CONTINUING THE PHILOSOPHY OF REGINALD O. KAPP

9.52 THE WAY AHEAD FOR LINKS AND HEALTHWATCH


Paper for Department of Health (DH) and the National Association of LINk Members (NALM) reviewing the effectiveness of LINKs and its predecessors, considering how LINks could be strengthened and funded by Healthwatch.
By John Kapp, NALM member for Sussex, johnkapp@btinternet.com 01273 417997       7.7.10


Contents
1 Executive summary
2 Why did LINks and their predecessors fail to create user-centred Services?
3 Recommendations
4 Historical attempts at regulating the Services
5 The problem of the paternalistic attitude of doctors
6 Allowing in competition in treatments
7 Conclusion – transform the Services by proper regulation by introducing the competition of complementary therapy
Appendix 1 Statutory regulating bodies over the Services
Appendix 2 List of voluntary and charitable sector bodies monitoring health
Appendix 3 Draft constitution for Carewatch, including terms of reference, rules and standing orders
Appendix 4 Draft constitution for each LINk, including terms of reference, rules and standing orders

1 Executive Summary
a) Healthwatch should be renamed ‘Carewatch’.
b) Carewatch’s job should be to regulate both Health (NHS) and Social Services (hereafter called the ‘Services’) to make them user-centred rather than provider-centred.
c) Carewatch should be the national body (hub of the wheel) above the 152 Local Involvement Networks (LINks) which are the spokes.
d) Carewatch/LINks job is to be gamekeeper, regulating the Department of Health (DH) providers as poachers, taking complaints of harm from other bodies and see that the system is changed to remedy them.
e) Carewatch/LINks should be kept at ‘arms length’ from providers, (the DH, and Local Authority Councils) so be funded from the Treasury.
f) Carewatch/LINks should have a mandatory constitution prohibiting staff of the Services (poachers) from membership, and giving members powers to hold the officers to account to ensure that it does its job of blowing the whistle when it sees harm (iatrogenesis) and getting effective action so that it does not happen again.

2 Why did LINks and their predecessors fail to create user-centred Services?
LINks and its predecessors are part of the regulatory system over the National Health Service (NHS) and Social Services (hereafter called the ‘Services’) Its aim is to make the Services user-centred, rather than provider centred. ‘User-centred’ means that the system is changed when users are harmed so that that harm does not happen again.

LINks' job is that of a ‘gamekeeper’, namely to blow the whistle on the ‘poachers’ (providers) when they see doctor induced harm (iatrogenesis) and pursue the problem until it is remedied by the system being changed. For example, LINks blew the whistle at Mid Staffordshire hospital (see Francis report) However, they were ignored by those in power, and many patients were harmed and some died. The government said that this should never happen again. LINks should be continued after government funding finishes on 31.3.11, and strengthened to hold providers to account on this pledge.

From 2003 to 2008 the predecessors of LINks were the Centre for Patient and Public Involvement (CPPIH) and over 400 Patient and Public Involvement Forums (PPIFs) Before them, from about 1990 to 2003, were the Community Health Councils (CHCs) and its central body the Association of CHCs. None achieved more than token regulation, (tokenism) because they were constitutionally weak. They were therefore prone to ‘regulatory capture’, which is when the gamekeepers are ‘captured’ by the poachers and wooed into a ‘cosy’ relationship. The gamekeeper becomes part of the vested provider interest, and does not blow the whistle very hard. Only token changes are made to the system, which continues to harm patients as usual.

Regulatory capture has been rife at every level of the NHS since its creation by the Labour government in 1948. Their MPs are financed by the trade unions who are naturally interested in creating ‘jobs for the boys’ at taxpayers expense. The Labour government from 1997-2010 allowed the providers (Services) to capture LINks and their predecessors, as follows:

a) Local Authority funding of Hosts
In 2008 the government built a financial conflict of interest into the Hosts’ contracts of employment. They enacted that LINks secretariat (Hosts) are funded by the Local Authority Councils who also fund Social Services. The staff of the LINk (gamekeepers) are therefore colleagues of the staff of the providers (poachers) so naturally collude not to blow the whistle or change the system. LINks cost about £190,000 pa each, with a total bill to the taxpayer of £28 mpa. Their 3 year funding finishes on 31.3.11.

b) LINks are spokes of a wheel without a hub
LINks are not accountable to anyone as the government created no central statutory body (like CPPIH) above LINks to whom they could report. Although NALM offered a central information service to each LINk for only £20 per year, less than half joined NALM. The officers of my LINk (Brighton and Hove) did not join NALM because they are not interested in information, and don’t want anyone above them to report to. They are only interested in maintaining their tinpot empire as an egotrip.

c) Do-it-yourself constitution for LINks
The government took the unprecedented step of creating 152 statutory bodies without giving them any constitution to which to work. This gave LINks officers and Hosts total freedom to write their own terms of reference. My LINk empowered themselves to build an empire over which they can rule as tinpot dictators who are not accountable to anybody. They do not listen to their members, who have no rights to challenge them. Anyone who tries (like me) gets disqualified and excluded. In the absence of checks and balances, it is human nature to do this. Furthermore, they allowed employees of the Services to be elected to the steering group and officerships, thereby putting poachers in control of the LINk.

