tag:blogger.com,1999:blog-27373541338224207992024-03-08T03:12:31.162-08:00The Distance From Should To IsAnonymoushttp://www.blogger.com/profile/06108770731501761352noreply@blogger.comBlogger26125tag:blogger.com,1999:blog-2737354133822420799.post-77942188820363020872016-01-12T15:51:00.000-08:002016-01-12T15:51:51.219-08:00Overshadowed<br />
<div style="margin: 0cm 0cm 8pt;">
<span style="font-family: Calibri;">A couple of years ago I did some work around inequalities in
healthcare; the fact that people with mental health problems or learning
disabilities tend to get significantly poorer access to and outcomes from
health services. This was a reaction both to the many examples I’d come across
through working with advocacy organisations and the BMA report that showed that
diagnostic overshadowing (i.e.</span><span style="mso-spacerun: yes;"><span style="font-family: Calibri;"> </span></span><span style="font-family: Calibri;">ascribing
physical health complaints to issues relating to mental health or disability)
contributes to a shortening of life expectancy of between 10 – 15 years. </span></div>
<br />
<div style="margin: 0cm 0cm 8pt;">
<span style="font-family: Calibri;">Sometimes these issues are framed in terms of a shortfall in
the person; that the person can’t speak up or articulate their problems well.
Or that there is an intrinsic interlinking of mental health and physical health
pathology. I’d like to offer an alternative narrative, but to do so I have to
give some additional context.</span></div>
<br />
<div style="margin: 0cm 0cm 8pt;">
<span style="font-family: Calibri;">There was a time when I was able to keep personal and
professional stuff completely separate. Some of you will know that this kind of
ended when I was open about my experiences with depression. In one post I
talked of trying to view my depression as a state from which I was recovering
rather than a one-off incident like a car crash. The comparison wasn’t
arbitrary. I’d recently been in car accident and was sure that the road to
recovery would be swift. Now, almost two years later, I am still dealing with
spinal pain. Though I am a fan of irony it is little compensation for the pain
and the impact that has on my life. </span></div>
<br />
<div style="margin: 0cm 0cm 8pt;">
<span style="font-family: Calibri;">So what does this have to do with anything? Well, a little
while ago after the physio had said I had a clear and consistent problem
relating to a couple of my vertebrae I was sent for an MRI scan. When I phoned
my GP surgery to find out the outcome, the doctor that I spoke to said that the
results were unclear as the image not good enough for diagnosis. No problem
there, such things happen. The next thing they said surprised me, though it
really shouldn’t have. In short it was along these lines (paraphrased for
brevity) :</span></div>
<br />
<div style="margin: 0cm 0cm 8pt;">
<span style="font-family: Calibri;">GP:</span><span style="mso-tab-count: 1;"><span style="font-family: Calibri;"> </span></span><span style="font-family: Calibri;">I see from
your notes that there are references to depression. Are you sure that the pain
isn’t just an expression of that?</span></div>
<br />
<div style="margin: 0cm 0cm 8pt;">
<span style="font-family: Calibri;">Me:</span><span style="mso-tab-count: 1;"><span style="font-family: Calibri;"> </span></span><span style="font-family: Calibri;">I’m pretty
sure. I think it’s more to do with being in a stationary car that was hit from
behind by a car going over 30 mph. The pain started about an hour after the
incident. It hasn’t changed for 2 years. I’m pretty sure that’s the more likely
cause.</span></div>
<br />
<div style="margin: 0cm 0cm 8pt;">
<span style="font-family: Calibri;">GP:</span><span style="mso-tab-count: 1;"><span style="font-family: Calibri;"> </span></span><span style="font-family: Calibri;">But you
might not know how depression can affect the way you perceive pain. Are you
sure it’s not about that?</span></div>
<br />
<div style="margin: 0cm 0cm 8pt;">
<span style="font-family: Calibri;">Me:</span><span style="mso-tab-count: 1;"><span style="font-family: Calibri;"> </span></span><span style="font-family: Calibri;">No, I’m
pretty sure it was the car accident. I know a bit about depression, this isn’t
part of it. By the way, how did you jump from “the image isn’t clear enough for
diagnosis” to “are you sure it’s not in your head?”</span></div>
<br />
<div style="margin: 0cm 0cm 8pt;">
<span style="font-family: Calibri;">GP:</span><span style="mso-tab-count: 1;"><span style="font-family: Calibri;"> </span></span><span style="font-family: Calibri;">Erm…</span></div>
<br />
<div style="margin: 0cm 0cm 8pt;">
<span style="font-family: Calibri;">There’s a wonderful idea in logic called Ockham’s (or Occam’s)
razor. It basically means that </span><span style="mso-spacerun: yes;"><span style="font-family: Calibri;"> </span></span><span style="font-family: Calibri;">if there
are a competing ways of explaining something, you should choose the explanation
that relies on the fewest assumptions. The GP assumed that it was more likely
that I would experience back pain as an expression of depression. I assumed
that it was more likely to be down to being rear ended by a car.</span></div>
<br />
<div style="margin: 0cm 0cm 8pt;">
<span style="font-family: Calibri;">The GP assumed that an unclear MRI scan was down to my
depression. (No, I don’t get it either). I assume it’s more likely to be down
to having to lie on my back for a scan on an injury that is exacerbated by any
pressure being put on my back. I would say that I’d leave it to you decide
which was the more likely explanation, but we’d both know I was lying.</span></div>
<br />
<div style="margin: 0cm 0cm 8pt;">
<span style="font-family: Calibri;">I was able to talk this through with the GP, we got to a
reasonable endpoint. But I absolutely felt as if a health problem with a
definably physical cause (it even had a registration plate for goodness sake) was
being put down to my past mental health. It takes a pretty big assumption to
overshadow a car.</span></div>
<br />
<div style="margin: 0cm 0cm 8pt;">
<span style="font-family: Calibri;">So I’m offering this up as an example. Whether we call it
diagnostic overshadowing or the credibility gap, the problem can’t be located
solely in the person who is disadvantaged in healthcare. It’s not just about
being able to speak up; I can do that. It’s not about a lack of articulacy; I hope
I’ve shown I can manage to string a few words together. It’s not even about
mysterious causes. Cars have not been mysterious since the early 1900s. The
problem is caused by the fact that, regardless of how</span><span style="mso-spacerun: yes;"><span style="font-family: Calibri;"> </span></span><span style="font-family: Calibri;">much it strains Ockham’s razor, too many
people think that mental health problems somehow preclude physical ill health.</span></div>
<b></b><i></i><u></u><sub></sub><sup></sup><strike></strike>Anonymoushttp://www.blogger.com/profile/06108770731501761352noreply@blogger.com1tag:blogger.com,1999:blog-2737354133822420799.post-50831434748093264542014-03-12T07:26:00.002-07:002014-03-12T07:29:01.225-07:00The Need for Care, Candour and Change<a href="http://shouldtois.blogspot.co.uk/2014/03/an-odd-form-of-parity.html" target="_blank">My last post</a> talked about the poor access to healthcare for people in hospitals. No, really. So I want to pose a simple question; what hospitals are for? <br />
<br />
Now, I would have thought that hospitals are something to do with health. I'd expect hospitals to play a role in treating someone's health issues to make their life better. Or if you don't know what's wrong, hospitals might assess the problem. And during that process, when people are unwell,or injured, scared, and desperately hoping for things to improve, I'd expect hospitals to be a place of care. Not just because it's socially acceptable, or right, but because a lack of care creates stress - and that's not good for recovery.<br />
<br />
So three purposes of a hospital; assessment, treatment and care. <br />
<br />
Let's see what happens in a place called an "assessment and treatment unit". They've gone for a Ronseal approach to the name. And you'd expect care because, well we’ve all heard of the <a href="http://www.nhs.uk/ipgmedia/national/Rethink%20Mental%20Illness/Assets/RightstoNHStreatment.pdf" target="_blank">duty of care</a>, haven’t we?<br />
<div>
<blockquote class="tr_bq">
<b> “The right to a duty of care – health professionals must use reasonable care and skill and patients are entitled to receive care of a standard which a responsible body of medical opinion‟ considers to be appropriate to their condition.”</b></blockquote>
So assessment, treatment and care – they’ve nailed it. Surely assessment and treatment centres should be the zenith of the care experience. Only, they're not. <br />
<br />
STATT, is an assessment and treatment unit run by Southern Health in Oxfordshire. That’s where 18 year old Connor Sparrowhawk went for care, and died. <br />
<br />
I first heard about Connor through a <a href="http://mydaftlife.wordpress.com/" target="_blank">blog </a>that his mother Sara writes. There he was known as LB (short for laughing boy) or The Dude. The blog was outstanding, not only because of the beautiful writing, but because it celebrated the oddities and joys that life with Connor entailed. The blog was often one source of joy and hope in a world where both are too often lacking. The blog is still outstanding, but since Connor's death, that's for far sadder reasons.<br />
<br />
The trust initially claimed that Connor had died of natural causes. He hadn't. <br />
<br />
Connor had a condition called Klinefelter's syndrome, which includes learning disability and epilepsy. He died after having a seizure in the bath. He drowned. In the unit where he meant to be cared for. There was no effective plan in place to deal with his epilepsy. The awareness of his epilepsy seems sketchy. His parents flagged up indicators that he was having seizures. They were ignored. </div>
<div>
An independent investigation began, but the trust didn’t seem to have its act together. Connor's family understandably feared a cover up. They engaged a legal team to prevent this and as a result they have run up legal costs. Despite the work of the legal team and the investigators, the trust still didn't cover itself in glory. For example, it found a bunch of documents only two days before the final report was published. Too late for any comment from Connor's family. The report was published, 84 days after the trust's own 60 day time limit for the enquiry had elapsed. Here’s a brief <a href="http://mydaftlife.wordpress.com/2014/03/09/at-home-with-the-slovens/" target="_blank">summary of the timeline relating to the investigation </a>from Sara’s blog.<br />
<br />
The trust did not appear to embrace the <a href="http://www.theguardian.com/society/2014/mar/06/patients-mistakes-senior-nhs-doctors" target="_blank">duty of candour</a> - one of the key recommendations of the Francis report. It appears to have been more concerned with denying responsibility than responding humanely to Connor's parents or dealing with the problems that were so clearly apparent in their services. They've obstructed the investigation into Connor's death, marginalised his family, and <a href="http://shouldtois.blogspot.co.uk/2013/10/whitewash-and-wonderland.html" target="_blank">tried to gag the person who was supposed to be providing support </a>to Connor's family in the investigation (to the point of saying that they couldn't pass on details to Connor's family and couldn't even say that they were operating under a gagging clause). <br />
<br />
Despite this the report did finally come out, and Sara’s <a href="http://www.bindmans.com/news-and-events/news-article/death-of-18-year-old-connor-sparrowhawk-was-preventable" target="_blank">solicitors described the outcomes of the report </a>as follows:<br />
<blockquote class="tr_bq">
<b>“The report, completed by the independent organisation Verita, investigated Connor’s death and found the following:<br />1. That Connor’s death was preventable<br /> 2. That there were significant failings in his care and treatment<br /> 3. That the failure of staff to respond to and appropriately risk assess Connor’s epilepsy led to a series of poor decisions around his care <br /> 4. That the level of observations in place at bath time was unsafe and failed to safeguard Connor<br /> 5. That if a safe observation process had been put in place and Connor had been appropriately supervised in the bath, he would not have died on 4 July 2013<br /> 6. That the STATT unit lacked effective clinical leadership<br /> 7. That there had been no comprehensive care plan in place for the management of Connor’s epilepsy and his epilepsy was not considered as part of Connor’s risk assessment, in breach of NICE epilepsy guidance<br /><br />The report follows a highly critical CQC inspection published in December 2013 in which the STATT unit failed on all 10 essential standards of quality and safety. Since that inspection report, the unit has been closed to new admissions.”</b></blockquote>
<b><br /></b>Now stop for a second. Go back and read point 5. Sometimes things are horribly simple.<br />
Now go back and read points 5 and 6 together. You might find yourself doing this for some time.<br />
<br />
Just in case you think that Sara’s solicitors might be putting an overly dramatic spin on things, take a look at some of the extracts from the report itself. It can be found on <a href="http://www.southernhealth.nhs.uk/news/report-into-death-sparrowhawk/" target="_blank">Southern Health’s website</a> .<br />
<br />
<blockquote class="tr_bq">
<b>F1 We found no evidence that an epilepsy profile was completed when CS was admitted to the unit. This was a key omission.<br /> <br />F2 We found no evidence that CS had a medical review on admission which should have included a review of his epilepsy.<br /> <br />F3 Epilepsy was not considered as part of CS’ risk assessment at or after his admission to the unit.<br /> <br />F4 The trust care pathway Epilepsy in people with a learning disability map (2012) had not been implemented in Oxford in 2013. This map is based on NICE guidelines which were in place at the time and should have been followed.<br /> <br />F5 There was no comprehensive care plan to manage CS’ epilepsy.<br /> <br />F6 The information in CS’ clinical notes was contradictory in relation to his epilepsy history and care.”</b></blockquote>
<b>A</b>nd here’s an excerpt from the report on what should have been expected and what actually happened <br />
<br />
<blockquote class="tr_bq">
<b>“6.8 Vicki Myson reviewed CS’ clinical notes for this investigation. She wrote in her report to us:<br /> <br />“There was no epilepsy profile completed for [CS] on his admission to the unit. Within the profile I would expect to have seen a history of [CS] epilepsy, a description of all seizure types experienced and a history of anti-epileptic medication. The care of [CS] was multi-disciplinary and, therefore, paramount for all staff involved being aware of seizure types so that they can be accurately observed and reported. When epilepsy was mentioned during written communications the seizure types are only named and not described.”<br /><br />6.9 The records indicate that CS should have been seen by a junior doctor on admission (known as clerking in). This ensures a medical assessment on admission along with decisions about observations, medication and physical care. This would often be in conjunction with nursing admission processes. We have not seen any record of such an assessment.<br /><br />6.16 We found no evidence in the clinical records to indicate that his epilepsy was explored. A number of physical and risk assessments were undertaken and updated during his stay at the unit but none that explored his epilepsy until 23 May 2013. Within CS’ notes there are no individual risk assessments about CS’ epilepsy or assessment of the risk of seizures.<br /><br />Comment<br /> <br />Had the risk assessment been done it should have considered risks associated with activities like bathing and cooking.<br /> <br />6.17 S11 wrote in the health action plan on 14 April that CS had received an epilepsy risk assessment. We found no documentary evidence of this. “</b></blockquote>
<br />
So Connor died in an assessment and treatment unit that seems short on assessment, and treatment, and care. It's hard to see how the professionals there lived up to their duty of care. And the way that the investigation has been handled shows no real sign of living up to the Duty of Candour that was recommended in the Francis report.<br />
<br />
So what now, what next? What can change?<br />
<br />
Sara started a campaign called <a href="http://sarasiobhan.wordpress.com/fundraising/" target="_blank">Justice for LB</a>. It needs support. The truth about the system and people that allowed Connor’s death to happen must come out, and merely saying that lessons will be learned is not enough. Things must change. And simply put, someone who has lost their son should not be left holding the bill for ensuring that happens.<br />
<br />
And it’s not just about LB, it’s for all the young Dudes. There were 5 people in the unit when Connor died. What was treatment like for the other 4? What is it like for others in assessment and treatment units in Oxfordshire, and up and down the country? What’s it like for so many people with learning disabilities, for so many people in residential care - given what we already know through the document<a href="http://www.mencap.org.uk/campaigns/take-action/death-indifference" target="_blank"> Death by Indifference</a>?<br />
<br />
