Select Committee on Health Written Evidence

51. Evidence submitted by the Local Government Association (PPI 108)


    —  We support the principle of the LINks scheme and the model proposed;

    —  Effective community networks can reduce health inequalities and increase community cohesion;

    —  All health and social care agencies must be under a duty to cooperate not only with LINks and scrutiny committees, but with Local Area Agreement partners as well;

    —  The relationship between LINks and scrutiny committees must be clarified to ensure that work programmes are not duplicated.


  1.  The Local Government Association (LGA) speaks for nearly 500 local authorities in England and Wales that spend some £78 billion pounds per annum and represent over 50 million people. The LGA exists to promote better local government. We aim to put local councils at the heart of the drive to improve public services and to work with government to ensure that the policy, legislative and financial context in which they operate, supports that objective. We would be pleased to give oral evidence to the Committee.


  2.  One of the LGA's ambitions for the people and places we represent is to give people greater power and influence over their lives, their services and the future of the places where they live. The challenges we face as a society place a premium on a local response to local circumstances, and the development of local solutions and local choice. It is at the local level, where services are delivered, that individuals have the knowledge and opportunities to make choices for themselves, and where they can, if they wish, play a part in the political process of making choices and shaping and determining public services in their area.

What is the purpose of patient and public involvement?

  3.  Responsiveness to local people means giving people the power to drive service improvement and value for money and hold all local public service leaders to account for their performance. The creation and fostering of active citizens' groups, voluntary and community organisations, and social enterprise is key to improving services, reducing health inequalities and building strong communities. Local councils are committed to the ethos of community development, regarding participatory democracy not as a threat to or substitute for, but a vital complement to representative democracy. We are concerned however that the Government's expectation of wide and deep community involvement in LINks is unrealistic without adequate support and training, particularly when dealing with specialist areas of medicine. In rural areas LINk members could incur significant costs to travel to meetings. These factors could lead to LINks being dominated by narrow, single issue groups, one of the criticisms of PPI Forums.

  4.  The LGA recommends that:

    —  expenses for LINks members are considered;

    —  adequate resources to train and support both individual and community capacity for patient and public involvement are made available;

    —  host organisations are required to ensure as broad community representation as possible.

What form of patient and public involvement is desirable, practical and offers good value for money?

  5.  The LGA supports the development of LINks, as set out in the Local Government and Public Involvement in Health Bill (the Bill), and the abolition of PPI Forums, as part of the move towards greater transparency and the integration of health and social care services. Accountability and sensitivity to local people has long been missing from the patient journey, which is becoming ever more complex in terms of the number of providers and different funding methods. There is also an increased focus on wellbeing in Local Area Agreements (LAAs). We are concerned that the main focus of LINks is expected to be the PCT, as the commissioning organisation, without sufficient emphasis on the performance of individual contractors such as NHS Trusts, Foundation Trusts and GPs.

  6.  It is right that host organisations and LINks will be independent of councils and health bodies. Locally-focused and locally-derived bodies, without prescribed structures, have the potential to provide the best avenue for local people's involvement at all stages of the commissioning cycle—strategic needs assessment, service planning, contracting and monitoring. The power to visit premises and ask for information will also support local people's input to the regulatory process. However, councils are increasingly devolving service provision externally, eg to voluntary and community organisations through "compacts", and we are keen to release the potential of these organisations to develop social enterprises and build social capital. We would not want any blurring of roles between provider, LINk host or LINk member within any single organisation to damage community confidence in LINks.

  7.  The LGA recommends that:

    —  the experience and knowledge of PPI Forums is not lost and that the transitional provisions ensure that knowledge is captured;

    —  the potential role of service providers as hosts or members of LINks be clarified to prevent conflicts of interest;

    —  all health and social care agencies must be under a duty to cooperate not only with LINks and scrutiny committees, but with Local Area Agreement partners as well; and

    —  in the context of an increasing number of people purchasing services for themselves, LINks be given guidance on how to involve individual budget holders and those in receipt of direct payments.