d) Regulating (gamekeeper) bodies staffed by poachers
CPPIH (2003-8) failed to regulate the NHS because CPPIHs’ officers were appointed by DH staff, were paid by the DH, hence effectively were all colleagues together, in the same union. There was no membership to elect them or hold them to account. They too were more interested in empire building (10 regional offices employing 117 staff), than in regulating the NHS. CPPIH was thus a gross waste of taxpayers money, so the government was right to abolish them in April 2008.

e) ‘I’m the king of the castle, get down you dirty rascal.’
CPPIH allowed PPIF officers and secretariat total freedom to build their own local tinpot empires and dictatorships, just as CPPIH did. The members of PPIFs had no powers whatsoever to hold them to account. They voted with their feet, leaving the PPIF as generals without an army. The government was right to abolish them too in April 2008.

3 Recommendations.
a) Name

Healthwatch should be renamed ‘Carewatch’ to include Social Services as well as health.

b) New statutory body to create user-centred Services
Carewatch should be the national hub, and the 152 LINks should be the spokes (local eyes and ears) of a properly constituted, fit for purpose, new statutory regulatory watchdog (gamekeeper) Their combined job is to regulate the Services (poachers) to make them user-centred, rather than provider-centred, which means that the system is changed to prevent user complaints of harm happening again.

c) ‘Arms length’ between gamekeepers and poachers
Carewatch/LINks (gamekeepers) should be kept constitutionally at ‘arms length’ from the Services (poachers) so that as gamekeepers they can do their job regulating the Services (poachers).

d) Regulating the Services means the following 4 steps:

i) Monitoring the Services as a watchdog, with eyes and ears and a bark in every place where the Services are provided.

ii) When the watchdog sees iatrogenisis (doctor induced harm) he barks by reporting on the providers (poachers)

iii) Writing reports to the providers recommending the action required to remedy the system to prevent the harm from happening again.

iv) Monitoring and pursuing the complaint of harm with the providers until the system has been changed so that the harm cannot happen again.

Many bodies have been created to do jobs i) and ii), (see appendix 2) but none have been given the job of doing iii) and iv) which we recommend Carewatch/LINks be given.

e) Gamekeepers and poachers should be independently employed
The staff of Carewatch and LINks (gamekeepers) should not be employed by the same organisation that employs the Services (poachers) so that there is no financial conflicts of interest built into the contracts of employment. In particular, Carewatch/LINks (gamekeepers) should not be funded by the DH or Local Authority Councils, who are providers of Social Services (poachers) now, and could soon also be the providers of the NHS, under government plans to place the NHS together with Social Services under the Local Authorities.

f) Gamekeepers and poachers should be independently unionised
The staff of Carewatch and LINks (as gamekeepers) and the staff of the Services (as poachers) should not be allowed to join the same trade unions, which would give them a conflict of staff loyalty interest as colleagues.

h) Carewatch/LINks members electoral register
LINks members should be registered into an electoral register, to enable democratic elections to be held for both LINks and Carewatch Councils. All persons eligible for membership should be allowed to be members by application. The officers should have no rights to disqualify them.

i) Employees of the Services should be prohibited from membership
Employees of the Services are paid to be providers (poachers) so have an inherent financial conflict of interest with LINks as a regulating body (gamekeeper) They should be specifically prohibited from membership registration in LINks in the constitution.

j) Carewatch and LINks should have mandatory constitutions
The constitutions, terms of reference and standing orders for Carewatch and LINks should be mandatorily imposed on them by government. These should clearly state their purpose, aims and objectives, and enable ordinary members to hold the elected officers and secretariat to account that they are doing their job of regulating the Services in the public interest. Members should have the right to remove the officers by calling a special general meeting at which a motion of no confidence is passed in the officers, so that other members can be appointed in their place. Draft model constitutions for Carewatch and LINks are proposed in appendices 3 and 4, below.

4 Historical attempts at regulating the Services

a) Community Health Councils (CHCs)
The CHCs were created by the Conservative government around 1990 during the course of privatising the Utility Services, such as the Post Office Telecoms, Aviation, Steel, Gas, Electricity, Water, Rail, etc. The government established new regulatory bodies called OFTEL, OFGAS, OFGEM, OFWAT etc which were ‘gamekeepers’ at ‘arms length’ from the provider ‘poachers’. They drove quality up and prices down by breaking the previous monopoly of supply by allowing competition to enter the market. This is described in my paper of 25.6.09 ‘Creating User-Centred Services ‘ a Mission for LINks and HALM to make extinct the Provider-Centred Dinosaurs’ published as paper 9.37 of www.reginaldkapp.org.

The NHS and Social Services were considered too difficult to privatise at the time, as the assets could not be sold off. They therefore remained as the last two remaining dinosaurs of the mass nationalisations from 1945-50. Nevertheless in 1990 they established the policy objective of creating patient-centred Services, and created the CHCs and ACHC to do this. They also split the commissioners away from the providers, as they did in the public utility services.