Good assessment, appropriate treatment, genuine care and candour when things are going wrong. We should not expect anything less from health services. No one should. Yet <a href="http://www.cqc.org.uk/public/publications/reports/mental-health-act-2012/13" target="_blank">CQC’s report</a> on mental healthcare show that physical health is too often ignored in psychiatric wards, how can we have hospitals that don’t provide treatment? Physical health problems do not disappear as soon as a diagnosis relating to mental health or learning disability comes along. Treating the whole person is the responsibility of whichever service, and whichever professional is meant to be providing care for you. <br />
<br />
Similarly, the CQC report's examples of ward staff not doing anything to stop intense pain, get someone their dentures, glasses or even a change of clothes for over a week casts some doubt on the willingness of some hospitals to provide basic care. Doesn't that echo Mid-Staffs? Surely that must change? But what will change if even a case as clear cut as Connor’s does not provoke immediate and meaningful action?</div>
<div>
<br /></div>
<div>
#justiceforlb</div>
Anonymoushttp://www.blogger.com/profile/06108770731501761352noreply@blogger.com1tag:blogger.com,1999:blog-2737354133822420799.post-89881679774054042792014-03-06T03:19:00.001-08:002014-03-06T03:19:52.285-08:00An odd form of parity<br />
I've had concerns about access to healthcare for a long time now. When I started working in mental health in the early 1990s, it became apparent that access to basic healthcare was far from simple for many people. Whether because of being away from their home healthcare providers, fear tht saying the wrong thing would raise concerns (and lead to being sectioned), or feeling stressed of not being able to express the problem in a short appointment, getting the right healthcare wasn't easy.<br />
<br />
That's without taking into account <a href="http://shouldtois.blogspot.co.uk/2012/08/the-credibility-gap-pitfall-in-social.html" target="_blank">the credibility gap</a>; the uphill battle of being believed, that this was not "all in your mind" when you have a mental health diagnosis. The idea that you are somehow "unreliable" combinded witht the pernicious term "attention seeking" often made people's journey to healthcare harder. As I started to work with more groups of people I found the same issues. Mencap's report "Death by indifference" gives a chilling catalogue of how poor access to healthcare has led to many deaths. Most advocates will have a story about someone they work with finding out that a DNAR notice had been put on their notes, without their knowledge or consent. In a recent presentation to the Human Rights Law association, Joanna Owen of EHRC spoe of reports demonstrating that older people get less spent on their care packages than younger people with equivalent needs. It can make it hard to have faith in the idea of parity in healthcare.<br />
<br />
Recently, the Care Quality Commission's report <a href="http://www.cqc.org.uk/public/publications/reports/mental-health-act-2012/13" target="_blank">Monitoring the Mental Health Act 2012/13</a> raised the issue of physical healthcare of peoplep in psychiatric wards. The picture that emerged was not good. 14% of people were on wards with no access to a GP. None. It described the case of one woman in sever pain, limping badly who was not povided with access to chiropody. Having been forced to miss one appointment due to hospital transport not turning up, the staff felt it acceptable for the woman to wait another 2 weeks for an appointment.<br />
<br />
Another case was described where a woman had been left without access to her glasses, dentures or a change of clothes for a week. She had also requested a dressing for an injury to her foot that was not provided. If someone were to not change clothes, put in their dentures, wear their glassess and leave an open wound on their foot when on a community treatment order it might be used as evidence of poor self care and self neglect. In a hospital environment it was seen as an unfortunate side effect of staff beign busy.<br />
<br />
The final example given in the report is of a woman on a psychiatric ward who, after returning from an invetigative procedure at another hospital, was told she must go out as there were not enough stafff on the ward to look after her. This was depite a letter from the hospital saying that she would need someone to remain with her at home after the procedure. When she returned to the ward, unsurprisingly unwell, she was put into seclusion.<br />
<br />
How can it be that people are having problems getting basic nursing care in a hopsital? How can the level of expectation for support be greater in someone's own home than it is in a building staffed by care professionals? Surely you should be able to see a doctor in hospital?<br />
<br />
Looking at the CQC report into deaths in inpatient units, many are noted as having natural causes. I suggest that risk of death by natural causes greatly increases if you do not have access to healthcare.<br />
<br />
The Royal College of Psychiatrists report "Wholeperson Care: from rhetoric to reality" sets out an agenda to tackle disparities in the provision of physical and mental health care. It's a bizarre way of achieving this parity, degrading the level of physical healthcare in psychiatric hospitals to that of mental healthcare in general. In both cases, the other side of healthcare is seen as another service's problem. So much for whole person care. So much for the person.Anonymoushttp://www.blogger.com/profile/06108770731501761352noreply@blogger.com0tag:blogger.com,1999:blog-2737354133822420799.post-15643496731607564392014-01-29T03:28:00.002-08:002014-01-29T03:28:40.170-08:00Short post, big problemCQC have just launched their report <a href="http://www.cqc.org.uk/sites/default/files/media/documents/cqc_mentalhealth_2012_13.pdf" target="_blank">Monitoring The Mental Health Act 2012/13</a>.<br />
I'll be writing about this in more detail soon, but here are some headlines to consider:<br />
<br />
<br />
<br />
<ul>
<li>10 % of care plans don't include the least restrictive option</li>
<li>27% of care plans show no involvement of the patient</li>
<li>29% of care plans do not include a discharge plan</li>
<li>20% of visits showed evidence of de facto detention</li>
</ul>
<br />
Many of the failings identified have remained the same for 2 years.<br />
<br />
There is still highly disproportionate detention rates for the following groups:<br />
<br />
Black African (2.2 times higher),<br />
Black Caribbean (4.2 times higher),<br />
Other Black (6.6 times higher)<br />
and Other groups (2.1 times higher).<br />
<br />
There was also a finding of the widespread usage of blanket rules that have no basis in law. The staff enforcing them were often unable to say why the rule existed. So, illegal and illogical then?<br />
<br />
The section on access to healthcare whilst in hospital is shocking and distressing. Some would have thought that a hospital was the very place to get healthcare. Apparently not.<br />
<br />
The report states note that access to IMHA has increased - 92% of ward managers say the ward has direct access to IMHA services but given that 18% of people aren't told of their right to an IMHA it's difficult to see how this translates into meaningful access. Also last year's report stated that the lack of consistent ward presence meant that many people had no meaningful access to an IMHA. Use of compulsory powers of the act have risen in the past year, funding for IMHA hasn't. Not sure how access to IMHA has significantly raised in this environment.<br />
<div>
<br /></div>
There's also a case study about IMHA that I find really unusual. I'll almost certainly be writing more about that, but if you're curious, please read pages 10 and 11. I'd like to hear your comments.<br />
<br />Anonymoushttp://www.blogger.com/profile/06108770731501761352noreply@blogger.com0tag:blogger.com,1999:blog-2737354133822420799.post-18807246027770756802013-12-05T13:45:00.000-08:002013-12-05T13:45:40.887-08:00Quality Performance Mark UpdateIn the last few months I’ve been asked by a number of people what is happening with the Quality Performance Mark. The future of the QPM has been up in the air for a while but now appears to be settled. <br /><br />NDTI have taken on the QPM and are going to be going through a review process in the next few months. I understand that this means it will not open for submissions or renewals until April next year. <br /><br />I’m proud of the role I played in developing QPM. Good luck to NDTI in their work of defining, assessing and celebrating protect high quality independent advocacy; protecting empowering services that make sure people’s rights are a reality. Something as important as advocacy has to be done well. <br /><br /><br />If you have any enquiries about the QPM they should be sent to <a href="mailto:a4aqpm@ndti.org.uk">a4aqpm@ndti.org.uk</a>Anonymoushttp://www.blogger.com/profile/06108770731501761352noreply@blogger.com0tag:blogger.com,1999:blog-2737354133822420799.post-3935639287879348792013-10-25T03:26:00.000-07:002014-03-12T05:36:39.868-07:00Whitewash and WonderlandAnyone who has been following @sarasiobahn’s remarkable blog <a href="http://mydaftlife.wordpress.com/">My Daft Life </a>will know about the death of her 18 year old son whilst he was in an NHS care facility. In Sara's blogs, her son (referred to as Laughing Boy, LB or The Dude) comes across as a remarkable person. This young man had epilpesy, and he died whilst having a bath in an assessment and treatment unit. It is appalling that she is having to face the aftermath of this loss. It is obscene that the investigation into his death has become a battle.<br /><br />She is now having to navigate her way through an internal investigation into the death of her son, and the nature of that investigation is becoming a little strange. It’s a worrying example of the lack of transparency of the NHS when dealing with failings. All those words about involving families, learning from events, transparency and openness that have appeared in so many reports recently seem stretched to breaking point here.<br /><br />One aspect of that bizarre process is the trust's odd use of the word advocate. I know a bit about advocacy - I've spent the last 10 years developing standards and quality systems in advocacy. I'm interested in the relationship between formal and natural advocates. I think both are vital. Until processes and services are designed to suit people rather than systems people will need advocates of one kind or another.<br /><br /> Sara was told that she could have an advocate at stages of the investigation. This could be seen as a way of bringing some transparency to the process. By “advocate” they meant a friend or family member. No problem there; friends and family members often play a natural advocacy role. It’s not the same as an independent advocacy role (the thing that I know most about) because family and friends automatically have a level of conflict of interests, they have another role in that person’s life. As I said, not a problem when that is the person that someone wants to be involved. It’s an odd use of the term advocate, but it does have an echo in a piece of research on the<span style="color: blue;"> <a href="http://www.blogger.com/">value of advocacy and supporters in child protection proceedings</a>.</span><br /> <br /> The trust could have suggested that she could have an independent advocate; someone who would have no other role in Sara’s life, who would look out for and avoid conflicts of interests. That’s something that would be a legal right if this were a complaint process rather than an investigation. But that’s not what happened. As it turned out Sara asked a friend who also happened to be an independent advocate to be involved.<br /> <br /> Then something odd happened. The trust said this person couldn’t be the advocate because they had a conflict of interests; she occasionally volunteers for a charity whose Chair used to work for the trust’s predecessor. I find it hard to see that as a realistic conflict of interests. And let’s remember, the trust had <b><i>specifically not tried to find an advocate without a conflict of interests</i></b>.<br /> How big is the possibility of conflict of interests? Well, if the “advocate” worked for the trust it would be a <i><b>BIG </b></i>conflict. Used to work for the trust? <i>Some conflict</i>. Worked for a former worker of the trust – <i>potential conflict</i>. Volunteered for an organisation, being supported by someone who reported to someone who had retired from the predecessor of the trust? The phrase vanishingly small comes to mind.<br /><br />I make it four degrees of separation. There's a theory that you'll be able to connect to anyone in the world in six. Given that, it would be hard to find anyone in a local area that can’t be connected to someone else through in four links.<br /><br />Then the trust appear to have made an even stranger decision. They said that Sara had now forsaken her right to choose an advocate and that one would be appointed for her. And that this “advocate” would not be able to tell Sara about what was happening in the investigation.<br />
<br />
So that’s someone that wasn’t asked for and who will keep information confidential from the person they’re meant to be representing. That’s not independent advocacy. It’s not a natural advocate. It doesn’t conform to any of the principles or reasonable expectations of what any type of advocate might be. I don't see how it can realistically be described as any form of advocacy. In fact, the word advocacy can only be used if the trust are employing the Humpty Dumpty convention that “words mean whatever I say they mean”.<br /><br /> <br />
So there was no advocate. A measure that was meant to introduce some transparency into an internal investigation into the death of a young man had been warped into another aspect of the investigation from which LB’s parents are excluded. The window into the investigation was blocked up. The circumstances of the death of LB need to be thoroughly and transparently. But how can anyone have confidence in the process where transparency is whitewashed, where Humpty Dumpty investigates?<br /><br />Pressure from Sara's team of supporters and social media has led the Trust to reconsider, and Sara's original advocate is now to be involved again. As she said on an update post,<br /><br />"Thanks to Team LB for such an instant and remarkable response to her removal, and the power of social media for such dedicated and collective support. And good on the Trust for listening and responding."<br />
I'm really glad that this has changed, but this should never have been necessary. There should never have been a need to struggle and battle for support. It wouldn't have been needed if the trust had remembered that the focus here must be on Sara, her family and The Dude. Here's hoping the change on advocacy reflects a wider change.Anonymoushttp://www.blogger.com/profile/06108770731501761352noreply@blogger.com0tag:blogger.com,1999:blog-2737354133822420799.post-49856633169880566512013-09-19T10:23:00.002-07:002013-09-19T10:23:26.630-07:00Comparative law - that's the way it is<div class="MsoNormal">
Comparative law</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Anyone remember the riots?</div>
<div class="MsoNormal">
You know, the disturbances over a couple of nights in a few
cities. A few hundred people were involved and the media was all over it. Come
on, you must remember it. All night courts and massively harsh punishments
delivered to make people clear that “this will not be tolerated”. Nick a bag of
rice? That’ll be two years in jail. Remember it now?</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
OK.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Anyone remember the Mental Health
Act? You know, that piece of legislation that was meant to protect rights of
people in psychiatric hospitals; a
reaction against the barbarous excesses of the old asylums. The one that was
amended in 2007 to ensure that people had support in understanding and making
use of their rights. Oh you must remember it, the CQC report on it every year.
They always say how people aren’t being given what is theirs by right. They
talk about unlawful detention, of using the threat of being sectioned to keep
people on the ward. They’ve reported year on year that the law is being broken
in thousands of cases. God, the judges mustn’t be able to catch a break, eh?
All night sittings for a few hundred offences, imagine what the work load is
for dealing with these ongoing, systematic breaches of the law.</div>
<div class="MsoNormal">
What’s that? No prosecutions? Not
one? Well, surely it can’t be through lack of evidence, I mean there’s reams of
the stuff in the CQC reports. And surely it can’t be through a lack of access
to legal systems, I mean it’s the CQC. They must have a lawyer or two knocking
around the place. Surely they’ve not been hamstrung by cuts to legal aid.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
So what’s going on?</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
To the untrained eye it appears
that depriving someone of their liberty and dignity are things best addressed
by holding up a mirror and going tut. Depriving a supermarket chain of a bag of
basmati will bring down the full force of the law. To my untrained eye this is wrong. </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
It’s a comparative law system.
Some laws are enforced, others are write only documents. What happens when a
health service or one of its employees breaches the mental health act? What is
the penalty when this is done again and again, year after year? Where is the
motivation to change when your failings are reported on but nothing happens? </div>
<br />
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Laws or frameworks that are not
enforced are mere fig leaves of protection; they tell us what should be and
ignore what is happening. This has a corrosive effect on people’s understanding
of the law and of their rights. As I remember the reason for punitive
sentencing of rioters was that the rule of law would otherwise be undermined.
