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Dr. Fox: The Government would be well placed to do that in any case without it being linked to tobacco advertising.

The House must understand that smoking is the biggest threat to the health of our nation. It is increasing our heart disease and cancer rates way beyond those in many other countries. We need to take action to reduce smoking, at a time when the prevalence of smoking is increasing. We must examine all the associated aspects, including the work of customs, the imposition of duties, health education and the promotion of products. There is no simple solution and no one should pretend that there is.

Dr. Stoate: In fact, the prevalence of smoking in this country is going down and has been doing so for the past 30 years. I believe that is in part due to the fact that tobacco advertising has largely been banned. The only group among whom tobacco smoking is going up is teenage girls, of whom something like one third now smoke. Previously, the figure was not that high. Overall, however, the prevalence of smoking is down significantly and we are seeing reductions in lung cancer because of that. However, because of the extraordinarily long lag-time of cancer formation, we do not necessarily get reductions as quickly as we would like. Does not the hon. Gentleman agree that anything we can do to reduce this enormous burden on public health must be worth doing? If the experts tell us that a ban on tobacco advertising would help, surely we should take it seriously.

Dr. Fox: I am not sure that Parliament should do what experts tell it. We should take into account the evidence

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that experts give us and come to our own judgment. That is why we have an elected House of Commons and why we are not run by groups of so-called experts. However, I think that this issue will be debated at length in future.

We are also looking forward to the details of the Government's plans for long-term care, especially in regard to workability. Christine Hancock, head of the Royal College of Nursing, is one of the strongest supporters of the NHS plan. She has said that the college would lobby against an artificial distinction between nursing and personal care that would

That is an important point. In health debates in the House, we have often spoken about how all members of the nursing and medical profession are obliged to work at the ceiling of their abilities and skills. The perverse incentives would apply when nurses would be likely to stop carrying out the less complex tasks that could be done by others for fear the treatment would be regraded and therefore cost patients more. We shall examine that when we see the details of the Bill.

There will be widespread disappointment in the House at the Government's approach to adoption and mental health. Both issues were mentioned earlier by my hon. Friend the Member for Sevenoaks (Mr. Fallon), and command widespread agreement among hon. Members. There is no reason why legislation on adoption has not been presented to the House. I am sure that I was not alone in expecting to hear about an adoption Bill in the Queen's Speech--in fact, I know that certain Labour Back-Bench Members expected that too.

The Prime Minister's review on adoption stated that

When the Care Standards Bill was considered on Report, the Minister of State, the hon. Member for Barrow and Furness (Mr. Hutton), said of the national adoption register:

He was talking about including such proposals in yesterday's Queen's Speech, but they did not appear. That primary legislation is necessary, because local authorities will face problems without it. For example, local authorities that block a couple from getting their names on the adoption register could face a legal challenge and be on very unsteady ground without primary legislation on the matter.

Therefore, I hope that the Government will be sympathetic to our plans to use a private Member's Bill to introduce those elements of adoption legislation that already command widespread consensus in the House. That would ensure that adoption legislation is present on the statute book in this Parliament, which is what many people outside the House want.

I certainly do not want to give the impression that the House's priorities are distorted. For example, Liv O'Hanlon, director of the Adoption Forum, has said:

The House needs to send out a clear message about its priorities.

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I am also sorry that the Queen's Speech contained nothing about mental health. There is broad agreement that there have to be changes in our approach to mental health. When care in the community was introduced, there was wide agreement that the principle behind taking people out of the old acute institutions and moving them into the community was right. However, many of us feel that that was done too quickly in some parts of the country, and with inadequate preparation. Sometimes that has led to a dual failure of care--for patients and for people in the wider community.

That matter needs examination. I think that there would be wide agreement between the parties in this House about that, but it seems likely that a whole Parliament will have passed with nothing being done, even though the matter was a high priority for the present Government before the last election.

Finally, I turn to the proposed abolition of community health councils, which we intend to resist most strongly. I have written to the chairmen of all the CHCs in the country, and have received some interesting replies. For example, the chairman of the South Durham and Weardale community health council--which covers the Sedgefield district--wrote:

Ministers have a very odd sense of responsibility. The Under-Secretary of State for Health, the hon. Member for Birmingham, Edgbaston (Ms Stuart), attended a meeting of the health councils' association, but wrote in advance to say:

So Ministers are willing to attend the meetings of bodies that they intend to abolish, but not to discuss the matter that is of greatest concern to those bodies.

Even more tellingly, perhaps, the letter from the South Durham and Weardale CHC also stated:

I guess that the man who wrote that can say goodbye to his job under the current culture, but he is being abolished anyway, so what has he got to lose? It is typical of the Government that they seek to abolish any voice that speaks out against them. We have a Prime Minister who regards Prime Minister's Question Time as impertinent, so it is entirely unsurprising that as the community health councils were willing to criticise the Government, the Government reacted in their usual fashion and decided to get rid of them.

We do not claim that the CHCs are perfect; they require substantial reform, which could be undertaken. There are also strong arguments for addressing patients' complaints. All those factors, however, are arguments for improving the way in which CHCs function. The Government will find widespread resentment of their plans among many of their own supporters.

Even at this stage, I ask the Government to drop what is a particularly damaging proposal. The Opposition will campaign to retain and reform community health councils.

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We will oppose the plans to abolish them and fight for the re-establishment of an independent body outside the NHS to monitor and inspect NHS plans. The Government are trying to convince us that a body entirely under the auspices of a trust would have the freedom and willingness to criticise that trust. We know that that is not true in the bullying NHS that we now have. They are asking us to believe that their Labour party cronies in local government who have not yet made it on to a trust or health authority will be willing to criticise their cronies who have already been promoted. That certainly will not happen in new Labour's current culture.

The Government were elected and have continued to run the health service on the "trust me" principle. They said, "You can trust us more than any other party. We believe more in the NHS than any other party. We are more committed than any other party, therefore trust us."

In June 1996, the Prime Minister said:

we should note the use of that word--

All the words that we associate with the Government are there--"new", "modern" and "urgent". At the end of last month, not in a winter crisis, but at the beginning of Labour's fourth winter in charge of the NHS, a 62-year-old lady with chest pain spent 17 hours on a trolley at the Darent Valley hospital in Dartford. A 79-year-old man with renal failure spent 14 hours on a trolley at the King George hospital, Redbridge. A 79-year-old man with a fractured leg spent more than 10 hours on a trolley at the William Harvey hospital in Ashford.

To listen to the Secretary of State's rhetoric one would think that the Government were responsible for none of it--that they had only just come to office. It is their fourth winter in charge of the NHS, yet when the problems pile up they say that it has nothing to do with them and their failure turns into a blame culture. They blame the previous Government, the NHS managers, the hospital consultants and the dark forces of conservatism. They blame GPs for misusing the waiting lists to get their patients into hospital more quickly. How dare they want to do that. So, we have the wrong managers and the wrong doctors. It is only a matter of time before we have the wrong patients, but never the wrong Ministers.

We no longer have a seasonal crisis in the NHS; we have a structural crisis. Patients are frustrated, doctors and nurses are demoralised and the public are disillusioned. The Government have promised so much, but delivered so little. They are out of touch, incompetent and obsessed with control. As the right hon. Member for Holborn and St. Pancras (Mr. Dobson), the former Secretary of State for Health, said:

We know it, the Government know it and increasingly the electorate know it.

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