.. the NHS in London declared on May 6th that the consultation had shown broad support for the plan, citing the 51% of respondents who had backed the proposal that almost all GP practices should be part of a polyclinic. That less-than-ringing vote of confidence seems particularly hollow as only 5,000 individuals and organisations responded. Almost a third of those filling in the questionnaire worked for the NHS, and just 3,760 answered the question on polyclinics. The determination of the London NHS to press ahead regardless inspires little confidence in Lord Darzi’s recent pledge that local people would have a say in changes arising from his national review.

The point here is that old-fashioned government always knew how to consult with important interest groups, including those representing minorities and so on. Our modern age is supposed to have devised ways of consulting with The People in some Big Conversation (in one New Labour formulation). It doesn’t seem to have worked in some new way, and yet its dubious results are still paraded as though evidence of a new way of doing business.

Here is Andrew Grice, political editor at the Independent on Sunday, in a piece entitled Cameron’s First Hundred Days (1 August 2008).

How would Mr Cameron run his government? “The Blair-Brown style is all about central control,” said Mr [Francis] Maude. “There would be a return to something much more like more conventional cabinet government, with a strong prime minister showing leadership and direction at the top.” He added: “To have a strong centre, you don’t need a prime minister’s department. What you need is a strong prime minister who sets direction clearly. David Cameron will be more trusting of his colleagues, with their departments being held accountable but not constantly being second-guessed and interfered with.”

“The Civil Service is extremely demoralised and fed up. It is not being treated with respect,” said Mr Maude. “Civil servants don’t mind if their advice is not taken – decisions are up to ministers. But there is real resentment that advice is not being sought.”

But preparations, however extensive, only get you so far. Mr Maude, a former minister, said: “In my experience, 75 per cent of what you do in government is not implementing your programme but dealing with events.”