The CHCs had a hub and spoke structure, with a national body called ACHC (check) and local CHCs in every Local Authority. They were funded by the Local Authorities who appointed representatives to sit on the local CHC boards. For reasons given below, they made little impact on regulating the NHS or getting changes made. They were abolished by the Labour government around 2003.

b) CPPIH and PPIFs
The Patient and Public Involvement Forums (PPIFs) were created in every Primary Care Trust (PCT) around 2003. There were initially over 400 of them, but they reduced in number with PCT amalgamations to 152 in 2008. They were funded by CPPIH, which in turn was funded by the DH. They too made little impact on regulating the NHS or getting changes made, and were abolished in April 2008. However, the PPIFs provided a forum which patients could join to air their grievances of iatrogenesis (doctor induced harm) They were mutually supportive committees. Many members made lasting friendships and associations which they carried forward into LINks in 2008.

c) LINks
These were created under the Local Authorities Act 2007. They were spokes without a hub, as the previous national body (CPPIH) was not replaced, leaving a vacuum above LINks. Many of the members of the PPIFs were dismayed at the loss of their committees, so attended a rallying meeting in London in 2007 held by Malcolm Alexander and other activists. He floated the idea of a National Association, which many people joined, including the author. It was called the National Association of LINk Members (NALM) and Malcolm became the chairman, and Ruth Marsden the vice chairman.

In early 2009 Malcolm and Ruth called for nominations for a national steering group of NALM on the basis of one representative per county. Elections by postal ballot were held in April 2009, and representatives from most counties in England were elected to create a NALM ‘parliament’ of about 25 ‘MPs’. Malcolm and Ruth were very active in politicking, and collected information which they e mailed to all LINk members and the members of the steering group. They have thus enabled activists to work together nationally to learn from experience, and propose a better regulatory body, hence this document.

5 The problem of the paternalistic attitude of doctors
The doctors have always seen themselves on a pedestal, looking down on patients and telling them what they should do. Patients have tended to acquiesce in this as it lets them off the hook of taking responsibility for their own health, and gives them someone to blame when things go wrong, which they frequently do.

The whole idea of Patient and Public Involvement (PPI) and LINks flies in the face of this. It reverses the roles, with patients telling doctors what to do. It ‘takes them down a peg or two’, from being ‘on top’ to being ‘on tap’, like any other service provider. Naturally doctors resent this, and resist with all their power. This is considerable because they are unionised with the British Medical Association (BMA) and Unison. As the unions finance the Labour party, Labour MPs tend to do what they are told by the unions. It is therefore not surprising that PPI as propounded by its various bodies has only been tokenism throughout 13 years of Labour government from 1997-2010.

However, the pendulum has swung and we now have a Conservative/Liberal Democrat government who are serious about making the Services user-centred rather than provider-centred. Health Secretary Andrew Lansley and his team of ministers recognise that patients fund the NHS (and doctors salaries) through the taxes they pay, and that ‘he who pays the piper should call the tune’. He has said that commissioning should be patient-led in partnership with their GPs. The layers of bureaucracy that were stifling innovation, and giving patients Hobson’s choice of treatment (drugs or drugs) are to go. The Strategic Health Authorities and 60% of the Primary Care Trusts (PCT) commissioners are to be abolished, to let in the fresh air of competition.

6 Allowing in competition in treatments (patient choice)
As the privatistations of public utilities by the Conservative government (1979-97) demonstrated, the way to improve quality and value for money is to introduce competition. The competitor to drugs is complementary therapy. It has flourished in the private sector, but has never been publicly funded, so patients have to pay for it out of their own pockets. Many cannot afford this, which is the cause of health inequalities (see Marmot report) which the government has pledged to remove.

The drug companies have put out propaganda that there is no evidence that complementary therapy works. The government has believed them, and given drugs a monopoly of public funding. However, studies show that the truth is the other way about. Complementary therapies for the commonest ailments (low back pain and depression) have achieved the gold standard of evidence based because they are NICE-recommended.

Many drugs have been proved scientifically not to work better than placebo. ‘Prozac doesn’t work’ was the banner headline in Feb 2008, yet 16 million prescriptions are written for it. Recently (24.5.10) all anti depressants have been shown not to work, and cost the taxpayer over £1 bn pa. All drugs have harmful side effects, so cause iatrogenesis. Adverse reactions to drugs cause a million patients to be hospitalised every year. Unsafe drugs is the main issue on which Carewatch/LINks should focus, and see that patients are given the choice of NICE-recommended complementary therapies instead.

Vaccinations also cause harm (iatrogenesis). Dr Andrew Wakefield published a possible link between the MMR jab and autism in 1998. (2) Recent reports suggest that the epidemic of asthma, (1 in 10 children born since 2005 are asthmatic) and autism (1 in 100 children born since 2005 are autistic) is linked to vaccinations. The swine flu ‘epidemic’ in 2009 caused the government to buy 20 million doses of Tamiflu vaccine, costing £1.2 bn, of which only 6 million were injected. Many people were made ill by it, causing more iatrogenesis.

Competition can be introduced into the NHS straight away by commissioning the 5 complementary therapies which have been recommended by the National Institute for Clinical Excellence (NICE) Four of them are for low back pain, namely spinal manipulation by chiropractic, osteopathy, and acupuncture and Alexander Technique. The fifth is for depression – the Mindfulness Based Cognitive Therapy (MBCT) course.

