1.0 The terms used in this document are intended to help to explain LINks.

 

Those terms used to describe methods of involvement in LINks aim to identify the different levels of involvement that there might be and how they might be implemented to enable inclusivity. The terms used are not definitive and we recognise that different terms may be used locally in different ways to explain the various roles within LINks.

 

1.1 Early Adopter Programme (EAP). Seven EAPs were established by the Commission for Patient and Public Involvement in Health (CPPIH) at the end of 2006. TheEAPs aim to identify learning about different models and approaches that LINks might apply based on the local issues. The EAPs were established in the following areas:

>Doncaster

>Dorset

>Durham

>Hertfordshire

>Kensington and Chelsea

>Manchester

>Medway

The EAPs are being evaluated by the NHS Centre for Involvement.

 

1.2 Healthcare Commission test sites as early adopters. In 2005 the Healthcare Commission established two test sites to look at how to widen engagement in their annual health check and the Healthcare Commission regulation process. The sites are based in Leeds/Bradford and the South West. The test sites are being rigorously evaluated and they have been incorporated into the EAPs.

 

1.3 Local care services. This term is used to describe both health services commissioned and provided by the NHS and social care services commissioned and/or provided by local authority social services departments. Increasingly health and social care services are commissioned jointly. The roles of LINks apply to both health and social care services.

 

1.4 Patient and public involvement (PPI). PPI is defined by the Department of Health as involving the public in shaping a care system’s development, and keeping patients well informed of clinical processes and decisions.1 There is no formal structure for involvement in social care, but since 1992 councils have been expected to have mechanisms for consulting and involving people in the area of community care services.

 

1.5 A number of key principles of effective PPI and user involvement have Been identified:

>Be clear about what involvement means.

>Focus on improvement.

>Be clear about why individuals and groups are involved.

>Identify and understand the stakeholders.

>Involve individuals and groups at all stages of decision-making in relation to the commissioning and provision of services.

>Be inclusive – working to involve as broad a group of people as possible.

>Give people a choice of how and when to get involved.

>Provide feedback on involvement and use the outcomes of involvement to shape commissioning and service development.

 

1.6 Consultation. This is defined as the dynamic process of dialogue between individuals or groups, based upon a genuine exchange of views, and with the objective of influencing decisions, policies or programmes of action.

 

1.7 LINk member. This is a person or group that makes a commitment to take part on a regular basis in the development and implementation of the roles of the LINk, and to provide information to and collect information from a local community or a specific group within a community. LINks will decide themselves how members will be chosen. For example, this may be through election from the wider LINk.

 

1.8 LINk participant. This is a person, group or organisation that wants to influence the bigger picture through the roles of the LINk, even though they may not be in a position to participate on a regular basis. A participant may be interested in a single issue, may take an active role in specific pieces of work that relate to their areas of interest, or they may take a less active role by answering surveys or providing information or a view on behalf of an interest group. A participant may make use of the power to enter and view health and social care premises.

 

1.9 Scrutiny. Public scrutiny is the ability to critically examine the activities of  those exercising power on behalf of the wider populace, in order to hold them accountable for it. The Centre for Public Scrutiny has developed four principles of effective scrutiny that it considers should be the basis for any scrutiny of public services. Such scrutiny should:

 

>provide a ‘critical friend challenge’ to executive policy-makers and decision-makers

 

>enable the voice and concerns of the public to be heard

 

>be carried out by ‘independent-minded governors’ who lead and own the

scrutiny role

 

>drive improvement in public services.

 

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2.0 This document provides an introduction to what an established and effective Local Involvement Network (LINk) might look like.

 

2.1 LINks 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 covering a county, unitary, metropolitan or London borough council, including the Common Council for the City of London, and also the Council for the Isles of Scilly. Their roles will be set out in legislation and their primary role is to enable local individuals and groups to actively influence local care services, from planning and commissioning to delivery.

 

2.2 Each LINk will be made up of members and participants, including individuals, groups and organisations, with an interest in their local care services. As the members and participants will be volunteers, every LINk should be established in a way that is inclusive and enables involvement from all sections of the local community, especially those who are difficult to involve or seldom heard. It is important to remember that LINks are not merely groups of individuals, but are primarily networks that will bring together diverse groups in the area, and representatives of other networks.

 

2.3 The transition to the LINk system is likely to be evolutionary, building on the achievements of existing patient, public and service user involvement but broadening statutory involvement to include, not only NHS services but also social care services. This should enable more people to get involved in helping to shape services and strengthen their ability to hold services to account.

