The fall-out from the Patient's Charter review casts doubt on the commitment to inclusivity and consultation on which New Labour prides itself. Patrick Butler considers what went wrong

The experience of the Patient's Charter advisory group, whose members complained of being ignored when its report came to be written, bring to mind the management philosophy of legendary football coach Brian Clough.

Asked about his relationship with the club board, the former Nottingham Forest boss said breezily that he always listened carefully and attentively to what the chairman had to say. Then, he added, 'we decide to do it my way'.

The government has set up a clutch of advisory groups. It boasts of inclusivity, consultation and listening to people. So was the allegedly mishandled Patient's Charter affair a one-off, or does it tell us something about the government's approach to task forces? The charter group was set up in October 1997. A government committed to consultation and openness appointed a trusted businessman and party donor, Greg Dyke, to shake up the charter.

'Greg,' said the then health minister, Baroness Jay, on his appointment in October 1997, 'has huge talents as a communicator'.

The following month, a 23-strong committee of experts was appointed to 'work with' Mr Dyke to develop the charter. 'The participation of people who can offer a range of perspectives on the new charter is crucial to its success,' said Baroness Jay.

The group held a couple of full meetings and a handful of sub-committee meetings. But after July 1998, according to one group member, National Consumer Council director Ruth Evans, no more meetings were held.

Despite writing to Mr Dyke, Ms Evans heard nothing more about its progress - until, on 7 December, she received a letter out of the blue from Mr Dyke informing her the report would be published two days later.

'Whilst acknowledging the valuable support and ideas that I have received from the advisory group and others, I have made it very clear that the recommendations are mine and mine alone,' wrote Mr Dyke.

Ms Evans was surprised, as she had clearly, and not unreasonably, expected to see a draft copy of the report and be given the chance to make comments. 'I saw the letter the day before (publication). He wrote: 'The government is likely to publish my report shortly.' I thought: 'What report?''

Ms Evans was not alone. Fellow group members Judy Wilson, chief executive of the Long Term Medical Conditions Alliance, and Claire Rayner, chair of the Patients Association, also complained publicly that the process had been unsatisfactory.

Ms Evans maintains that the report was 'valuable', and 'not a failure'. But she says the advisory group was badly organised, there was poor communication from its chair, and ambiguity about the extent of the advisers' role.

'I think Greg Dyke is very talented and has done a good job. But I'm surprised about the lack of ownership of the group's report.'

Mr Dyke says: 'I was not asked to chair a review committee. I was asked to come up with a set of proposals for a new NHS charter. An advisory group was set up by the DoH but it was never an executive group, nor was it asked to prepare a report. As far as I know, everyone on it understood that.'

Ms Wilson says: 'The group did not have any terms of reference, no notes of meetings; it was badly chaired by Greg Dyke and it was an ineffective way of using the expertise of a very good group of people.'

Like Ms Evans, who chairs a group on consumer involvement in the NHS research and development programme, Ms Wilson says she has had more meaningful experiences on other groups on which she sits, including the Crown review of prescribing, which reports next year.

This review group, she says, has lots of time for consultation, is well chaired, and has a sense of balance between the different members of the group - qualities apparently lacking in the NHS charter group.

Mike Marchment, chief executive of Southern Derbyshire health authority, who sits on the NHS efficiency task force, and is a veteran of task forces under the previous administration, believes the government is committed to consultation.

'The difference between this government and the Conservatives is that this government has genuinely made more of an effort to closely involve people from the field in policy,' he says. And he feels it has listened to the efficiency task force, which also counts Institute of Health Service Management president Peter Homa and Newcastle City Health trust chief executive Lionel Joyce among its members.

'I think all the people in the efficiency task force are clear that their discussions are reflected in guidance. I feel we are an influencing body. Not superbly influential. But I would like to think ministers and civil servants find it quite useful.'

Bob Abberley, Unison head of health, sits on the ministerial task force on staff involvement. It is 'going well', is well chaired by NHS human resources director Hugh Taylor and has committed members.

He says: 'Task forces can be an effective way of tackling issues and forming strategy. We have started to think about how partnership can work at all levels... politics doesn't come into it. It's a group of people committed to the NHS who want to make it work.'

But he accepts all that counts for little if ministers ignore its findings. The group expects to report to ministers shortly.

Sit on it

Among the many NHS working groups, advisory groups, and task forces set up by the government over the last 18 months are: advisory group on the implementation of acting on complaints; NHS charter advisory committee; NHS direct national advisory group; external expert advisory group for learning disability nursing; ministerial task force - staff involvement; eight regional waiting list task forces plus waiting list support force in Scotland; efficiency task force.