Under the NHS constitution, which became law last January, patients have the right to NICE-recommended treatments if their doctor says it is clinically appropriate for them. These two conditions of low back pain and depression make up two thirds of GP consultations, so millions of patients would be glad of the choice of them rather than taking drugs, which mask the symptoms, but do not cure the cause.

These 5 complementary therapies could be provided by the private sector straight away if commissioners agreed to fund them. This issue is discussed in my paper: ‘Improving Health by Intelligent Commissioning of NICE-recommended Complementary Therapy, and Decommissioning Harmful Drugs.’ published on 9.51 of www.reginaldkapp.org.

7 Conclusion – transform the Services by proper regulation introducing the competition of complementary therapy
The present appalling (and worsening) statistics in public health can be reversed, and halved by 2016 by adopting the recommendations above. By preventing iatrogenesis, much suffering can be saved, and a transformed NHS that delivers a healthier nation and less cost.


Appendix 1 Statutory regulating bodies over the Services
There are 35 bodies regulating health to whom Carewatch/LINks could report in order to get effective action in the event of iatrogenesis. Some of them are listed below.

a) MHRA (Medicines and Healthcare Products Regulatory Agency) regulating drugs safety and licensing, with the power to withdraw licences for unsafe drugs, such as Thalidomide (1960) Vioxx (2004), Seroxat for children (2006).

b) NICE (National Institute for Clinical Excellence) www.nice.org.uk regulating which drugs and treatments are cost-effective so can be publicly funded.

c) CQC (Care Quality Commission - an amalgamation of the Healthcare Commission and ….) regulating the fitness for purpose of hospitals, GP surgeries and care homes, who have the statutory powers to close premises on grounds of health and safety.

d) NPCA (National Patient Safety Agency)

e) Commission for Health Audit and Inspection


Appendix 2 List of voluntary and charitable sector bodies monitoring health
The following is a list of a few of the bodies monitoring health, from whom Carewatch/LINks could take reports of iatrogenesis and deal with them effectively. None of them have the statutory power to change the system so that iatrogenesis does not happen again, so the government should give Carewatch/LINks the teeth to do this.

a) ICAS (Independent Complaints Advocacy Service) with a budget of £12 mpa Helps patients and carers make complaints about the NHS info@carersfederation.co.uk, 0115 962 1776.

b) AvMA Action Against Medical Accidents admin@avma.org.uk 0845 123 2352 Gives support and legal advice to people who have had medical accidents.

c) National Voices Coalition of over 200 national voluntary organisations in health, www.nationalvoices.org.uk

d) SMC (Safer Medicines Campaign) www.safermedicines.org 020 8265 2880 info@safermedicines.org campaigns to stop testing drugs on animals.

e) SIN Sufferers of Iatrogenic Neglect (SIN) www.sin-medicalmistakes.org, sinfo@boltblue.com 0115 943 1320 Gillian Bean

f) NAPP (National Association for Patient Participation) Umbrella group for over 500 patient led groups within general practices www.napp.org.uk Equivalent of Carewatch/LINks.


Appendix 3 Draft constitution for Carewatch, including terms of reference, rules and standing orders

1 Name
The body hereby constituted shall be called Carewatch.

2 Aim
The aim of Carewatch shall be to create a user-centred National Health Service (NHS) and Social Care Services (hereafter called ‘the Services’) in England and Wales, hereafter called ‘the area’.

3 Objectives

a) To monitor and report on the safety, quality, effectiveness and user experience of the Services provided in the area.

b) To make recommendations to improve the Services commissioned and provided in the area.

c) To be a statutory consultee on consultations concerning Services policy formulation in the area.

d) To request representation of user representatives (lay members) on every Services committee concerned with user care, such as patients, clients, service users, carers, hereafter called ‘users’., in the area.

d) To recruit and support such user representatives (lay members) on those committees, to have equal rights with clinicians and managers to speak and to vote.

4 Powers
Carewatch shall be a statutory regulating body, (a ‘gamekeeper’) to monitor the Services. (the ‘poachers’) It shall be set up either by Ministerial Decree under the Local Government Act, 2007, or under new legislation to be enacted. It shall have the following statutory powers:

a) To monitor the Services as a watchdog by being its eyes and ears.

b) To be a statutory consultee in all policy matters relating to Patient and Public Involvement (PPI) in the Services in the area.

c) To support LINks with funding.

d) To receive from LINks, other PPI bodies, Health Overview and Scrutiny Committees (HOSCs) and other like bodies, reports of unsatisfactory service, (whistle blowing) and recommendations of what should be done to improve the Services.

e) To request information from commissioners and providers of the Services, and other bodies, and to get a reply within 20 working days.

f) To inspect the premises of Services providers and report on them.

g) To write and send reports recommending action to commissioners and providers of the Services, and get a response within 20 working days.

h) To report to other Services regulatory bodies, and government departments to get changes made to the system to improve user safety.

5 Accountability
Carewatch shall be accountable to the Treasury as part of the government regulation of the Services.

6 Funding
Carewatch shall be funded by the Treasury.

7 Eligibility for membership of Carewatch
All adults residing in the area who are not employees of the Services shall be eligible for membership. All members of LINks are automatically members of Carewatch.

