Wednesday, 11 July 2012

Caring For Our Future by Forgetting Advocacy?

I’ve just taken a quick look at  “Caring for our future: reforming care and support” and it seems to signal an end to the phrase “information, advice and advocacy”. Information? Yes. Advice? Yes? Advocacy?.....

Well in terms of advocacy there seems to be some misunderstanding, some rewinding of the clock, a whole lot of forgetting and a potentially risky future. Here’s the sum total of the report’s mention of advocacy.

“Advocacy services have been in place for more than 30 years, often providing support for people who lack mental capacity and who have no-one to act on their behalf. These services will continue to play a vital role in supporting people and we need to understand better the benefits of these services and how cost-effective they can be. We will therefore work with partners to develop and disseminate best practice and potential new business models”
That's it. 

Well, most advocacy is for people who have capacity. Overwhelmingly so. It’s not the lack of capacity to make a specific decision that leads people to need advocacy. Rather it’s the experience of not being listened to, not being included in decision making, being discriminated against, being abused, being in receipt of poor or inappropriate services or not being able to access services (including basic health care) at all. Those are the main triggers.  To focus on a lack of capacity risks locating the fault with the individual, not the services. 

And advocacy is not just for people who have no-one to act on their behalf. Not even the IMCA role is limited to this. Many of  carers I spoke to at the social care lobby of parliament talked about wanting an advocate for the person they looked after. And while I’m firmly behind the idea of getting a better view on the impact and effectiveness of services, I'm concerned that this single statement ignores a wealth of evidence pointing to the impact and value of advocacy. 

If that’s the case, forget all of those mentions about the importance of advocacy as a safeguard against abuse and in safeguarding processes. Forget the CQC's thematic review on learning disability services, ignore SCIE guidance on safeguarding, forget the lessons from Winterbourne view, forget the Kerr-Haslam report, forget all the other reports that make the same point. 

Ignore Valuing People, forget about the Care Quality Commission’s excellence framework. Forget about the NHS Confederation’s report Delivering Dignity. Forget the value that the Mental Capacity Act  Code of Practice puts on advocacy as a means of enabling people to be more involved in decisions about their lives (and no, that’s not a reference to IMCA). Forget EHRC's report "From safetynet to springboard". Forget the Law Commission’s report on reforming social, they were obviously having an off day when they recommended realising the right to advocacy for all disabled people. And I can only conclude that the Joint Committee on Human Rights was similarly confused when they supported the call.  Forget them both, forget them all, but remember this.

Every single time someone approaches an advocacy service, it is an indication that they believe some decisions about their life are out of their control; that something about them is being decided without them, that they are at risk or their voice is not being heard. A request for advocacy is a request for autonomy and control. It’s often a sign that the care and support system isn’t working. And, with the exception of some statutory provision, it’s a statement of belief from individual people that advocacy creates real change for them.

So when we look for the effectiveness, cost effectiveness and value of advocacy, let’s make sure we don’t choose models that ignore those problems or are incapable of offering credible solutions. And when it comes to decisions that materially impact on the lives of people who demand advocacy services, let’s live up to the statement  that the health white paper borrowed from the advocacy movement - “Nothing about me without me”.


  1. "These services will continue to play a vital role...and we need to understand better the benefits of these services..."

    At this point I almost wanted to swear. There may well be questions about efficacy of different modes and cost in relation to benefits...but having to argue that advocacy has a benefit - this is year zero stuff. Its displacement activity.

    Does anbody question whether an advocate in court has a benefit?

  2. Clearly the advocacy sector has to fight hard for everything it gets, I often feel harder than some other services do. However and I don't want to be the merchant of doom or overly critical but here goes.....the government is correct to say that they need to understand the benefits better. Firstly as a sector we haven't credibly been able to do that, we know it but we can't prove it......evidence comes in different forms and there are some great examples out there but they are lost like a fart in the wind if there is no national direction and cohesion.

    Therefore work must be done in this area for the good of the whole sector, not just those that are wining and dining with ministers and picking up super contracts. The big boys of the sector could actually part finance this development in the interests of the whole sector including the small local providers that provide the necessary texture and grass roots to the know who you are, do something benevolent I dare you...

    My view is that this type of process will improve advocacy overall, there won't be a hiding place for the rubbish providers. Pricing will stabilise based on the level of investment that needs to be made to hit standards and prove benefit.

    Commissioners have a role to play also. The sector has been beaten up metaphorically by blood thirsty procurement officers fresh out of university with a mandate to cut costs at any cost. I have made my views known on why we failed to protect all of what we had. This has to change in the future, it's a long road but the smoothest path is the one where benefits are proven, costs are established and pretty consistent throughout the patch and the sector has enough surplus to invest in development.

  3. Advocacy is a vital element of a fully functioning and effective system of support. Moreover it should be one of the key elements that enables such a system to stay healthy and sustainable - partly by protecting individual rights, partly by making the case for those rights to society as a whole. Instead advocacy has become just an add-on for a system which is broken, shrinking and under sustained attack from central government. It is inevitable that it will be one of the first victims of the current cuts - cuts which have not yet hit the half way stage and have already reduced social care spending by £2 billion.

    Worse is to come and we are not organised to do anything about it - this is why it is vital that organisations join together to develop a concerted campaign to defend basic human rights and to create a new, sustainable and legally protected system of care and support for all.