The number of people who put up with injustices in the care system because
“that’s just how it is” tells us that the rule of law has already been
undermined here. Something needs to change.</div>
Anonymoushttp://www.blogger.com/profile/06108770731501761352noreply@blogger.com0tag:blogger.com,1999:blog-2737354133822420799.post-92172281270304761542013-08-23T15:52:00.003-07:002013-08-30T01:24:54.475-07:00The point of advocacySome people have asked me why I keep banging on about advocacy.<br />
<br />
Well, imagine that you need support, or care, or housing or a GP.<br />
<br />
Now imagine that you are <a href="http://shouldtois.blogspot.co.uk/2012/08/the-credibility-gap-pitfall-in-social.html" target="_blank">routinely disbelieved </a>or given poorer services.<br />
<a href="http://www.mencap.org.uk/campaigns/take-action/death-indifference" target="_blank">That you don’t get access to a GP</a>.<br />
Or that your physical health problem are ignored or put down to your mental health .<br />
<br />
Or imagine that you are in a care home where you are being abused by the staff. <br />
Or that in your care home <a href="http://www.olderpeoplewales.com/en/news/news/12-09-18/Voice_Choice_and_Control.aspx" target="_blank">you feel like you have no say </a>at all in what happens or what you do.<br />
<br />
Imagine finding out that someone put a Do Not Resuscitate notice are put on your file.<br />
That they did this without your knowledge because they believed your life had no quality or value.<br />
That they didn't ask you because you are old, or have a learning disability, or have a diagnosis of depression.<br />
<br />
<br />
Then imagine that there was a thing called advocacy that could help you be listened to.<br />
<br />
Imagine the difference that it would make to have someone standing alongside you.<br />
Someone whose presence actively demonstrates that they think that you matter.<br />
Someone showing that you are not alone, that you are part of our wider society.<br />
Someone who treats you with respect and who expects others to do the same.<br />
<br />
Someone who helps you to be heard.<br />
Someone who is there to make it harder for others to ignore your voice, you rights.<br />
<div>
Someone who makes it harder to ignore you.<br />
<br />
<b><i>That's the point of advocacy. </i></b></div>
<div>
I think that's worth banging on about. It needs to be kept on the agenda.<br />
<br />
Other people ask why anyone should care that Action for Advocacy has closed?<br />
<br />
Well, put yourself back in that position.<br />
If advocacy was available, you’d want to know about it. </div>
<div>
You'd want an advocate who could be there for you.</div>
<div>
Someone who knew what they were doing.</div>
<div>
Someone who could do these important things as well as possible.</div>
<div>
<b>Advocacy is too important to get wrong.</b> </div>
<div>
<div>
<br />
Advocates need to be trained, accountable, clear about their role and supported to deliver this..</div>
<div>
Advocacy organisations need to be robust, independent and able to challenge poor practices.</div>
<div>
That's what a4a was trying to achieve. </div>
<div>
We got part of the way, but it can't be left there.<br />
<b>We need to talk about what happens next.</b><br />
<br />
I need your help.<br />
I want you to get involved, have your say & help decide what happens.<br />
If you're interested email <a href="mailto:martin@truevoicetrust.org">martin@truevoicetrust.org</a> and I'll get in touch soon.<br />
<br />
As ever, comments welcome.<br />
<br />
<br /></div>
</div>
Anonymoushttp://www.blogger.com/profile/06108770731501761352noreply@blogger.com5tag:blogger.com,1999:blog-2737354133822420799.post-80402557684593988002013-08-19T02:26:00.001-07:002013-08-19T02:26:41.817-07:00Action for Advocacy - a kind of obituaryIt is with some regret that I have seen the notice that <a href="http://actionforadvocacy.org.uk/articleServlet?action=display&article=2133" target="_blank">Action for Advocacy has ceased trading</a>.Although the organisation continues to exist for the present, I think it fair to assume that this marks the end of a4a as an active force.<br />
<br />
In the past couple of months I have been asked about this many times by many people. In fact, I had expecting the future of a4a to be announced before I left the organisation in May. However, this didn't happen and I have not made any public comment until now. I was hoping to ensure that the future of the Quality Performance Mark was secured and, having been informed that a new home will be found for the QPM, I want to flag up some of the organisation's work which I think deserves recognition.<br />
<br />
Having started in 2001 under the name Advocacy Across London, a4a's work spanned 12 years that saw remarkable change in the independent advocacy sector. a4a started in a period when independent advocacy was only known about by a small group of people. The external perception of advocacy as that it couldn't make up its own mind about what it was. The idea that it would one day be a part of legislation was beyond fanciful. The idea that it would have an agreed quality framework, cited in commissioning guidance seemed implausible.<br />
<br />
I joined in 2006 as the National Development Officer and held a number of roles since then. I'm proud to have worked with some remarkable people, to have been involved in an enterprise to try to make the vision of a strong and equal voice for all citizens a reality. I personally got to see the work of a couple of hundred advocacy organisations and met countless advocates. Almost without exception, they were inspirational.<br />
<br />
I believe a4a did some great work, and it did it with a pretty small team. I also know that a4a made mistakes, got things wrong and occasionally messed up on a grand scale (I'll put my hand up to a couple of those). When it did that, it was usually because it was trying to do something good.<br />
<br />
Now it's effectively gone. I won't get into the why, how or who's fault stuff here, although I'd be lying if I said I don't blame myself to a certain extent. It was singularly unfortunate that I needed to take time off for health reasons at precisely the time a4a needed the most support.<br />
<br />
Anyway, this is an obituary, not an autopsy. However, I decided to take 5 minutes to jot down some of the things that a4a did in its time; just to take stock. Here's what I came up with...<br />
<br />
<ul>
<li>The Advocacy Charter</li>
<li>The London Support Project</li>
<li>Developing A Code of Practice for Advocates </li>
<li>Quality Standards for Advocacy Schemes</li>
<li>Founder member of Advocacy Consortium</li>
<li>Supporting the inclusion of advocacy included in the Mental Capacity Act</li>
<li>Promoting Independent Mental Health Advocacy in the Mental Health Act</li>
<li>Human Rights Toolkit for Advocates</li>
<li>Promoting understanding of Non-Instructed Advocacy</li>
<li>Training over 5000 advocates</li>
<li>Developing and running the ILM accredited Managing for Excellence in Advocacy</li>
<li>Standards Support Project which supported hundreds of advocacy organisations raise quality</li>
<li>Developing the Quality Performance Mark</li>
<li>Member of the Care and Support Alliance</li>
<li>Representing independent advocacy in parliament</li>
<li>Advocates forums - both in person and online</li>
<li>IMHA support Project</li>
<li>IMCA support project</li>
<li>Free online map of advocacy services</li>
<li>Lost in Translation - developing a framework for recording soft outcomes in advocacy</li>
<li>Supporting organisations to prepare for contracts and tendering</li>
<li>Challenging poor tender documents</li>
<li>Representing advocacy organisations to commissioners</li>
<li>Planet Advocacy Magazine </li>
<li>Advocacy Commissioners' Support conference and emails</li>
<li>3 National IMCA conferences</li>
<li>Working with Welsh Government to develop monitoring framework for IMHA in Wales.</li>
<li>Highlighting shortfalls in IMHA commissioning in national media</li>
<li>Giving evidence to Joint Scrutiny Committee on the Social Care Bill</li>
<li>Review of rollout of IMHA in the North East</li>
<li>Review of learning disabilities funding in Wales</li>
<li>Review of use of IMCA in Safeguarding</li>
<li>Influencing the guidance on IMHA in Mental Health Review tribunals</li>
<li>First official review of the advocacy workforce</li>
<li>Keeping the sector informed on policy consultations</li>
<li>Input into CQC Mental Health Review report</li>
<li>Safeguarding courses</li>
<li>Responding to countless (and seemingly increasingly quick) policy consultations</li>
<li>Role of advocacy in financial abuse situations</li>
<li>Signatory of the Winterbourne Concordat</li>
<li>Hundreds of In House training sessions</li>
<li>Joint work with British Institute of Human Rights, British Institute for Learning Disabilities, National Development Team for Mental Health, Mind, Equality and Human Rights Commission, Scottish Independent Advocacy Alliance, Inclusion North, Valuing People Support Team, Advocacy Wales, Mental Health Foundation......</li>
</ul>
...and I know I've missed lots of stuff out. Some would say that's pretty good for 12 years. I know I always felt we needed to do more.Maybe that was part of the problem.<br />
<br />
To everyone who worked at a4a in its lifetime - thanks for putting in your time, effort, energy and skills. You gave much more than you might have needed, you were committed to helping us change things.. For all trustees, thanks for your part in the journey.<br />
<br />
We all believed in working for a society where all citizens can be sure of a strong and equal voice. We didn't get there, but I do think we made some difference and much of those ripples that we caused will carry on. To the funders, especially The Baring Foundation, City Bridge Trust, Department of Health, Awards for All, and Department for Education, thanks for supporting the work. In fact, this being a personal blog, particular thanks to the Baring Foundation for believing in independence, believing in us and for sticking with us. They are, without doubt, the most positively engaged funder I have ever worked with.<br />
<br />
In the end, we knew that we were only a small part of a story. The real work must be done by organisations, advocates and ultimately by those who challenge the inequality and poor service delivery that they face on a daily basis. In my time at a4a it was a privilege to meet so many committed, skilled and stubborn people who were determined to make a difference. That was one of the things that kept me going, through seemingly endless journeys on public transport throughout England and Wales. It is some comfort to know that there is no shortage of people out there who are carrying on that fight, championing voice, choice, control and dignity for all.<br />
<br />
So raise a glass - for good or ill, a4a is no more.<br />
<br />
Salut!<br />
<br />
....I wonder if anyone will miss usAnonymoushttp://www.blogger.com/profile/06108770731501761352noreply@blogger.com10tag:blogger.com,1999:blog-2737354133822420799.post-45794497854339307802013-07-24T02:34:00.003-07:002014-03-24T09:08:16.129-07:00To The Barricades?In the last few posts I've used information from a CQC publication to show a few, widely acknowledged problems with the mental health system in England. The first showed that over <a href="http://shouldtois.blogspot.co.uk/2013/06/12000-people-is-that-much-of-problem.html" target="_blank"><span style="color: blue;">12,000 people are being denied their legal rights</span></a>. The second showed that<span style="color: blue;"> <a href="http://shouldtois.blogspot.co.uk/2013/07/a-legal-wrong.html" target="_blank">poor commissioning has led to people being denied their rights</a></span>, and gave some suggestions for changing this. The <span style="color: blue;"><a href="http://shouldtois.blogspot.co.uk/2013/07/bang-to-rights.html" target="_blank">most recent post</a> </span>pointed to wider problems of illegal detention and treatment of people in psychiatric hospitals, of an attempt by some staff to outsource their legal responsibilities for providing people information.<br />
<br />
This collection of statements should shock us. The fact that most people who have had dealings with the mental health system will not be shocked by them troubles me deeply.There seems to be a widespread resignation that things are like that, that change is unlikely, that we should settle for small victories. I no longer want to settle.<br />
<br />
I've had a lot of discussions with people as a result of those blogs. Most agree that the situations is appalling. However, when asked how things should be changed the answers dry up somewhat.<br />
<br />
Take the example of underfunding of <a href="http://www.mindcharity.co.uk/servicesinpatients.asp" target="_blank">IMHA services</a>. IMHA is accepted as having a key role in supporting people to have more control over their care in very distressing situations. Yet despite proof that IMHA is generally underfunded, that this has been known since at least 2009, that people have a legal right of access to this service and that this is being denied to thousands, nothing happens. People point out that if we were to fund the IMHA service properly it would lead to reductions in funding for other kinds of advocacy, that maybe we shouldn't be rocking the boat. I don't believe we should be picking and choosing which legal rights we are willing to fight for.<br />
<br />
Given the importance that CQC rightly places on people having a voice in their own care, and the fact that CQC reports have repeatedly observed a systematic breaching of people's rights to an IMHA, I might naively expect them to take some action. I have been told that the noting of these breaches leads to a pressure, a knowledge that services should improve their practice, the weight of expectations. Unfortunately, I still believe the title of this blog is relevant - that the distance from "should" to "is" is immense. If CQC does not have some means of implementing the service improvement aspect of its role, of compelling change in a system which it has identified is malfunctioning, it creates a vacuum that leads either to anger or despair.<br />
<br />
So what happens next? How are professionals, services and commissioners meant to be held to account? Unless there is some concerted action by CQC in this regard, it appears that the responsibility lies ultimately on people who are being mistreated and denied their rights. I have heard many people say that things won't change until someone takes a professional or authority to court . Not so much "to the barricades!" as "To the barristers!"<br />
<br />
I feel that this is highly unfair. It should not be up to the people who use a hospital to make the system work. Nevertheless, as things currently stand we are placing responsibility for maintaining dignity and rights upon the very people who are having these things denied them.<br />
<br />
Personally I do not want to see the money that is so badly needed to support good care being diverted into legal battles, costs and damages. I don't want people to have to fight for good care. I don't want to see hard worked doctors or nurses sued for treating someone without obtaining their consent as a result of inappropriate threats of detention. These do not seem like good uses of energy, but in the absence of other moves towards addressing the situation they seem increasingly likely.<br />
<br />
Of course, one barrier to legal challenges being raised is that often people aren't aware of their rights or of their ways of accessing justice. That doesn't have to be the case. There are ways in which people could be supported to raise legal challenges more easily; ways that a link could be forged between individuals, service user groups and the legal profession.<br />
<br />
I'm reminded of the yellow card scheme for reporting undocumented side effects of medication. Any time someone talked about a doctor disbelieving them when they described unwanted side effects of the medication they were taking, you could pull out a card on which to record this and send it to a central point for collation. The view of one person might be discounted. The accumulated experience of hundreds or thousands are harder to ignore.<br />
<br />
Think of how many service user groups there are out there. Think how many advocacy providers. Think how many local services or support systems for people facing mental health issues. These are all points of potential access, information and support. Imagine how easy it would be connect these experiences now in this age of social media. Imagine how many legal challenges could arise - my quick calculation in my first blog puts the potential number above ten thousand. That's starting to sound quite expensive to me.<br />
<br />
So should we spend public money ensuring people have dignified, appropriate and <b><i>legal</i></b> treatment that supports people towards recovery or should spend it instead fighting legal battles to defend a system that isn't working properly? I believe that positive change is the better route but I'm willing explore alternatives.<br />
<br />
I'm in the process of developing an organisation called True Voice. I'm going to use it for various things, one of which is to do some campaigning. If you're interested in continuing this conversation, either comment below or <a href="mailto:ask@truevoicetrust.org" target="_blank">email me </a>Anonymoushttp://www.blogger.com/profile/06108770731501761352noreply@blogger.com5tag:blogger.com,1999:blog-2737354133822420799.post-4959426999720977082013-07-10T02:16:00.001-07:002013-07-10T02:16:34.841-07:00Bang to RightsThere’s a recurring trope in police and procedural dramas. After the chase, the bending of the rules, the adrenalin charge and the (inevitably) emotional arrest, someone starts to intone, “You have the right to remain silent….”. It’s not only about a grounding in the real world. It’s a signifier. The crisis is over, normal service has been resumed, justice has retaken its natural guise. Even in these hyper-charged dramas, you’ve got to tell people their rights, right? Right.<br /><br />Now, imagine that you’re in a psychiatric hospital. You’re scared, but you’re not a criminal. You’re ill or at least perceived as being ill. If you’ve been detained against your will you are now experiencing the effects of the Mental Health Act (MHA) one of the most powerful pieces of legislation on the statute books – and you’re on the wrong end of it. Unless you’re somehow working in the mental health area you probably won’t know what the powers mean. But now that the drama’s over you’ll be told your rights, right? Well, sometimes. <br /><br />Giving people information about their rights is one of the obligations of those using the Mental Health Act. For that reason, it’s one of the areas examined in the CQC report, <a href="http://www.cqc.org.uk/public/reports-surveys-and-reviews/reports/mental-health-act-annual-report-2011/12" target="_blank">Monitoring The Mental Health Act</a>. The data in the last report suggests that people are often not told their rights, showing that 10% of people appear not to have been given information about their rights under the Mental Health Act at the start of their detention. It stated that,<br /><br /><span style="color: #073763;"> “MHA Commissioners reported a lack of evidence of staff discussions with patients about their rights on 458 visits overall. In some cases discussions had taken place but they were not recorded; in others patients were unaware of or unclear about their rights. In a number of cases the relevant forms (section 132) were missing or incomplete.”</span><br /><br /><div>
