Every part of the NHS must take steps to work in partnership 'with all parts of the local community', not just the groups with which they have traditional links, the NHS Executive has said.

'Only by involving local communities can we gain a better understanding of how local services need to be changed and developed, ' says junior health minister Gisela Stuart in a foreword to the document Patient and Public Involvement in the New NHS .

The document says organisations should 'strategically and systematically build patient and public involvement into the way they operate'.

This should extend beyond simple consultation on service changes to ensure patients and the public are involved in clinical governance arrangements and quality improvement programmes.

Somerset health authority chief executive Jac Kelly said the document provided a 'useful touchstone' on progress towards developing genuinely responsive services.

A cultural shift was needed in many parts of the service 'to see users of the service and those who fund it as influential partners in the care they receive'.

Many public consultations by health bodies have been of 'dubious quality' because they are really public relations exercises or because the consulting organisation fails to act on the response, a new book claims.

Dr Ruth Chambers, professor of health commissioning at Sheffield University, says in the book that unwanted results may also be disbelieved and therefore ignored.

'Moving to meaningful user or public involvement will not happen until there is a change in culture where those in the NHS want to engage with people and respond to their views, ' she says.