 

2.4 The sooner LINks can be established, the sooner they can build on the work of existing forums and enable users to have a stronger voice across the health and social care system. There is no reason why members of existing forums who become part of a LINk cannot continue to build on the often positive relationships they have formed with specific NHS trusts. Specifically, LINk members will be able to form specialist sub-groups focusing on areas such as hospital trusts or mental health trusts. They will also be able to focus on LINk-wide commissioning issues at a primary care trust (PCT) and local authority level.

 

2.5 The flexibility of the new system will enable the best practice developed by some Patient Forums to continue but to extend into social care services, while enabling other LINk participants and members to focus on different roles and functions.

 

2.6 Each LINk will be supported and guided by a host organisation that is contracted to undertake this role by the relevant local authority. To understand the relationship between the LINk, host and local authority, it is recommended that this document is read in conjunction with the Department of Health document Getting ready for LINks – Contracting a host

organisation for your Local Involvement Network. LINks will have a role in:

 

>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.

 

2.7 This will be achieved by establishing a flexible organisational framework, which can be tailored in each area to take advantage of the work that is already taking place and fit with local circumstances.

 

2.8 A LINk is not:

 

>a group of volunteers who are solely responsible for inspecting NHS and social care premises and services

 

>a method of performance managing health and social care services

 

>a method of dealing with individual complaints about local care services

 

>a network that duplicates other networks and initiatives

 

>a group of self-appointed people who are unaccountable

 

>a group of professional workers

 

>a bureaucracy based on political issues.

 

2.9 The details of the powers of LINks will be provided in future regulations.

These are likely to be consulted on

 

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3.0 The primary role of a LINk is to provide a stronger voice for local people in the planning, design or redesign, commissioning, and provision of health and social care services.

 

3.1 Although LINks have flexibility about how they undertake their roles, there are a number of principles that should be common to all. These include:

 

>being open and inclusive

 

>being accessible to all, including those with full-time jobs, those who feel excluded and those who might need support to participate

 

>reaching out to all communities, looking for and collecting evidence of their views

 

>recognising that tackling health inequalities, looking at public health issues and addressing the wider determinants of health are central to their role

 

>a commitment to communicating the information they receive In a constructive way to service planners, commissioners and providers

 

>always feeding back responses and outcomes to the wider community.

 

3.3 There are a variety of methods of involvement that LINks can use, each of which provides a different type of influence and outcome, and which may require different levels of involvement and time commitment. These include the following:

 

>Information, for example publicity, holding public meetings, undertaking opinion surveys. This method is often seen as ‘one way’ (i.e. not an interactive method) and the least influential, but it may be helpful in gathering data and raising awareness.

 

>Consultation, for example consulting people during the planning stage as well as involvement in formal consultations on plans or decisions to make changes to services. Often this involves asking individuals and groups to provide ideas or to comment, using a variety of methods, on a series of options. The LINks system will be a key resource when statutory partners want to consult within their communities.

 

>Participation, for example working in partnerships, undertaking outreach, helping to shape proposals. This includes taking a direct role in influencing commissioning decisions. This approach relies on consistent input from the same people when an issue is being examined.

 

>Delegation, i.e. asking other networks, groups or individuals to undertake work on their behalf. For example, an overview and scrutiny committee (OSC) may commission a LINk to undertake research on an issue that it plans to review as a method of collecting evidence.

 

>Co-production, i.e. some groups may want to become involved in designing and delivering services on a user-led model; the ‘expert patient’ approach is one example of co-production, peer support for independent living is another. LINks might be a route to facilitating this engagement and encouraging groups to take part.

 

3.4 The Healthcare Commission is evaluating methods of engagement as part of the assessment of its test sites. LINks will need to use and promote different methods of involvement when they seem most appropriate and effective in order to be accessible to all. There are many creative and innovative examples of methods within the community development field that LINks might use and that will enable those who currently don’t get involved to participate.

 

 

3.6 A host organisation is contracted to provide support to the LINk. It is the responsibility of the local authority to procure the host, and funding will be provided to the local authority by the Department of Health in the form of a specific grant. Each host will be contracted to provide support for an initial period of three years. Although it is accountable to the LINk for ensuring that the support provided is appropriate and that it meets the needs of participants, the host will be performance managed against the contract by the local authority. To ensure that this dual accountability is carried out effectively and in a cost-efficient way, it is suggested that the LINk and local authority develop a process of joint performance management that includes reporting evidence of the effective influence of the LINk. The issue of accountability of the LINk is discussed in more detail in the accountability

section of this document (see Chapter 9).