Unsurprisingly, the area where the least information was given was on people’s right to access an Independent Mental Health Advocate (IMHA). One of the roles of the IMHA is to help people understand and realise their rights. There was no evidence of telling people of this right in 21% of records. There was often no effort to contact an IMHA service for the person if that person was unable to do so themselves. But I want to come back to rights in a wider sense, so I’m going to do something unusual. I’m not going to bang on about advocacy. I’m going to talk about outsourcing instead.<br /><br />The hospital has the legal duty to tell people their rights. Usually this is delegated through ward staff, but the duty remains. That’s why I was alarmed to read the following section of the MHA report:<br /><br /><span style="color: #073763;">“The Code suggests that it will usually be appropriate for professionals working with the patient to provide the information about rights required by statute. In some instances, CQC is concerned to see this role delegated to IMHAs. Although IMHAs also have a statutory role to give patients information about their legal status, their rights and how to exercise them, this duty is described in the Code of Practice as an “additional safeguard”. It does not relieve nursing staff or other professionals who work under the direction of the hospital management of their duties under section 132.”</span><br />Well, quite. <br /><br />Mental health staff can not outsource the provision of information about their own curtailment of people’s rights. That would be an abrogation of responsibility. It could be seen as part of a package where involvement, treating people with respect and dignity, supporting people to make their voice heard and ensuring person centred care is somehow seen as someone else’s job. Obviously this would never happen, it’s just hyperbole. Probably some glitch in the system led to a belief that discussing rights was the IMHA’s job, right? Erm,…<br /><br />I’d be more inclined to believe that were it not for a long standing problem in mental health, one which prompts me to remind you what a psychiatric ward is. It’s part of a hospital – you know, the kind of place you go to for care and treatment. The combination of media portrayals of mental illness and the weight of the MHA can sometimes obscure this fact, but it’s important. So, not everyone on a psychiatric ward is detained under section. That means they can leave any time they want, right? Well, yes, but, only in theory.<br /><br />In reality many people who are voluntary patients hit a barrier when they try to leave. They’re told that they will be sectioned if they go out of the door. So, you’re free to leave unless you try to. This piece of logic is so deliberately perverse it deserves the name Catch 23. And it is not legal. Yet anyone who has worked in mental health knows that this happens with depressing regularity. The powers which are regularly used by staff on psychiatric wards, to detain and to treat without consent, do not inherently arise out of a professional status. Nor is the loss of rights an inherent consequence of mental health problems. Both come from the MHA, a piece of legislation of that is meant to protect the rights of people. Using the Mental HEalth Act as a threat suggests a system too used to the concept of coercion, of enforced compliance. A system that has forgotten where its powers end.<br /><br />The <a href="http://webarchive.nationalarchives.gov.uk/20130107105354/http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_084597" target="_blank">Mental Health Act Code of Practice</a> could not state the law more clearly.<br /><br /><span style="color: #073763;">“4.12 The threat of detention must not be used to induce a patient to consent to admission to hospital or to treatment (and is likely to invalidate any apparent consent).”</span><br />I agree with the twitter commentator <a href="https://twitter.com/Ermintrude2" target="_blank">Ermintrude</a> (Registered Social Worker, ex-AMHP and ex-Best Interests Assessor) this piece of information should be on an poster in every mental health ward in the country.<br /><br />Because the thing about rights, the important thing, is that you can’t use them if you don’t know you’ve got them. And if your only means of finding out about your rights is through the very people most likely to infringe them, I’m not convinced that will work. It would be like asking someone to open a box with the crowbar contained inside it. Or like delegating the provision of information to an IMHA service you’ve not told the person about. Frankly, it would be madness.<br /><br />So back to illegally coerced treatment. How many care professionals have forgotten the meaning of informed consent, and the legal liabilities that attach to treating people without this consent? What legal options would you take if someone gave you powerful medication that can have serious side effects without your consent? I doubt I’d want to put it down to experience or accept it as the natural way that a system works. Yet every person who has been subject to the coercive threat of detention has experienced just that thing. It’s a wrong that is well known, and it needs to change.<br /><br />I believe that it is vital that people know what their own rights are in care and treatment so that they can make use of them; so they can hold remind care professionals of their duties and protect their own rights. <br /><br />So this is where I ask for your help. What are the common wrongs that you know about? What information should everyone have available? Either leave a comment below or email <a href="mailto:ask@truevoicetrust.org">ask@truevoicetrust.org</a> and I’ll see what I can put together.<br /><br /> <br /><br />Next time, a question of accountability.</div>
Anonymoushttp://www.blogger.com/profile/06108770731501761352noreply@blogger.com0tag:blogger.com,1999:blog-2737354133822420799.post-21864140985244476362013-07-02T15:55:00.003-07:002013-07-04T02:00:39.608-07:00A legal wrongIn my <a href="http://shouldtois.blogspot.co.uk/2013/06/12000-people-is-that-much-of-problem.html" target="_blank">last post</a> I showed that at least 12,000 people are being denied there legal right to access independent mental health advocacy. The <a href="http://www.cqc.org.uk/public/reports-surveys-and-reviews/reports/mental-health-act-annual-report-2011/12%20." target="_blank">CQC report -Monitoring the Mental Health Act</a> also states that 1 in 8 people who contact the IMHA service don't get to see an advocate. Given that IMHAs have a duty to respond to referrals, yet the report says that 1 in 8 people who request an IMHA do not get to see one. How can that happen? Are advocacy services wilfully ignoring their legal duties?<br />
<br />
My experience suggests not. It has been known since 2009 that advocacy services have been underfunded in regards to IMHA provision. This was recognised in the CQC report for 2010/11. Since then, despite increasing use of compulsory powers of the Mental Health Act, the funding of IMHA seems to have (at best) stayed constant. If demand increases and supply stays constant a shortfall is inevitable. There is a problem with commissioning.<br />
<br />
If the role of advocacy is to be developed in any way as a result of the abuse at Winterborne View, it would be in ensuring regular access to in-patient settings that do not depend on a referral. However, the CQC report shows that roughly one quarter of settings have no regular access to IMHA. That means the lessons of Winterborne are a long way from being acted upon.<br />
<br />
A regular IMHA presence within in-patient settings is necessary if people's rights are going to be real rather than theoretical. This regular presence reduces the ability for staff to block access to advocacy services, allows advocates to see the regular ward environment and gives advocates the ability to perform a minor, proactive safeguarding role; spotting and challenging poor practice affecting people they are not directly advocating for. These actions would not be sufficient to guarantee the safety of patients and residents in care settings, but that responsibility lies ultimately with care staff. Advocacy's small role here is to act as a warning, a reporting mechanism, a means of identifying problems before they become disasters.<br />
<br />
However, many advocacy services do not even have the resources to respond to the specifically requested need they face, never mind providing more proactive services to reach those who might not be able to ask for advocacy themself. As a result many people who are eligible for an IMHA never find out about it, and many who ask for support do not receive it. Some IMHA services even find themselves having to make tough prioritisation decisions about referrals that they receive; referrals to which they have a legal duty to respond. Sometimes, by the time they can respond to someone, that person is no longer there. This is no small thing. It is the denial of a legal right, and it has major consequences at a personal, financial and legal level.<br />
<br />
At a personal level, I suggest that being deprived of support you were promised at a time of extreme distress is far from ideal. It adds to distress and suggests that you are not a high priority; your rights are secondary. From a financial perspective, plans that people actively collaborate in are more likely to be effective and create long term well being. That's a lot cheaper than poor planning and multiple re-admissions. Oh, and the person themself will have a better experience and be more likely to be treated with respect. Thirdly, legal duties are meant to be enacted. They are made to be real and tangible, they are not meant to be put into statute for political expediency or as some kind of window dressing. Local authority commissioners now have the responsibility to for facilitating this.<br />
<br />
So what about the commissioners? Now that responsibility for commissioning IMHA has moved over to local authorities are we likely to see the legal obligation to resource advocacy provision better met? The CQC report seems to project a positive picture. It cites the important report <a href="http://www.uclan.ac.uk/research/environment/projects/the_right_to_be_heard.php" target="_blank">The Right To Be Heard </a>by Karen Newbigging and colleagues at the University of Central Lancashire. This called (amongst other things) for IMHA to become an opt out rather than an opt in service. The CQC report states,<br />
<br />
<span style="color: #0c343d; font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">"Commissioning of IMHA services moves to local authorities in April 2013, although responsibility for promoting access will remain with providers. Local authorities will be taking on this commissioning role at a time of financial austerity, and CQC hopes that the recommendation of the research is heeded"</span><br />
I find it surprising to see a regulatory body publicly deferring to hope over experience or expectation.<br />
<br />
The need for some level of regular outreach presence does not seem to have been recognised sufficiently by commissioners, never mind presumed access. Advocacy services have reported funding levels that are reducing despite an increase in demand and eligible populations. Advocacy is simply not seen as a high enough priority and the right to advocacy is seen as fudgeable because those who lose out are unlikely to take the matter to law.<br />
<br />
The commissioning of advocacy has been widely variable across local authority areas.Too often, contract size is determined before need is established. The person holding the advocacy commissioning portfolio seems to change with depressing regularity.<br />
<br />
Does CQC's apparent reluctance to get involved in this aspect this may be explained by the inherent difficulty of finding the person or persons responsible for commissioning advocacy. Without a direct line to influencing, might CQC find it difficult to exert influence in this regard?<br />
<br />
It has been suggested by some that IMHA commissioning will only become a priority when a local authority is sued by someone who was denied access to a right set out in law. That seems to place the responsibility on precisely the wrong person. Who should challenge poor commissioning practice, an individual aiming to recover from a traumatic incident or a regulatory/monitoring body. CQC is aware of large scale, systematic failure to comply with legislation. It has publicly stated this in its two most recent reports on the Mental Health Act. Is there not some obligation to act on this? Surely monitoring is not enough when improvement is so clearly needed.<br />
<br />
So, not wanting to offer problems without some possible ways of addressing them, here are a few ideas that might help CQC to address this problem:<br />
<br />
<ol>
<li><b>Ensure that the line of CQC's enquiries about IMHA service commissioning goes via the Director of Adult Social Services. Local </b>authorities can change their commissioning team as they see fit. The Director of Adult Social Services should know who is responsible for meeting this legal obligation.</li>
<li><b>Ask to see how the funding allocation for IMHA has been related to the number of uses of compulsory powers of the MHA in that local authority. </b>If the LA can't produce evidence of this it suggests that commissioning has not been taken seriously.</li>
<li><b>Make the commissioning of advocacy, and particularly statutory advocacy, a core standard against which local authorities are judged in CQC inspections. </b>CQC's framework already states that increasing and supporting service user voice and facilitating greater involvement in care planning are fundamental aspects of good care. IMHA is a particularly neatly defined method by which this can be measured. If the LA is not meeting its requirements where there is a legal obligation to do so, is it really likely to do so where it is merely good practice?</li>
</ol>
<div>
Until the commissioning of advocacy is better scrutinised and related to actual need, the legal right to advocacy will continue to go wrong.</div>
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<br /></div>
<div>
Next time; why are mental health professionals not telling people their rights, some posters that should be put up in all psychiatric settings and a particularly worrying trend in outsourcing.</div>
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Anonymoushttp://www.blogger.com/profile/06108770731501761352noreply@blogger.com0tag:blogger.com,1999:blog-2737354133822420799.post-71778704720128517852013-06-26T02:36:00.000-07:002013-06-26T02:36:46.456-07:0012,000 people - is that much of a problem?This is the first in a series linked posts about thousands of people being denied their rights to an Independent Mental Health Advocate (IMHA). This isn’t merely some technicality in the implementation of a health system. <div>
<br /></div>
<div>
Ask yourself this question, if you were detained against your will, or treated without your consent, would you want to know what was going on? As you try to find out why you're there - scared and confused, would you want to know what your rights were? Would you want to have someone there that to make sure you were treated with respect; that you were listened to? That is what an IMHA is there for. That's what thousands of people are being denied.</div>
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The lack of access to IMHA is a matter of systemic and ongoing breaches of mental health law relating to Independent Mental Health Advocacy. Upcoming posts will address how the problem could be resolved and some wider underlying issues. This post looks at how big the problem is and why it matters.</div>
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Around this time last year I wrote a piece for the Guardian Social Care Network about <a href="http://www.guardian.co.uk/social-care-network/2012/jul/04/independent-mental-health-advocates" target="_blank">thousands of people being deniedtheir rights</a>. People subject to compulsory powers of the Mental Health Act, whether in hospital or on a community treatment order, have a right to an independent mental health advocate (IMHA) to help them know their rights and to ensure they have a voice in decisions about their care and treatment. The<a href="http://www.cqc.org.uk/public/news/our-second-mental-health-act-annual-report-2010/11" target="_blank"> Care Quality Commission’s report on the MentalHealth Act (2010/11)</a> showed that for many people this was not the case.</div>
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In January this year, the CQC released their <a href="http://www.cqc.org.uk/public/reports-surveys-and-reviews/reports/mental-health-act-annual-report-2011/12" target="_blank">report on theMental Health Act 2011/12</a>. I was hoping to see some changes as a result of the previous report, and indeed there were some. For example, the report showed that people were more likely to be informed of their legal right to see an IMHA. There was also a rise in the number of wards on which an available IMHA service was found and the attendance of an IMHA when one was requested.</div>
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<br /></div>
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<br /></div>
<table border="1" cellpadding="0" cellspacing="0" class="MsoTableGrid" style="border-collapse: collapse; border: none; mso-border-alt: solid windowtext .5pt; mso-padding-alt: 0cm 5.4pt 0cm 5.4pt; mso-yfti-tbllook: 1184;">
<tbody>
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<td style="border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 253.5pt;" valign="top" width="338">
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Mental Health Act Report Area</div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 106.3pt;" valign="top" width="142">
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2010/11</div>
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<td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 49.6pt;" valign="top" width="66">
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2011/12</div>
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</tr>
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<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 253.5pt;" valign="top" width="338">
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Is there evidence of an IMHA service?</div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 106.3pt;" valign="top" width="142">
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85%</div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 49.6pt;" valign="top" width="66">
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89%</div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 253.5pt;" valign="top" width="338">
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Do patients have regular access to an IMHA?</div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 106.3pt;" valign="top" width="142">
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65%</div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 49.6pt;" valign="top" width="66">
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74%</div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 253.5pt;" valign="top" width="338">
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
Does the IMHA come when requested?</div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 106.3pt;" valign="top" width="142">
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86%</div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 49.6pt;" valign="top" width="66">
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88%</div>
</td>
</tr>
</tbody></table>
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(Taken from figure 11 of CQC report)</div>
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However, as these areas are meant to be guaranteed by the Mental Health Act, these figures should be close to 100% . The CQC report shows that their reality is
still far from guaranteed. That means that the table could be presented like this:</div>
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<table border="1" cellpadding="0" cellspacing="0" class="MsoTableGrid" style="border-collapse: collapse; border: none; mso-border-alt: solid windowtext .5pt; mso-padding-alt: 0cm 5.4pt 0cm 5.4pt; mso-yfti-tbllook: 1184;">
<tbody>
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<br /></div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 106.3pt;" valign="top" width="142">
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2010/11<o:p></o:p></div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 49.6pt;" valign="top" width="66">
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2011/12<o:p></o:p></div>
</td>
</tr>
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<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 253.5pt;" valign="top" width="338">
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No evidence of an IMHA service<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 106.3pt;" valign="top" width="142">
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
15%</div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 49.6pt;" valign="top" width="66">
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
11%</div>
</td>
</tr>
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<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 253.5pt;" valign="top" width="338">
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
No regular access to an IMHA<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 106.3pt;" valign="top" width="142">
