Letters

As members of the NHS Modernisation Board we broadly welcome the government's response to the patient and public involvement listening exercise.

The amended proposals bring mechanisms for external redress - through the Independent Advocacy Service - on an equal footing with those for internal redress through PALS, helpfully renamed the patient advice and liaison service.

We now need to guarantee patients equal access to internal or external redress as the point of entry into the system.

Commissioning ICAS locally should not await the formation of the Commission for Patient and Public Involvement in Health - it is needed now.

The proposals considerably enhance the national role of the proposed CPPIH by aggregating local experience of services to influence the overall direction of the NHS. Importantly, they ensure an appropriate degree of independence with a direct route to Parliament.

At the same time, CPPIH will play a crucial role in enabling the involvement of patients and public locally through patient forums and via its local networks - although there is need for further clarification on exactly how local structures will complement each other to fulfil an enormously challenging role.

CPPIH will need a strong and demonstrably independent board if it is to be an effective champion of patients and public and hold the government and the NHS to account in delivering its promise of a patient-centred service.

National patient organisations with a track record of influence and independent funding should play a crucial role in this, alongside individuals and local representatives of the new structures with the right skills and experience, many of whom may be drawn from the best of the current community health councils.

The implementation task ahead is formidable. Almost 18 months have passed since the NHS plan was signed off.

In that time most trusts have struggled with the implementation of patient and public involvement initiatives as a key driver of change.

With its heavy responsibilities, CPPIH is going to take time to make a difference and, while we welcome the transitional arrangements, the government needs to set up a shadow body soon.

This needs proper funding to succeed. The NHS plan's promise of letting 'patients and citizens have a greater say in the NHS' was never going to be achieved on the cheap. We await the outcome of the spending review to see how committed the government really is to a patient-centred NHS.

Paul Streets, chief executive Diabetes UK Harry Cayton, chief executive Alzheimer's Society David Harker, chief executive National Association of Citizens Advice Bureaux Eve Knight, service development director British Cardiac Patients Association Melinda Letts, chair Long-Term Medical Conditions Alliance Cliff Prior, chief executive National Schizophrenia Fellowship