Employees of the Services are excluded from membership of the LINks and Carewatch, and are specifically ineligible for membership. This is because, being paid by the provider (poacher) they have a financial conflict of interest, so cannot be expected to be the gamekeeper and blow the whistle on their employer.

8 Members of Carewatch
Members shall be those persons eligible for membership who have registered to be a member, and been put on the membership list by the Secretaries of the LINks.

9 Rights of membership of the LINks and Carewatch

a) All members of LINks shall have the right to stand for election to the Executive Council of Carewatch.

b) All members shall be publicly informed of the date, time and place of meetings to which they are entitled to attend, speak and vote by that being placed on the Carewatch website.

c) Non-members, including employees of the Services, shall have the right to attend meetings in a public gallery area, but shall not have speaking or voting rights.

d) Members shall have the right to call a Special General Meeting (SGM) if 40 members sign a petition for it. The officers shall hold the SGM within 2 months of the date of the serving of the petition.

10 Annual General Meetings (AGM)
There shall be an AGM within 15 months of the previous AGM in public, in which the following business shall be transacted.

a) To receive the chairman’s annual report
b) To receive the secretary’s report
c) To receive the treasurer’s report and accounts
d) To receive annual reports from the chairmen of sub committees.
e) To elect the members of the Executive Council of up to 40 people
f) To transact such other business as shall be determined by the Executive Council.
g) To transact such other business as shall be requested by a member of the LINk in writing to the secretary giving 2 month’s notice.

11 General meetings
One clear month’s notice shall be given to all members of any general meeting, giving the place, date and time of the meeting, together with the business to be transacted, including the reasons for calling the meeting.

12 Election of the Executive Council

a) Term of office of the Executive Council
The term of office of the Executive Council shall be nominally one year, measured from one AGM to the end of the next AGM, which time shall not exceed 15 months.

b) Election
The election of the Executive Council of 40 people shall take place at a general meeting, normally the AGM. The notice convening the meeting shall call for nominations to be communicated to the secretary in writing. Nominations shall close at noon 7 days before the meeting, unless there are still vacancies, when nominations shall remain open until all vacancies have been filled, or by the time of the issue of ballot papers.

c) Eligibility to stand for election.
All members shall be eligible to stand for election unless they have already served for the preceeding 5 years consecutively by nominating themselves by the due time. The list of valid nominations shall be created by the secretary and promulgated on the website as soon as possible after close of nominations, together with the election addresses of those standing.

d) Election address
By the close of nominations, those nominated shall provide the secretary with an election address of up to 100 words. The election addresses shall be printed on a paper in alphabetical order of surname, tabled and distributed to those present at the start of the meeting.

e) Hustings
If there are more persons nominated than vacancies, an election shall be held at the general meeting convened for that purpose. Candidates in alphabetical order of their surname shall be invited to address the meeting for up to 2 minutes, and answer questions from the floor for a further 2 minutes.

f) Voting
Voting shall be in person at the meeting by the issue of a ballot paper to each member voting containing the names of all those standing for election. The member voting shall place a cross opposite the name of the candidate that he wishes to vote for, fold his paper to hide his vote and place it in a ballot box. Members who cannot be present may appoint a proxy member to vote for them, by giving notice to the secretary in writing to that effect.

g) Returning officer
The returning officer for the election shall not have any interest in the outcome of the election, and shall not be an officer of the Secretariat or the LINk. The retiring chairman shall relinquish the chair for the election, and the returning officer shall chair the meeting and conduct the election. The returning officer shall appoint two scrutineers who shall not be candidates nor officers of the Secretariat to oversee the count, which shall take place immediately after voting. The returning officer shall announce the number of votes received by each candidate and the names of those elected.

13 Membership of the Executive Council
The members of the executive committee shall be those members elected at the AGM, plus those people co-opted for the remainder of the year by the executive council up to a maximum of 40 people. Members may resign at any time by giving written notice to the Secretary. Members who miss three meetings in a row without good reason shall be deemed to have resigned, and their places filled by co-option.

14 Officers
The first executive council meeting of the year shall elect the officers for the coming year from among the elected members of the Executive Council, who shall take office until the end of the subsequent AGM.

The officers shall be the chairman, the deputy chairman, the vice chairman, the secretary, the minutes secretary, the membership secretary, the treasurer, the president, the vice presidents, the patrons, and such other officers as the Executive Council shall decide. All offices need not be filled at the first meeting, and offices may be changed by the decision of any Executive Council meeting. Some of the officers (other than the chairman, deputy chairman and vice chairman) may be paid by the Secretariat, on the decision of the Executive Council.

15 Executive Council meetings
The Executive Council shall meet at least 6 times per year in public. At least 1 weeks notice shall be given to all Executive Council members of the time and place of the meeting, and the agenda of business to be transacted, which shall include the following as a standing agenda:

1 Apologies for absence
2 Notice of Any Other Urgent Business to be taken at this meeting
3 The minutes of the last meeting shall be taken for accuracy, amended and approved as a correct record and signed and dated by the chairman.
4 Matters arising from the minutes not covered on the agenda.
5 Feedback reports from members attending as lay representatives of committees under 4c)
6 Feedback reports from members attending other meetings
7 Such business as shall be decided by the chairman and secretary
8 Any Other Business as raised by any member of the Council in writing or in person, by giving the secretary 2 week’s notice in writing.
9 Any Other Urgent Business as raised by any member of the Council in person at the meeting, preferably by giving the chairman or secretary notice before the meeting, or raised under item 2.

