Voluntary and community groups must be actively involved if LINks are to work. Yet the sectors' goodwill, undermined by the botched creation of patient forums, is eroding further.
Once there were community health councils, then patient forums. Soon there will be local involvement networks. Changes in the NHS accountability structures have come fast, yet without obvious gains.
It is essential that the NHS understands and responds to the needs of local communities, but this function has been sidelined by NHS reforms and undermined by the constant tinkering with the way it is structured.
Lessons from the last botched reform have not been learnt properly. CHCs were run down before they were replaced by patient forums. Three years later, history is being repeated with many forums disintegrating.
This is before proposals for LINks have even been finalised. A bill is due to be presented in November and LINks are scheduled to be in place in the summer. We face a vacuum of accountability in the interim.
The Department of Health must oversee a properly managed and orderly transition to prevent the existing infrastructure simply dissolving. If existing organisations fade out, the task of new organisations starting from scratch becomes much more difficult.
There are worries, too, about how LINks will work. Many patient forums were based on local infrastructure organisations in the voluntary and community sector - our members, in other words. But LINks will be administered through local social services authorities, helping reinforce councils' overview and scrutiny functions. Given that councils will be explicitly barred from controlling LINks, what exactly will local authorities' role be? And what will be the role of local infrastructure organisations?
LINks need to be networks of organisations, not of individuals, otherwise they will be sucked into the morass of narrow and vested interests, failing to provide a vehicle of proper accountability. Positive leadership is required to ensure that LINks are properly representative of a broad cross-section of the local community, with the active involvement of that community.
These are issues very relevant to the voluntary and community sector. Many of our members employ partnership link workers, helping to bring together the health and social care services. They are acutely aware that forums never achieved what was hoped of them and suffered from weak administration and direction. This must not be allowed to happen again.
The role of LINks will be to oversee, strategically, the commissioning of NHS services, not to consider the provision of services. This makes LINks significantly different from forums and CHCs. LINks will not be closely tied to particular NHS provider trusts.
There are risks associated with this approach. While LINks will work closely with primary care trusts, they may have difficulty building relationships with acute trusts - especially those based out of their area. Trusts' own arrangements for patient involvement and accountability must dovetail with those of LINks, or else LINks will be sidelined - as forums have been. Trusts may have no incentive to engage with new bodies without statutory powers.
The DoH needs to explain how the policy strands can be pulled together. With LINks focusing on strategy and planning, how will patients' voice be heard on operational matters? Our preference is for patients' representatives to become lay Healthcare Commission inspectors.
Voluntary and community groups must be actively involved if LINks are to work. Yet the sectors' goodwill, undermined by the botched creation of patient forums, is eroding further because of the administrative burden involved in seeking short-term extensions of forums' support contracts.
With little clarity over what powers LINks will have and whether they will be listened to at all, the DoH needs to act urgently to reassure our members. Unless they do, it looks like deja vuall over again.
Dianne Leyland is director of development the National Association for Voluntary and Community Action (formerly NACVS). NAVCA is running a workshop on LINks and the future of patient and public involvement in health, in London on 23 November.