Thursday, 6 March 2014
An odd form of parity
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.
That's without taking into account the credibility gap; 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.
Recently, the Care Quality Commission's report Monitoring the Mental Health Act 2012/13 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.
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.
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.
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?
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.
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.
Wednesday, 29 January 2014
Short post, big problem
CQC have just launched their report Monitoring The Mental Health Act 2012/13.
I'll be writing about this in more detail soon, but here are some headlines to consider:
Many of the failings identified have remained the same for 2 years.
There is still highly disproportionate detention rates for the following groups:
Black African (2.2 times higher),
Black Caribbean (4.2 times higher),
Other Black (6.6 times higher)
and Other groups (2.1 times higher).
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?
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.
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.
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.
I'll be writing about this in more detail soon, but here are some headlines to consider:
- 10 % of care plans don't include the least restrictive option
- 27% of care plans show no involvement of the patient
- 29% of care plans do not include a discharge plan
- 20% of visits showed evidence of de facto detention
Many of the failings identified have remained the same for 2 years.
There is still highly disproportionate detention rates for the following groups:
Black African (2.2 times higher),
Black Caribbean (4.2 times higher),
Other Black (6.6 times higher)
and Other groups (2.1 times higher).
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?
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.
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.
Thursday, 5 December 2013
Quality Performance Mark Update
In 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.
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.
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.
If you have any enquiries about the QPM they should be sent to a4aqpm@ndti.org.uk
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.
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.
If you have any enquiries about the QPM they should be sent to a4aqpm@ndti.org.uk
Friday, 25 October 2013
Whitewash and Wonderland
Anyone who has been following @sarasiobahn’s remarkable blog My Daft Life 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.
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.
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.
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 value of advocacy and supporters in child protection proceedings.
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.
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 specifically not tried to find an advocate without a conflict of interests.
How big is the possibility of conflict of interests? Well, if the “advocate” worked for the trust it would be a BIG conflict. Used to work for the trust? Some conflict. Worked for a former worker of the trust – potential conflict. 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.
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.
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.
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”.
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?
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,
"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."
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.
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.
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.
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 value of advocacy and supporters in child protection proceedings.
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.
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 specifically not tried to find an advocate without a conflict of interests.
How big is the possibility of conflict of interests? Well, if the “advocate” worked for the trust it would be a BIG conflict. Used to work for the trust? Some conflict. Worked for a former worker of the trust – potential conflict. 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.
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.
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.
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”.
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?
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,
"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."
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.
Thursday, 19 September 2013
Comparative law - that's the way it is
Comparative law
Anyone remember the riots?
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?
OK.
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.
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.
So what’s going on?
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.
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?
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.
Friday, 23 August 2013
The point of advocacy
Some people have asked me why I keep banging on about advocacy.
Well, imagine that you need support, or care, or housing or a GP.
Now imagine that you are routinely disbelieved or given poorer services.
That you don’t get access to a GP.
Or that your physical health problem are ignored or put down to your mental health .
Or imagine that you are in a care home where you are being abused by the staff.
Or that in your care home you feel like you have no say at all in what happens or what you do.
Imagine finding out that someone put a Do Not Resuscitate notice are put on your file.
That they did this without your knowledge because they believed your life had no quality or value.
That they didn't ask you because you are old, or have a learning disability, or have a diagnosis of depression.
Then imagine that there was a thing called advocacy that could help you be listened to.
Imagine the difference that it would make to have someone standing alongside you.
Someone whose presence actively demonstrates that they think that you matter.
Someone showing that you are not alone, that you are part of our wider society.
Someone who treats you with respect and who expects others to do the same.
Someone who helps you to be heard.
Someone who is there to make it harder for others to ignore your voice, you rights.
Advocates need to be trained, accountable, clear about their role and supported to deliver this..
Well, imagine that you need support, or care, or housing or a GP.
Now imagine that you are routinely disbelieved or given poorer services.
That you don’t get access to a GP.
Or that your physical health problem are ignored or put down to your mental health .
Or imagine that you are in a care home where you are being abused by the staff.
Or that in your care home you feel like you have no say at all in what happens or what you do.
Imagine finding out that someone put a Do Not Resuscitate notice are put on your file.
