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Local Government and Public Involvement in Health Bill

My Lords, perhaps I may intervene for a moment to ask the Minister what the need is for the change that she talks about. The French structure of local government has not changed since Napoleon. The French have something like 38,000 separate municipalities, which manage to work together extremely efficiently, effectively and well without all this constant ferment. That is one example from what I would call a fairly radical wing of European local government. The United States is in a similar situation. It has a very stable structure in local government. It has states, cities, municipalities and counties with known powers. It does not keep changing the structures, although it may change the way in which bodies work together, which can be done very easily. It is simply a matter of responsible local bodies taking a responsible view of their capacity to deal with problems, alone or co-operatively. Those arrangements are made ad hoc, without regulation. I have never quite understood why, for the past 40 years, we in this country have had such a passion for structural change. Having sat on the other side of the argument in local government for much of that time, I have concluded that very often those who run our national affairs do not think that they have enough sufficiently serious matters to occupy them, so they tinker with the structure of local government, keeping everyone in a state of ferment so that they cannot properly do what they are supposed to do on behalf of those whom they serve. The real problem behind this so-called need for change is that it is a massive distraction from the proper provision of services to local communities. I say with my hand on my heart that the intellectual effort that goes into dealing with this subject in every authority at every level is beyond anything that is put into service provision. In my view, that is a disgrace and the longer the argument is perpetuated the worse things will become.