Local Government and Public Involvement in Health Bill

May I begin by congratulating the hon. Member for North Durham (Mr. Jones) on his contribution? I hope that he has done enough to be drafted on to the Public Bill Committee. I shall be brief, and deploy a broad-brush approach to part 11, which endeavours to deal with patient and public involvement. In health, we are confronted with two parallel worlds—the world of decision making and the world of consultation. The world of decision making is made up of quangos, trusts, appointees, NHS networkers and so on, who decide what services are available, commissioned and cut, as well as the way in which they are configured, structured, run and financed, and even where they are located. They respond to ministerial instructions, financial pressures, turnaround teams, European directives, advice from the royal colleges, pressures from professional and union bodies and, of course, market forces. That is called local decision making, in the same sense that colonial government was local decision making. The parallel world of consultation produces bodies such as community health councils and patients forums, which will be replaced by LINKs—local involvement networks. It produces, too, brochures, meetings, consultations and pseudo-consultations, surveys, much frustration and not a great deal of change in the eventual decision making. The public are given rights to be heard and consulted, as well as rights to a response, a hearing, a survey and a visit, but not a scrap of decision-making power is surrendered to them. Power remains with commissioners and providers and, ultimately, head office at Richmond house. One cannot move from one world to the other without confusion, so one cannot avoid developing a deep cynicism. The Bill resolutely keeps those worlds apart. Poring over its small print, I could not find a single clause allowing the public to determine what the decision makers do. Ministers should be honest and tell us what they think—that the public are not capable of shaping the health service. If they think that locally elected people are probably too dim or lack relevant expertise, why do they not come out and say so? Why do they not admit that such people cannot make tough decisions or are likely to make bad ones if they are allowed such powers? The Government choose to ignore the fact that many health services were locally grown, planned, owned and, at one stage, locally financed in part. Things are run differently in other parts of Europe. Almost every hospital has a long history of public involvement and local commitment going back many years, and it would be great to revive that practice. I accept that we have overview and scrutiny committees, which I support—indeed, they should be enhanced—but apart from fine words, ultimately they have the power only to refer things to the Secretary of State. So in my view the Bill, unamended, leaves the parallel worlds of the decision-makers and the consulted just as far apart as they were before, and still parallel. Patrician rule remains, and hollow consultation and quango rule are still in place. There will be patient and public involvement, but it will be an extraordinarily frustrating business.