The relationship with council Overview and Scrutiny Committees (OSCs)

  8.  LINks will be able to refer health and social care matters affecting their area to an overview and scrutiny committee (OSC). The Bill allows for external scrutiny of council social care services by patients and the public (via LINks) for the first time. The scope of scrutiny is explicitly extended to cover the activities of partners contributing to the development or delivery of Local Area Agreements and scrutiny committees will be given powers to require evidence from such partners and to require them to respond to scrutiny recommendations. We support these proposals.

  9.  However, we want to be sure that the proposals in the Bill do not undermine LINks or compromise the health scrutiny role of councils, and that the enhanced powers of OSCs (to call partners to give evidence, and the duty on partners to respond to scrutiny recommendations) extend fully to health matters. If we are to integrate health and social care provision to improve patient outcomes and reduce health inequalities then all health contractors, including NHS Trusts and NHS Foundation Trusts, should be named as LAA partners and fall within the extended scope of OSCs. We do not believe that the community elements of NHS Trust and Foundation Trust governance arrangements are a substitute for independent local scrutiny.

  10.  Additionally, practise based commissioning (PbC) allows for social care commissioning by GPs yet it is not clear how concerns LINks may have about GP commissioned social care, including charges and eligibility criteria, would be dealt with by OSCs.

  11.  The LGA recommends that:

    —  the enhanced powers of OSCs apply to all health bodies;

    —  concerns about social care commissioned by GPs can be referred to OSCs by LINks; and

    —  in order to make best use of resources, the work programmes of LINks and OSCs are co-ordinated to prevent duplication or omissions.

National co-ordination of LINks

  12.  It is crucial that these new organisations can share information, research and good practice increase their effectiveness and to reduce overall costs.

  13.  The LGA recommends that:

    —  a central website, through which all LINks can communicate with each other, is established, most sensibly by the recently established NHS Centre for Involvement.

Accountability of the LINk

  14.  As with any organisation there is potential for it not to carry out its functions properly. At present there appears to be no robust mechanism for performance management or for managing a situation in which a LINk has become dysfunctional other than to enforce the contract with the host organisation.

  15.  The LGA recommends that:

    —  scrutiny committees have the power to scrutinise the performance of LINks, perhaps when the LINk publishes its annual report; and

    —  scrutiny committees have the power to scrutinise the operations of LINks should organisational dysfunction occur, possibly through a referral from the host organisation.

A specification and budget for LINks

  16.  DH proposes to publish a model specification for LINks for council procurement officers. Currently £28 million is spent on the Commission for Patient and Public Involvement in Health (CPPIH), forum support organisations and Patients' Forums. Although LINks will be fewer in number than Patients' Forums it is possible that the wider remit of LINks and the need reach out to the full diversity of communities will increase costs, however the amount of money to be provided to councils to carry out this new duty has yet to be confirmed.

  17.  The LGA recommends that:

    —  the relative roles of the host organisation and the LINk itself be well defined in the model specification; and

    —  the budget provided by DH to councils must cover the costs to the council of procurement and contract monitoring, as well as the running costs of the host and LINk.

Strengthening section 11 of the Health and Social Care Act 2001

  18.  The Bill strengthens the provisions of section 11 of the Health and Social Care Act 2001 (as amended) by placing a new duty on NHS bodies to consult service users (or their representatives) about proposals that would have a substantial impact on the manner in which services are delivered or the range of health services available as experienced by the user. Primary Care Trusts will now be required to give information on consultations it has carried out before making commissioning decisions and how influential the results of the consultation were on those decisions.

  19.  Several OSCs have referred "substantial" changes in healthcare to the Secretary of State yet the process that the Department goes through to determine whether such referrals are upheld or rejected, and the criteria used to assess whether the Independent Reconfiguration Panel is asked to provide advice, is not publicly available. OSCs, and in future LINks, would certainly find such information helpful.

  20.  The LGA recommends that:

    —  the Department for Health publishes its process for determining referrals from OSCs, perhaps in collaboration with the Centre for Public Scrutiny.

Local Government Association

January 2007

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