If, as Harold Wilson memorably remarked, a week is a long time in politics, what on earth should we think of 10 years? That is the time it will take to bring the NHS plan to completion. What will screw it up, of course, is what another Harold - Macmillan - described as 'events, dear boy, events'. And any number of events will occur between now and 2010.

But the NHS plan still remains a source of fascination. I am old enough to recall earlier plans, and so am intrigued by such features as the confident assertion that too much of GPs' income is geared to the number of patients on their lists - the precise opposite of what was said in the consultation documents which foreshadowed the GPs' new contract back in 1990.

What intrigues me most is the proposal to create 'care trusts'. For those few who may not have been able to summon up the enthusiasm to read Tony and Alan's vision of their brave new world, something called 'care trusts' are now to be the ultimate step in the process which started with primary care groups, and which were originally intended simply to grow up to become primary care trusts. But now completely new 'care trusts' - in which PCTs finally snaffle social care budgets from local authorities - are to be the latest pinnacle of perfection.

I am all for more co-operation between the providers of health and social care; indeed, so is everyone else - they must be: they've been talking about it for decades, though spectacularly failing to achieve it. But is this really the best way forward?

Those readers who were not around more than a quarter of a century ago may have forgotten that the NHS was once organised in a tripartite structure: NHS executive councils administered the family health services, hospital management committees ran the hospitals, while local authorities had responsibility for community health services and public health - and of course, social services.

Back in 1974, in the reorganisation to end all reorganisations, local authorities' health functions were lost to area health authorities, though that still left social services in their tender care.

Now it seems that, via the back door, social services, too, may be forcibly wrested from the hands of our civic dignitaries. There is surely no law which says that power should always consistently flow away from local authorities and towards central government, although cynics may argue that power inevitably flows from the weak to the strong. So if we must have this sort of development, let's have a proper debate about how the NHS and social care should be organised.

The first item on the agenda should be whether we would like to see the historic transfer of power from our town halls to Westminster being thrown into reverse. Why should it be local authorities which are asked to surrender their service budgets rather than the NHS? Might not local government be just as good, if not better, at integrating health and social care?

Local authorities had plenty of practice managing the forerunners of the health service long before the NHS was heard of. From the time of Elizabeth I they were providing healthcare to the poor and needy. Many of our now denigrated Victorian hospitals were built and run by local authorities until they were taken over by the NHS in 1948.

And for long after 1948 not only did local authorities continue to provide large parts of what today we consider to be strictly NHS business, but until recently local authority members participated extensively in the administration of the NHS, directly providing members to serve on the boards of its many institutions.

So let's try out a different vision and consider giving power back to local people. Health authorities are going to become increasingly irrelevant as time goes on, so let's envisage a future where they no longer exist and consider transferring their functions to local authorities.

While We are about that, let's reconsider the implications of creating care trusts which combine health and social care budgets - why can't they be abandoned and, with other trusts, simply be transferred to local authorities?

One of the problems with the NHS today is that it no longer has any pretence of local political accountability - board members are appointed by the secretary of state or, in effect, elected by tiny electoral colleges, and that is wrong. On a local level the public stay away from local elections. So let's fight back; yes, let's integrate health and social care, but let's do it in the opposite direction to that proposed. Let's have our NHS run locally, by local people for local people. And let's stop dead in its tracks this trend towards centralisation which only serves to make the NHS seem ever more distant from those it is intended to serve - the public: you and me, the ratepayers of the realm.