www.publicinvolvement.org.uk

Back in mid December 2006 we gave readers a field report just after the first sighting of the greater spotted LINks as it broke cover and headed off in the direction of Westminster. Since then the beastie has been prowling the parliamentary corridors and generally tagging rather diffidently behind the bulging baggage train of the Local Government and Public Involvement in Health Bill. Guidance on getting ready for LINks and learning from the early adopter sites was published recently so we thought it timely to set out our thoughts on key characteristics of a successful LINk Host.

The LINks has now freed itself from committee and only awaits a royal pat on the head sometime around November this year before coming into its own. To celebrate the Royal Assent there will be a mass bonfire of the CPPIH and the Patients Forums. But once the ashes of that debacle cool what happens then? If everything works to the DH’s plan – a big if – we are meant to see LINks popping up all over England by the 1st of April next year.

A lot has to happen quickly in the interim, most particularly the appointment of host bodies for each Local Involvement Network. That’s a tricky procurement task for each Local Authority for it is they who are the conduits – we hope without overly sticky sides – for the funding for LINks in each area.

Marketing and recruitment

Our experience over the past 5 years of running a consultancy specialising in user involvement in public services, is that involvement and engagement doesn’t happen spontaneously. It has to be marketed and “sold in” by going out to people in their natural settings and finding something that will attract them to be involved initially. Sustaining their involvement afterwards is equally important, but we will probably have to accept that engagement with the LINk will vary on an individual and organisational level depending on issues and interests. And that means marketing and recruitment must be a continuous process in order to reflect the diversity of each area, not just a front-ended campaign to start things off. Urban and rural areas will take differing approaches no doubt.

The LINk Host needs to be more than just an efficient administration and communication machine – that’s taken for granted. The Host needs to be the marketing tool of the LINk without becoming a tail which wags the dog. That’s a challenge, but one which could be handled by a section in the local authority tender document that described the marketing objective as part of the recruitment function and specified how the Host would help the LINk devise a marketing and recruitment plan and then deliver this plan and report on its performance so the LINk was always seen to be in charge. This reflects how Foundation Trust Governors are responsible for the FT’s membership strategy even though they do not do the actual grass-roots member recruitment work.

When they are established locally, we think that Members and Governors of FTs will find the LINk a very interesting organisation to get involved with, so the LINk Host will need to know its way around the FT governance world in order to make use of these potential synergies.

Access and visiting criteria

If national guidance isn’t satisfactory on the access and visiting rights issue, it could be resolved locally by a voluntary agreement between the Local Authority (as the main social services commissioner and provider – a possible conflict in itself), the PCT commissioners and their primary care providers (GPs) and NHS Trust and Foundation Trust providers and the LINk. A local “access and visiting concordat” would be to everyone’s advantage by promoting trust and openness and giving clarity to the social care access issue in particular.

As part of its side of the bargain, the LINk would have specially trained and CRB-cleared members who would undertake visiting. The Host’s contract should specify that arranging this training and supporting visiting LINk members was a Host function for which they had to show they had the right competencies and experience.

Status of Host organisation

Councils should look for a best value solution when commissioning a LINk Host organisation without prejudice to potential commercial providers. The tender should be open to all competent and willing organisations. The Host is certain to be VAT-registered. Holding a contract around the £150K per annum level for three years – the average being discussed - will require it.

It would be logical for the Host to be paid by the Local Authority on a regular basis on submission of an invoice and a report on satisfactory performance of its objectives. Managing the dual accountability to the LINk for delivering its work and accountability to the local authority for contractor competencies won’t be particularly easy. Sorting out performance management arrangements early on will be a priority.

Professional references supporting the competencies claimed by the Host candidates must by sought by the local authority commissioners. No one wants a repeat of the FSO debacle which caused so much damage to the present PPIFs when many of the voluntary sector providers saw the support contract as easy money and then failed to meet their obligations to provide competent support. A proper tender and business contract, including break clauses for poor performance, between the Local Authority and the LINk Host would, we believe, guard against a repeat of the FSO experience.

Assuring future stability – a challenge for the LINk Host body

MAC Associate Christine Hogg recently discussed LINks in the context of what is going to happen next about PPI in the NHS. She conlcuded: “LINks provide an opportunity to integrate patient and public involvement into wider initiatives for local democracy and citizen engagement. The challenge is considerable. Many questions need to be addressed as to who they are, what they will do, what powers they will have, how they will be set up and held to account. Particularly important is how their stability can be assured.” We believe that assuring the stability of the LINk in the potential turbulence of its local environment is a key role for the LINk Host body as without stability the LINk cannot be effective. It is essential therefore that local authorities appoint robust, responsive and knowledgeable providers who are well-grounded in the local area to undertake that key role.

'Getting ready for LINks' resources

The NHS Centre for Involvement’s report on learning from the early adopter sites

Hogg C. “Patient and public involvement – what next for the NHS?” Health Expectations 2007; 19(2): 129-138.