It makes more sense for elected representatives to concern themselves with how health services are planned than how they are provided

Commissioning remains the area in which patient and public involvement is weakest, despite the fact that the strongest proponents of 'choice' argue that it is a lop-sided policy without 'voice'.

The Department of Health paper A Stronger Local Voiceis a first step towards changing that after the failed experiment of patient forums.

It provides most detail about local involvement networks, underlining their role as information gatherers and disseminators largely under local authority control in terms of organisation and funding. That marks a genuine and significant difference from their predecessors, but their effectiveness will depend on the ability to draw on new types of members; they will struggle without new blood.

The paper envisages overview and scrutiny committees focusing on commissioning - something it argues they are 'ideally placed' to do. There is a clear case for this: it makes more sense for elected representatives to concern themselves with how health services are planned and prioritised across an area than how they are provided. But that does not mean OSCs will not stand for any narrowing of their influence.

For their part, it is still unclear what will be required of commissioners in terms of consultation, and just how the current section 11 duty will change. The report talks approvingly about the role of direct payments and individualised budgets in social care. Thinking about patient involvement in these terms would require new ways of thinking for the NHS, seeking not just tacit approval of prepared plans but genuine engagement.

Will it work this time? The paper makes clear that primary care trusts will be assessed robustly by the regulators as part of their annual performance review. What is much less certain is how the networks would best be managed to ensure a balance between local freedom and nationally agreed standards.