Archived decisions

Preparing for LINks: Excerpt for Democratic Health Network Summary

Two documents have been published by the DoH:

1.  Planning your Local Involvement Network sets out what local communities need to prepare for LINks including:

    · actions that local authorities need to take

    · who should be involved

    · resources required

    · different models for the operation of LINks

2.  Provides information for local authorities on procuring a host organisation to establish  and support a LINk including:

    · the procurement process

    · services hosts will be required to provide

    · processes for establishing LINks.

LINks

A LINk will be established within each area that is served by a local authority with responsibility for social services. This means that there will be 150 LINks. Each LINk will be made up of volunteer "members", ie a person or group that makes a commitment to take part in LINks' activities on a regular bases and volunteer "participants", ie a person, group or organisation that wants to influence the work of LINks , even though they may not participate on a regular basis. The roles of LINks apply to both health and social care services. They will differ from Patient Forums in that they will be attached to an area, rather than to an individual NHS institution. The roles of LINks will include:

    · promoting and supporting the involvement of people in the commissioning, provision and scrutiny of local health and social care services

    · obtaining the views of people about their need for, and experiences of, local health and social care services

    · enabling people to monitor and review the commissioning and provision of care services

    · raising the concerns of local people with those responsible for commissioning, providing, managing and scrutinising services.

The Department of Health has been at pains to emphasise that the structures and ways of working LINks are intended to be flexible, broad and inclusive and that they may differ from area to area. Methods of involvement used by LINks may vary from providing information, through consultation and participation to "co-production" in which some groups may want to design and deliver services on a user-led model (the "expert patient" approach being cited as one model of this kind).

Local authority departments and a LINk may agree to pool information or work together to gather the views of local people about particular health and social care services.

The details of the powers of LINks will be provided in future regulations. The DH has said that they are likely to be consulted on shortly.

Host organisations

Each LINk will be supported by a host organisation that is contracted to undertake this role by the relevant local authority. The role of the host may be considerably different during the set-up period while recruiting a group to establish the LINk. The host's long-term role is to provide support that enables LINk members and participants to maximise their involvement.

The DH is currently scoping the needs of an IT infrastructure for LINks to be overseen by the host organisations. The guidance also makes clear that the hosts should assist the LINks in communicating with other participants and networks, making effective use of the media and accounting to the local community on how it is using the resources invested in LINks.

Procurement/commissioning of host organisations by local authorities

Funding will be provided to the local authority by the DH in the form of a specific grant to carry out the procurement/commissioning of host organisations. The allocation will comprise a baseline amount for all authorities, to ensure all areas are able to put a contract in place as well as covering their costs, with the remainder of the funds allocated by the relative needs funding formula.

Each host will be contracted to provide support for an initial period of three years, and will be performance managed against the contract by the local authority.  It is suggested that the LINk and local authority develop a process of joint performance management. Local authorities will be expected, in conjunction with local people, to develop performance indicators for host organisations. Further guidance will be published by the DH once Royal Assent has been received for the Local Government and Public Involvement in Health Bill.

The DH guidance recommends that local authorities and interested stakeholders begin to engage with local groups and interested individuals now to identify a working model for the LINk and to prepare for the procurement process.

The second guidance document which is specifically about the procurement process is in two parts.

1.  A specification of the basic requirements that the Department of Health expects of a host organisation, with the caveat that this specification is a starting point and will need to be integrated with local authorities' own style of commissioning and standard documentation. Host organisations will be expected to:

    · undertake the initial set-up of the LINk

    · work with LINk participants to facilitate the establishment of the LINk's arrangements for managing and deciding on its activities

    · hold the finances of the LINk

    · facilitate the correspondence and communication activities of the LINk

    · ensure data management and record-keeping of LINk information

    · provide advice and support to the LINk

    · have a strong commitment to forming strategic partnerships and effective working relationships with other organisations, and support the LINk in developing such partnerships

    · support the LINk in the development and promotion of its priorities, work plan and activities

    · build networks to support recruitment to the LINk

    · provide an appropriate and non-discriminatory service

    · operate within agreed contractual performance frameworks

    · report back to the local authority on its activities and finances on a six-monthly basis

2.  A set of criteria that local authorities can use to advertise for a host organisation (again with an indication that these should serve as a starting point only). The criteria are indicate that each prospective host organization should:

    · provide specified information about itself

    · demonstrate its experience and expertise

    · demonstrate its knowledge of health and social care and community networks in the area

    · show experience and capacity for community engagement and involvement

    · show how it will recruit LINks members and build capacity

    · show how it will manage conflicts of interest

    · show a flexible approach to delivery

    · demonstrate active commitment to equal opportunities and human rights

    · have appropriate recruitment and employment procedures

    · provide an annual report and accounts

    · provide information on its proposed working methods and the added value it can bring.

