The consultation meeting held in the Town Hall last week about the proposed mergers of Strategic Health Authorities (SHAs), Ambulance Trusts and Primary Care Trusts (PCTs) was well attended and left the representatives of the SHA in no doubt that Wyre Forest people regard mergers of the three PCTs in the County as a retrograde step not in any Worcestershire person's best interests.

The mergers_

• may not save money, 
• are not necessary for improved commissioning and 
• could disrupt the delivery of care significantly. 

Worcestershire communities will lose their local representation from patients, the public and clinical staff. 
Indeed mergers such as this against the wishes of people make a mockery of the Government's vaunted phrase "a patient-led NHS". 

It is essential that we all write to express our views about the mergers before 22 March to: 
David Nicholson, CBE, 
Commissioning a Patient-Led NHS, 
West Midlands Consultation Office, 
PO Box 2675, 
Stafford, 
ST16 9BW.

There were three crucial votes for the Government this week. 

First the House of Lords amendments to the ID Cards Bill were defeated by the Government. Their lowest majority was 31 on the issue of compulsion. 

They escaped a rebellion on the Health Bill and its proposed ban of smoking in public enclosed spaces by making this a free vote. 
The Bill no longer exempted pubs that do not supply food in response to representations from many sources including the Health Committee. However the possibility of excluding private members' clubs from the ban remained. A Government amendment to remove these clubs from the exclusion was hotly debated but then won by a large majority of 200. Thus the total ban of smoking in public enclosed places has gone through and will be enforced in 2007. 
The medical arguments in favour of this are overwhelming and it is the single most important public health measure that Parliament could have supported. Some of the arguments in favour of excluding private members' clubs from the ban focussed on the issue of freedom of choice. However, if you are going to protect 100% of the workforce my view is that you cannot exclude any place where significant numbers of people work. 
Of course there is no ban on smoking in residences or places that count as homes for those in residential care, long stay hospitals and prison cells. 
An extra advantage shown in Ireland, where the total ban has been in place for sometime, is that the ban can help some people who have been struggling to stop smoking actually to do so.

At the time of writing the third test for the Government is still to come over the Lords Amendments to the Terrorism Bill. 
Labour rebels will have to be very determined to withstand the pressure of their whips following the recent dramatic Government defeats.