right hon. Friend has announced his intention of standing down from the House at the coming election. His legacy will be one of campaigning on issues that matter to people throughout the country, from the minimum wage to other matters that he has campaigned on. Tonight his campaigning force has yet again delivered another major step forward in protecting the health of the children of this country.

I pay tribute to my Ministers, including my hon. Friend the Member for Lincoln and my right hon. and learned Friend Mr. O'Brien, and to Lord Darzi and Baroness Thornton in another place, who have placed the Bill in its strong position today.

We want the Bill to go forward, and we will work to ensure that this evening's amendments are put into a workable form. The Bill leaves the House in a strong position. It will protect our children from the dangers of smoking, empower patients, ensure the highest possible standards of care throughout our national health service and lay the ground for the next stage of reform in the NHS. I commend the Bill to the House.

Question put and agreed to.

Bill accordingly read the Third time and passed, with amendments.