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
35%</div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 49.6pt;" valign="top" width="66">
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
26%</div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 253.5pt;" valign="top" width="338">
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
People who requested an IMHA who didn’t get one<o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 106.3pt;" valign="top" width="142">
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
14%</div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 49.6pt;" valign="top" width="66">
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
12%</div>
</td>
</tr>
</tbody></table>
<div class="MsoNormal">
<br /></div>
<br />Percentages can be a bit dry, so let’s put some real numbers to that. The CQC report states that there are approximately 61,000 people detained in a hospital setting at any one time. This means that last year 6,710 people were detained somewhere that there was no evidence of a safeguard to which they are legally entitled. Last year 15,860 people were detained but had no regular access to someone who could help them know their rights and speak up alongside them. And even where people requested an IMHA, 7, 320 didn’t get to see someone. One in eight people that had requested access to a service to which they are legally entitled never received it. <b><i>One in eight</i></b>.<br /><br />Whatever way you slice it, somewhere between 7,000 and 15,000 people in hospital last year were denied something promised to them in law. Given that the report also showed minimal awareness of IMHA amongst the 5,000 people Community Treatment Orders, the figure would rise above 12,000. <br /><br />12,000 people can be a bit hard to visualise, so here’s some ways to think about it. <br /><br /><ul>
<li>It’s more than the entire English based staff of the Care Quality Commission, Department of Health, Department of Communities and Local Government, Crown Prosecution Service and the UK Space Agency (although, to be honest, there are only 40 of the latter.)</li>
</ul>
Prefer a sporting example? <br /><br /><ul>
<li>When Andy Murray walks onto Number One Court at Wimbledon today he will be playing in front of a capacity crowd of 11,430. Or put another way, it’s more than the entire crowd that watched Burnely vs Crystal Palace in January 2013 (11,564).</li>
</ul>
If you prefer culture to sport...<br /><br /><ul>
<li>Get the massed audiences of packed houses at Royal Albert Hall, Hammersmith Apollo and Royal Opera House combined – that’s about it.</li>
</ul>
Now imagine the news report that says that an entire football stadium is denied its rights, that all those at Number One court today will be failed by a system, that the staff of those government departments will be failed by service commissioning, delivery and regulation. That this state of affairs will be known but not acted on. That this will go on for years. <br /><br />I dare you to walk onto the pitch at Turf Moor and tell the crowd that you're going to do that to them. I wonder if the staff of those government departments and agencies would feel it a mere problem of implementation if it were happening to them. Well, it is happening right now to people who have been diagnosed with mental health problems. It's been set out in black and white in numerous reports, yet it doesn't seem to create much alarm. Is it the stigma of mental health that prevents us from being up in arms about it? I don't know, but it needs to change.<br /><div class="MsoNormal">
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Next time, I'll give some practical examples of what I think what needs to change and how we can make them happen. For now I ask that you accept that this is a major problem.</div>
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Anonymoushttp://www.blogger.com/profile/06108770731501761352noreply@blogger.com0tag:blogger.com,1999:blog-2737354133822420799.post-85845317255098631072013-03-20T14:29:00.002-07:002013-04-05T02:21:33.475-07:00Getting From A to B<br />
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The Distance From Should To is…. It’s an idea that fascinated
me for a long time. Usually it's a way of comparing policy, theory and
announcements to reality. This time it’s about me. </div>
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<br /></div>
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It’s been a while since my last post, and some might think
that this gap is a little curious given the recent select committee report on
the Draft Social Care Bill. I’ll write about the draft bill shortly but first I’ll
talk about the gap.</div>
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I’ve just returned to work following sick leave. Late
last year I reluctantly accepted that:</div>
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<div class="MsoListParagraphCxSpFirst" style="margin-left: 19.5pt; mso-add-space: auto; mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
a) I was suffering from depression </div>
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b) It was stopping me working properly</div>
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It took me a long time to get from
a to b.</div>
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I don’t intend to speculate on the reasons for depression or
to spell out the effects. There are other bloggers out there that can do that
far better than I. But other people’s openness about their own mental health
issues is something I’ve always admired. It was really useful to me when I was
finding my own way through. It seems only fair to add my own small
contribution. <br />
<br />
I also want to publicly
acknowledge that there was a problem, particularly for anyone who may have been
wondering why I’ve been so bad at communicating with them recently. It wasn’t
you, it was me….</div>
<div class="MsoNormal">
...so, back to me.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
I should have taken time off earlier. One of the things that
stopped me was the belief that I would be able to turn things round. Even when
I accepted that I had depression I didn’t accept that it meant that I would be
affected by it. <i>Other people</i>? Yes. <i>Me</i>? No. </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<i>I</i> should have been able to sort things out. <i>I</i> was able to
seem ok to most people, surely that meant I was almost ok. I was convinced of
this, so I piled more and more pressure on myself.<br />
<br />
I always felt that I just needed to sort out one more thing. I’d take some time off in a bit, but not just now. The problem was that I was
dealing with what should be, not with what was really happening. As a result I
worked longer hours, achieved less, and got worse.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
If I had broken my leg I
wouldn’t have expected myself to keep running. However, despite a lifetime working
in and around mental health, I couldn’t accept that depression would reduce my
ability to get things done, so I kept going. In retrospect, this was a special
kind of idiocy. It was harder to sort
things out, many things didn’t get sorted. I got worse.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Recently I’ve been asking myself why I was so reluctant to
accept the impact of my depression. I've came to the uncomfortable realisation
that despite many years trying to reduce the stigma and prejudice that people
with mental health problems face, despite being a fan of the <a href="http://www.time-to-change.org.uk/" target="_blank">Time To Change</a>
campaign and the <a href="http://www.blackdogtribe.com/" target="_blank">Black Dog Tribe</a>, when it came to me I was somehow ashamed. Other
people would be affected by mental health problems. Somehow I thought that
shouldn’t apply to me. </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Well, it did apply to
me.<br />
<br />
Taking time off was one of the scariest things I’ve ever done. It was probably one of the best things I’ve ever done. As the eagle eyed
amongst you may have noticed from my profile, although I’ve returned to Action
for Advocacy, I’m not coming back as Chief Executive. I need to make sure I’m able
to put some things into that wonderful pile marked “someone else’s problem”, but
believe me, I have enough to get my teeth into. So let me finish by saying a few things both
you and I should already know.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Depression is as real as physical illnesses. It has as great
an impact as physical illnesses or injuries. I expect that our society should
treat mental and physical health problems with a parity of respect and
understanding. Mental health problems no more define a person than does a fractured
rib. I have spent years of my life challenging fears, assumptions and prejudice
about mental health. It’s strange to realise that one of the most ingrained
problems was sitting in my own head. </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
Anonymoushttp://www.blogger.com/profile/06108770731501761352noreply@blogger.com5Harrogate, North Yorkshire, UK53.99212 -1.541811999999936253.9174435 -1.7031734999999362 54.0667965 -1.3804504999999363tag:blogger.com,1999:blog-2737354133822420799.post-48125073952133198832012-10-09T08:43:00.001-07:002012-10-09T08:47:49.695-07:00How soon is soon?<br />
<div class="MsoNormal">
What can we learn from Jeremy Hunt’s speech today? There is
so much to say on health, so much to say on social care, so many challenges ahead.
And lurking in the background, Dilnot.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Mr. Hunt's statement about naming the guilty in care scandals,
mid-Staffs, Winterboune View etc were striking - as was his statement that quality
of care was as important as good financial management. Of
course, given that most enquiries into
abuse in care situations recommend that independent advocacy is an important
safeguard against such abuse, it would have been nice to have had a mention, but that's another story. </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
It would also have been good to hear about cultures of care,
commissioning practices, out of sight placements, eligibility thresholds, mental health. And discussion about social care seemed to focus almost exclusively on older
people, something which ignores a large number of people who need or benefit
from social care. And what about Dilnot?</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
I was surprised to hear Hunt state that the conservatives want to implement
Dilnot “as soon as we are able” – it seems to give a sense of urgency. However
it also leaves the door open to excuses, to barriers and to more delay. We need to move from "as soon as we are able" to "we are able to do it soon". </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
The challenge now must be for the government to find ways to be able to do this soon. It must urgently manage away potential obstacles to implementation. It must also to find ways to resource a social care that
keeps the dignity of the individual central.</div>
Anonymoushttp://www.blogger.com/profile/06108770731501761352noreply@blogger.com0tag:blogger.com,1999:blog-2737354133822420799.post-2144139475215357312012-08-31T02:47:00.000-07:002012-08-31T10:12:47.256-07:00The Credibility Gap - A Pitfall in Social Care<br />
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;">Why do some people find it so hard to be heard, to get the
services they want or to be respected to make their own choices? It’s a
question I’ve been discussing a lot recently as the <a href="http://careandsupportalliance.wordpress.com/" target="_blank">Care and Support Alliance</a> try to ensure that the
</span><a href="http://careandsupportbill.dh.gov.uk/home/" style="font-family: Arial, Helvetica, sans-serif;" target="_blank">social care bill</a><span style="font-family: Arial, Helvetica, sans-serif;"> will give sufficient support to people to have true control
over how their social care needs are met. </span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;">So what gets in the way of voice, choice and control? Too often the view is that the cause lies in the person
– in their disability or the barriers that they have communicating. If that were true, this view
would make assessment of who is eligible for advocacy simple; you could measure against a checklist. But phrasing it overlooks three really
important facts. </span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;">First, not every disabled person needs or wants an advocate. Not
everybody with learning disabilities, not everyone with a mental health
problem, not every person with autism, not everyone in any group. To suggest
that they do is to massively undermine the ability of people to speak for themselves.
</span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;">Second, it suggests that the problem lies in the person, not
the system. I know of many people who
have used advocacy who in almost any other situation are remarkable
communicators. However, when they are trying to deal with systems, and saying the wrong thing can have long term consequences,
communication gets tougher. </span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;">Professionals can be hard to
contact, are sometimes pressed for time, refer to knowledge you don’t have, use their own
language, control access to services and don't always respond well to criticism. It is unsurprising therefore that people are reluctant to speak up and find it
hard to be heard. Information and advice might help reduce this problem for
some, but for many that is not enough.</span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;">But it is often a third factor that forms the biggest barrier; when the preconceived ideas that people have about you stop you being heard or having control over your life and your choices. This is
something which I call the <b><i>credibility gap</i></b>, and it is expressed in many ways.</span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;">The credibility gap is what makes it harder for people with
mental health problems to get access to good general healthcare – too often symptoms
of physical problems are ascribed to psychological factors. It’s one factor in
the under-identification of depression in older people. It’s what makes people
with learning disabilities have the validity of their requests and statements
challenged, as if they couldn’t possibly understand what they’re saying. It’s the
barrier to justice when people in residential report abuse by staff to the
police – because we know all care staff are nice and people in care can’t be
believed, yes? These perceptions have been shown to be false countless times,
yet they persist and compromise the dignity and rights of too many people in
our society.</span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;">Put simply, the credibility gap is what you experience when
someone has made up their mind about you before you’ve even spoken. It’s an
expression of all forms of prejudice that allows people in power to undermine
or ignore those who need something from them. And the credibility gap is not solely
related to disability or age, it’s something that carers experience too. </span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;">The dreadful experience of Mark Neary shows this all too
clearly. A devoted father and carer to his adult son, Mark faced the prejudice
of care staff who decided that his relationship with his son was a problem.
Every action he then made, all communications he had with care staff were viewed
through this distorted lens. For over a year, Mark’s son was kept in residential
care rather than being at home with his father. For Mark, this credibility gap
was an impassable chasm despite his energy, perseverance and his eminent
ability to communicate well (<a href="http://markneary1dotcom1.wordpress.com/about/" target="_blank">read his blog</a> – it’s great). One turning point came when an independent advocate was involved who managed to challenge staff
perceptions. Eventually the case went to court. Mark won and his son returned home,
but the cost to all involved was considerable. That is not how social care should be.</span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;">As it stands, the <a href="http://careandsupportbill.dh.gov.uk/home/" target="_blank">draft social care bill</a> ignores the effect
of the credibility gap. Information and advice do not close the credibility gap.
Independent advocacy can. (You might want to click on that link and suggest that there should be a general duty to ensure there is information, advice and independent advocacy.)</span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;">Even outside the context of the bill, without facing
this injustice which so many people face we won’t get the balance of advocacy
provision right. But far worse than that, we will be supporting the idea that
the problem in communication is a deficit of the individual. It’s not. Rather,
it’s a challenge for individuals, professionals, services and the state to
address together; communicating openly, fairly and without prejudice to ensure
we all have choice, dignity and control in our own life.</span> </div>
Anonymoushttp://www.blogger.com/profile/06108770731501761352noreply@blogger.com1London, UK51.5073346 -0.127683151.3492066 -0.4435401 51.6654626 0.1881739tag:blogger.com,1999:blog-2737354133822420799.post-3357883846598999502012-08-22T11:25:00.003-07:002012-08-22T11:30:26.957-07:00Questions, questions, questions<br />
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;">I still can't quite believe how many questions I've been asked about advocacy this week. I found out that it’s actually quite refreshing to be asked questions who don’t know
anything about advocacy; it makes you have to re-examine your language, your
answers and your assumptions.</span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;">Fortunately, most of the questions were easy to answer, I
could even direct people to websites, codes of practice and legislation. But
with some questions it struck me that the answer
is more nuanced, more dependent on other people or services than some might
expect. It became easier to see how some things are unclear to people.</span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;">I’ve been asked every question bar one in the list below,
and many others besides. </span><span style="font-family: Arial, Helvetica, sans-serif;">I think we in the advocacy sector might need to ask ourselves
some of these questions again to make sure the answers are as clear as
possible. And if there’s ambiguity we need to either know that it’s like that
for a very good reason or we need to identify what needs to change.</span></div>
<div class="MsoNormal">
<br /></div>
<span style="font-family: Arial, Helvetica, sans-serif;">Those questions.....</span><br />
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;">Who is an advocate? What is an advocate? What’s the
difference between an advocate, a supporter and a friend. Can nurses be
advocates? What is a legal advocate? Can I call myself an advocate? What is a
mental health advocate? Do you need to be attached to an organisation to be
able to advocate? </span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;">Do advocates have any special status in law? Could I just
call myself a mental health advocate? What’s the difference between a mental
health advocate, someone who calls themselves a mental health advocate and an
independent mental health advocate? What is a self advocate? What is a peer
advocate? Can you be a volunteer advocate? Who regulates advocates? When you
say self advocacy, don’t you just mean talking? What training do advocates
have? Do advocates have a special badge, or card or something? </span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;">Can you strike
off an advocate who is found guilty of wrongdoing? If I call myself an advocate
do I get treated differently? How do find out what kind of advocate someone is?
What rights do advocates have? Can you stop someone who isn’t an advocate
calling themselves an advocate? If someone was trained as an advocate, but isn’t working for an
advocacy organisation in relation to this person, can they still call
themselves an advocate? If an advocate falls in the woods but there’s no-one there to hear them, will they still challenge the fairness of the process? </span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;">Can advocates just walk into hospitals? What do
advocates keep confidential? Do advocates have legal privilege? Whose
responsibility is to check the status of an advocate? Who pays for advocacy?