That they did this without your knowledge because they believed your life had no quality or value.
That they didn't ask you because you are old, or have a learning disability, or have a diagnosis of depression.
Then imagine that there was a thing called advocacy that could help you be listened to.
Imagine the difference that it would make to have someone standing alongside you.
Someone whose presence actively demonstrates that they think that you matter.
Someone showing that you are not alone, that you are part of our wider society.
Someone who treats you with respect and who expects others to do the same.
Someone who helps you to be heard.
Someone who is there to make it harder for others to ignore your voice, you rights.
Someone who makes it harder to ignore you.
That's the point of advocacy.
That's the point of advocacy.
I think that's worth banging on about. It needs to be kept on the agenda.
Other people ask why anyone should care that Action for Advocacy has closed?
Well, put yourself back in that position.
If advocacy was available, you’d want to know about it.
Other people ask why anyone should care that Action for Advocacy has closed?
Well, put yourself back in that position.
If advocacy was available, you’d want to know about it.
You'd want an advocate who could be there for you.
Someone who knew what they were doing.
Someone who could do these important things as well as possible.
Advocacy is too important to get wrong.
Advocates need to be trained, accountable, clear about their role and supported to deliver this..
Advocacy organisations need to be robust, independent and able to challenge poor practices.
That's what a4a was trying to achieve.
We got part of the way, but it can't be left there.
We need to talk about what happens next.
I need your help.
I want you to get involved, have your say & help decide what happens.
If you're interested email martin@truevoicetrust.org and I'll get in touch soon.
As ever, comments welcome.
We need to talk about what happens next.
I need your help.
I want you to get involved, have your say & help decide what happens.
If you're interested email martin@truevoicetrust.org and I'll get in touch soon.
As ever, comments welcome.
Monday, 19 August 2013
Action for Advocacy - a kind of obituary
It is with some regret that I have seen the notice that Action for Advocacy has ceased trading.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.
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.
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.
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.
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.
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.
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...
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.
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.
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.
So raise a glass - for good or ill, a4a is no more.
Salut!
....I wonder if anyone will miss us
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.
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.
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.
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.
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.
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...
- The Advocacy Charter
- The London Support Project
- Developing A Code of Practice for Advocates
- Quality Standards for Advocacy Schemes
- Founder member of Advocacy Consortium
- Supporting the inclusion of advocacy included in the Mental Capacity Act
- Promoting Independent Mental Health Advocacy in the Mental Health Act
- Human Rights Toolkit for Advocates
- Promoting understanding of Non-Instructed Advocacy
- Training over 5000 advocates
- Developing and running the ILM accredited Managing for Excellence in Advocacy
- Standards Support Project which supported hundreds of advocacy organisations raise quality
- Developing the Quality Performance Mark
- Member of the Care and Support Alliance
- Representing independent advocacy in parliament
- Advocates forums - both in person and online
- IMHA support Project
- IMCA support project
- Free online map of advocacy services
- Lost in Translation - developing a framework for recording soft outcomes in advocacy
- Supporting organisations to prepare for contracts and tendering
- Challenging poor tender documents
- Representing advocacy organisations to commissioners
- Planet Advocacy Magazine
- Advocacy Commissioners' Support conference and emails
- 3 National IMCA conferences
- Working with Welsh Government to develop monitoring framework for IMHA in Wales.
- Highlighting shortfalls in IMHA commissioning in national media
- Giving evidence to Joint Scrutiny Committee on the Social Care Bill
- Review of rollout of IMHA in the North East
- Review of learning disabilities funding in Wales
- Review of use of IMCA in Safeguarding
- Influencing the guidance on IMHA in Mental Health Review tribunals
- First official review of the advocacy workforce
- Keeping the sector informed on policy consultations
- Input into CQC Mental Health Review report
- Safeguarding courses
- Responding to countless (and seemingly increasingly quick) policy consultations
- Role of advocacy in financial abuse situations
- Signatory of the Winterbourne Concordat
- Hundreds of In House training sessions
- 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......
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.
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.
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.
So raise a glass - for good or ill, a4a is no more.
Salut!
....I wonder if anyone will miss us
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