Given the skill, knowledge and experience required of host organisations, the guidance indicates that it is likely that they will be chiefly be drawn from local non-profit organisations which are well versed in community engagement, involvement and networking and have links to a wide range of organisations and communities.

The role of overview and scrutiny committees

It should be emphasised that it is the local authority (ie its executive function), not the health overview and scrutiny committee (OSC) that is being given the role of procuring the host organisation. However, the guidance states that the overview and scrutiny committee has a role in scrutinising how the contracting process was undertaken, and ensuring that best value is achieved. The guidance recommends that relevant OSCs look at how much money authorities are spending on LINks and the value they receive for the funding available. However, it will not be an OSC's role to challenge tendering processes, nor to act as an appeal authority should an organisation fail to win a contract.

Overview and scrutiny committees may also commission LINks to undertake work on their behalf, for example to consult people on their views on issues that they plan to scrutinise.

Establishing a LINk

The guidance refers to the experience of the group of "Early Adopters" set up by the Commission for Patient and Public Involvement in Health (CPPIH). It suggests the following steps in setting up a LINk.

    · Set up a working group of interested stakeholders which may include individuals and representatives of groups

    · Establish channels of communication with potential members and participants eg through an interactive website

    · Map population diversity and need

    · Develop a working model for the LINk

    · Identify principles for involvement with the LINk

    · Consider different models of membership and participation

    · Identify other networks and groups which may participate in, support or be influenced by the LINk.

The DH claims that LINks differ from previous systems as they are based on broad networks rather than on small specialist groups, involving representatives from organisations as well as individuals, and addressing issues across health and social care rather than focusing on individual organisations or services. Experience already exists of developing participative and inclusive "networks of networks" that enable people to link into new initiatives without duplicating their efforts. Where such networks of networks already exist, the guidance states that LINks should seek to build on their work. It is likely that LINks will develop over a period of time and that in some areas a LINk may be established quickly, whereas in other areas it may take longer to engage with local individuals and groups.

Different models which LINks might use to structure themselves and organise their work are discussed in the guidance, with a proviso that LINks may wish to pursue other models in the longer term. Models discussed in the guidance include:

    · a hub approach, with participants and members agreeing to the LINk core functions and electing or appointing a hub to implement governance arrangements and to "manage" the work of the LINk.

    · a model based on a flexible structure where the host organisation co-ordinates the work that comes out of periodic citizens' meetings and there is no central hub of members. LINk participants and members take part in task groups that end when the task ends.

    · a model based on a LINk steering group with a cyclical approach to developing the work programme and to developing and learning from good practice, based on input from voluntary and community sector and other groups.

It is pointed out in the guidance that some local organisations, Patient Forums and interested participants are already considering the possibility of LINks developing into social enterprises, co-operatives or other types of stand-alone organisations over time. Over time, LINks may develop their roles, for example to take on work commissioned by other organisations.

Appendix A of the first guidance document contains a summary of actions for developing an effective LINk.

Governance arrangements for LINks

The membership of LINks may decide their own governance structures, but each should be able to:

    · agree overall priorities and work plan using consultation

    · establish principles for LINk participation

    · create and review governance arrangements and monitor adherence to the governance framework

    · decide where, when, how and by whom the LINk's powers should be used

    · sign off external reports

    · promote the LINk and its acitivities, including via an annual report

    · contribute to the performance management of the host by the local authority

    · ensure that equality and human rights principles are integral to the LINk's work.

Core issues to be addressed with the governance framework include:

    · a code of conduct for participants

    · a process for implementing visiting powers

    · dealing with complaints

    · dealing with conflicts of interest

    · the use of resources

    · the use of influence in working with stakeholders

    · communication

    · achieving an equitable balance between individuals and organisational participants

    · dealing with Criminal Records Bureau checks.

Further suggestions are given as to how some of these elements could be addressed.

Carrying out LINk roles

It is suggested in the guidance that LINks may want to set priorities in the first year that are highly visible or relatively easy to bring to a conclusion. The guidance indicates that, in looking a particular service issue, LINks will first be expected to contact the commissioner of the service.

According to the guidance, an effective LINk will be in a good position to provide data and evidence to Local Strategic Partnerships (LSPs) about whether the Local Area Agreement (LAA) targets relating to health and social care are being met and to contribute to the joint PCT/local authority strategic needs assessments that will be required under the Local Government and Public Involvement in Health Bill.

To enable joint working between LINks and others, it may be necessary to establish processes for "payment in kind", pooling budgets or sharing resources.

Accountability

Accountability will need to be demonstrated:

    · by the host to the local authority through performance monitoring arrangements

    · by the host to the LINk

    · by the LINk to local people and organisations

    · by LINks to the Secretary of State for Health through an annual report.

The guidance sets out various indicators that can be used to measure the performance of LINks.