What does independent mean in advocacy? Who came up with the word advocacy?</span></div>
Anonymoushttp://www.blogger.com/profile/06108770731501761352noreply@blogger.com0tag:blogger.com,1999:blog-2737354133822420799.post-8185030250087639932012-08-18T01:15:00.000-07:002012-08-19T23:51:49.666-07:00A few simple questions?In the past few days I've been asked more questions about advocacy than you would believe. Actually, I've been asked only a few questions, but they've been asked lots and lots of times...<br />
<div>
<br /></div>
<div>
What is an advocate?</div>
<div>
Do advocates have special legal privileges?</div>
<div>
What is a mental health advocate?</div>
<div>
What is an Independent Mental Health Advocate.</div>
<div>
<br /></div>
<div>
..and most of these easy enough to deal with (see <a href="http://actionforadvocacy.org.uk/articleServlet?action=display&article=2074" target="_blank">Action for Advocacy latest news</a> for some answers).</div>
<div>
<br /></div>
<div>
But the problematic one is explaining that while, yes, there is a well understood role of a mental health advocate (supported by and accountable to an advocacy organisation), it's also possible to describe yourself as a mental health advocate if you are not operating in this way.</div>
<div>
<br /></div>
<div>
This poses a problem for the advocacy sector and places a responsibility on the health and social care sectors. For advocacy: is there a way for us to make it easier for others to know what role and status someone has? For care providers: what steps are you taking to ensure you are clear about advocacy; its role, its boundaries and people's right to access advocacy.</div>
<div>
<br /></div>
<div>
I've worked for almost a decade (the last 6 years with Action for Advocacy) to try to clarify some of these issues. We've created the Advocacy Charter, A Code of Practice for Advocates, high quality training, the Quality Performance Mark and lots of information to help address this issue. We may think people should know about advocacy.<br />
<br />
There's a reason this blog is called the distance from should to is, and it looks like we've still got a long way to go when it comes to developing a general understanding of advocacy. But that work is essential if we're going to ensure those who are striving to be heard and to have control over their lives are going to gain access to safe, effective and high quality advocacy. And that's a journey worth making.<br />
<br />
<br /></div>
Anonymoushttp://www.blogger.com/profile/06108770731501761352noreply@blogger.com0tag:blogger.com,1999:blog-2737354133822420799.post-42672816693246383862012-08-07T14:58:00.000-07:002012-08-07T14:59:19.769-07:00Stop, watch! Olympics, Elitism and Winterbourne View<br />
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;">A stopwatch is a useful thing. It can show us in fine detail
what matters. Tonight, amidst Olympic glory, it showed us something has gone
very wrong.</span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;">At 11:00 am today, the serious case review into the
appalling abuse at Winterbourne View was released. Earlier , Mencap and the
Challenging Behaviour Foundation launched their report, “Out of Sight” which
flagged up that Winterbourne View was one part of a potentially huge problem. These
reports aren’t just important if you are in residential care services. If you will
be in residential care in the future, or know someone who might be, or work in
social care, or just give a damn about dignity, rights and respect, this is a
story for you.</span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;">So where does the stopwatch come in? Well, I’m not so naïve as
to think that a landmark low in our treatment of marginalised people will
outstrip the achievements of Olympians. And no, I’m not being sniffy about
sport, I love sport, always have. I might think that the ongoing abuse of
numerous people in our society is more important, but that’s my call.</span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;">But the stopwatch comes in when you see how the story was
cut, particularly how it set out to learn the lessons from Winterbourne and
listen to someone who had the courage to blow the whistle on what was
happening. Terry Bryan took this risk
because he cared about what care is meant to be, and he did it again and again.
It might have been worth listening to him.
BBC news at 10 gave him 2 seconds. OK, I didn’t have a stopwatch but it
wasn’t any longer than that. That can’t be right can it? And how much time did
it give to the reports the police ignored, the admissions to A&E that the
local hospital didn’t spot a pattern in? None for the first, little for the
second. That doesn't seem like reporting that changes things, there's no learning, no depth. It looks more like shock and run. </span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;">Tonight, Newsnight is talking about elitism in sport. The serious case review isn't mentioned. So let's look at the wider problem of elitism. It seems that if you have care needs of any kind you’re
going to be way down the pecking order.
Shunted out of area, placed where choice is removed from you, at greater
risk of abuse. As a society we turn our attention away, and the media is complicit
in this. </span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;">We who are more able to get things talked about need to keep
social care, disability, work capability assessments, abuse and that whole
bunch of forbidden topics on the agenda. Look at the coverage, get your stop watches out, and if the
balance seems wrong, speak up.</span></div>Anonymoushttp://www.blogger.com/profile/06108770731501761352noreply@blogger.com7tag:blogger.com,1999:blog-2737354133822420799.post-40393801851943604842012-07-31T11:31:00.000-07:002012-07-31T11:31:58.623-07:00All Rock, No Blackpool?<br />
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;">I’ve been thinking a lot about the Care and Support bill and
the fact that it defines advocacy as a social care service for which there may
be a need. Identifying needs is important. </span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;">Many years ago I did some research about needs evaluation in
care planning. It turned out that there was a big difference between what was written
in care plans and what was understood and known by ward staff. In general,
staff were aware of and acted on a range of information that was rich, complex
and arose from an ongoing relationship with the people on the unit. The care
plan on the other hand was a bare essentials plan of must do actions. It often
missed out some of the most important facts about a person’s needs and
abilities because it was assumed that “everyone knows that”. The problem was
that when the use of agency staff increased, not everybody did know that. Lesson; sometimes we assume and imply too
much when we really need to spell it out.</span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;">On that note, a recent meeting relating to the draft social
care bill and white paper is worth exploring. The Department of Health’s
<a href="http://www.dh.gov.uk/health/2012/06/interimwinterbourne/" target="_blank">interim report on Winterbourne View</a> explicitly stated that the care white paper would explore the role of
information, advice and advocacy. In that regard (and many others) it was
surprising to see that so little actually appeared in the white paper about
advocacy. However, it appears from the meeting at DH that advocacy is implied within
the need for information and advice within the bill. We can argue that it needs
to be further developed, that the advocacy “bit” needs to be clarified as
somewhat different to the information and advice roles, but we were told that
advocacy hadn’t been entirely forgotten. The lessons from Winterbourne are too
important for that.</span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;">In fact, looking through the principles of the white paper
and the aim of the bill, it is hard to imagine the step change in services
being delivered without advocacy. You could say that advocacy runs through the white
paper like the words in a stick of rock, but I’m concerned that it doesn’t
stand out clearly enough. If you haven't been told it's there, if you aren't plugged into the need for advocacy, then you won't notice the word advocacy.</span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif;">And that means that at the moment with have a stick of rock with no “Blackpool”
in it. If the need for advocacy isn’t explicitly spelled out it may get missed
when guidance goes from national to local level, something which would reduce
the chance of ensuring dignity, choice and control for all. We need the writing
to be clearer. If you think so too, please get involved in the consultation on the
<a href="http://careandsupportbill.dh.gov.uk/home/" target="_blank">Care and Support Bill website </a> – or sign up to Action for Advocacy’s
<a href="https://www.surveymonkey.com/s/KDGVJTJ" target="_blank">100 Words on Advocacy</a>.</span></div>
Anonymoushttp://www.blogger.com/profile/06108770731501761352noreply@blogger.com0tag:blogger.com,1999:blog-2737354133822420799.post-55280269355775294272012-07-11T10:16:00.000-07:002012-07-11T10:35:53.886-07:00Caring For Our Future by Forgetting Advocacy?<br />
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<span style="font-family: Arial, Helvetica, sans-serif;">I’ve just taken a quick look at “<a href="http://www.dh.gov.uk/health/files/2012/07/2900021-CaringForFuture_ACCESSIBLE-10.07.2012.pdf" target="_blank">Caring for our future: reforming care and support</a>” and it seems to signal an end to the phrase “information, advice and
advocacy”. Information? Yes. Advice? Yes? Advocacy?.....</span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">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.</span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">“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”</span></blockquote>
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<o:p><span style="font-family: Arial, Helvetica, sans-serif;">That's it. </span></o:p></div>
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<o:p><span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></o:p></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">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. </span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">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. </span><span style="background-color: white; font-family: Arial, Helvetica, sans-serif;">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. </span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">If that’s the case, f</span><span style="background-color: white; font-family: Arial, Helvetica, sans-serif;">orget all of those mentions about the importance of advocacy as a safeguard against abuse and in safeguarding processes. Forget </span><span style="background-color: white; font-family: Arial, Helvetica, sans-serif;">the CQC's thematic review on learning disability services, </span><span style="background-color: white; font-family: Arial, Helvetica, sans-serif;">ignore SCIE guidance on safeguarding, </span><span style="background-color: white; font-family: Arial, Helvetica, sans-serif;">forget the lessons from
Winterbourne view, forget the Kerr-Haslam report, forget all the other reports that make the same point. </span></div>
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<span style="background-color: white; font-family: Arial, Helvetica, sans-serif;">Ignore Valuing People, f</span><span style="background-color: white; font-family: Arial, Helvetica, sans-serif;">orget 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</span><span style="background-color: white; font-family: Arial, Helvetica, sans-serif;">
</span><span style="background-color: white; font-family: Arial, Helvetica, sans-serif;">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. </span><span style="background-color: white; font-family: Arial, Helvetica, sans-serif;"> </span><span style="background-color: white; font-family: Arial, Helvetica, sans-serif;">Forget them both, forget them all, but
remember this.</span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">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. </span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">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”.</span></div>Anonymoushttp://www.blogger.com/profile/06108770731501761352noreply@blogger.com3tag:blogger.com,1999:blog-2737354133822420799.post-61894195605045832602012-06-26T10:16:00.000-07:002012-06-27T14:06:58.772-07:00How much to empowerment?<br />
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<span style="background-color: white; font-family: Arial, Helvetica, sans-serif;">You’ll never guess what I learned in the back of this cab yesterday... </span></div>
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<span style="background-color: white;"><span style="font-family: Arial, Helvetica, sans-serif;">I’ve been
spending a lot of time thinking about commissioning recently. Having heard so
many stories of bad commissioning (poorly thought through tenders, slashed budgets, no demand
analysis, ineffective monitoring, prioritisation of price over quality...) the subject consumes much of my thinking. </span></span><span style="background-color: white; font-family: Arial, Helvetica, sans-serif;"> </span><span style="background-color: white; font-family: Arial, Helvetica, sans-serif;">And then suddenly, sitting in a taxi at the end
of a long train journey, I realised that a good model was staring me in the
face. There, on a laminated yellow card, was a table saying what I'd pay for getting in, mileage, luggage, cleaning costs etc.</span></div>
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<span lang="EN-GB"><span style="font-family: Arial, Helvetica, sans-serif;">It struck
me that this set of charges effectively took price out of the equation of competition
in the local taxi market. Freed from this consideration, other factors come
into play; how quickly the cab will appear, how reliable the service is, the courtesy of
the operator, ease of ordering.....The choice is made on quality because I
already know what I’ll be spending.</span></span><br />
<br />
<span lang="EN-GB"><span style="font-family: Arial, Helvetica, sans-serif;">I have nothing against competition, in fact I quite like it. But there are some fields where competition on price is useless, and independent advocacy is among them. So I’ve been trying to identify relevant examples of other forms of competition and this table of tariffs gave me one.<o:p></o:p></span></span></div>
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<span lang="EN-GB"><span style="background-color: white; font-family: Arial, Helvetica, sans-serif;">I would argue that price driven commissioning in advocacy creates an incentive to provide poor quality.</span><span style="font-family: Arial, Helvetica, sans-serif;"> </span></span><span style="background-color: white; font-family: Arial, Helvetica, sans-serif;">In independent advocacy, too many commissioning decisions appear to have been made on price.</span><span style="background-color: white; font-family: Arial, Helvetica, sans-serif;"> </span><span lang="EN-GB" style="background-color: white;"><span style="font-family: Arial, Helvetica, sans-serif;">If current trends continue, the “advocacy” that is being
commissioned is at risk of becoming a purely mechanical response to an identified
need; neither seeking to change the system or empower the individual. That is
not advocacy. </span></span><span style="background-color: white; font-family: Arial, Helvetica, sans-serif;">Commissioning such services as advocacy, or pressuring advocacy services towards such a model, leads to a waste of public funds and denies people the support they need to have control over their own life. </span></div>
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<span lang="EN-GB"><span style="background-color: white; font-family: Arial, Helvetica, sans-serif;">Price driven competition is at risk of defeating its own objective. </span><span style="font-family: Arial, Helvetica, sans-serif;">It takes longer to be creative, create
change, release someone’s potential or challenge systematic poor practice than
it does to tick a box. </span></span><span style="background-color: white;"><span style="font-family: Arial, Helvetica, sans-serif;">Using price only comparisons in advocacy commissioning is like judging Masterchef on who can get their weekly shop at Lidl for the least money (in case of a draw, winner decided on speed). </span></span></div>
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<span lang="EN-GB"><span style="font-family: Arial, Helvetica, sans-serif;">So why aren’t
we looking for that tariff of fares? Why aren’t we saying, “This is the need in
the area, these are the resources that are available. Show us what you can do
with that. What difference will you make?” </span></span></div>
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<span lang="EN-GB"><span style="font-family: Arial, Helvetica, sans-serif;">That would </span></span><span style="background-color: white; font-family: Arial, Helvetica, sans-serif;">create competition based on excellence, </span><span style="background-color: white; font-family: Arial, Helvetica, sans-serif;">make monitoring simpler and
more relevant, make local commissioners accountable.... and make it more likely that people have a strong and equal voice.
