The conclusion that 'many health authorities clearly see community consultation in its rightful place as one of the key processes involved in strategic planning' ('Raising the stakes', pages 26-27, 7 September) is a positive one. This optimism complements the ideal set out in the NHS plan to give people 'more influence over the way the NHS works'.

However, the Pricewater-houseCoopers survey also raises important questions about the value, costs and benefits of building community involvement into strategic planning processes and the extent to which this is actually taking place in HAs.

The survey is based on the responses of 25 HAs; 75 did not respond, so we are unable to comment on their practice.

Another important area of interest, not reported in the survey, is outcomes. What difference does public involvement make? It is necessary to analyse, not only whether consultation initiatives are carried out (strategy) and what methods are used (process), but also how the results of such an exercise influenced decisions.

In order to persuade boards that involving local people is of value, research is needed to unpack the effects of such relationship building. Unfortunately, evaluation of these initiatives often focuses on process alone, rather than outcomes.

Julie Wells Communications consultant Bourton Buckingham