That's not bureaucracy, that's localism

Of all the arguments that are being used to 'Kill the Bill', one in particular needs to be exposed as nonsense.  I'd hate the Lib Dem conference to come to the wrong conclusion because of it.

No, I don't mean the stuff about frontline services already struggling.  That may be so, but that is an argument about spending cuts, not about changing the law.

I mean the one about the number of statutory organisations rising from 163 to 521.  Those who believe that the NHS should be a great, centralised monolith - and that this is somehow more efficient - might believe that this is a problem.  It isn't.  Quite the reverse: that is what happens when you decentralise power and provide genuine local democratic oversight.

So don't let anyone tell you that more local commissioning bodies is a bad thing in itself.  When Labour reduced the number of PCTs, were they making it more efficient or democratic? Just wander into them any time in the last few years and you will find otherwise.

In fact, the size of public bodies is probably inversely proportionate to their efficiency and effectiveness.

We know, at least in Illinois, that the smallest local government units have the lowest annual spending per capita.  We know that small schools (300-800 pupils at secondary level) have better results, better behaviour, less truancy and vandalism and better relationships than bigger schools. They show better achievement by pupils from ethnic minorities and from very poor families.

We know, thanks to a series of studies by the think-tank Reform and others, that the smallest police forces are the most effective in the UK, catching more criminals for their population than the big ones. We know that American hospitals cost more to run per patient the bigger they get, and it doesn’t make any difference if those hospitals are non-profits or profit-making.

We also know, because it was reported today, that Whitehall departments have spent £1.4 billion over the last seven years sharing back office services in an attempt to save £159 million, according to the National Audit Office.

So don't tell me that leaving the NHS with the New Labour status quo - with its expensive and inappropriate cometitive structures - is the right way to go.  Not if it means bigger and more bureaucratic commissioning.  Don't let's go along with the idea that services are better and more responsive when fewer people take decisions.