Advocacy for Social Care:
A Strategy to enable
Vulnerable Adults to have a
stronger voice and choice in
services.
2008 – 2011
Community & Adult Care Directorate
January 2008
Updated August 2008
Advocacy for Social Care:
A Strategy to enable Vulnerable Adults to have a
stronger voice and choice in services
Contents
Page
Acronyms
3
1 Introduction
4
2.
What is advocacy?
4
3.
National Policy Context
4
4.
Local Policy Context
7
5.
Strategy Statement
9
6.
Needs Assessment
9
7.
How will we deliver our vision ?
11
8.
Conclusion
13
Appendices
14
2
Advocacy for Social Care:
A Strategy to enable Vulnerable Adults to have a
stronger voice and choice in services.
Acronyms
CYPD – Children & Young Peoples Directorate
C & ACD – Community and Adult Care Directorate
CASSR – Councils with Adult Social Services Responsibilities.
CATG – Citizens Advocacy Trust, Gloucestershire
CSCI – Commission for Social Care Inspection
CYPD – Children and Young People’s Directorate
ERIC – Electronic record for integrated care
GASS – Gloucestershire Advocacy Support Service
GSUF – Gloucestershire Service Users’ forum
IMCA – Independent Mental Capacity Advocate
LINks – Local Involvement Networks
NSF – National Service framework
POPP – Partnerships for older people projects
QuAd- Quality Advocacy standard
VCS – Voluntary & Community Sector
For more information on this Strategy please contact:
Fiona Jones, Strategic Planning and Policy Manager,
[email protected]
Tel. 01452 425125
Janet Waters, Planning, Policy and Projects Officer
mailto:[email protected]
Tel 01452 42 6838
Brenda Yearwood, Voluntary Sector Resource Officer
[email protected]
Tel. 01452 42 6336
3
Advocacy for Social Care:
A Strategy to enable Vulnerable Adults to have a
stronger voice and choice in services.
1.
Introduction
The aim of this strategy is to set out how advocacy can contribute to
delivering the Directorate’s vision of supporting vulnerable adults to have a
stronger voice and choice in how their own and their community’s social care
needs are met. The Community & Adult Care Directorate is committed to
giving those who use its services more choice and control in their lives.
To make it easier to read, when this document says “we” and “us” it is
referring to the Community & Adult Care Directorate.
We thank everyone who made comments on the draft Strategy. These
comments have been used in the revision and production of this Strategy. A
summary of the feedback is available on request.
2.
What is advocacy?
Advocacy is when a person helps another person to be heard. Action for
Advocacy defines advocacy as:
“ taking action to help people say what they want, secure their rights,
represent their interests and obtain the services they need. Advocates
and advocacy schemes work in partnership with the people they
support and take their side. Advocacy promotes social inclusion,
equality and social justice”1
There are different types of advocacy are described in Appendix 2.
Advocates are normally instructed so that the issue and desired outcome is
defined and stated by the person, or group of people, whose voices wish to be
heard. However, the Mental Capacity Act has introduced the role of a noninstructed advocate called an Independent Mental Health Advocate (IMCA).
Non instructed advocacy also has a place in this Strategy; this is when the
issue and desired outcome is defined by the advocate on behalf of the person
unable to voice their views independently. This Strategy also recognises the
importance of advocacy being independent and so free from conflicts of
interest that accompany staff within the Council.2
3.
National Policy Context
Since the draft of this Strategy was issued for consultation, there have been a
number of significant policy statements that together place more importance
on enabling vulnerable adults to have a stronger say and choice in services.
1
2
Action for Advocacy 2002, www.actionforadvocacy.org.uk
See Appendix 3: Key Principles.
4
The Department of Health has set out its’ plans for transforming social care
for adults and expects that by 2011 all Councils with Social Services
Responsibilities (CSSR) should be delivering “personalised services which
enable individuals or groups to develop solutions, which work for them”. 3
The Government has put much greater emphasis on both the responsibilities
of Local Authorities to commission services for the whole community, whether
people are funded by the Council or not and the importance of advocacy in
delivering its personalisation agenda. 4 The Government has very recently
set out the progress it expects these councils to make by 2011 and this
includes expectations about advocacy.
The Local Authority Circular for the new Social Care Reform Grant explains
what this will mean. The Government recognises that advocacy plays an
important part in assisting people to exercise the choice and control in their
lives. The Department of Health expects, amongst other things, that everyone
eligible for statutory support, should have a personal budget with more people
having this budget as a direct payment and that there is a mechanism to listen
to the views and experiences of users, carers and other stakeholders.
This Strategy addresses the policy agenda under 3 themes:



