51. Evidence submitted by the Local Government
Association (PPI 108)
LGA KEY POINTS
— 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.
ABOUT THE
LGA
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.
INTRODUCTION
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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