 

3.7 As the procurement and contracting process for the host will take time to complete, it is recommended that local authorities and interested stakeholders begin to engage with local groups and interested individuals now, and that they begin to identify a working model for the LINk at the same time as preparing for the procurement process. This will encourage

people already engaged in influencing local care services to help to shape the LINk and to begin the process of change that will be necessary to be effective in the new involvement system. Early work should include the widest range of people in discussions and use a variety of methods to encourage involvement. It will also be a step towards establishing the LINk and thus minimising any gaps in involvement that might exist when Patient Forums are abolished and LINks established. The outcomes of preparatory work can be handed over to the host when it is in place.

 

3.8 As the accompanying resource Getting ready for LINks – Contracting a host organisation for your Local Involvement Network makes clear, the role of the host organisation is to establish, maintain and support the LINk. The role of the host may be considerably different during the set-up period when it will have a responsibility for engaging with individuals and organisations in recruiting a diverse and representative group to establish the LINk. In order to get things started, the host will need to focus on outreach and be innovative, to draw in potential participants, suggest options for structures and help to identify priorities. Following the establishment of the LINk the relationship between the LINk and host needs to be defined clearly in its local context, reflecting the methods of working that the LINk has adopted.

 

3.9 The core roles of the host organisation, such as informing and supporting the LINk, will need to be supplemented by the LINk itself setting priorities and developing its sense of direction.

 

 

3.11 The relationship between the host and the LINk should be complementary And build upon the skills and expertise that each brings to their role.

 

3.12 The host’s role is to provide support that enables LINk members and participants to maximise their involvement. This may include seeking out models of best practice for LINks, for example models for supporting volunteers, capacity-building and training. LINks, however, need to focus on the experience of local people and organisations who receive or have an interest in local care services.

 

3.13 The LINk role is therefore primarily facilitative – enabling and encouraging the process of involvement and participation as a method of influencing future services.

 

3.14 Both LINks and the host organisations will need to have their own forms of performance management, and each will have a role in participating in the evaluation of the effectiveness of the other.

 

 

3.16 Local authorities have a number of roles in relation to the establishment, implementation and ongoing development of LINks and will need to develop a working relationship with the LINk. In particular, local authorities should consider the following points.

 

>Prior to their establishment, local authority officers and councillors should undertake work to stimulate interest in LINks, with both potential members and participants and with potential host organisations. This may be undertaken through workshops, meetings, information on council websites or in council newsletters, and through discussion with interested groups and organisations. Local authorities may find it helpful to make use of processes developed through the compact to achieve this.

 

>Local authorities are responsible for contracting with a host organisation, initially for three years, for effective support for the LINk within the budget allocated. This will involve developing a contract specification, making use of the document Getting ready for LINks – Contracting a host organisation for your Local Involvement Network, tendering and letting the contract, and performance managing the contract against the specification.

 

>The overview and scrutiny committee (OSC) within the local authority has a role in scrutinising how the contracting process was undertaken, and ensuring that best value is achieved.

 

>The OSC may commission a LINk to undertake work on its behalf, for example to consult people on their views on an issue that it plans to scrutinise and review in the future.

 

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

 

4.0 There are many local networks and groups that can provide useful lessons for establishing a LINk, and we are aware that in many parts of the country work has already begun to start this process of sharing information. Learning from Patient Forums, the Early Adopter Programme (EAP), Healthcare Commission test sites, and from other community-based initiatives, may be helpful for those areas that are beginning their preparation.

 

4.1 The first step in establishing a LINk may be to set up a working group of interested stakeholders. The aim of the group would be twofold: to identify existing engagement activity, and to ensure that the group is able to reflect the needs of all interested and diverse communities, not just those with the loudest voice. Membership of a group should be determined locally, but may include interest from:

 

>representatives from local voluntary and community sector organisations, including neighbourhood forums, Councils for Voluntary Organisations, self-advocacy groups, black and minority ethnic community groups, local support groups, and youth councils or parliaments – special attention should be paid to involving marginalised and disadvantaged groups from the start

 

>representatives from Patient Forums and Forum Support Organisations

 

>social care users and user groups

 

>representatives of local networks, for example Community Empowerment Networks, homelessness networks, and gay and lesbian networks

 

>local representatives of national charities, for example the British Heart

Foundation

 

>local authority officers and members

 

>representatives from NHS commissioners and providers

 

>representatives of social care commissioners and providers.

 

 

5.1 The legislation to establish LINks is designed to enable each LINk to develop its own methods of working according to the needs of the local area. An established LINk is likely to have sufficient flexibility within its structure to encourage individuals and groups to participate as and when they want.