3.1

Promoting independence and control
Commissioning services
Strengthening the citizen’s voice
Promoting independence and control
The Government’s personalisation agenda includes how people can
take control of their own lives but also how they can shape the services
they receive. ”5 The availability of independent advocacy is now seen
as a key part of promoting people’s independence and well-being:
“The direction is clear: to make personalisation, including a
strategic shift towards early intervention and prevention, the
cornerstone of public services…for some, exercising choice and
control will require a significant level of assistance either through
professionals or through independent advocates”. 6

Commission for Social Care Inspectorate’s Key Lines of Enquiry
(KLOE) include statements about advocacy. For example, the KLOE
for Local Authorities includes Advocacy in by 2 of the 7 outcomes,
Increased Choice and Control and Freedom from Discrimination and
Harassment. The CSCI expect that in good authorities advocacy
services are available, timely, respectful and suitable to the needs of
most individuals and that almost all people who use services and their
Local Authority Circular announcing the Social Care Reform Grant “Transforming Social
Care” (Gateway ref.9337)
4 The State of Social Care in England 2006-07, Commission for Social Care Inspection
5 Building on Progress: Public Services, HM Government Policy Review, Prime Minister’s
Strategy Unit, 2007
6 See no. 3
3
5
carers report that advocacy services have been offered to them.7
CSCI also expect Care Homes and Domiciliary Care Services to
support individuals to know their rights and that advocacy services are
encouraged to promote these.

3.2

Commissioning services
The Commissioning Framework for Health and Well-Being aims to put
“people at the centre of commissioning” and recommends that
Commissioners can do this through advocacy that can support both
those who find it hard to express views about their individual
circumstances, and also advocacy for groups to influence the
commissioning of services.

The Department of Health expects that by 2011 that there will be a
framework in place to ensure that people can exercise choice and
control with the support of advocacy if they choose. Between 2008
and 2011, the Department of Health will be making arrangements for
all councils in the each region to be supported to ensure that there are
sustainable advocacy and brokerage organisations that are accessible
to people entitled to public support as well as those who fund
themselves.

Action for Advocacy encourages Commissioners to adopt their
Advocacy Charter, Code of Practice for Advocates, Quality Standards
for Advocacy Schemes and forthcoming Quality Mark for Advocacy
Providers as a way of driving up the quality of independent advocacy
provision. The Government is developing a national qualification for
advocates that is anticipated to be available in 2009. The Government
is also investing in a new learning disability advocacy development
programme.

The Mental Capacity Act grant made by the Department of Health will
be part of the new Area Based Grant from 2008/09 and so not ringfenced.
3.3


7
The Government has recognised the important part that staff working in
the social care sector have in giving people more choice and control. It
has emphasised that staff, users and carers should work together to
developing how this happens.
Strengthening the citizen’s voice
The Department of Health says that CSSRs must ensure that people
are much more involved in the design, commissioning and evaluation
of services and how their needs are met.
The Local Government and Public Involvement in Health Act 2007 will
help to implement the Government’s vision of strengthening the
citizen’s voice. The Act introduces new requirements for consultation. It
CSCI Key Lines of Assessment to Standards of Performance, March 2007
6
also introduces Local Involvement Networks as a way of giving a
stronger voice to local people in the commissioning and provision of
local health and care services. This will raise the profile of collective or
group advocacy as the same issues of equality, communication and
the need for empowerment among service users and carers will be
important.

4.
Action for Advocacy recommended, in their feedback to the
Commissioning Framework, that a distinction is made between
advocacy, self-advocacy and consultation. Self-advocacy groups
agree what issues they want to consider themselves. However, we
must not overlook the fact that we will want to engage, consult with and
hear the views of these groups.
Local Policy Context
Our research revealed a general lack of knowledge about advocacy and local
advocacy services.
4.1
Promoting independence and control

As part of promoting independence and control, the Directorate has
implemented the Mental Capacity Act and commissioned an
Independent Mental Capacity Advocates Service. This has started to
raise the profile of independent advocacy (recognising that it is noninstructed). The Directorate is currently implementing its Direct
Payments Strategy which acknowledges the role of advocacy. The
Learning Disabilities Joint Commissioning Strategy also includes
advocacy and will be reviewed in the light of Valuing People Now.

