Local involvement networks, set to replace public and patient involvement forums, will be denied access to mental health facilities, children's care homes and non-communal areas of residential care homes.

An internal Department of Health draft policy document, seen by HSJ, includes a table of where LINks members will and will not be allowed to visit. The representative bodies are set to replace patient and public involvement forums next year.

The document says that LINks will not be able to enter social care services establishments and institutions for children; patients' homes to see services provided by social services or through individual budgets; group homes for those who are disabled or have mental health and leaning disabilities; and care housing for older people.

The DoH confirmed it was planning limitations and this is also backed up in its response to the health select committee's report on patient and public involvement, which states: 'A change in the mechanisms for patient and public involvement has been made necessary by significant changes in the health and social care system.

'It is no longer appropriate to have a system based around scrutiny of individual institutions. We want this new system to consider both health and social care.'

DoH chaos

Malcolm Alexander, chair of the newly elected National Association of Patients' Forums Steering Group, said he was not surprised at the restrictions: 'The way LINks are being set up is absurd. There is no intention to appoint members, which means they will be very weak compared to what [PPI forums] do now - it's another example of DoH chaos.'

PPI forum members are subject to Criminal Records Bureau checks, but as LINks will not have members, Mr Alexander said checks will be difficult to implement. He added: 'The whole system is designed to result in less scrutiny. There is currently a duty for members to monitor and influence standards. The new system will keep public and patients at arm's length.

'The DoH is trying to design a system which excludes the public from proper monitoring and prevents them having some input.'

Steering group vice-chair Ruth Marsden said: 'These new powers are regressive. That forums have less accountability to the public is dangerously ill-advised.'

Permission to inspect

At present there is a forum for each individual primary care, acute and mental health trust. Forums do not have jurisdiction in social service areas but they can go into the independent sector if NHS patients are being treated.

They have the power to carry out spot checks on trusts, but under the new system they will have to write to the Healthcare Commission or its successor Ofcare for permission.

The document states that LINks members will be able to enter and view care and respite care units; intermediate care and stroke units; day care services for older people and health service facilities.

Commission for Patient and Public Involvement in Health chair Sharon Grant, whose organisation is set to be disbanded next April, said: 'We were shocked when we first heard the proposals. If they are agreed, not only will LINks have fewer powers than patient forums but they will let down the patients that most need a voice.

'The DoH is seeking to impose limits such as having to seek permission for a visit or excluding particular groups. This would remove important elements of independence and the current rights and responsibilities to monitor and inspect that existing patient forums have used to great effect.

'By excluding vulnerable groups from inspections, the DoH is denying them a right to be heard and designing a wholly inadequate system.'

Undermining influence

London Network of Mental Health Patient and Public Involvement Forums chair Mike Loosley said: 'This latest proposal from the government only shows that they pretend to be in favour of public and patient involvement but are really undermining the principle.'

He slammed the government's proposal not to allow inspections until they have been sanctioned by the regulator: 'Inspections are not undertaken frivolously. Approval by the Healthcare Commission will inevitably lead to delay and in a minority of cases it is important to carry out an inspection quickly.'

A spokesman for the Commission for Social Care Inspection said it had concerns about giving LINks right of entry to premises.

He said: 'We felt that this proposal did not take account of the difference between a health setting and a social care setting.

'Care homes are just that homes for people who live in them. It is important that people in care homes have as much say as possible about who comes into their home.'