Dr Dominique Florin, GP and health service researcher, and Professor Jennifer Dixon, Director of Health Policy, say that although the Government aims to increase public involvement in health care policy making, there is little "clarity and consensus" about what this means, or whether the measures proposed will engage the public effectively.

Currently initiatives to involve the public vary significantly, say the authors, and the lack of a rigorous and co-ordinated approach may "cost the NHS and the public time, effort, and resources, without conferring any significant benefit."

Various methods of engaging the public in NHS decision-making exist, from citizens' juries to representation on health boards, but not all are effective for every type of service. Initiatives to date have proved 'piecemeal and disparate' argue the authors, and little attention has been paid to how schemes complement each other across the public sector. Finding a balance between the experts' and the public's voice in deciding on policy has also not been addressed. All of these issues must be examined by the new Commission for Patient and Public Involvement, say the authors.

Patient-centred approaches to making health services more publicly accountable should also be considered. Initiatives such as the Expert Patient Programme are tentative but have proved promising and popular, say the authors.

'"/>

Contact: Linda Millington
pressoffice@bma.org.uk
44-207-383-6473
BMJ-British Medical Journal
15-Jan-2004