05 October 2007
The government has done it again, rushing to set up new structures without waiting for the due process of law. This time it concerns Local Involvement Networks, which are set to replace NHS patient forums
Once again the government has been so keen to see change in the public sector that it has acted without waiting for the necessary parliamentary approvals. In our previous article, we wrote about the unseemly rush to approve the new unitary councils ('Jumping the gun', August 31–September 6). And now there are similar concerns over efforts to improve joint working by local authorities and the health sector.
In July 2006, the Department of Health published its plans to replace patient forums with Local Involvement Networks (Links) in A stronger local voice. The aim of these is to promote stronger public and community influence in health and social care through a strengthened system of user involvement, with more transparent communication and a bigger say in the way local care services are provided. Voluntary and community organisations are expected to be major players in Links, as well as individuals.
The 400 or so patient forums, which were run by the NHS, will be replaced with 150 Links managed by local authorities with social services functions, ie, county, unitary and metropolitan councils. The DoH will give each local authority a grant to pay a 'host organisation' to set up and run the Link. This will be accountable to the Link and will also be independent from any local authority and health body.
The government plans to end the current arrangements in March 2008 and have the Links up and running by April 1. But one of the difficulties is that the legislation is not yet in place. The Local Government and Public Involvement in Health Bill is expected to receive royal assent this autumn and it will need Statutory Instruments to be laid to implement part 14 (Patient and Public Involvement in Health and Social Care) and some of the detailed requirements.
The Bill expresses the role of Links as:
- promoting and supporting the involvement of people in the commissioning, provision and scrutiny of local care services;
- enabling people to monitor and review the commissioning and provision of local care services;
- obtaining the views of people about their needs for and their experiences of local care services; and
- making those views and any recommendations for how local care services might be improved known to persons responsible for commissioning, providing, managing or scrutinising local care services.
There will be a new duty on service providers to give Links information and respond to their recommendations. They will also have to allow authorised Links representatives to enter their premises and observe activity. Links will be able to report matters to local authorities' overview and scrutiny committees. They will also have to produce an annual report.
Much of the detail that will be required to implement the provisions will be made by regulations. The government has just launched a consultation on the draft regulations with a closing date of December 21, 2007. This includes questions such as whether children's services should be exempted from the duty to respond to Link recommendations relating to social care activities. Given that the government has to evaluate the consultation responses and amend the draft regulations, the final version is unlikely to be available until some time in 2008.
Additionally, the levels of grant aid have yet to be set and depend heavily upon the 2007 Comprehensive Spending Review.
In August, the DoH published two guidance notes, Getting ready for Links, to help authorities set up the bodies and contract the host organisation. The guidance makes only a couple of fleeting references to the need for a tender exercise, and there is no reference to the likely need to pursue a full European Union procurement process.
There are nine pilot Link 'Early Adopter Projects', supported by the Commission for Patient & Public Involvement in Health and the Healthcare Commission, and most of these have recognised the need to place adverts in the Official Journal of the European Union. It is unlikely that any of these three-year projects would come under the £144,000 services threshold for tenders.
There is some sense of déjà vu here. The government is proposing reform and implementing it in advance of any explicit powers to do so — not unlike the Comprehensive Performance Assessment regime and Local Area Agreements.
But the main concern is that unless authorities start now, most will not have time properly to plan, specify and deliver their new Link. April 1 is only round the corner.
This begs the question — why is there such a rush?
Stephen Cirell is head of local government and Professor John Bennett is a consultant solicitor with Eversheds. They are co-authors of Best Value law and practice, published by Sweet & Maxwell
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