Local voices: evolving a realistic strategy on public consultation.

The publication of Local Voices in 1992 challenged Health Authorities to develop an effective system for their public consultation activities compatible with the requirements of the internal market.1 The general rhetoric was persuasive, but it was less clear how, and to what extent, Local Voices work would influence Health Authority decisions. Serious questions about the nature, purpose and impact of Local Voices were raised within a year of publication.2 This paper re-examines the issues and discusses some of the benefits and limitations of public consultation exercises, using as illustrations two projects carried out in East Lancashire, one on adult mental illness3 and the other on maternity services.4 Particular consideration is given to the precise impact on commissioning of public consultation exercises, and the dilemmas and tensions which emerge as the commissioners consider different findings from different methodologies and different population subgroups. The final section of the article summarises the lessons learnt and sketches out a more systematic and critical approach to public consultation.