Published: 27/03/2003, Volume II3, No. 5848 Page 23

Long-awaited retrospective policy guidance on section 11 of the Health and Social Care Act 2001 ('strengthening accountability involving patients and the public') has just appeared. It is designed to be a key element of the patient and public involvement programme across the NHS.

Section 11 requires that 'persons to whom...services are being or may be provided are, directly or though representatives, involved in and consulted on' all aspects of service planning and operation.

The 'through representatives' provision is essential as it is not possible to consult and involve all users about everything.

Working through user representatives requires more than just willingness. NHS bodies need both guidance and time to put good ideas into practice and learn from the experience. It is sad and strange, therefore, that the new policy guidance fails to address user representative aspects of section 11. This places NHS bodies in an awkward position.

A positive way forward is for PCTs and trusts to adopt an iterative approach which embraces and encourages new and diverse user representatives and groups. More delay simply heightens the risk of breaching today's section 11 duties.

Andrew Craig Lay member, professional executive committee Wandsworth PCT South London