The launch of the King's Fund's 'Citizen Participation' programme last month had all the trappings of an exciting step forward for public involvement in decision making. Sadly, the content was old and weary, and little more than an attempt to promote democracy by focus group.

Citizens' juries - the model promoted by the King's Fund - are expensive, elaborate focus groups which purport to reflect ordinary citizens' views of health policy. They are no better or worse than a pub discussion on a good night, and have about the same effect on health policy. Their methodological twin, health panels, have the advantage of cheapness and are equally impotent. Neither are about public involvement but its avoidance.

If health authorities wish to go beyond rhetoric, they will have to demonstrate commitment to developing policies which reflect expressed local needs. That means listening to diverse and dynamic community groups, and changing policy as a result of what they hear. It means taking on board community health councils' opinions; they have extraordinary networks and an informed view from a real community perspective.

It means listening to local councillors and representatives of religious and cultural organisations. It means hearing the voices of people silenced by depression, fear, violence and the lack of a common language.

HAs embody the democratic deficit in health. They do not want communities to influence their decisions because that would mean giving away power to the citizen, taxpayer, poor and deprived, refugees and homeless people, the very people who are supposed to benefit from the social exclusion policy. There is no harm in a few focus groups or health panels or citizen's juries or even an opinion poll or two, but let's not fool ourselves that they have anything to do with democracy or community empowerment.

It's time for HAs and the primary care groups they have spawned to demonstrate they can - and are willing - to share power with local communities.

That really will mean a new way of developing health policy for the millennium and new genuine partnerships that involve not only hearing local voices but being transformed by them.

Malcolm Alexander

Chief officer

Southwark CHC

See books, pages 32-33.