Currently, however it appears that the Directorate does not place a
great deal of emphasis on the role advocates could play in enabling
service users to express their views, although the introduction of the
IMCA service is starting to change this. Some local commissioners
and service providers lack a good understanding of independent
advocacy, when it might help and how to access it. This is reflected in
the Summary Report of 2006 –07 Annual Performance Assessment of
Social Care Services for Adult Services in Gloucestershire only rated
us as ‘adequate’ for ‘Increased choice’ and control. In addition to
commenting on the service provided, CSCI also said:
“Service users and carers however seem to have little
awareness of what advocacy was or where”

With the exception of the Mental Capacity Act, advocacy does not
feature very much in staff training.
4.2
Commissioning services
7
The local context shows that there are opportunities to improve the
awareness and provision of advocacy but that it is starting from a low base.

The introduction of the Council’s new funding framework means that it
will no longer grant fund the Voluntary & Community Sector but will
‘shop’, ‘invest” and ‘give’ instead. This will help the County Council
develop a more business-like relationship with the Voluntary and
Community Sector which will mean better value for money through
clearer arrangements. We have prioritised advocacy as one the three
specific areas in the first phase of this change. Organisations will be
expected, to show that the service they intend to deliver is fully costed,
sustainable, meets the needs of the service user and meets our
criteria.

The system of grant funding has meant that, in the past, voluntary and
community groups have been funded rather than each specific service
they provide – so most of the groups we grant fund also run other
services with this funding. This makes it difficult to see how much
money we are spending specifically on advocacy. Some of the groups
who provide advocacy also provide advice and information and it is
difficult to separate this out. Some groups employ paid advocates while
others recruit volunteer advocates.

Voluntary organisations have told the Directorate about the difficulties
they have experienced as a result of short-term and reducing funding.
This undermines the development of quality advocacy and
compromises their ability to attract other funding. Groups providing
advocacy also receive funding from many other sources. As well as
using local advocacy groups some Care Providers also buy advocacy
from out of county providers.

The only comparative information available on funding levels is in
relation to Learning Disabilities. The 2006 Record of Performance
Assessment for Adult Social Care8 recommended that advocacy
services for adults with a learning disability and those with mental
health problems need significant improvement in Gloucestershire
because: “the amount spent on advocacy services for adults with a
learning disability is the joint lowest compared similar councils.”
However, the Learning Disabilities Development Fund has allocated
£25,000 to advocacy for people with learning disabilities in 2007/08.
4.3. Strengthening the citizen’s voice
The County Council’s Consultation Strategy and our work on community
engagement will inform how we will improve the way we consult with
communities, user groups and stakeholders. The Directorate’s Service User
and Carer Involvement Strategy, introduced in 2004, needs to be updated to
8
http://www.csci.org.uk/professional/default.aspx?page=7114&csci=881
8
take into account the national context. Appendix 5 describes the current
situation in more detail.
5.
Strategy Statement
The Directorate is committed to enabling vulnerable people to exercise choice
in how they meet their social care needs and to making advocacy services
available to those who need help to do so. This strategy aims to enable
vulnerable people to be able to have a stronger voice and choice in two
important areas: firstly in decisions about their own well-being and social care
needs and secondly how services are developed to meet the needs of the
wider community.
We will do this by:
1. Increasing awareness and understanding of advocacy and how it can
help with making choices.
2. Increasing the availability of reliable, quality independent advocacy
services for vulnerable adults with social care needs.
3. Improving individual outcomes by increasing the number of vulnerable
people who are offered advocacy.
4. Implementing a performance management framework that means that
it is clear how advocacy is contributing to achieving good outcomes for
service users.
5. Developing ways for the Directorate to learn from the advocacy
undertaken in Gloucestershire and elsewhere and so improve the
services it commissions and provides as a result.
6.
Needs Assessment
We did not find any national models to help us estimate the implications of
this vision. We have estimated the size of the gap between the current levels
of investment and the possible need and demand for advocacy. There will be
many people who do not need or want the support of an advocate.
Current levels of investment
 The Directorate has one contract specifically for advocacy: the IMCA
Service which is funded via the Department of Health Mental Capacity
Act Grant. From 2008/09 this grant will be contained within the Area
Based Grant. The Partnership Trust has a contract for advocacy for
people subject to the Mental Health Act.

In 2007-08, the Directorate awarded 13 grants to voluntary and
community groups who included advocacy in their bid (i.e.not the DH
carers grant or the DH MCA grant) representing a value of £83,500.
This included £29,131, or 35% of the grant spend on advocacy, on the
Gloucestershire Advocacy Support Service.
9
Current levels of service
 There is management information available from the IMCA service as
the Department of Health is monitoring service levels closely.