That's a destination it's worth paying to reach. </span></div>Anonymoushttp://www.blogger.com/profile/06108770731501761352noreply@blogger.com6tag:blogger.com,1999:blog-2737354133822420799.post-13326855393605433812012-05-17T10:26:00.001-07:002012-05-17T10:26:06.222-07:00When more isn't better<br />
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Over the last couple of days at Action for Advocacy’s conference we’ve been helping the advocacy sector to think through some difficult choices for the future. Not just asking “what is advocacy?” but trying to figure out what advocacy needs to be in the future. We’re still working on it.</span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">I’m proud to be part of the independent advocacy sector, but I believe that we must challenge the idea that more advocacy is an inherently good thing. More control for people over their own lives is a good thing. Better ability to speak up is a good thing. People shaped services and dignity in care, all good things which advocacy helps to bring about. Advocacy is merely the tool for achieving these, and independent advocacy is only part (albeit a very important part) of what advocacy is.</span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">In my <a href="http://prezi.com/c4iujckxmrds/pressures-beyond-our-sector/">presentation</a> I asked the question, “Who is my advocate?” We need to move beyond advocacy being only about the independent advocacy role, otherwise we exclude natural advocates (e.g. friends, family and carers) undermine self advocacy, and subvert the need for nurses, social workers and all health and care staff to speak up for the person in their care. Yes, there are times when independent advocacy is needed but we must be clear that the responsibility is on health and care professionals to listen, to include, to build person centred services, to put the person at the centre of decisions about their life, to ensure that all are treated with dignity and respect.</span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">The provision of independent advocacy must be seen as a supplement, not a replacement, to this duty of care. We need to do more as a sector to work inclusively, supporting people to speak up about their own lives and ensuring carers (paid or unpaid) have the tools and support to enable this to happen. We need to look at how we respond with true meaning to our diverse communities. We must find ways of supporting groups that have an advocacy role within their wider purpose. We need to work together, develop skills create contacts for us all to make rights a tangible reality for all. I’m determined to explore how we can play a role in making this happen.</span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">And despite a climate for increasingly tightly case managed services, when independent advocacy is used it must aim to truly give people more control over their own life. Advocacy services should seek to create change at a system level by being willing and able to robustly challenge poor practice and using data from advocacy work to build a case for wider change. Without this, advocacy runs the risk of being complicit in accepting poor treatment, abuse and denial of rights. We would be saying that we now accept that services will fail people, and that we’re fine with that. We’re not.</span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">We’ve achieved much in the past 10 years but we have a long way to go. Advocacy is a sector that should not celebrate a growth in demand. In the long term we don’t want more independent advocacy; we want better services, tangible rights, fulfilled lives and a strong and equal voice for all. In the meantime, we need to prove to ourselves, our service users, our commissioners and our communities that advocacy is really making a real difference, that it is narrowing the glaring gap between how people should be treated and how they are. </span></div>Anonymoushttp://www.blogger.com/profile/06108770731501761352noreply@blogger.com0tag:blogger.com,1999:blog-2737354133822420799.post-11110440136931489042012-03-06T10:17:00.000-08:002012-03-06T10:17:35.831-08:00Right answer, wrong question?<div class="MsoNormal"><span style="font-family: Arial, Helvetica, sans-serif;">I recently got a birthday card that said “The answer is football. The question is largely irrelevant”. Someone knows me very well. When people hear organisations talk about the need for more advocacy provision they may well suspect the same kind of failing. It doesn’t matter what the question is, we’ll tell you that the answer is advocacy.</span></div><div class="MsoNormal"><span style="font-family: Arial, Helvetica, sans-serif;"><br />
</span></div><div class="MsoNormal"><span style="font-family: Arial, Helvetica, sans-serif;">So today I spent the day with the Care in Crisis lobby of parliament and taking part in the online #twobby. I met many inspirational people, heard challenging stories from people struggling to get the right social care, met and had a good discussion with my local MP and heard Paul Burstow talk about his plans for the Social Care White Paper. And I tried not to talk about advocacy too much, because the questions weren’t always about advocacy; they were usually about dignity, fairness, funding, appropriate services, connection to communities. Advocacy isn’t the answer to these questions, but it is a mechanism that informs those answers. </span></div><div class="MsoNormal"><span style="font-family: Arial, Helvetica, sans-serif;"><br />
</span></div><div class="MsoNormal"><span style="font-family: Arial, Helvetica, sans-serif;">So when we hear that people need support to navigate the new care system, that people need support speaking up, that getting appropriate care is a constant battle, that people are afraid of complaining on behalf of relatives, that closed care systems breed abuse – well, advocacy <b><i>is</i></b> part of the answer. <span style="color: #351c75;">(If you don't believe me you may want to look at my previous post <a href="http://shouldtois.blogspot.com/2012/03/gap-in-rights-and-dignity.html" target="_blank">A Gap in Dignity and Rights</a>.)</span></span></div><div class="MsoNormal"><span style="font-family: Arial, Helvetica, sans-serif;"><br />
</span></div><div class="MsoNormal"><span style="font-family: Arial, Helvetica, sans-serif;">Paul Burstow spoke of a future where local authorities should be held to account within national frameworks of expectations. He has previously spoken of the role that advocacy plays in demonstrating that local authorities are meeting their equalities duties. Including a requirement to record the advocacy needs of a community in the Joint Strategic Needs Assessment would help local communities hold LAs to account on this; it would let us see the distance between should and is.</span></div><div class="MsoNormal"><span style="font-family: Arial, Helvetica, sans-serif;"><br />
</span></div><div class="MsoNormal"><span style="font-family: Arial, Helvetica, sans-serif;">Then local communities would </span><span style="font-family: Arial, Helvetica, sans-serif;">be able to check that there is </span><span style="font-family: Arial, Helvetica, sans-serif;">at least one mechanism in place to address the real question; have we done enough to make sure that everyone's care needs will be met in a personal, appropriate and dignified way?</span></div>Anonymoushttp://www.blogger.com/profile/06108770731501761352noreply@blogger.com0tag:blogger.com,1999:blog-2737354133822420799.post-89413546690967147592012-03-06T03:17:00.000-08:002012-03-06T03:17:13.676-08:00A gap in rights and dignity<span style="font-family: Arial, Helvetica, sans-serif;"><i>This is the first draft of this post. It's far too long but might be useful info particularly in light of the Care Crisis lobby today.....</i></span><br />
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<div class="MsoNormal"><span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: 12pt; line-height: 115%;">Last week, the Joint Committee on Human Rights (JCHR) published a report highlighting areas of policy development and implementation that were disproportionately affecting disabled people. </span><span style="font-size: 12pt; line-height: 115%;"> </span><span style="font-size: 12pt; line-height: 115%;">The report highlighted a shortfall in advocacy provision and a gap between policy, legislation and practice. The JCHR report</span><span style="font-size: 12pt; line-height: 115%;"> </span><span style="font-size: 12pt; line-height: 115%;">is not the first to show this.</span><span style="font-size: 12pt; line-height: 115%;"> </span></span></div><div class="MsoNormal"><span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: 12pt; line-height: 115%;"><br />
</span></span></div><div class="MsoNormal"><span style="font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: Arial, Helvetica, sans-serif;">This article will demonstrate how advocacy’s role in ensuring quality care, dignity, making personalisation work, safeguarding people from abuse, inclusion in decision making, upholding legal rights is established. ; Advocacy is recognised as particularly useful in supporting older people, looked after young people and disabled people (particularly those people with learning disabilities and/or mental health problems) is recognised in policy and legislation.<o:p></o:p></span></span></div><div class="MsoNormal"><span style="font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: Arial, Helvetica, sans-serif;">Yet research from the sector shows advocacy services facing increased demand and losing funding. . So why are advocacy services struggling for funding? Why are people finding it harder to get support to make their voice heard?<o:p></o:p></span></span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span style="font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: Arial, Helvetica, sans-serif;">The JCHR report It called for implementation of the right to advocacy, showing this as a necessity to support the successful implementation of the personalisation agenda. It reported that <o:p></o:p></span></span></div><div class="MsoNormal" style="margin-left: 36.0pt;"><span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">“</span><span style="color: #333333; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">The Government acknowledged that ‘Local disability organisations can play an important role in providing the assistance that disabled people may need to exercise choice and control over their lives, ensuring that sufficient information, advice and advocacy is available’”.<o:p></o:p></span></span></div><div class="MsoNormal"><span style="color: #333333; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;"><span style="font-family: Arial, Helvetica, sans-serif;">And stated that <o:p></o:p></span></span></div><div class="MsoNormal" style="margin-left: 18.0pt;"><span style="color: #333333; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;"><span style="font-family: Arial, Helvetica, sans-serif;"><b>“Access to information, advice and advocacy is critical for all disabled people to benefit from personalisation. The Government should:<o:p></o:p></b></span></span></div><ul type="square"><li class="MsoNormal" style="background-attachment: initial; background-clip: initial; background-color: white; background-image: initial; background-origin: initial; background-position: initial initial; background-repeat: initial initial; color: #333333;"><span style="font-family: Arial, Helvetica, sans-serif;"><b><span style="font-size: 12.0pt; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">monitor access to information, advice, and advocacy services in the context of the roll-out of personal budgets;</span><span style="font-size: 12.0pt; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;"><o:p></o:p></span></b></span></li>
<li class="MsoNormal" style="background-attachment: initial; background-clip: initial; background-color: white; background-image: initial; background-origin: initial; background-position: initial initial; background-repeat: initial initial; color: #333333;"><span style="font-family: Arial, Helvetica, sans-serif;"><b><span style="font-size: 12.0pt; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">continue to support and develop the role of Disabled People's User-Led Organisations to enable them to provide independent information, advice, and advocacy services; and</span><span style="font-size: 12.0pt; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;"><o:p></o:p></span></b></span></li>
<li class="MsoNormal" style="background-attachment: initial; background-clip: initial; background-color: white; background-image: initial; background-origin: initial; background-position: initial initial; background-repeat: initial initial; color: #333333;"><span style="font-family: Arial, Helvetica, sans-serif;"><b><span style="font-size: 12.0pt; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">implement the advocacy provisions in sections 1 and 2 of the Disabled Persons Act 1986 when reforming community care legislation.”</span><span style="font-size: 12.0pt; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;"><o:p></o:p></span></b></span></li>
</ul><div class="Default"><span style="font-family: Arial, Helvetica, sans-serif;">This echoed the calls of The Law Commission’s Adult Social Care Law report <a href="http://lawcommission.justice.gov.uk/docs/lc326_adult_social_care.pdf">http://lawcommission.justice.gov.uk/docs/lc326_adult_social_care.pdf</a> which recognised that, <o:p></o:p></span></div><div class="Default" style="margin-left: 36.0pt;"><span style="font-family: Arial, Helvetica, sans-serif;">“The evidence presented by consultees makes clear that advocacy services play an essential role in assisting people to make and communicate decisions, safeguarding people from abuse and neglect and helping people to enforce their rights, secure access to justice and obtain an effective remedy”. <o:p></o:p></span></div><div class="Default" style="margin-left: 36.0pt;"><br />
</div><div class="MsoNormal"><span style="font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: Arial, Helvetica, sans-serif;">The report goes on to recommend that <o:p></o:p></span></span></div><div class="MsoNormal" style="margin-left: 36.0pt;"><span style="font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: Arial, Helvetica, sans-serif;">“the right to advocacy contained in the Disabled Persons (Services, Consultation and Representation) Act 1986 should be retained in the statute, with a power ...to implement the right and modify it to bring it into line with modern understandings.”<o:p></o:p></span></span></div><div class="MsoNormal"><br />
</div><div style="background: white; line-height: 13.1pt; margin-bottom: 11.2pt; margin-left: 0cm; margin-right: 0cm; margin-top: 2.8pt;"><span style="font-family: Arial, Helvetica, sans-serif;">Also published last week Dignity In Care, a <i><span style="color: #211918;">report by NHS Confederation, Age UK and the Local Government Association </span></i>on how to tackle the severe shortcomings in the care of older people strongly recommends advocacy provision. <span style="color: #211918;">The report states <o:p></o:p></span></span></div><div style="background: white; line-height: 13.1pt; margin-bottom: 11.2pt; margin-left: 36.0pt; margin-right: 0cm; margin-top: 2.8pt;"><span style="font-family: Arial, Helvetica, sans-serif;"><span style="color: #211918;">"Hospitals and care homes should work with local advocacy groups to provide access to independent advocates for older people and their families. Commissioners should consider requiring independent advocates in service specifications, who would then give feedback to both the commissioners and the providers." </span><a href="http://www.nhsconfed.org/Documents/dignity.pdf">http://www.nhsconfed.org/Documents/dignity.pdf</a><o:p></o:p></span></div><div class="MsoNormal"><span style="font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: Arial, Helvetica, sans-serif;">Responses to the Winterbourne View abuse scandal, both by Castlebeck Care and in Parliament, highlighted the vital role that advocacy can play in preventing and addressing abuse. On 7<sup>th</sup> June 2011, Paul Burstow talked positively of the fact that those at Winterbourne View now had advocates and responded to <o:p></o:p></span></span></div><div class="MsoNormal" style="margin-left: 36.0pt;"><span style="font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: Arial, Helvetica, sans-serif;">“an important point about <span style="background-attachment: initial; background-clip: initial; background-color: white; background-image: initial; background-origin: initial; background-position: initial initial; background-repeat: initial initial;">the role that advocacy plays for those who lack capacity or the ability in certain circumstances to advocate on their own behalf. We are looking at that as part of the overall reforms of health and social care” <o:p></o:p></span></span></span></div><div class="MsoNormal"><span style="font-family: Arial, Helvetica, sans-serif;"><span style="background-attachment: initial; background-clip: initial; background-color: white; background-image: initial; background-origin: initial; background-position: initial initial; background-repeat: initial initial; font-size: 12pt; line-height: 115%;"><br />
</span></span></div><div class="MsoNormal"><span style="font-family: Arial, Helvetica, sans-serif;"><span style="background-attachment: initial; background-clip: initial; background-color: white; background-image: initial; background-origin: initial; background-position: initial initial; background-repeat: initial initial; font-size: 12pt; line-height: 115%;">In this context, as well as considering the recommendations of The Law Commission and the Joint Committee on Human Rights, the government may wish to reflect on the findings of the Dilnot Commission which recommended that </span><span style="font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">Local Authorities should <o:p></o:p></span></span></div><div class="MsoNormal" style="margin-left: 36.0pt;"><span style="font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: Arial, Helvetica, sans-serif;"><br />
</span></span></div><div class="MsoNormal" style="margin-left: 36.0pt;"><span style="font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: Arial, Helvetica, sans-serif;">“<i>work with trustworthy local voluntary, community-based organisations to provide support and advocacy services”<o:p></o:p></i></span></span></div><div class="MsoNormal"><span style="font-family: Arial, Helvetica, sans-serif;"><span style="background-attachment: initial; background-clip: initial; background-color: white; background-image: initial; background-origin: initial; background-position: initial initial; background-repeat: initial initial; font-size: 12pt;"><br />
</span></span></div><div class="MsoNormal"><span style="font-family: Arial, Helvetica, sans-serif;"><span style="background-attachment: initial; background-clip: initial; background-color: white; background-image: initial; background-origin: initial; background-position: initial initial; background-repeat: initial initial; font-size: 12pt;">The issue of trustworthiness is something the advocacy sector takes very seriously and is neatly addressed by Action for Advocacy’s Quality Performance Mark (QPM) which care services minister Paul Burstow MP rightly described in a written answer in 2012 </span><a href="http://www.theyworkforyou.com/wrans/?id=2012-02-20d.95141.h#g95141.r0">http://www.theyworkforyou.com/wrans/?id=2012-02-20d.95141.h#g95141.r0</a> <span style="background-attachment: initial; background-clip: initial; background-color: white; background-image: initial; background-origin: initial; background-position: initial initial; background-repeat: initial initial; font-size: 12pt;">as<o:p></o:p></span></span></div><div class="MsoNormal" style="margin-left: 36pt;"><span style="background-attachment: initial; background-clip: initial; background-color: white; background-image: initial; background-origin: initial; background-position: initial initial; background-repeat: initial initial; font-size: 12pt;"><span style="font-family: Arial, Helvetica, sans-serif;"><br />
