Michael white on patient involvement

My notes confirm that dissident mutterings included, 'Rubbish,' 'She doesn't understand it,' and 'Do you understand it?' I have no wish to distress you, but I even caught one cry of 'Bollocks!' By general consent Ms Winterton had a hard time.

Fast forward to this week, when the fate of patient forums and their national organisation, the Commission for Patient and Public Involvement in Health (CPPIH or Chippy), was set out during the Commons' second reading of the Local Government and Public Involvement in Health Bill on Monday night. It is the culmination of expert rumination since the Our Health, Our Care, Our Saywhite paper 12 months ago.

If that strikes you as a rather hybrid title for a bill, you're right. The bill's mum is not Patricia Hewitt, but communities and local government minister Ruth Kelly. Its main purpose is to promote fashionable notions on the devolution of power away from the centre to communities, not least by restoring parishes.

Don't jeer. They do it well in France, where villages all have elected mayors. I know it's difficult, but all UK political parties are struggling to make it work. It is part of a worldwide effort to make the public services more effective, not least by engaging the public as parents, patients and so on.

So it's not completely daft to tack the Chippy question on to the Kelly bill, although opposition MPs are unhappy that no health minister will be directly accountable for changes in NHS scrutiny. Many Labour MPs are wary of the early replacement of patient forums only three years after they replaced community health councils.

'A bit of New Labour permanent revolution,' quips Jim Cousins, Labour MP for Newcastle Central. He says there must be a serious debate on the powers of the new local involvement networks (LINks), which should be as close to the old CHCs as possible. He wants formal consultation powers and powers to delay implementation of any change to service delivery pattern.

At this stage I don't think he's going to get that much, although Ms Winterton tells me that the LINks will be able to refer an issue to the local council's overview and scrutiny committee and through them to the secretary of state.

That's one point of the change. CHCs were patchy, some brilliant, others not. As the forums got off to a slow start, with not much continuity of personnel, a similar pattern emerged. Ministers want LINks to be much wider in their remit, with many more members, who specialise in, say, mental health or strokes.

LINks will be statutory but flexible in shape. Ministers want them to embrace social service inspection, and to be part of the closer ties with local government in a world where primary care trusts will be more engaged in commissioning services. Somewhere in the Stronger Local Voice report on the Department of Health's website, there is talk of a two-way flow of information between citizens and providers.

Ian Gibson, left wing MP for Norwich North, whom I also rang, says his local patients' forum group believes Ms Winterton has met them half way since he witnessed her bollocking on the terrace. He is encouraged.

LINks members must have the right of access to hospital wards - a sore point on the terrace after Rosie said that would mean Criminal Records Bureau checks - very over the top, MPs say.

'They're volunteers who want to help, not busybodies,' says Mr Gibson. Indeed, and the Commons health select committee, chaired by Labour's Kevin Barron, this week began an inquiry into the issue. It will run in parallel with the bill's committee stage, likely to be long, so that any changes the committee may seek to strengthen LINks should be in time for the report stage - or the Lords.

Ms Winterton is keen that LINks are more patient-oriented and even wants designated members to have the right of hospital entry. Not everyone, of course, she says. That will cause trouble for starters.

Michael White is assistant editor (politics) ofThe Guardian.