The POPP project is currently supporting a project to introduce
advocacy into care homes for older people; this will inform our
knowledge on the likely demand for advocacy services.
Possible Need
 The population of Gloucestershire is projected to change and this is
likely to increase the demand for advocacy. The population is
expected to follow the national trends with an increase in older people
and single person households. From a base of 439,416 adults in 2006
aged over 19, this is projected to increase by around 3% to an
estimated 453,917 in 20019; this is an additional 14,501 people.
However, to estimate the level of need for advocacy, we need to look
within this overall picture. For example:

Between 2006 and 2011 there is expected to be a 15%
increase in people aged between 65 and 74 and 12%
increase in those aged 85 and over. By 2011, there will be
around 52,570 people aged 75 and over.

National prevalence suggests that 2% of the population will
have a learning disability; this translates to approximately
14,000 people in Gloucestershire of which 1,400 are known
through social care services.
Possible demand
 If service users going through the assessment process were to use
advocacy at the same rate as users of the Adult Placement Service
(20%), then in 2006/07, some 1,870 people may well have benefited
from the services of an advocate if either they or their professional
assessor had been aware of this service and that advocacy was
available.10 The limited and anecdotal information that we have from
advocacy providers and fieldwork services suggests that nowhere near
this number of service users benefited from advocacy.