</span></span></div><div class="MsoNormal" style="margin-left: 36pt;"><span style="background-attachment: initial; background-clip: initial; background-color: white; background-image: initial; background-origin: initial; background-position: initial initial; background-repeat: initial initial; font-size: 12pt;"><span style="font-family: Arial, Helvetica, sans-serif;">“an innovative scheme, developed by the sector for the sector, with the aim of recognising quality where it exists, and assisting all advocacy organisations to identify quality as an important part of their work.”<o:p></o:p></span></span></div><div class="MsoNormal"><span style="font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: Arial, Helvetica, sans-serif;"><br />
</span></span></div><div class="MsoNormal"><span style="font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: Arial, Helvetica, sans-serif;">He went on to describe advocacy as a vital means of helping Local Authorities to meet their equalities duties .<o:p></o:p></span></span></div><div class="MsoNormal"><span style="font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: Arial, Helvetica, sans-serif;"><br />
</span></span></div><div class="MsoNormal"><span style="font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: Arial, Helvetica, sans-serif;">Though undoubtedly shocking, the report on Winterbourne View was merely one more entry in a catalogue of institutional abuse in our country, Kerr/Haslam, Sutton and Merton, Cornwall; the list grows. . It appears that each time a scandal is uncovered, the recommendations call for more advocacy. The Healthcare Commission’s Report “A Life Like No Other” stated that “Having people acting as advocates on behalf of people with learning difficulties can provide valuable external scrutiny and shine a light on poor behaviours.” <o:p></o:p></span></span></div><div class="MsoNormal"><span style="font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: Arial, Helvetica, sans-serif;"><br />
</span></span></div><div class="MsoNormal"><span style="font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: Arial, Helvetica, sans-serif;">This role of advocacy in otherwise closed systems is vital. Advocacy can be a window into private systems reminding everyone that the world is watching, that normal rules do apply, that abuse will not be tolerated, will be uncovered and will be challenged. <o:p></o:p></span></span></div><div class="MsoNormal" style="margin-bottom: 0.0001pt;"><span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: 12.0pt; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><br />
</span></span></div><div class="MsoNormal" style="margin-bottom: 0.0001pt;"><span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: 12.0pt; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">As SCIE’s publication Prevention in Adult Safeguarding stated, “Advocacy can make a significant contribution to prevention of abuse through enabling adults at risk to become more aware of their rights and able to express their concerns” . </span><a href="http://www.scie.org.uk/publications/reports/report41/files/report41.pdf"><span style="font-size: 12.0pt; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">http://www.scie.org.uk/publications/reports/report41/files/report41.pdf</span></a><span style="font-size: 12.0pt; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"> , yet advocacy funding is falling.<o:p></o:p></span></span></div><div class="MsoNormal" style="margin-bottom: 0.0001pt;"><br />
</div><div class="MsoNormal"><b><span style="font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: Arial, Helvetica, sans-serif;">Older People<o:p></o:p></span></span></b></div><div class="MsoNormal"><span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">The Equality and Human Rights Coimmission report into home care of older people </span><a href="http://www.equalityhumanrights.com/legal-and-policy/inquiries-and-assessments/inquiry-into-home-care-of-older-people/"><span style="font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">http://www.equalityhumanrights.com/legal-and-policy/inquiries-and-assessments/inquiry-into-home-care-of-older-people/</span></a><span style="font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"> <span style="background: white; color: #211918;">revealed disturbing evidence that the poor treatment of many older people receiving home care is breaching their human rights and too many are struggling to voice their concerns about their care or be listened to about what kind of support they want.<o:p></o:p></span></span></span></div><div class="MsoNormal"><span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">A Joseph Rowntree Foundation report looking at the experience of older people in care stated that “<span class="apple-converted-space"><span style="background: white; color: #333333;"> </span></span><span style="background: white; color: #333333;">"the potential role and impact of advocacy is striking, but also missing for most people we met" </span></span><a href="http://t.co/OykqnTJY"><span style="background: white; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">http://t.co/OykqnTJY</span></a><span style="background: white; color: #333333; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><o:p></o:p></span></span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><b><span style="font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: Arial, Helvetica, sans-serif;">People in mental distress<o:p></o:p></span></span></b></div><div class="MsoNormal" style="margin-bottom: 0.0001pt;"><span style="font-size: 12.0pt; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: Arial, Helvetica, sans-serif;">The Care Quality Commission’s Mental Health Act Annual Report 2010/11 described Independent Mental Health Advocacy Services as “an important safeguard that help and support patients to understand and exercise their legal rights”. However, it also discovered insufficient funding and access to these services, despite both being a legal requirement Quick calculations based on CQC’s figures would suggest that 5,000 people who have a legal right of access to IMHA are currently being denied the service. <o:p></o:p></span></span></div><div class="MsoNormal" style="margin-bottom: 0.0001pt;"><br />
</div><div class="MsoNormal" style="margin-bottom: 0.0001pt;"><span style="font-size: 12.0pt; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: Arial, Helvetica, sans-serif;">CQC also found that non-statutory mental health advocacy services (which are more likely to be involved in preventative, community based work) were losing funding despite clear commissioning guidance <o:p></o:p></span></span></div><div class="MsoNormal" style="margin-bottom: 0.0001pt; text-indent: 36pt;"><br />
</div><div class="MsoNormal" style="margin-bottom: 0.0001pt; text-indent: 36pt;"><span style="font-size: 12.0pt; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: Arial, Helvetica, sans-serif;">“The Department of Health’s commissioning guidance states that IMHA services should be seen as an addition to advocacy provision and not a replacement for non-statutory advocacy services.<b> </b>However, some commissioning bodies have cut back on non-statutory advocacy in order to make efficiency savings, on the implicit or explicit rationale that advocacy is being provided by IMHA services to the degree required by law.”<o:p></o:p></span></span></div><div class="MsoNormal"><span style="font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: Arial, Helvetica, sans-serif;"><br />
</span></span></div><div class="MsoNormal"><span style="font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: Arial, Helvetica, sans-serif;">This finding echoes that of Action for Advocacy’s 2009 survey, the Mental Health Alliance report and Action for Advocacy’s 2011 report Advocacy In A Cold Climate. <o:p></o:p></span></span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><b><span style="font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: Arial, Helvetica, sans-serif;">Children and Young People<o:p></o:p></span></span></b></div><div class="MsoNormal"><span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">Office of the Children’s Commissioner published </span><a href="http://www.childrenscommissioner.gov.uk/content/publications/content_513"><i><span style="background: white; color: #e65b71; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">Where is my advocate?</span></i></a><i><span style="background: white; color: #211918; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"> </span></i><a href="http://www.childrenscommissioner.gov.uk/content/publications/content_513"><span style="font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">http://www.childrenscommissioner.gov.uk/content/publications/content_513</span></a><span style="font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"> which calls for a blueprint for advocacy services to protect vulnerable children<o:p></o:p></span></span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><b><span style="font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: Arial, Helvetica, sans-serif;">People with learning difficulties<o:p></o:p></span></span></b></div><div class="MsoNormal" style="margin-bottom: 0.0001pt;"><span style="font-size: 12.0pt; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: Arial, Helvetica, sans-serif;">Mencap’s updated report “Death By Indifference “ continues to show the human cost of inequitable access to healthcare for people with learning disabilities with the phrase “74 deaths and counting”. As well as highlighting the need for the use of DNAR notices to be reviewed and the role that Independent Mental Capacity Advocacy can play in this, the report rightly goes further, recommending that <o:p></o:p></span></span></div><div class="MsoNormal" style="margin-bottom: 0.0001pt;"><br />
</div><div class="MsoNormal" style="margin-bottom: 0.0001pt; margin-left: 36pt; margin-right: 0cm; margin-top: 0cm;"><span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: 12.0pt; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">“</span><span style="font-size: 12pt;">All Trust Boards should demonstrate in routine public reports that they have effective systems in place to deliver effective, ‘reasonably adjusted’ health services for those people who happen to have a learning disability. This should include arrangements to provide advocacy for all those who need it, and arrangements to secure effective representation on PALS from all client groups including people with learning disabilities.”</span><span style="font-size: 12.0pt; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><o:p></o:p></span></span></div><div class="MsoNormal"><br />
</div><div class="Default"><b><span style="font-family: Arial, Helvetica, sans-serif;">Mental Capacity Act and Deprivation of Liberty Safeguards<o:p></o:p></span></b></div><div class="Default"><br />
</div><div class="Default"><span style="font-family: Arial, Helvetica, sans-serif;">The judgement in the case of Hillingdon / Neary– shows one vital aspect of the Independent Mental Capacity Advocate (lMCA) in supporting people’s rights. As <span style="font-size: 11.5pt; mso-bidi-font-weight: bold;">The Honourable Mr Justice Peter Jackson<b> </b>strikingly states; <o:p></o:p></span></span></div><div class="Default"><br />
</div><div class="Default" style="margin-bottom: 14.0pt; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm;"><span style="font-size: 11.5pt;"><span style="font-family: Arial, Helvetica, sans-serif;">“On 18 November, the IMCA delivered her report. It is an impressive document. For the first time, professional support was given to Mr Neary's arguments. The previous best interests assessments are subjected to analysis. The IMCA’s conclusion is that Hillingdon was potentially not acting in Steven's best interests by refusing his father's request to have his son live with him at home. The fact that this is the most important relationship in Steven's life was noted. No evidence had been presented to show that the care he had given to Steven over the years was no longer appropriate. A return home, even as a trial period, should be considered. Further depriving Steven of his liberty might lead to emotional harm. Steven’s wish to return home was rational and understandable and Mr Neary had demonstrated in a number of ways his willingness to work positively with professionals involved in providing care for his son. <o:p></o:p></span></span></div><div class="Default" style="text-indent: 36.0pt;"><span style="font-size: 11.5pt;"><span style="font-family: Arial, Helvetica, sans-serif;">This report pointed the way towards a different outcome for Steven.”<o:p></o:p></span></span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span style="font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: Arial, Helvetica, sans-serif;">However, the IMCA role is only one small aspect of advocacy’s role in ensuring that the basic freedom and dignity enshrined in the Mental Capacity Act are made real for people. The rights to be included in decisions, to be supported to make your voice heard, to make unwise decisions – all of these are merely theoretical for many people without the presence of someone who will stand by their side in decision making processes.<o:p></o:p></span></span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><b><span style="font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: Arial, Helvetica, sans-serif;">Ensuring quality care<o:p></o:p></span></span></b></div><div class="MsoNormal"><span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">The Care Quality Commission’s regulation framework Essential Standards of Quality and Safety </span><a href="http://www.cqc.org.uk/sites/default/files/media/documents/gac_-_dec_2011_update.pdf">http://www.cqc.org.uk/sites/default/files/media/documents/gac_-_dec_2011_update.pdf</a> <span style="font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"> (1a) states that, in a good quality service, <o:p></o:p></span></span></div><div class="MsoNormal" style="margin-left: 36.0pt;"><span style="font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: Arial, Helvetica, sans-serif;"><br />
</span></span></div><div class="MsoNormal" style="margin-left: 36.0pt;"><span style="font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: Arial, Helvetica, sans-serif;">“ People who use services are involved in and receive care, treatment and support that respects their right to make or influence decisions because the service:” <o:p></o:p></span></span></div><div class="MsoNormal"><span style="font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: Arial, Helvetica, sans-serif;"><br />
</span></span></div><div class="MsoNormal"><span style="font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: Arial, Helvetica, sans-serif;">For many people this would require support from an advocate, and indeed the guidance goes on to specifically state that a good service<o:p></o:p></span></span></div><div class="MsoNormal" style="margin-bottom: 0.0001pt; text-indent: 36pt;"><span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: 12.0pt; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><br />
</span></span></div><div class="MsoNormal" style="margin-bottom: 0.0001pt; text-indent: 36pt;"><span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: 12.0pt; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">“</span><span style="color: #6b205f; font-size: 6.5pt;">●● </span><span style="font-size: 12pt;">Makes people who use services aware of independent advocacy services<o:p></o:p></span></span></div><div class="MsoNormal" style="margin-bottom: 0.0001pt; text-indent: 36pt;"><span style="font-size: 12pt;"><span style="font-family: Arial, Helvetica, sans-serif;">wherever they are available.<o:p></o:p></span></span></div><div class="MsoNormal" style="margin-bottom: 0.0001pt; text-indent: 36pt;"><span style="font-family: Arial, Helvetica, sans-serif;"><span style="color: #6b205f; font-size: 6.5pt;">●● </span><span style="font-size: 12pt;">Cooperates with independent advocacy services wherever a person who<o:p></o:p></span></span></div><div class="MsoNormal" style="text-indent: 36.0pt;"><span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: 12pt; line-height: 115%;">uses services uses one.”</span><span style="font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><o:p></o:p></span></span></div><div class="MsoNormal" style="margin-bottom: 0.0001pt;"><span style="font-size: 12.0pt; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: Arial, Helvetica, sans-serif;"><br />
</span></span></div><div class="MsoNormal" style="margin-bottom: 0.0001pt;"><span style="font-size: 12.0pt; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: Arial, Helvetica, sans-serif;">Section 2a which deals with managing risk through effective consent procedures talks about the services <o:p></o:p></span></span></div><div class="MsoNormal" style="margin-bottom: 0.0001pt; margin-left: 36pt; margin-right: 0cm; margin-top: 0cm;"><span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: 12.0pt; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><br />
</span></span></div><div class="MsoNormal" style="margin-bottom: 0.0001pt; margin-left: 36pt; margin-right: 0cm; margin-top: 0cm;"><span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: 12.0pt; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">“</span><span style="font-size: 12pt;">Respecting the right of people who use services to have an advocate to assist them in understanding their options and enable them to make an informed decision.”</span><span style="font-size: 12.0pt; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><o:p></o:p></span></span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span style="font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: Arial, Helvetica, sans-serif;">This guidance also highlights the value of advocacy in addressing abuse and talks about the need for advocacy services for those who wish to complain. <o:p></o:p></span></span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span style="background-color: white; color: #333333; font-family: Arial, Helvetica, sans-serif; font-size: 12pt; line-height: 115%;">As I said at the top, this post is far too long. That's because there are so many places where the need for advocacy is recognised. However, despite these clear indications that advocacy is effective at </span></div><ul><li><span style="background-color: white; color: #333333; font-family: Arial, Helvetica, sans-serif; font-size: 12pt; line-height: 115%;">helping people shape and control their own care</span></li>
<li><span style="background-color: white; color: #333333; font-family: Arial, Helvetica, sans-serif; font-size: 12pt; line-height: 115%;">upholding people’s dignity in care settings</span></li>
<li><span style="background-color: white; color: #333333; font-family: Arial, Helvetica, sans-serif; font-size: 12pt; line-height: 115%;">encouraging service providers to be responsive to individual service users</span></li>
<li><span style="background-color: white; color: #333333; font-family: Arial, Helvetica, sans-serif; font-size: 12pt; line-height: 115%;">establishing informed consent and </span></li>
<li><span style="background-color: white; color: #333333; font-family: Arial, Helvetica, sans-serif; font-size: 12pt; line-height: 115%;">dealing with safeguarding/abuse issues</span></li>
</ul><br />
<div class="MsoNormal"><span style="background-color: white; color: #333333; font-family: Arial, Helvetica, sans-serif; font-size: 12pt; line-height: 115%;"><br />
</span></div><div class="MsoNormal"><span style="background-color: white; color: #333333; font-family: Arial, Helvetica, sans-serif; font-size: 12pt; line-height: 115%;">neither central government, local government nor CQC have any means of establishing whether there is sufficient advocacy provision in any given area.</span></div><div class="MsoNormal"><span style="background: white; color: #333333; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: Arial, Helvetica, sans-serif;"><br />
</span></span></div><div class="MsoNormal"><span style="background: white; color: #333333; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: Arial, Helvetica, sans-serif;">We need a formal mechanism by which advocacy need is established and recorded in local areas. We need a publication or assessment of whether these needs are being addressed. We need a right of access to advocacy to uphold people's rights.</span><o:p></o:p></span></div><div class="MsoNormal"><span style="background: white; color: #333333; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: Arial, Helvetica, sans-serif;"><br />
</span></span></div><div class="MsoNormal"><span style="background: white; color: #333333; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: Arial, Helvetica, sans-serif;">We need to reform social care.</span></span></div>Anonymoushttp://www.blogger.com/profile/06108770731501761352noreply@blogger.com0