 

5.2 Experience already exists of developing participative and inclusive ‘networks of networks’ that enable people, already active on one issue within their communities, to link into new initiatives without duplicating their efforts.

 

For example, Community Empowerment Networks in many areas act as co-ordinating groups to link together existing networks based on specific topics or communities of interest. The Community Network for Manchester has established a health inequalities theme – drawing together voluntary and community sector organisations to comment and feedback on health and social care issues – and a LINk could expand this. Where such ‘networks

of networks’ already exist, a LINk should seek to build on their work.

 

5.3 The Healthcare Commission test sites and the other Early Adopter Programmes (EAPs) have identified learning about the impact of other local factors on the approach and speed of progress insetting up their projects.

 

Both have identified particular challenges relating to involving diverse participants in rural areas, especially those with less developed voluntary And community sector networks. This suggests that in rural areas the communities are more likely to be dispersed, and that there may be less developed voluntary sector infrastructures that can be built on, whereas in the more urban areas there appear to be more established structures that can more readily become part of the LINk approach.

 

It is important that these challenges are recognised and that the planning and implementation phases are allocated enough time to develop effectively. 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 and begin to have the level of influence that the participants and partners would aim for.

 

 

The following questions may help those engaged in developing a model for the LINk to identify some of the issues that will need to be addressed.

 

>What do we know about the area, the organisations, perspectives and priorities, and the needs of local people?

 

>What are the particular challenges that the area provides (for example rurality, poor transport, variety of ethnic groups, inequalities)?

 

>What networks already exist and how do they relate to one another?

 

>What don’t we know?

 

>How can we find out more?

 

5.6 The legislation and the service specification for the host organisation identify

that it is the role of the LINk itself to develop its own methods of working, and thus its own model. This may be a particular challenge during the initial establishment phase. It is important for a host organisation to have a clear understanding of these challenges, and for both the local authority that is procuring a host and the potential host organisations to be aware of models and approaches that may be adapted or applied by the first LINk

participants.

 

5.8 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. For example, the principles and values of the co-operative movement may have resonance in some areas and for some LINks.

 

Values and principles

 

>Led by agreed principles, the co-operative movement works with its members to make changes for the better.

 

>Members show their values by working together for everyone’s benefit.

 

>Members act responsibly and play a full part in their community.

 

Co-operative values

 

>Self-help – we help people to help themselves.

 

>Self-responsibility – we take responsibility and answer for our actions.

 

>Democracy – we give our members a say in the way we do business.

 

>Equity – we carry out our business in a way that is fair and unbiased.

 

>Solidarity – we share interests and common purposes with our members and

other co-operatives.

 

Our ethical values

 

>Openness – nobody’s perfect, and we won’t hide it when we’re not.

 

>Honesty – we are honest about what we do and the way we do it.

 

Social responsibility

 

>We encourage people to take responsibility for their own community and

work together to improve it.

 

Caring for others

 

>We work to support local charities and community groups.

 

Our principles and the way we put our values into action

 

>Voluntary and open membership – membership is open to everyone.

 

>Democratic member control – all members have an equal voice in making policies and electing representatives.

 

>Economic participation – all resources are controlled democratically by members for their benefit.

 

>Autonomy and independence – co-operatives are always independent, even when they enter into agreements with the Government and other organisations.

 

>Education, training and information – co-operatives educate and develop their members as well as their staff.

 

>Co-operation among co-operatives – co-operatives work together with other co-operatives to strengthen the co-operative movement as a whole.

 

5.9 The ‘social justice’ type model aims to use statutory powers and rights for the public good in a fair, equitable and transparent manner. It is likely to have a flat or non-hierarchical structure that is dynamic and self-correcting.

 

5.10 A similar set of principles has been developed by the Healthcare Commission’s Northern test site, which involves Leeds Involvement Project (LIP) and Bradford Alliance on Community Care (BACC). The principles are as follows:

 

i) To use a barriers-based approach to issues of health inequality, for example the social model of disability, and to remove barriers to participation in the way that we work in the project, for example meeting people’s access requirements.

 

ii) To ensure that a diverse range of service users, patients and carers are involved, prioritising those who face additional discrimination or disadvantage such as:

 

>black and minority ethnic people

 

>people with disabilities, including mental health service users, people

with learning difficulties, people with hearing impairments and people

with physical and sensory impairments

 

>lesbian, gay and bisexual people

 

>refugees and asylum seekers

 

>women

 

>young people

 

>older people

 

>unemployed people and people on low incomes.