During the course of the consultation period, concerns were expressed
about how service users in permanent residential care might be
enabled to have a voice in services. There were 2,727 Gloucestershire
funded residents in permanent care at March 31st 2007 so potentially
they could also benefit from the services of an independent advocate.
Healthy Gloucestershire: Gloucestershire’s Health and Community Well-Being Strategy ,
Annexe A Gloucestershire Needs Analysis: A brief profile, Table 2.8,Annexe A
10 Between 1/4/06-31/3/07, the Directorate completed 9,343 assessments and based on the
knowledge that in the Adult Placement Service, 20% of all their service users accepted
advocacy as a service when it was offered we can assume that 1,869 people
9
10
7.
How will we deliver our vision ?
7.1
Increasing awareness and understanding of advocacy and how it
can help with making choices.
The Directorate will do this by:
a) updating its Advocacy Policy;
b) improving information available to the public, service users and
carers about independent advocacy, what it is, how it can help and
how to get it;
c) promoting advocacy services to its staff and expecting them to offer
independent advocacy to service users and their carers whenever a
person is seen to be or perceives themselves as vulnerable.
d) reviewing the training for all care staff to ensure they are aware how
independent advocacy can help
e) ensuring that training about advocacy is available for staff working
with people profound and multiple needs.
f) updating its Service User and Carer Involvement Strategy and
developing a coherent approach to group advocacy across the
various service user groups.
7.2
Increasing the availability of reliable, quality independent
advocacy services for vulnerable adults with social care needs.
The Directorate will do this by:
a) Recognising the important part advocacy has to play in the
personalisation agenda;
b) Extending grant funding to currently funded groups until March
2009 in order to give them time to work with the Directorate on
understanding the likely demand and current supply of advocacy;
c) Giving more stability by awarding a small number of development
contracts for the provision of independent advocacy in 2008/09.
These contracts will be: for two years, outcomes based and will
adopt clear quality assurance standards. They will include funding
for training and quality assurance.
d) Developing a model that involves working with providers to
understand more about the need and demand for advocacy and
how it should be made available, so that the service can be
expanded should additional investment become available.
11
e) Extending the current IMCA contract to ensure that there is no gap
in service. The provision of the IMCA service will be a separate
contract and not included in a single wider contract.
f) Commissioners working with Care Providers on the Care Providers
arrangements for providing independent advocacy so that this
contributes to the availability of sustainable advocacy services.
7.3
Improving individual outcomes by increasing the number of
vulnerable people who are offered advocacy.
The Directorate will do this by:
a) including advocacy in training courses so that staff can develop a
confident approach to working with independent advocates.
b) Commissioners working with service providers to ensure that
independent advocacy is made available to service users.
c) Building on the learning from the POPP experience to develop
advocacy for people in care settings.
d) Asking advocacy providers to demonstrate how their service is
helping service users achieve the outcomes they want.
e) Making independent advocacy available to all people using the
social care complaints process and those subject to the
safeguarding adults process.
7.4
Implementing a performance management framework that means
that it is clear how advocacy is contributing to achieving good
outcomes for service users.
The Directorate will do this by:
a) developing a performance management framework, indicators and
targets for advocacy that will demonstrate whether advocacy is
being offered so that it can monitor its progress towards meeting
the CSCI standards.
b) Involving service users and carers in the development of this
performance management framework.
c) Reviewing recording practice so that it is possible to demonstrate
the independent advocates are being used, that service user’s
outcomes are being met and that performance has improved.
d) Benchmarking our progress by getting a better understanding of
how other local authorities measure their performance and
particularly the spend on advocacy for people with learning
disabilities.
12
e) Review current contract monitoring arrangements in order to
include reporting on provision of independent advocacy by care
providers.
7.5
Developing ways for the Directorate to learn from the advocacy
undertaken in Gloucestershire and elsewhere and so improve the
services it commissions and provides as a result.
The Directorate will do this by:
a) Fostering a culture of service user participation by developing
systems to learn from the experiences of those using advocacy
services, independent advocates and social care staff in order to
improve the quality of services that the Directorate both
commissions and provides.
b) Recognising that contracts provide the opportunity for learning and
consultation and including funding to support this.
c) Reviewing the training provided to support and enable people to
participate in service development in the light of the contract for the
LINk host.
d) Agreeing how POPP fits with delivering the aims of this strategy for
older people specifically.
e) Developing a coherent approach to group advocacy across the
various service user groups
f) Working with Children and Young People’s Directorate on how best
to provide advocacy for vulnerable adults who are parents and in
particular parents with learning disabilities.
8.
Conclusion
This strategy seeks to promote the different types of advocacy to ensure that
vulnerable adults have a voice in both their own lives and in the
commissioning of services so that services are developed which better meet
their needs.
13
Appendices
Appendix 1
Action Plan
15
Appendix 2
Advocacy Models
16
Appendix 3
Statement of principles
17
Appendix 4
Summary of national policy context
18
Appendix 5
Summary of local context – performance in
Gloucestershire
22
14
Appendix 1: Action Plan 2008 – 2011
Improvement Area Outcomes
SUPPLY
Actions
Lead
15
Completion date
Appendix 1: Action Plan 2008 – 2011
Improvement Area Outcomes
SUPPLY
1.
Quality, accredited
Commissioning
advocacy services are
available
Constructive relationship
between GCC and VCS
that delivers
demonstrable
improvements in
outcomes
Actions
Lead
Completion date
Extend grant funding until March 2009.
Brenda Yearwood
March 2009
Work with the voluntary sector on the
support they need to move from grants to