16 Sub Committees of the Executive Council
The Executive Council shall be empowered to create and disband such sub committees as it sees fit, which may be standing sub committees, or ad hoc sub committees (task and finish groups) subject to the following conditions:

a) The terms of reference of every subcommittee shall be agreed by the Executive Council.
b) At least one member of the subcommittee shall be a member of the Executive Council, (hereafter called ‘the member’)
c) The member shall undertake to make the sub committee happen by accepting the following duties.

17 Duties of the member setting up a sub committee

a) To recruit suitable people to sit on the sub committee, (who should preferably be members, but do not have to be).
b) To arrange a suitable place, date and time for sub committee meetings (which may be the homes of members)
c) To report back on the progress at each meeting at the executive council
d) To write up the final report and present it to the executive council
e) To get it established as an issue, get it sent by the secretariat to the appropriate office of the Services and regulatory bodies, to monitor replies, and take appropriate follow-up action
f) To write it up for the annual report and present it at the AGM.

18 Standing orders
The following standing orders shall apply to all meetings, including sub committee meetings:

a) Every meeting shall have an elected chairman and secretary.
b) The chairman is responsible for getting through the business of the meeting within the allotted time, and for signing the minutes as a correct record, which shall be made publicly available as an audit trail.
c) The secretary is responsible for recording the minutes of the meeting, distribute them to all members of that meeting within a week of the meeting, and for giving at least a week’s notice of the holding of the next meeting.
d) Members shall indicate that they wish to speak to the chairman, who shall call them to speak in the order that they indicated. When they have the floor they shall address the chairman.
e) Any member may interrupt the proceedings and propose a motion at any time, (such as ‘the motion be put’, ‘next business’, ‘point of order’) which the chairman shall deal with and dispose of straight away.
f) The chairman shall treat all members equally, and listen to proposals and contributions to the discussion with respect, but shall not allow any member to harass other members or hog the discussion.
g) The chairman shall sum up the discussion on each issue, and state the decision of the committee, which the secretary shall minute. If that decision is contested, the chairman shall allow the discussion to continue to try to reach consensus. Only if that cannot be achieved within reasonable time shall the chairman put the matter to the vote, when the decision shall be that of the majority. The chairman shall have a casting vote.
h) The minutes shall include proposals made, decisions taken, the number of votes cast for and against, and the action to be taken by whom and by when. Points made in discussion need not be minuted. Any member has the right to request a recorded vote, when the vote shall be recorded against the name of the member voting.

19 Secretariat support
Carewatch shall be a user-led, statutory body for which paid secretarial support is provided at public expense by the government. The model for support shall be the way that council officers support elected councillors, to make the Council member-led (rather than officer-led) The paid Secretariat should be like a bus driver, getting the 40 members of the Executive Council to where they want to go. The chairman is like the navigator, telling the driver where to go.

Under the general direction of the chairman, the paid secretariat shall provide support for members as follows:

a) Meetings for members, including general meetings and Executive Council meetings, but not sub committee meetings. The paid secretariat shall organise the setting up of the meeting, hiring the meeting hall, paying the room hire, notifying the members of the place, date and time, preparing the agenda in discussion with the chairman, sending out the agenda papers, writing and sending out the minutes.

b) Secretarial services for the chairman and members of the Executive Council, including implementing the decisions taken at the meetings, writing and answering letters, e mails and other correspondence, maintaining an office with a filing system, answering the telephone, dealing with enquiries from members, other bodies and the public.

20 Changes to this constitution
Changes may be made to this constitution by any member writing to the secretary with the reasons for the proposed change, and the proposed new wording. The secretary shall put the matter on the agenda of the next Executive Council, who shall determine the appropriate action. The constitution shall only be changed at a general meeting, which can be an AGM or a Special General Meeting (SGM)


Appendix 4 Draft constitution for each LINk, including terms of reference, rules and standing orders

1 Name
The body hereby constituted shall be the Local Involvement Network (LINk) hereafter called
‘the LINk’, for the Local Authority of ……………………………… (hereafter called ‘the area’).

2 Aim
The aim of the LINk shall be to create a user-centred National Health Service (NHS) and Social Care Services (hereafter called ‘the Services’) in the area.

3 Objectives

a) To monitor and report on the safety, quality, effectiveness and user experience of the Services provided in the area.
b) To make recommendations to improve the Services commissioned and provided in the area.
c) To be a statutory consultee on consultations concerning Services policy formulation in the area.
d) To request representation of user representatives (lay members) on every Services committee concerned with user care, such as patients, clients, service users, carers, hereafter called ‘users’., in the area.
e) To recruit and support such user representatives (lay members) on those committees, to have equal rights with clinicians and managers to speak and to vote.

