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'or imposing requirements in relation to'.- (Mr. McCartney.)
.- (Mary Creagh.)
Lembit Öpik: 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.
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 the right hon. Member for Makerfield (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.
Sandra Gidley: 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 the Member for Southport (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.
Mr. Barron: 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.
"(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".
"Slide is all about packaging".
"appeals to young adult smokers and research shows they will buy into innovations such as unique packs".
"marketing restrictions make the pack the hero".
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.
Philip Davies: 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?
Mr. Barron: 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.
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