contracts
Brenda Yearwood/
Janet Waters
September 2010
Award 2 year development contracts for
Advocacy and put in place monitoring
arrangements
Brenda Yearwood
April 2009
Brenda Yearwood/
Louise Flaherty
April 2009
Brenda Yearwood/
In consultation with local advocacy services
Louise Flaherty
agree:
 Service mapping & needs assessment
for future provision
 quality assurance standards
 training for advocates
 learning from advocacy provided
 performance management
 how existing voluntary BME service
providers/advocates are included in
delivering services
 diversity monitoring
April 2009
Set up contract development steering group
with grant funded services in order to procure
a range of advocacy provision: group, peer
and self advocacy
Quality advocacy
provision is available
Advocacy services are
relevant to cultural
needs of all communities
Tender for advocacy services informed by
contract development group and outcomes of Louise Flaherty
Brenda Yearwood/
development contracts
16
April 2011
Appendix 1: Action Plan 2008 – 2011
Improvement Area Outcomes
SUPPLY
Actions
Improved arrangements Work with Joint Commissioner & Mental
with 2gether for
Health Act Programme Manager to agree
commissioning of mental future commissioning.
health advocacy
Assess the impact of the Mental Health Act
on the IMCA contract.
IMCA service is
Commission IMCA service from 1/4/09
available and no gap in
provision
Work with the POPP project on the exit
strategy for the advocacy project
Availability of quality
advocacy for people in
care settings and
demonstrate use of the
learning from the POPP
project
17
Lead
Completion date
David Pugh
April 2009
David Pugh
March 2009
April 2009
Brenda Yearwood/
Janet
Waters/Justine
Rawlings
Appendix 1: Action Plan 2008 – 2011
Improvement Area Outcomes
SUPPLY
2. Finance
Transparent use of
resources
3. Joint Working
DEMAND
4. Culture Change
Actions
Lead
Completion date
Identify all current funding arrangements for
advocacy within the Directorate
Fiona Jones/
Brenda Yearwood
December 2008
Increase in advocacy
services
Apply for funding from the Transforming
Social Care Grant
Fiona Jones
TBA
Improved medium term
planning
Create a single budget for advocacy within
C&ACD, (to include Carers Support, Mental
Health Advocacy Services, (including joint
PCT/GCC funded services), and any other
arrangements identified in 2.1
Mark Branton
TBA
Security for providers to
develop services
Advocacy services for
parents with learning
disabilities involved with
Children & Young
Peoples Directorate
Commit budget for 3 years
Mark Branton
TBA
Work existing advocacy providers to estimate Brenda
demand and then with CYPD to agree
Yearwood/Janet
eligibility criteria
Waters
September 2010
Service users, carers
and staff understand the
role that advocacy can
play in giving people a
stronger voice in how
their needs are met.
Review public information on advocacy and
then update in line with new arrangements
Janet Waters
September 2008
April 2009
Care services promote
advocacy to their service
users and can
demonstrate an
increased uptake as a
result
Through the contracts, Advocacy providers
promote advocacy to service users, carers
and staff across the social care sector
Promote advocacy and available services at
commissioner/provider meetings
Brenda Yearwood
March 2011
18
Appendix 1: Action Plan 2008 – 2011
Improvement Area Outcomes
SUPPLY
Increased use of
advocacy services
Staff have confidence in
advocacy providers and
so refer or recommend
advocacy to service
users and carers
5. Policy &
Planning
Framework
Staff are clear about
when and how advocacy
services should be used
By offering advocacy at
the earliest opportunity,
service users will be
supported to make
choices about their care
Actions
Lead
Completion date
Improve advocacy input in relevant training
courses, particularly to raise awareness with
staff working with those with profound and
multiple needs. Promote e-learning.
Janet Waters/
Jeanette Fitzpatrick
March 2011
Raise & maintain staff awareness by Policy
Officers by promoting advocacy at team
meetings twice a year.
Janet Waters
March 2011
Develop internal quality assurance process
so staff contribute to evaluation of advocacy
services
Janet Waters/
Implementation
Group
March 2011
Advocacy is promoted through the Putting
People First work programme
Carey Wallin/
Fiona Jones
TBA
Develop coherent approach to group
advocacy across service user groups
Revise the Advocacy Policy in line with
fieldwork redesign and by considering
consultation feedback and strategy
conclusions.
Laura Jerram
September 2009
Janet Waters
December 2008
Revise Advocacy Policy in line with the
outcomes of the work of the contract
development steering group
Janet Waters
September 2010
Incorporate advocacy into the fieldwork
redesign, e.g. self assessment and first point
of contact buckets
Dave Tradgett
December 2008
19
Appendix 1: Action Plan 2008 – 2011
Improvement Area Outcomes
SUPPLY
GOVERNANCE
6. Project
Management
7. Performance
Management
Actions
Lead
Completion date
Ensure that all service
users involved in
Safeguarding Adults
procedures are routinely
offered advocacy to
ensure that they are
empowered.
Review existing policies and training
Janet Waters
December 2009
Complainants are
offered advocacy and
are supported during the
resolution of their
complaint
Revise the complaints process to ensure
complainants are offered advocacy.
Colin Davies
March 2009
Learning from complaints is integrated into
the internal quality assurance process
Colin Davies
Services improve as a
result of customer
experience
Develop and implement a system for
organisational learning from quality and
consistency of advocacy provision
Brenda
Yearwood/Janet
Waters
March 2010
Local people have a say
about local services
available
Update the Service User and Carer
Involvement Strategy
Laura Jerram
June 2009
Project Management
arrangements
successfully implement
the Strategy
Establish a group to implement the strategy
Janet Waters
July 2008
Put in place and use a risk management plan
and risk register
Fiona Jones
October 2008
The aims of the strategy
are met
Develop a performance management
framework and relevant performance
indicators that concentrate on outcomes.
Brenda
Yearwood/Janet
Waters
April 2009
20
Appendix 1: Action Plan 2008 – 2011
Improvement Area Outcomes
SUPPLY
Ensure that services are
user led.
Actions
Lead
Involve service users and carers in the
development and use of the performance
management framework.
Brenda Yearwood/
Janet Waters/
Laura Jerram
Undertake evaluation of the strategy.
Fiona Jones
March 2011
A baseline is established To put in place arrangements to ensure
Jacky Smith
from which it is possible information is recorded and available in order
to measure
to monitor progress.
improvements
March 2009
Benchmark against other LA’s.
21
Brenda Yearwood/
Janet Waters
Completion date
March 2009
Appendix 2:
Advocacy Models
Source: Action for Advocacy