 

iii) To usecommunity development approachesto the work. This involves:

 

>collective working:

 

• working together towards common goals

 

• forming networks and making connections to help people collaborate and come together in groups

 

>equality and justice:

 

•challenging discrimination and working alongside those who are powerless

 

•raising awareness about inequality and how things can be changed

 

>learning and reflecting:

 

• recognising that everyone has skills and knowledge

• learning from mistakes as well as successes

 

>participation:

 

• helping individuals to get involved and sharing power through communities

 

• increasing people’s influence over decisions that affect their lives

 

>political awareness:

 

• raising awareness of communities’ concerns

 

• linking local concerns to the bigger picture

 

>sustainability:

 

• working with and investing in the capacity of people and groups so that change lasts

 

• using environmental resources responsibly.

 

iv) To develop innovative approaches to involvement work, for example by trying out new methods of working.

 

v) To regard any views gathered in the project as an ‘additional stream of information’ about healthcare from ‘experts by experience’ rather than as ‘representative views’.

 

vi) To recognise that this is phase one of a project and a main aim in this phase is to get the engagement processes and tools with the Healthcare Commission right, before expanding the project to reach out widely to new groups of people with whom LIP and BACC do not currently have contact.

 

vii)To evaluate the project against this set of principles, as well as against other outcomes.

 

5.11 It should be remembered that the establishment of the LINk is not an end in itself but only one small part of the process, and that it is the effective implementation of the LINk roles that is important. Over time, the LINk May develop its roles, for example to take on work commissioned by other organisations, and as a result of this it may reorganise how it works and the methods that it uses.

 

 

 

 

6.0 The role of governance is sometimes confused with that of accountability. The two concepts are related, but in the context of LINks we are using the term ‘governance’ to describe the processes and systems by which a LINk operates and governs itself. These need to be clear to LINk participants and also to be shared with external stakeholders, including commissioners and providers of local care services.

 

6.1 The form of the governance structure will be for the membership to decide, supported by the host organisation and by Department of Health guidance that sets out examples of best practice. This might be achieved, for example, by the participants electing a board or steering group, or the participants might choose to take a co-operative approach. The LINk should ensure that it has a governance structure that will:

 

>agree the overall priorities and work plan of the LINk in consultation with the wider LINk participants

 

>establish principles for LINk participation, including being the arbiter of membership decisions within the governance framework

 

>create, review and make recommendations on the governance arrangements

 

>decide where, when, how and by whom the LINk’s powers should be used, for example to enter and view specified health and social care premises

 

>sign off external reports

 

>ensure that the LINk operates within the agreed governance framework

 

>promote the LINk and report on its activities, including via its 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.

 

6.2 While LINks will be responsible for establishing their own governance

frameworks, the experience of the Early Adopter Programmes (EAPs) and

Patient Forums, and that gained within the community and voluntary sector,

identifies the need for a number of core issues to be addressed, such as:

 

>a code of conduct for participants, especially those who take up roles relating to outreach, and use of the power to enter and view premises, and who represent LINk in working with other groups and organisations

 

>a process for implementing of the power to enter and view health and social care premises

 

>dealing with complaints (internal and external)

 

>dealing with potential conflicts of interest

 

>the use of resources, including the allocation of financial resources

 

>the use of influence in working with stakeholders

 

>communication (between participants, between participants and the host, and between the LINk and the outside world)

 

>achieving an equitable balance between individuals and organisational participants

 

>dealing with Criminal Records Bureau (CRB) checks for those members and participants with an interest in taking up the power to enter and view premises.

 

6.3 Many of the participating groups and organisations in the set-up phase of a LINk are likely to have experience of dealing with some of these issues and should be able to share good practice and learning. They will recognise that good governance is crucial to ensuring that networks operate effectively.

 

6.4 It will be the responsibility of the LINk itself to decide how it is established and to identify whether any groups of people or types of representative should be excluded from the LINk as a whole or from roles within the LINk. These decisions will need to be communicated widely and will form part of the governance arrangements.

 

6.5 An established LINk that is working effectively to achieve its roles will have clear governance arrangements that demonstrate the following:

 

>The method of appointment to any ‘stewardship’ or governance steering group. One model of achieving this would be for all people who register an interest in a LINk to have the opportunity to stand as a member of a group and to be able to vote for members. This would be a similar approach to that used in NHS foundation trusts to elect a board of governors and, if this model is applied, learning could be taken from the development of

foundation trusts.

