The annual reports of Local Involvement Networks (LINks) for 2009/10 makes for interesting reading. This is particularly in light of the fact LINks will become local HealthWatches under the proposed reforms of the government’s White Paper, and will be the major vehicle through which patient/user representation will be secured.
LINks are membership organisations which empower people in the community to have their say or influence local health and social care services. In 2009/10 there were 150 of them, with a total spend of £24.3m.
The numbers in terms of people engaged aren’t, I’ll be honest, particularly good. Even then, the data collected probably represents a slightly rosy view: as the report highlights:
Many LINks were not able to provide details of their finances, membership, activities or their effects.
It doesn’t inspire confidence, does it? Even so, we will plough on with what the annual reports tell us.
Across all LINks, the average number of members (both individuals and organisations) was 489. In total, around 192,000 people were engaged in their activities (of which 42% related to social care). Given the population of Essex alone, for example, is 1.4m, this doesn’t strike me as a great number. Nor does the number of LINks that report engagement directly with people from a BME background or disabled people: less than 60 and just over 50 respectively.
If the engagement numbers don’t grab you, then potentially of more interest is the headline finding that LINks provided a net return on investment of £4.10 for every £1 invested.
I’m afraid to say the data behind this is optimistic at best. On the basis of the average benefit for 4 – just four – case studies being of the order of £270k, someone has simply multiplied this benefit by the number of changes that were “inspired” in services by LINks in 2009/10 – some 463. This gets you to a figure of £126m gross annual benefit.
Whilst the veracity of the 4 case studies seems reasonable, it’s a leap of faith to suggest the same financial benefit applies on average across each of the service interventions LINks achieved, wouldn’t you say?
My overall impression of the report is that there are undoubtedly some LINks making a positive difference through engaging their local communities in issues relating to health and social care services. However, the level of this engagement isn’t particularly deep, isn’t particularly innovative and is really quite limited. Nor can the level of financial benefit accrued from changes made by LINks be considered realistic.
At best, the report reads as if the most optimistic of civil servants has written it, looking for good as a whole where it only exists in patches.
Given this forms the foundation for patient and user enagement under the new health reforms, I draw the following implications for HealthWatch:
- Engagement is actually very low. LINks may have improved from 2008/09 to 2009/10, but the base was incredibly low in the first place. In particular, disabled people and people from a BME background were evidenced to be poorly engaged in LINks as a whole. HW will have to do much better than this.
- The report indicates that the money allocated by DH for LINks was not ringfenced within LAs: £27m was allocated by DH to LAs, £24.3m was allocated by LAs to LINks. Will the DH require money allocated for HW to be spent only on HW?
- The performance of LINks was patchy, but no enforcement mechanism seems to have been in place to address this. How will this be dealt with under HW?
- Data collection for LINks was quite poor. Given it underpins so much of the work HW do, will there be standards and requirements that are enforced in order to understand the work HW do?
- The annual report seems very keen to attribute financial benefits to the work of LINks in order to justify their works. Will a cost-benfit outcome be a key driver of HW, or is their value recognised as being one of engaging local communities in decision making on health and social care?