Professional/Paid Advocacy usually involves casework in specific
areas and adopts a problem solving approach in relation to the
outcome desired by the person they are supporting. The advocate
may have developed specific knowledge of systems and services
and support the person through them.

Volunteer Advocacy usually involves volunteers working alongside
paid advocates, holding a small caseload and offering support to
individuals.

Citizen Advocacy involves volunteers, recruited, supported and
trained by a co-ordinator who matches them with an individual who
is not in a good position to defend their rights as a citizen. The work
is one to one, usually long term and partnerships can last for a
lifetime.

Peer Advocacy is when the advocate has something in common
with the person they are advocating for, for example they may also
be a user or ex-user of services.

Group/Collective Advocacy often develops when individuals
come together over a particular issue. It may need independent
facilitation or resources.

Self Advocacy – encompasses the ideal of individuals speaking up
for themselves. All forms of advocacy would aim to promote selfadvocacy in their work and would view this as the ideal form of
advocacy.
23
Appendix 3:
Statement of Principles
The Community & Adult Care Directorate proposes to underpin its
commissioning decisions by using the Action for Advocacy Quality Standards.
This is based on the Advocacy Charter and turns each principle into a
standard and describes its rationale and what evidence is needed to
demonstrate it. The standards have been developed to inform, raise
awareness, be used with commissioners and support quality assurance. 10
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
10
Clarity of Purpose – the scheme will have clear aims and
objectives and they will ensure that service users, service providers
and funding bodies will have information on the scope and
limitations of their scheme.
Independence – the advocacy scheme will be structurally
independent from statutory organisations and preferably all service
provider organisations to minimise any conflict of interest.
Putting people first – the advocacy scheme will ensure that they
respect and prioritise the needs and wishes of the people they
advocate for and share information with them.
Empowerment – any advocacy scheme should support selfadvocacy and empowerment through its work, both by allowing
service users to dictate the level and style of support they want and
by contributing to the running and management of the scheme.
Equal opportunity – Each advocacy scheme must have a written
equal opportunities policy and active procedures to promote
fairness and diversity. Schemes must have systems for the fair and
equitable allocation of advocates’ time.
Accessibility – advocacy must be provided free of charge to
eligible people and its premises, policies and procedures must be
open to the whole community.
Accountability – All schemes must have in place systems for the
effective evaluation and monitoring of its scheme. All users of the
scheme will have a named advocate and a means of contacting
them.
Supporting advocates – the advocacy scheme will ensure that
advocates are prepared, trained and supported in their role and
provided with opportunities for professional development.
Confidentiality – all advocacy schemes must have a written policy
on confidentiality, which their workers adhere to.
Complaints – All advocacy schemes must have a written
complaints policy and ensure that people who use its services can
access external independent support to make or pursue a
complaint.
Action for Advocacy http://actionforadvocacy.org.uk
24
Appendix 4 Summary of National Policy Context
The Government vision is that everyone in society has a positive contribution
to make and has a right to control their lives. Advocacy features strongly in
many of the very recent national policy documents11. They all expect
advocacy to help individuals to maintain their independence and choice by
supporting them to have a voice. Also the desire for social inclusion, which
features in many regeneration policies emphasises the need for community
involvement.