 

>A method of identifying any individuals or groups that the LINk considers should be excluded from taking a leadership/governance role. For example, a LINk might consider it appropriate to exclude elected councillors, or that a participant who work for a provider of care services should be able to participate and lead work on one type of issue but not on another that relates more closely to their commissioner.

 

>Consideration who must be included in order to achieve suitably diverse and inclusive governance arrangements.

>A strategy for renewal of participants involved in the governance arrangements, or other specified roles, that takes into account drop-out rates and end of term of involvement. It should be recognised that there will be drop-out from engagement in the LINk as individuals’ and groups’ circumstances and priorities change. It is important that an established LINk has an agreed process with the host organisation to recruit and engage more participants on an ongoing basis rather than waiting until there are gaps in governance or leadership roles. This is also important to ensure that over time a LINk does not become dominated by one view or one priority, creating a risk of becoming exclusive.

 

>The balance between individuals and group/organisation representatives. There are risks and benefits to involving both individuals and group representatives in LINks. It is important that an established LINk is clear that both have an equal but different role. Ensuring equity of influence will be a challenge during the establishment phase, but this may be helped if the culture of the LINk recognises the value of both. In other contexts, networks of individuals and groups usually allow all participants to have one vote (if voting is required), even when the participant represents a large organisation.

 

>The balance between the LINk’s role in representation and that of other representative bodies such as Older People’s Forums and Centres for Independent Living. LINks will need to develop good working relationships with these bodies so that they feel their voice is being amplified, not duplicated or replaced.

 

>How particular roles will be carried out, for example chairing meetings, representation to the host or local authority, outreach to groups, discussions with commissioners, providers or regulators of services, or the power to enter and view premises.

 

>Length of tenure in a role.

 

>Terms of reference or a constitution for the LINk. Guidance on setting terms of reference or constitutions for voluntary and community groups is available through a number of national voluntary organisations and support structures.

 

>A method for ensuring that the decisions taken, for example on setting standards for participation or agreeing a code of conduct, are representative of the wider LINk membership.

 

>How conflicts of interest of members or participants will be addressed. It is common practice to develop a policy that defines what a conflict of interest is and states when and how the policy should be applied. This may be of particular importance where there are participants or members from NHS foundation trusts or voluntary organisations that also provide

local care services.

 

>How complaints will be dealt with. This should include:

 

– complaints by individual LINk participants, external bodies or individuals about LINk representatives when they are undertaking LINk functions

 

– complaints about the content of work undertaken by the LINk

 

– complaints about the LINk as a whole.

 

The host organisation will be able to provide advice and guidance on these issues, but individual LINks may wish to work with other LINks in order to develop effective and consistent approaches. For example, two LINks might consider sharing their practice on individual complaints and acting as a support process, advising and arbitrating for each other.

 

>Processes for approving the budget and accounts and how financial matters are discussed with LINk participants and the host organisation.

 

>How a framework of delegation (if needed) will be established.

 

>The process for monitoring the LINk’s performance (see Accountability, in Chapter 9).

 

>How it will be ensured, with advice from the host where appropriate, that the LINk’s affairs are conducted lawfully and in accordance with accepted standards of best practice and probity.

 

>How the processes of decision-making and communication within and external to the LINk will be agreed, for example the use of ‘authorised representatives’ to liaise with stakeholders on particular issues.

 

>How a process of review for the governance/leadership group will be agreed and how LINk participants will take part in this.

 

>How the power to enter and view premises will be implemented, for example who will undertake the role, what training they will be given, and what processes they will use to feedback their findings to the LINk, to commissioners and to service providers.

 

>How information that has been collected is stored, and how Freedom of Information Act requests will be dealt with.

 

>How the LINk relates to the host.

 

6.6 It has been suggested that there will be some roles within a LINk that will need to be clarified through more rigorous governance processes than others. For example, those LINk participants who form a governing body, those who undertake a regular and active outreach role, or those who take up the power to enter and view premises should sign up to the Nolan Principles of public life and should be subject to CRB checks. This would help to ensure that the risk of inappropriate behaviour related to a LINk is reduced. More information on these issues will be provided in the formal guidance to be published when the Local Government and Public Involvement in Health Bill receives Royal Assent.

 

6.7 As the service specification for the host organisation suggests, an effective host will be able to demonstrate that it has good governance structures in place. This should enable the host to provide guidance and support to the LINk as it develops its own approach to governance.

