'One of the strengths of the local involvement networks was supposed to be that, rather than examining the services in a particular institution, they could range across a whole area to gain a rounded view of all aspects of services users' experiences'

Political slogans are so often a hostage to fortune. Seven years ago, when then health secretary Alan Milburn unveiled the NHS plan, he pledged to deliver a 'patient-centred NHS'. Now the Department of Health is under fire over how the latest round of reforms may undermine patient representation.

Patient involvement in service delivery is far from a sideshow. As the NHS moves towards local empowerment, ideas around real influence for service users such as a role in the performance management of services are now being debated.

The years since the NHS plan have been marked by a widening of patient influence. From duties to involve and consult the public to the Healthcare Commission's national patient survey, the consumer voice is heard as never before.

But the structures to deliver it suffer from the malaise seen too often in health and social care of being scrapped, replaced and scrapped again.

Community health councils survived for 27 years, patient and public involvement forums are on their last legs after just three. The arrangements for LINks - the local involvement networks scheduled to replace the forums - are supposed to be central to this burgeoning patient power. But draft regulations for the Local Government and Public Involvement in Health Bill currently before Parliament reveal a potential flaw (See 'LINks scrutiny system to bar patient networks from access to key services').

Fatal flaws

LINks will be denied access to mental health facilities, children's care homes, non-communal areas of residential care homes and clients' own homes.

This undermines the rationale for LINks in two ways. First, it removes their ability to represent the interests of many of the most vulnerable clients.

Second, one of the strengths of LINks was supposed to be that, rather than examining the services in a particular institution, they could range across a whole area to gain a rounded view of all aspects of services users' experiences, including how the various parts of the health and social care system interlinked. That would be fatally weakened if these draft regulations ever come into force.

Even the ability to visit hospitals is far from impressive, requiring sanction from the Healthcare Commission - hardly a spot check.

The DoH appears to have lost its way on patient involvement. While the aspirations in the NHS plan were laudable, progress has been hampered by sharp changes in strategy and a failure to truly understand what effective involvement can bring to the NHS.