4 Powers
LINks shall be a statutory regulating body, (a ‘gamekeeper’) to monitor the Services. (the ‘poachers’) It shall be set up either by Ministerial Decree under the Local Government Act, 2007, or under new legislation to be enacted. It shall have the following statutory powers:

i) To monitor the Services as a watchdog of Carewatch, by being its local eyes and ears.
j) To be a statutory consultee in all policy matters relating to Patient and Public Involvement (PPI) in the Services in the area.
k) To receive information from Carewatch.
l) To receive from other LINks, other PPI bodies, Health Overview and Scrutiny Committees (HOSCs) and other like bodies, reports of unsatisfactory service, (whistle blowing) and recommendations of what should be done to improve the Services.
m) To request information from commissioners and providers of the Services, and other bodies, and to get a reply within 20 working days.
n) To inspect the premises of Services providers and report on them.
o) To write and send reports recommending action to commissioners and providers of the Services, and get a response within 20 working days.
p) To report to Carewatch and other Services regulatory bodies, and government departments to get changes made to the system to improve user safety.

5 Accountability
The LINk shall be accountable to Carewatch as part of the government regulation of the Services.

6 Funding
The LINk shall be funded by Carewatch.

7 Eligibility for membership of the LINk
All adults residing in the area who are not employees of the Services shall be eligible for membership of the LINk. All members of the LINk are automatically members of Carewatch.

Employees of the Services are specifically excluded from membership of the LINks and Carewatch, and are ineligible for membership. This is because, being paid by the provider (poacher) they have a financial conflict of interest, so cannot be expected to be the gamekeeper and blow the whistle on their employer.

8 Members of Links
Members of LINks shall be those persons eligible for membership who have registered to be a member, and been put on the membership list by the Secretary of the LINk. To register they shall give their name, address, e mail address and telephone number.

9 Rights of membership of the LINk

a) All members shall have the right to stand for election to the Executive Council.
b) All members shall be publicly informed of the date, time and place of meetings to which they are entitled to attend, speak and vote by that being placed on the LINk website.
c) Non-members, including employees of the Services, shall have the right to attend meetings in a public gallery area, but shall not have speaking or voting rights.
d) Members shall have the right to call a Special General Meeting (SGM) if 20 members sign a petition for it. The officers shall hold the SGM within 2 months of the date of the serving of the petition.

10 Annual General Meetings (AGM)
There shall be an AGM within 15 months of the previous AGM in public, in which the following business shall be transacted.

h) To receive the chairman’s annual report
i) To receive the secretary’s report
j) To receive the treasurer’s report and accounts
k) To receive annual reports from the chairmen of sub committees.
l) To elect the members of the Executive Council of up to 20 people
m) To transact such other business as shall be determined by the Executive Council
n) To transact such other business as shall be requested by a member of the LINk in writing to the secretary giving 2 month’s notice

11 General meetings
One clear month’s notice shall be given to all members of any general meeting, giving the place, date and time of the meeting, together with the business to be transacted, including the reasons for calling the meeting.

12 Election of Executive Council
a) Term of office of the Executive Council
The term of office of the Executive Council shall be nominally one year, measured from one AGM to the end of the next AGM, which time shall not exceed 15 months.

b) Election
The election of the Executive Council shall take place at a general meeting, normally the AGM. The notice convening the meeting shall call for nominations to be communicated to the secretary in writing. Nominations shall close at noon 7 days before the meeting, unless there are still vacancies, when nominations shall remain open until all vacancies have been filled, or by the time of the issue of ballot papers.

c) Eligibility to stand for election
All members shall be eligible to stand for election unless they have already served for the preceeding 5 years consecutively by nominating themselves by the due time. The list of valid nominations shall be created by the secretary and promulgated on the website as soon as possible after close of nominations, together with the election addresses of those standing.

d) Election address
By the close of nominations, those nominated shall provide the secretary with an election address of up to 100 words. The election addresses shall be printed on a paper in alphabetical order of surname, tabled and distributed to those present at the start of the meeting.

e) Hustings
If there are more persons nominated than vacancies, an election shall be held at the general meeting convened for that purpose. Candidates in alphabetical order of their surname shall be invited to address the meeting for up to 2 minutes, and answer questions from the floor for a further 2 minutes.

f) Voting.
Voting shall be in person at the meeting by the issue of a ballot paper to each member voting containing the names of all those standing for election. The member voting shall place a cross opposite the name of the candidate that he wishes to vote for, fold his paper to hide his vote and place it in a ballot box. Members who cannot be present may appoint a proxy member to vote for them, by giving notice to the secretary in writing to that effect.

g) Returning officer
The returning officer for the election shall not have any interest in the outcome of the election, and shall not be an officer of the Secretariat or the LINk. The retiring chairman shall relinquish the chair for the election, and the returning officer shall chair the meeting and conduct the election. The returning officer shall appoint two scrutineers who shall not be candidates nor officers of the Secretariat to oversee the count, which shall take place immediately after voting. The returning officer shall announce the number of votes received by each candidate and the names of those elected.

13 Membership of the Executive Council
The members of the executive committee shall be those members elected at the AGM, plus those people co-opted for the remainder of the year by the executive council up to a maximum of 20 people. Members may resign at any time by giving written notice to the Secretary. Members who miss three meetings in a row without good reason shall be deemed to have resigned, and their places filled by co-option.

14 Officers
The first executive council meeting of the year shall elect the officers for the coming year from among the elected members of the Executive Council, who shall take office until the end of the subsequent AGM.

