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Saturday 21st April 2018

Local Involvement Networks

20th March 2007

The arrangements for patient and public involvement in the NHS are changing. Local Involvement Networks will replace Patient and Public Involvement Forums, and Oversight and Scrutiny Committees will have new powers to review health and social care provision.


1 How are patients and the public involved in the NHS now?

At present patient and public involvement in the NHS takes place through the following different forums which were set up following the NHS Plan:

• Patient Advice and Liaison Services (PALS). This service is available in every hospital and PCT to help patients and their families resolve concerns and complaints. PALS staff liaise with hospital staff, and other relevant organisations as appropriate, to sort out difficulties and change the way services are delivered to improve the patient experience.  PALS can also refer patients and families to local / national support agencies and the Independent Complaints Advocacy Services (ICAS).

• Patient and Public Involvement (PPI) Forums. PPI forums are working in every trust to influence the way that healthcare is delivered locally.  They are staffed by volunteers, and are responsible for reflecting the views of local people into the hospital Trust / PCT. At present over 5000 people are members of these forums.

• The Commission for Patient and Public Involvement in Health (CPPIH) is an independent, non-departmental public body, sponsored by the Department of Health. CPPIH's role is to make sure the public is involved in decision making about health and health services in England. It is responsible for appointing, providing advice, guidance and support to PPI forums.

In addition, all local authorities with social services responsibilities in England (county councils, London Borough Councils and unitary authorities) have specific powers to examine health services on behalf of their local communities. These powers are vested in the Overview and Scrutiny Committee (OSC) and enable health policy to be influenced locally. OSCs have the power to:

• Take on the role of scrutiny of the NHS regarding major changes as well as the ongoing planning and operation of services.
• Be consulted by the NHS where there are to be major changes to health services.

• Refer contested service changes to the Secretary of State for Health.

• Summon NHS managers to give information about services and decisions.

• Report their recommendations locally.
2 Why are these arrangements changing?

In 2006 the ‘Our Health, Our Care, Our Say’ White Paper set out a new direction for social care and community health services with greater patient involvement. This aimed to:

• Change the way services are provided in communities and make them as flexible as possible.
• Provide a more personal service which reflects the specific health / social care needs of individuals.
• Give patients and service users more control over the treatment they receive.
• Work with health and social care professionals and services to get the most appropriate treatment or care for their needs.
 An expert panel identified a number of reforms to how patients and the public are involved in the NHS. These are set out in ‘A Stronger Local Voice’. This describes the Government’s framework for future patient and public involvement in health and social care. The forward to the document states that ‘the arrangements will enable genuine involvement in a much wider range of ways, bring real accountability at the commissioning level, and enable a broad spectrum of people to influence how their local services are designed and delivered".

3 So what will be different?

PALS and ICAS will continue but all other elements of patient and public involvement will change as follows:

• Local authorities with social services responsibilities are being given:

o A statutory duty to make arrangements to set up Local Involvement Networks, by identifying a suitable host organisation.
o Enhanced powers for OSCs to call partners to give evidence.

o A greater focus for OSC on ’the work of commissioners’.

• Section 11 of the Health and Social Care Act 2001 will be made more explicit and a new duty will be placed on partners to respond to scrutiny recommendations.

• CPPIH and PPI forums are being formally abolished.

A bill setting out these changes is currently before parliament.

4 What are LINks?

LINks organisations will work with existing voluntary groups, patients, and the local community to influence health and social care locally. They will gather local views and make recommendations to commissioners, providers and Overview and Scrutiny Committees.
LINks will be:

• Set up under contract by all local authorities with social services responsibilities.

• Hosted by an organisation local to the area. (NHS, local authority or service providers are specifically excluded from hosting to prevent a conflict of interest.)

• Funded through the contract between the local authority and the host organisation. Central government will provide additional finance to local authorities.

• Free to develop structures and ways of working which best suit local needs.

• Required to publish an annual report of activities.

• Reporting directly to the Secretary of State for Health.
As LINks are being established by local authorities, they will be coterminous with PCT boundaries in most cases.

5 What will LINks do?

LINks will have a wide ranging remit. They will be able to:

• Review the whole patient pathway across local health and social care services.

• Look at all services provided to local people, including those located outside the area or by independent providers.

• Refer health and social care issues to OSCs.

• Inspect premises - sspecialist teams will undertake the necessary training and checks to allow them to carry out inspections of premises.

These new proposals are being piloted in 7 areas – Hertfordshire, Kensington & Chelsea, County Durham, Doncaster, the City of Manchester, Dorset and Medway. These ‘early adopters’ are:

• Testing out different approaches to establish best practice.
• Developing a tender specification.
• Identifying learning points.
The findings from these pilots are being disseminated widely.

6 How are they different to PPI forums?

LINks will be different from PPI forums because they will:

• Cover a geographical area rather than an NHS organisation.
• Have responsibility for health and social care.
• Involve many more people.
• Work closer with the voluntary sector.
7 What do people think about them?

Almost 500 people responded to the ‘A Stronger Local Voice’ consultation. Overall, many welcomed the introduction of LINks and changes were made following feedback. For example,  LINks have now been given the power to inspect premises.
Sharon Grant, Chair of The Commission for Patient and Public Involvement in Health, has stated that ‘Whilst we agree on the need to strengthen the voice of the public in health and social care, current proposals will be seen as weakening it at a critical time. The system will be strapped for cash from the outset, and duplication of functions at local level will waste what resources are available. Local LINks are a vague concept, and will have fewer powers to investigate local services – and they will have no national voice. Without adequate resources and support they will face an unmanageable task over huge geographical areas, and will be unable to engage with those whose needs are often the greatest in health.?

Elizabeth Manero, Chief Executive of patient involvement charity Health Link, described the proposal for LINks as 'an amorphous, fluctuating group of people with no leadership and little accountability'. 

8 When will LINks start to operate?

The Government is now legislating to take these proposals forward in the Local Government and Public Involvement in Health Bill which was placed before Parliament in December 2006. The bill is mainly concerned with the reorganisation of local government, but includes some changes which impact on the NHS as set out above.

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