 

Helpful Aspects of the New Legislation

 

8.2 The Local Government and Public Involvement in Health Bill proposes a number of new local arrangements that LINks may add value to or develop relationships with. For example, the Bill introduces Health and Well-being Partnerships, which should enable local partners to achieve a truly integrated approach to delivering local government and NHS priorities. The Bill will require local authorities and primary care trusts (PCTs) to produce a joint strategic needs assessment. This will ensure that local partners have a shared understanding of the needs of their locality, enabling them to agree more effective long-term health and well-being priorities. The intelligence that LINks collect and collate from within their areas may be very useful in informing the needs assessment and vice versa.

 

8.3 It is a relatively small but nonetheless powerful change that will help the PCT and local authority to work in partnership to deliver care that is more responsive to the needs of individuals and the community that they serve. It would be for the local authority and PCT to encourage involvement of the LINk in their area in the Health and Well-being Partnership and the strategic needs assessment that it produces. We would encourage them to engage with their local LINk as an important voice to be included among the LSP partners.

 

8.4 In addition to local working, there will be times when LINks need to work with each other across more than one local authority boundary, although their focus will remain on the needs of their local populations. For example, this would be the case if one LINk has concluded that it should scrutinise issues relating to mental health services that include NHS and social care provision commissioned for local people but provided across a region, or if LINk participants across more than one LINk identify concerns relating to

emergency ambulance provision. An established LINk will be aware that such issues may arise, and will have developed processes to enable joint work to take place with its neighbouring LINks. This may be undertaken in a number of ways, including:

 

>the nomination of a ‘lead’ LINk member within each LINk, with a remit for collecting data, leading discussions and outreach for a particular topic of interest, and liaising with other ‘leads’ within a specified geographical area

 

>the establishment of a ‘network of interest’ across a number of LINks, communicating with each other (possibly electronically) with one host collecting and collating data on behalf of the partnership of LINks

 

>the establishment of a joint working group including representatives from each LINk within a region or geographical area of interest

 

>the organisation of regular workshops or stakeholder events across a number of LINks to discuss one or more common areas of interest.

 

8.5 There may be other models of working that LINks will wish to develop jointly. These will rely on good working relationships with the host organisations and between host organisations, and on the facilities being available for hosts to support larger areas for targeted work. This may require the LINks and hosts to establish processes for ‘payment in kind’, pooling budgets or sharing resources across more than one LINk to ensure that working across areas is adequately funded and on supported. Joint working of this nature will lead to additional benefits such as avoiding duplication and sharing the expertise of both LINks and host organisations with their neighbours.

 

 

9.1 Being accountable can mean different things to different people. In the context of LINks, we think of accountability as the process for explaining or justifying actions and decisions, and demonstrating the progress of work that the LINk has undertaken in relation to its roles. No national system of accountability has been put in place, as this should be determined locally.

 

LINks are responsible for deciding their priorities and actions, and they should be able to account for those actions, decisions and achievements to local people and organisations.

 

9.2 Accountability needs to be demonstrated:

 

>by the host to the local authority

 

>by the host to the LINk

 

>by the LINk to local people and organisations

 

>by LINks to the Secretary of State for Health.

 

9.3 Each LINk therefore needs to be clear about what it is accountable for and how it will account for its actions. This is not a difficult task if the LINk considers accountability in conjunction with the following:

 

Transparency: ensuring that it is open about its methods, processes and performance.

 

Liability: taking into account the consequences of the actions, decisions and views that it takes and communicates.

 

Responsibility: making sure that it follows the methods of working that have been agreed by the LINk as a whole, including codes of conduct for participants and working groups.

 

Responsiveness: listening to and involving interested individuals and organisations, and responding to their information and priorities based on evidence of need.

 

9.4 Host accountability to the local authority

 

This should focus on performance monitoring arrangements. The host will need to account for how it fulfils its contract, including how the money that it receives is spent, and how it engages with organisations and individuals within the community.

 

9.5 Host accountability to the LINk

 

It is important that the host and the LINk are clear about which roles the host is accountable for in relation to the LINk. For example, in the Getting Ready for LINks regional workshops, it was identified that the host should be accountable for demonstrating that there are robust ways of ensuring that issues that emerge from LINk participants and contributors are managed effectively. The host and the LINk will need to clarify expectations about

accountability early on in their relationship to enable the host to undertake, for example, any data collection that the LINk might ask for.

 

9.6 LINk accountability to the community

A number of different methods of accountability are used by voluntary and community organisations, public bodies and private companies, including:

 

>production and dissemination of an annual report, explaining how the roles have been undertaken, how broad, diverse and equitable involvement has been maintained, and how outcomes have been achieved

 

>publication of materials using different methods to suit a diverse audience, for example a website, text messaging, outreach presentations, or a proactive relationship with the local media

 

>holding meetings or events in public where the LINk presents its achievements, is open to questions and debate, and demonstrates its inclusivity.