The officers shall be the chairman, the deputy chairman, the vice chairman, the secretary, the minutes secretary, the membership secretary, the treasurer, the president, the vice presidents, the patrons, and such other officers as the Executive Council shall decide. All offices need not be filled at the first meeting, and offices may be changed by the decision of any Executive Council meeting. Some of the officers (other than the chairman, deputy chairman and vice chairman) may be paid by the Secretariat, on the decision of the Executive Council.

15 Executive Council meetings
The Executive Council shall meet at least 6 times per year in public. At least 1 weeks notice shall be given to all Executive Council members of the time and place of the meeting, and the agenda of business to be transacted, which shall include the following as a standing agenda:

1 Apologies for absence
2 Notice of Any Other Urgent Business to be taken at this meeting
2 The minutes of the last meeting shall be taken for accuracy, amended and approved as a correct record and signed and dated by the chairman.
3 Matters arising from the minutes not covered on the agenda.
4 Feedback reports from members attending as lay representatives of committees under 4c)
5 Feedback reports from members attending other meetings
4 Such business as shall be decided by the chairman and secretary
5 Any Other Business as raised by any member of the Council in writing or in person, by giving the secretary 2 week’s notice in writing
6 Any Other Urgent Business as raised by any member of the Council in person at the meeting, preferably by giving the chairman or secretary notice before the meeting, or raised under item 2.

16 Sub Committees of the Executive Council
The Executive Council shall be empowered to create and disband such sub committees as it sees fit, which may be standing sub committees, or ad hoc sub committees (task and finish groups) subject to the following conditions:

d) The terms of reference of every subcommittee shall be agreed by the Executive Council.
e) At least one member of the subcommittee shall be a member of the Executive Council, (hereafter called ‘the member’)
f) The member shall undertake to make the sub committee happen by accepting the following duties.

17 Duties of the member setting up a sub committee

a) To recruit suitable people to sit on the sub committee, (who should preferably be members, but do not have to be).
g) To arrange a suitable place, date and time for sub committee meetings (which may be the homes of members)
h) To report back on the progress at each meeting at the executive council
i) To write up the final report and present it to the executive council
j) To get it established as an issue, get it sent by the secretariat to the appropriate office of the Services and regulatory bodies, to monitor replies, and take appropriate follow-up action
k) To write it up for the annual report and present it at the AGM.

18 Standing orders
The following standing orders shall apply to all meetings, including sub committee meetings:

i) Every meeting shall have an elected chairman and secretary.
j) The chairman is responsible for getting through the business of the meeting within the allotted time, and for signing the minutes as a correct record, which shall be made publicly available as an audit trail.
k) The secretary is responsible to record the minutes of the meeting, distribute them to all members of that meeting within a week of the meeting, and for giving at least a week’s notice of the holding of the next meeting.
l) Members shall indicate that they wish to speak to the chairman, who shall call them to speak in the order that they indicated. When they have the floor they shall address the chairman.
m) Any member may interrupt the proceedings and propose a motion at any time, (such as ‘the motion be put’, ‘next business’, ‘point of order’) which the chairman shall deal with and dispose of straight away.
n) The chairman shall treat all members equally, and listen to proposals and contributions to the discussion with respect, but shall not allow any member to harass other members or hog the discussion.
o) The chairman shall sum up the discussion on each issue, and state the decision of the committee, which the secretary shall minute. If that decision is contested, the chairman shall allow the discussion to continue to try to reach consensus. Only if that cannot be achieved within reasonable time shall the chairman put the matter to the vote, when the decision shall be that of the majority. The chairman shall have a casting vote.
p) The minutes shall include proposals made, decisions taken, the number of votes cast for and against, and the action to be taken by whom and by when. Points made in discussion need not be minuted. Any member has the right to request a recorded vote, when the vote shall be recorded against the name of the member voting.

19 Secretariat support
The LINk shall be a user-led, statutory body for which paid secretarial support is provided at public expense by the government. The model for support shall be the way that council officers support elected councillors, to make the Council member-led (rather than officer-led) The paid Secretariat should be like a bus driver, getting the 20 members of the Executive Council to where they want to go. The chairman is like the navigator, telling the driver where to go.

Under the general direction of the chairman, the paid secretariat shall provide support for members as follows:

a) Meetings for members, including general meetings and Executive Council meetings, but not sub committee meetings. The paid secretariat shall organise the setting up of the meeting, hiring the meeting hall, paying the room hire, notifying the members of the place, date and time, preparing the agenda in discussion with the chairman, sending out the agenda papers, writing and sending out the minutes.
b) Secretarial services for the chairman and members of the Executive Council, including implementing the decisions taken at the meetings, writing and answering letters, e mails and other correspondence, maintaining an office with a filing system, answering the telephone, dealing with enquiries from members, other bodies and the public.

20 Changes to this constitution
Changes may be made to this constitution by any member writing to the secretary with the reasons for the proposed change, and the proposed new wording. The secretary shall put the matter on the agenda of the next Executive Council, who shall determine the appropriate action. The constitution shall only be changed at a general meeting, which can be an AGM or a Special General Meeting (SGM) Changes to the constitution shall have to be ratified by Carewatch before taking effect.

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