Yesterday (30th of October) the 'Local Government & Public Involvement in Health Bill' received the Royal Assent, with wide ranging impacts on local government and the health services in England and Wales.
Key highlights of the bill include:
* More powers have been devolved to local authorities, giving them the opportunity to delegate more decision to communities.
* Local Area Agreements (LAAs) and an accompanying duty to cooperate requires local agencies to work with their communities around service provision and improvement.
* The Overview & Scrutiny powers of local councils have been strengthened and the new 'Community Calls for Action' provide a new route for community members to raise issues at the local level.
* A new duty requires local authorities to "inform, consult and involve local people in running local services".
* Councillors will have more powers to resolve issues of concern to the communities they represent (if necessary by requiring consideration by Overview and Scrutiny Committees).
* There has been a reduction in the number of central targets, with the goal of a more balanced performance framework and more proportionate inspection regime.
* Patient and Public Involvement (PPI) Forums will be replaced by new Local Involvement Networks (LINks)
* The duty of Strategic Health Authorities, NHS Trusts and Foundation Trusts to involve the public and patients has been strengthened. These institutions now need to consult on all “significant” proposals and decisions.
Controversy and Change
Some parts of the bill have been controversial, not least the transition from PPI Forums to LINks. For the critics of the reforms the transition is a way of silencing challenging community voices and creating new structures with less powers to challenge NHS decisions.
It is unclear how the LINks will work in practice but on paper they have several advantages over the PPI Forums. There is a formal expectation that they will work more closely together with Overview & Scrutiny committees and local councils and they will also cover social care issues as well as those around health. Hopefully this should lead to to more joined up working and less duplication of effort.
However it is clear that the transition from one structure to another could have been managed better. Many of the people who have given up their time in PPI Forums do not feel that their efforts have been valued by the government and the NHS. As the foundation for all engagement and participation is the enthusiasm of the public this is a disappointing result indeed.
Delivering meaningful results
These new requirements add up to considerable change for local authorities and the heath services. There are a number of encouraging developments contained in the bill, not least devolving more power to local service providers and to citizens directly as well as setting out clearer involvement requirements.
However it is important to remember that the old analogy of leading the horse to water holds true when it comes to participation. It is easy enough to place duties to involve on local authorities and force them to go through the motions of participation. What central government cannot do on its own is to ensure that local involvement is meaningful. Half hearted engagement rarely delivers good results and there will need to be a concentrated effort to convince public agencies that they need to involve and empower their communities, not just because the law requires them to but because of the benefits it brings to local communities and institutions.
The new Empowerment Action Plan outlines some of the valuable work being done to provide support and move the public sector from mere compliance to enthusiasm for the agenda.
This blog is a repository for posts I have made over the years at Involve as well as more personal reflections.