The guest who won't take no for an answer

SEVENTY-EIGHT per cent said no. When the result came through shortly after midnight exactly a year ago, the size of the No vote was extraordinary to behold. "NO - loud and clear", said The Northern Echo's front page headline.

The North-East seemed to have not so much shut the door on regionalisation, but slammed it hard in the jowly face of Deputy Prime Minister John Prescott, whose brainchild a directly-elected regional assembly had been.

And then, such was the size of the majority, the door appeared to have been locked, bolted and nailed up tight, just for good measure.

But a year on, what is that slinking in through the back door? It doesn't knock. It doesn't dare introduce itself.

Yet it is none other than our old friend Regionalisation.

Health, police, fire, ambulance and learning services are all in the throes of being regionalised. The regional development agency, One NorthEast and its partner the North East Assembly still exist as they did before November 4's landslide. They still play make-or-break parts in all of the region's major infrastructure projects, from planning to realisation.

In fact, since the No vote, the Association of North-East Councils has stepped out of the assembly's shadow to create its own manifesto to deliver "a strong political voice in the region". It is made up of councillors from all of the region's 26 councils, which it says gives it a democratic legitimacy - unlike the North East Assembly which includes some councillors plus plenty of placemen.

Whichever is the more legitimate, it now appears that there are two "assemblies" in the North-East even though the people of the region voted against even having one.

But beyond this, there is a new word entering the lexicon of local government. It is the sexy-sounding "co-terminousity". It means that the geographical boundaries of your local health trust, your local ambulance service, your local police force and your local council should all be the same - they should be co-terminous.

Let's have a look at what's happening, and see what we can learn:

POLICE

The Government wants all forces to have 4,000 officers so they can cope with large scale terrorist attacks and natural disasters. Therefore North Yorkshire (1,556 officers), Durham (1,700) and Cleveland (1,772) have to go. The Government would like the new forces to be co-terminous with regional government boundaries, so Northumbria (4,088 officers) would expand to takeover everything twixt Tweed and Tees. North Yorkshire would take the southern scraps of the Cleveland Constabulary and join Humberside.

Lesson: Cleveland is fighting valiantly for its future. It wants to expand to take in Darlington, Sedgefield, Teesdale and Weardale to create a "city region" (a wholly inappropriate phrase as this city region would include some of the North-East's most rural outposts, but never mind).

Cleveland's fight mirrors other battles: smaller authorities are fighting to keep the service providers small, whereas bigger authorities are fighting to make them bigger.

Tees Valley's unitary councils, which are small, want to keep their local police force small. For example, mayor Stuart Drummond of Hartlepool said: "My personal feeling is that a single North-East force would not be very good for Hartlepool. We are doing very well at the moment thank-you, and no change would be very good for us."

Privately, many district councils in Durham are also against a big region-wide force, but the bigger county council is in favour of the biggest possible force. The same divides are opening up over health.

HEALTH

AT the moment there are 15 primary care trusts (PCTs) in the North-East and four in North Yorkshire. PCTs have the money in the NHS - they pay hospitals to perform operations on their customers.

They were set up by Darlington MP Alan Milburn when he was Health Secretary to cover populations of about 100,000 so they could be responsive to local needs.

In their four years, these PCTs have become popular because they've championed local bricks and mortar. There are visible new community hospitals in Barnard Castle, Sedgefield and Chester-le-Street, and in Darlington there is a new walk-in centre which is so rooted locally that it is named after a doctor who died more than a century ago.

But those 15 PCTs look likely to become four, and North Yorkshire's four will turn into one. Mr Milburn says this is "ludicrous", and MPs Kevan Jones and Dari Taylor have pressed the case for PCT conservation with Health Secretary Patricia Hewitt.

However, the region's handful of hospitals find negotiating with so many PCTs time consuming, and the PCTs themselves appear to think there are times when they are too small because they band together to barter a better deal.

Therefore, some form of regional rationalisation seems inevitable, and it would mirror what else is happening in the NHS foodchain. Once there were separate trusts running hospitals in Darlington, Bishop Auckland and North Durham. But Darlington and Bishop merged to become South Durham, and then North Durham merged with South Durham to become the County Durham and Darlington Acute Hospitals Trust.

Similarly, Northallerton has shacked up with South Tees, and Hartlepool has found itself in bed with North Tees.

At the top of the NHS foodchain are the strategic health trusts with extremely long and unwieldy names (the longest being the utterly unwieldy North and East Yorkshire and Northern Lincolnshire Strategic Health Authority). Suffice to say, there are currently two in the North-East and one in North Yorkshire. But in the near future, the two will become one, and North Yorkshire will find itself lobbed in with the rest of Yorkshire and Humberside.

Lesson: Yes - both of the new strategic health authorities will be co-terminous with the new police forces and, coincidentally of course, the Government's regional boundaries.

LEARNING AND SKILLS COUNCIL (LSC)

Currently the LSC has four offices in the North-East, but just this week it announced that it will now concentrate on a new regional centre, probably in Gateshead, and the other three offices will be downgraded.

Lesson: This demonstrates one of the driving forces behind regionalisation: 45 jobs will go and the national reorganisation of the LSC will save £40m. The mass cull of the PCTs will save £250m. It is said that these savings will be ploughed back in to make services even better.

FIRE AND AMBULANCE

Once there were ambulance services in County Durham and Northumberland; now there's just the North-East Ambulance Service. Very soon, it is likely to get larger still, as co-terminousity dictates that Teesside should join the North-East while North Yorkshire goes looking for a new partner on Humberside.

This mirrors what's happening in the fire service where a £110m regional control room is being built in Durham to replace smaller, local rooms in Hartlepool, Newcastle and Morpeth.

Lesson: Should the ambulance service grow, it seems smaller, local ambulance stations in Barnard Castle, Middleton-in-Teesdale and St John's Chapel will go.

These changes represent the public's biggest fear about regionalisation. They voted No last November because they didn't want to disappear into an amorphous "Geordie Parliament"; they wanted things run locally because they believe local people know best. If their house is burning down, they want the fire engine directed by someone with local knowledge who can tell their Cleveland Avenues from their Cleveland Terraces.

ON his visit to Middlesbrough on Tuesday, Tory leadership contender David Cameron said: "I would like more local structures that are more accountable to local government. People know what their local council does so trying to have - that awful word - co-terminous boundaries is not right."

But, before putting the boot into our guest who's sneaking in through the back door, let us acknowledge a couple of points.

Firstly, those in favour of the regional agenda point out that the North-East overwhelmingly rejected the powerless talking shop proposed by the Government - if real devolution had been on offer, the result might have been different. Possibly...

Others suggest that as the public voted against the regional set-up, now each public service has to find a new suitable structure - and it is just coincidental that that structure should be regional. Hmm...

But we must acknowledge that this is a new form of regionalisation. It is regionalisation with a very local outlook. The bigger PCTs are already grappling with how to have a "local presence"; those drawing up plans for bigger police forces are also pressing the concept of "neighbourhood policing".

This is "new localism", as Mr Milburn once called it, and it ties in with the community councils, partnerships and local area agreements that are springing up all over the place.

Life is being increasingly controlled at a regional level by a system that strains our understanding of democratic accountability, but there are very local, street-by-street structures being put in place to bring it closer to the people.

So although it is our old friend Regionalisation who is sneaking in through the back door, he is at least wearing new clothes. But does that make him welcome?