opinion : POLITICS

By the time you read this you may have struggled through Gordon Brown's new hopes for NHS spending and the more austere realities of the annual cash allocations to health authorities.

But the statistic that most grabbed my attention was this: faced with a tidal wave of accusation that the NHS Reform and Health Care Professions Bill is the opposite of the decentralising measure it claims to be, my man in the bunker replies that Alan Milburn has issued only 22 NHS circulars this year, in contrast to the 398 in the last - Dorrellian - year of John Major's government.

I mention it in mitigation for what follows.

For rarely have I heard such an onslaught against a bill during second reading as occurred last week. It is not that Mr Milburn did not have supporters. But with one or two exceptions (like Labour's Paul Truswell) their impact was less than that of critics on all sides. Try this sample.

Warm w o r d s : In Wales the bill will create a total of 52 bodies. . . to 'control and administer the health service for a small nation of 3 million people' - Denzil Davies (Labour, Llanelli).

Sinister move: 'Patients' forums will be constructed by the NHS Appointment Commission - more cronies, more members of the chattering classes.

This worrying cult of complicity will be fuelled by the inclusion of a patients' forum member on trust boards. . . It is surely not right to allow [them] to be tarred with the decision-making by the trust under scrutiny' - Dr Andrew Murrison (Conservative, Westbury).

Emperor's new clothes: 'Health authorities have already made it clear that the growth money is already spoken for, in 'must-dos' . . . that have been issued centrally. The government cannot claim to decentralise power, when in fact they are centralising it' - Dr Evan Harris (Lib Dem, Oxford West and Abingdon).

As bad as ever: 'On patient involvement the government has failed completely to produce a coherent argument to convince me and others of the need for the abolition of community health councils. . . I find [the new proposals] baffling. I honestly do not understand them' - David Hinchliffe (Labour, Wakefield).

Highly bureaucratic: 'The secretary of state [is] unable to answer one of the most basic questions: who owns the information? CHCs keep large amounts of confidential patient information. . . It would be quite wrong for that information to go to trusts' - Dr Liam Fox (Conservative, Woodspring).

Baffling changes: 'Some local doctors have a shock coming because their hands will be tied . . .They will have the money, but they will not be as free to spend it as they would like' - Sandra Gidley (Lib Dem, Romsey).

Voter indifference: 'Even HSJ has found it impossible to limber itself up to care about the bill. . . Voters do not care because they know that the reforms. . . will not deliver what is claimed for them' - Stephen Dorrell (Conservative, Charnwood).

I think you get the picture. A lot of sensible MPs believe the latest structural changes will cost more money than they save and will further demoralise a hard-pressed service. They also express doubt about Minister Milburn's oft-declared promise to devolve powers to primary care trusts and hospital trusts.

The expanded role for the Commission for Health Improvement aroused least criticism.

Despite junior health minister Hazel Blears' efforts to make sense of CHC reform, there is still trouble ahead.Dr Fox's point about privacy of information was not answered in the debate, though I have the answer. The new National Commission for Patient Involvement would take over the records.

I leave you with a parting shot from ex-health minister Sir George Young. Compared with the way the£36bn annual local government settlement is open and transparent, the£59bn health distribution system is not. l