 

9.7 An established LINk that is confident and influential is likely to use these methods and collect annual feedback from stakeholders and partners to identify how it is perceived by groups and organisations within the community. This is often called ‘360-degree feedback’. The process might include asking for feedback from commissioners and providers of care services, as well as from a selection of groups, organisations and individuals within the locality. The collated feedback can be incorporated into the annual report and shared with

LINk members and participants as well as with stakeholders, enabling the LINk to demonstrate transparency and accountability.

 

9.8 LINk accountability to the Secretary of State for Health and Parliament

 

LINks will be required to produce an annual report with the support of the host organisation. This report will be a method of accounting to the Secretary of State and ultimately to Parliament.

 

9.9 It will be important for the LINk to develop an accountability process that enables people and organisations who are not engaged in its work to ask questions, challenge priorities and be given an opportunity to shape the way in which it works for the future.

 

 

9.11 In addition to being accountable to local communities, LINks need to be able to measure and demonstrate how they have performed to the local communities, to the host, to the local authority and, through this local approach, to the Government. We believe a LINk will be a success if it can demonstrate the following achievements:

 

>People know of its existence and what its role is, and perceive it as a credible local organisation.

 

>People are able to gain access to it through the avenues and opportunities that suit them (within a reasonable cost).

 

>People know what it is doing and why, and are able to comment on its work.

 

>It has reached out widely and deeply into the community and can show evidence of the effectiveness of this.

>It works in inclusive and non-discriminatory ways and is able to show a diverse range of participation in its activities.

 

>It knows what people’s needs are for health and social care services – it should have an evidence base which encompasses views from an appropriate section of the local population.

 

>It has an evidence base of how people in its area perceive the health and social care services they have received.

 

>It has identified areas in which health and social care services can be improved in the eyes of the public or users of services – and has made recommendations to those bodies responsible for those services.

 

>It has established constructive and open relationships with health and social care commissioners and providers.

 

>It has a focus on partnership, outreach, networking, relationship-building and making common cause.

 

>It has a constructive and open relationship with its host organisation.

 

>It has a constructive and open relationship with relevant overview and scrutiny committees, with health and social care regulators, with strategic health authorities and with local voluntary and community sector organisations.

 

>It is rated by key local organisations as a credible partner, adding value and providing effective insight.

 

>It is able to account (via the host) for the money that has been made available to it to fulfil its activities.

 

>It can identify the impact the involvement of the LINk and recommendations it has made have had on services.

 

9.12 It is important that these performance indicators focus on the qualitative aspects, such as quality of interaction, the building of relationships, influence and achievements, as well as quantitative indicators such as the number of people reached and reports made. Outcomes and indicators will need to be negotiated locally to ensure that they are appropriate to local circumstances and informed by the knowledge and experience of the local partners.

 

9.13 It will be up to local authorities to decide, in conjunction with local people, stakeholders and prospective host organisations, what the appropriate indicators are to demonstrate that a host organisation has enabled, supported and guided the LINk successfully in its activities.

 

9.14 To support both LINks and host organisations to undertake their roles in relation to accountability and performance management, we will be developing national quality benchmarks for LINks, including tools for localised performance management, peer review and recognisable success criteria for key areas, including the performance of hosts. This will be published when Royal Assent has been received for the Local Government

and Public Involvement in Health Bill.

 

 

 

 

10.2 Information is also available on the NHS Centre for Involvement website at

 

 

 

 

 

 

 

10.9 We recognise that there are a number of details about the development of LINks that will need to be provided in more formal guidance from the Department of Health. Such guidance will be published when the Local Government and Public Involvement in Health Bill has received Royal Assent in the autumn of 2007. We currently expect guidance to include information about the following issues:

 

>expenses policy

 

>a LINk standard of conduct policy or code of conduct

 

>complaints procedure

 

>relationship between local authorities, primary care trusts and providers

 

>relationship between the governance structure and the host

 

>finance

 

>rights and powers (including referring to the NHS model contract for the independent sector)

 

>annual reports

 

>models of governance structures

 

>training/development

 

>recruitment/induction

 

>branding/communications

 

>the role of the NHS Centre for Involvement and the Social Care Institute for Excellence.

 

10.10 We are also working with the NHS Centre for Involvement to produce a compendium of resources for LINks collated from Patient Forums and existing initiatives that will help support the future role of LINks.

 

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