Published: 02/12/2004, Volume II4, No. 5934 Page 10

Two days after Tony Blair jousted with Michael Howard over the dark contents of the Queen's Speech programme, he popped up again to take questions directed to Number 10 by young voters via text message.

Daft or what? I try to keep an open mind. There is grave concern about communication with voters in general; the non-voting 18 to 24year-old cohort in particular. They use texting more than us oldies, though lately I have become rather a dab hand.

It transpires that officials had to do the premier's texting because his 16-year-old daughter had not been able to teach him beyond the basics.

But Mr Blair's foray reminded me of a pile of photocopied letters sent by my old friend Peter Bottomley, exminister, spouse of Virginia and saintly Tory MP for Worthing West.

In one recent handwritten note which began 'Dear Prime Minister' and ended 'Copy to Michael White', Mr Bottomley had asked why members of the public who serve on primary care trusts should have any means-tested benefits they enjoy cut in lieu of allowances, whereas councillors, for instance, do not.

It is a good question, typical of Mr B's wayward, lateral mind. As a PS he suggested: 'Do respond by e-mail if you can and choose to do so. I have recently asked No 10 for your e-mail address. No one could give it.' Having recently read that Microsoft's Bill Gates gets 4 million emails a day, I have some sympathy with the Luddite Blair in not having one.

When I rang the MP he was feeling combative. When the then health minister Hazel Blears paid what he claims is the only ministerial visit to Worthing since 1997 - 'we get more visits from the royal family' - she 'allowed regional health apparatchiks to ban the local media, ' he recalls. Typical New Labour manipulation, says Mr Bottomley, who is a kind and thoughtful MP. If I was wrongly locked up by the police or the NHS, I would be glad to have him on my case. But that was not the focus of his recent campaign.

What is troubling the Sage of Worthing is the cost and purpose of patient and public involvement forums, 572 of which replaced community health councils in hospital and primary care trusts across England a year ago.

In the last year of operation CHCs cost£13.9m, the MP was told by Rosie Winterton, who took over responsibility from Ms Blears. The overall cost of setting up the Commission for Patient and Public Involvement in Health and the new forums in 2003-04 was£66.8m, she admitted.

Precisely, says the Sage. 'Almost without exception the fine people involved in PPIFs whom I speak to across the country find it impossible to work with the support system the government has imposed on them.

Everyone says that CHCs, without being perfect, were significantly better. The government has imposed confusion and waste.' By this Mr Bottomley means they are reduced to squabbling over secretarial support and access to shared computers. I duly rang a friendly Labour MP in the North, a man of great experience and independence. How is his city PPIF going? 'I've not come across them, ' he said. 'They've made no contact.' They were also not very visible in his famous local hospital the other Saturday when he picked up dirty clothing that had been lying on the floor in one ward.

Little wonder, then, that a review of the benefits of the new system was quietly announced in early November, shortly after Mr Bottomley started piling in questions, though he is too modest to claim any credit. But now CPPIH is being abolished, part of the DoH's welcome cull of quangos, though the role of PPIFs will continue.

Privately, officials admit that not all the new forums are working too well in engaging with the wider public or with patients. Hence the review.

They sidestep the fact that CHCs were abolished precisely because they were patchy, but do make an interesting parallel point.

The growing focus on patient involvement and choice at a personal level leads to a greater range of engagement: not just the mechanics of which hospital, but also of which treatment - and why.

That is an interesting way of justifying individual patient care, but the collective dimension of healthcare is neglected at all our peril.

Michael White is political editor of The Guardian.