Public and patient involvement in health and social care has been seriously set back by widespread delay in establishing local involvement networks, a report claims.
The new organisations should have been in place by 1 April, when patient and public involvement forums were abolished, but some have still not been established.
The interim report to be published by the National Association of LINks Members also accuses local authorities of failing in their duty to put contingency arrangements in place.
There has been an "almost total loss of public involvement in healthcare", it says.
Authorities with a social care responsibility must contract a host organisation to run the networks.
The Department of Health and Department of Communities and Local Government have "failed to provide adequate support" and been "reluctant to take responsibility", it says. "A lack of meaningful involvement activity has caused many would-be LINks members to drift away. There is considerable variation in interpretation of the legislation by local authorities, which has caused a great deal of confusion and frustration."
The report shows some authorities are retaining a significant amount of their allocated funds for the network for administration while others are spending it all on their host contract.
Association chair Malcolm Alexander and vice chair Ruth Marsden said in a statement that they were concerned there was no monitoring of the relationship between authorities, hosts and networks.
"This could lead to disaster for LINks," they said.
Picker Institute head of policy and communications Don Redding said in some cases the confusion was setting back primary care trusts' public and patient engagement plans.
A DH spokeswoman said it was offering extra support to the "small number" of authorities where no network had been established.
"We are confident that all local authorities will have a LINk in place by the end of December."
Picker Institute chief executive Angela Coulter is to step down at the end of the year.