Published: 07/06/2002, Volume II2, No. 5808 Page 20

Bob Sang (letters, 23 May) makes some important points about the current patient and public involvement controversy. However, he has fallen into the name game trap that has dogged this debate.

Differentiating between citizens and patients is useful when testing for inclusivity: citizens have the right to direct the theory of the NHS through local and national democratic process; patients and carers offer the most valuable perspective on the practice - because they have experienced it. However, to look at someone contributing to a strategy discussion or monitoring exercise and then to decide whether they are a citizen or a patient and grade their contribution accordingly is artificial.

Structures are comparatively easy to set up with the right amount of money. Effective ways of working and inclusivity are much harder to achieve. Just as the NHS is planned on the basis of need, so involvement in it should be planned on the basis of need. Innovative practices and existing good practice, such as Southwark community health council's work on community involvement at Dulwich Hospital, are necessary to engage those whose needs are greatest.

There is no single way of managing this.

However, it will only be effective if the structures to deliver involvement are independent, removed from the tangle of vested interests which all too often underlies health and social care decision-making.

Without independent and accountable structures, tokenism will rule and the energy of patient and public involvement to improve services will not be released. The support of the Lords is built on that principle.

Elizabeth Manero Chair London Health Link