Pete Fleischmann, Head of Co-production at the Social Care Institute for Excellence and Karen Newbigging, Senior Lecturer in Health Care Policy and Management at the University of Birmingham, highlight Care Act advocacy and its role in offering support for vulnerable people…
Imagine being unable to express yourself, and having no one to turn to. All too often in recent years, people who need care and support haven’t had anyone there for them to communicate what they want to say. In other words, an advocate. We’ve perhaps all needed one at times in our lives, but when you are struggling to navigate the health and social care system, the need for independent advocacy can become critical.
In social care, advocacy sees an independent person representing the views of service users or carers over their social care or health needs. Advocacy “helps people say what they want, secure their rights, represent their interests and obtain services they need.” That description was taken from Action for Advocacy’s Charter. It goes on to say that advocacy promotes social inclusion, equality and social justice.
And now, advocacy is a right. The 2014 Care Act contains a new right for people who use care services to be given access to an advocate. The law now requires that local authorities must offer a Care Act advocacy service to all eligible service users and carers. However, Care Act advocacy is a specific approach, defined by the 2014 legislation. Nowadays, local authorities must involve people in decisions made about them and their care and support. It does not matter how complex a person’s needs are; the local authority must support people to express their views and feelings, and to help them make choices. The advocacy duty applies if someone has care and support needs or if they are judged to have substantial difficulty in understanding information and communicating their wishes and if there is not an appropriate person who can represent them. If these conditions apply then the local authority must find an independent advocate.
The implementation of Care Act advocacy has not been without controversy. Some organisations have claimed that the funding set aside in the legislation for advocacy has been insufficient. Also, the funding has not been ring-fenced. On top of that it has also been anticipated that it might be hard to estimate the level of demand for Care Act advocacy. Some people also feel that giving the responsibility to local authorities to commission advocates and to provide referrals is an inherent conflict and might compromise the independence of the advocacy service. This is because the advocacy role includes, at times, challenging local authority decision making. There are also fears that the service is not being implemented consistently across the country. There have already been several legal challenges against local authorities.
It is now almost 18 months since the new right came into force, so how has the implementation of care act advocacy worked in practice? SCIE commissioned some research from the Universities of Birmingham and Central Lancashire to look at what has been happening since April 2015 and to identify examples of positive practice. This study involved surveys of commissioners and providers; interviews; documentary analysis; and a roundtable discussion involving a range of stakeholders to identify improvements in the commissioning of Care Act advocacy.
The research team, which included an independent service user consultant, found evidence of positive practice in commissioning Care Act advocacy, with several local authorities adopting a cautious ‘wait and see’ approach. Respondents highlighted the difficulties in estimating demand for this service, despite Department of Health guidance. During this first year, local authorities had worked with local stakeholders, including people using social care and providers, to refine their understanding of need and what the options for provision might be.
However, under half of the local authority respondents reported involving people using, or likely to, use social care and / or family carers in the commissioning process. Effective commissioning of Care Act advocacy see local authorities having a good understanding of the role of independent advocacy. It also sees them appreciating the contribution that other forms of advocacy can make to realising the Care Act principle of well-being. A single gateway is emerging, as the preferred model, to enable access to different forms of advocacy, although this is not appropriate for all contexts.
It is also clear that despite training, a major barrier to the uptake of Care Act advocacy is the understanding or reluctance of frontline staff to ask for it. So frontline staff need to ensure that people who need advocacy are informed and then made able to access the form of advocacy that’s appropriate to them. Understanding the underpinning values and principles of advocacy cannot only strengthen the commissioning and provision of advocacy, but it can also promote the well-being of people using social care.
The new SCIE report on Good practice in commissioning Care Act advocacy will be available on our website shortly.
Head of Co-production
Social Care Institute for Excellence
Senior Lecturer in Health Care Policy and Management
Health Services Management Centre (HSMC)
University of Birmingham