Transforming Social Care
Putting People First
Valuing People Now
Local Government and Public Involvement In Health Act
Mental Health Act
“Hearts and minds: commissioning from the voluntary sector”
Commissioning Framework for Health and Well-Being
Making Experiences Count
‘Our health, Our care, Our say”
Mental Capacity Act
Direct Payments
Safeguarding Vulnerable Groups Act
1.1 Transforming Social Care12
This Local Authority Circular sets out information to support the transformation
of social care signalled in the Department of Health’s social care Green
Paper, Independence, Well-being and Choice (2005) and reinforced in the
White Paper, Our Health, Our Care, Our Say: a new direction for community
services in 2006. It introduces the new ring-fenced Social Care Reform Grant
that will help Councils to redesign and reshape their services over the next 3
years.
1.2 Putting People First13
This Concordat signalled the transformation of social care and was signed by
six Government Departments, the Local Government Association, the
Association of Directors of Adult Social Services, the NHS, representatives of
independent sector providers, the Commission for Social Care Inspection and
other partners.
1.3 Valuing People Now
“Valuing People”, published in 2001,set out the Government’s vision for
people with a learning disability across a range of services based on the four
principles of rights, independence, choice and inclusion. Amongst other
things, it recognised that independent advocacy services were inconsistently
distributed across the country so it made money available to address this
inconsistency. “Valuing People Now” seeks people’s views on the priorities
11
These documents are all available at www.dh.gov.uk
LAC (DH) (2008) 1, Gateway reference 9337,
13 Putting People First: a shared vision and commitment to the transformation of Adult Social
Care, HMG,
http://www.dh.gov.uk/Publicationsandstatistics/PublicationsPolicyandGuidance/DH081118
12
25
for the learning disability agenda over the next three years. It has updated its
proposals for advocacy in line with the choice and control agenda.
1.4 Local Government and Public Involvement In Health Act
This will help to implement the Government’s vision of strengthening the
citizen’s voice. In particular, the introduction of Local Involvement Networks in
2008 will provide a way of giving a stronger voice to local people in the
commissioning and provision of local health and care services. This will raise
the profile of groups who wish to contribute to service development and
scrutiny. The need for empowerment among service users and carers will be
important for their voices to be heard.
1.5 Mental Health Act
This Act amends the Mental Health Act 1983 and introduces the concept of
independent mental health advocates who will be available for all patients
liable to be detained, including under guardianship and Community Treatment
orders. They should ensure that information is given to patients about the Act
they are subject to and its implications and what, if any, medical treatment is
explained to the patient.
1.6 “Hearts and minds: commissioning from the voluntary sector”
The Audit Commission has recommended that local public bodies should
apply what they have called “intelligent commissioning” 14 practice by ensuring
they have:
i.
ii.
iii.
a sound understanding of user needs which means they have thought
about the kind of services that they want to procure for a range of
service users
a well-developed understanding and management of markets which
includes
good procurement practice which comprises:
o the choice of funding approach (grant or contract)
o the process prior to awarding the grant or contract
o the basis for determining price
o post award, the effective management of the working
relationship.
1.7 The Commissioning Framework for Health and Well-Being15
This aims to put “people at the centre of commissioning” and recommends
that Commissioners can do this through advocacy that can support both those
who find it hard to express views about their individual circumstances, and
also advocacy for groups to influence the commissioning of services. This
document spells out what local authorities must seek to achieve by:
“ giving people greater choice and control over services and treatments
(including self care), and access to good information and advice to
support these choices. Mechanisms will be developed to help the
Audit Commission, July 2007, “Hearts and minds: commissioning from the voluntary sector”
Public Services National Report,
15
Department of Health, 6/3/2007, Gateway ref 7361
14
26
public get involved in shaping these services, with advocacy to
support groups who find it hard to express views”
There is also recognition that Third sector organisations have a role to play in
providing information about vulnerable groups and providing advocacy where
appropriate.
1.8 Making Experiences Count: The proposed new arrangements for
handling health and social care complaints16
The current Social Care Complaints Regulations require that If the
complainant is a child, young person or vulnerable adult, the local Social Care
Complaints service will offer support by referring them to the appropriate
advocacy and support services.
The Department of Health sees the provision of advice and advocacy to
people making complaints as an essential principal, especially for vulnerable
people. The DoH is exploring the possibility of either extending the availability
of PALS and ICAS to local authority complainants or developing parallel
services in social care.
1.9 ‘Our health, Our care, Our say’17
This government paper designated seven outcomes for local authorities to
achieve:
1.
2.
3.
4.
5.
6.
7.
Improved health and emotional well-being
Improved quality of life
Making a positive contribution
Choice and control
Freedom from discrimination
Economic well-being
Personal dignity
1.10 Mental Capacity Act
The role of an Independent Mental Capacity Advocate (IMCA) was introduced
for the first time in the Mental Capacity Act (2005) as a statutory duty for
commissioners. It is envisaged that they will play a crucial role in helping to
determine the preferences of someone who lacks capacity at specific points in
their life when important decisions need to be made. IMCAs must be
independent of the provision of care or treatment of the service user that they
are dealing with. Their role is much more defined than that of most advocates
so consequently their training has been organised nationally initially to ensure
a consistent approach.
1.11 Direct Payments
Since 2003 Local Authority’s have had a statutory duty to provide Direct
Payments. They create more flexibility in the provision of social care by giving
16
Department of Health, 2007,
Our health, our care, our say, 2006
http://www.dh.gov.uk/en/Policyandguidance/Organisationpolicy/Modernisation/Ourhealthourc
areoursay/index.htm
17
27
money instead of services to people. This enables them to have increased
choice and control over their lives by making decisions about how and when
their care is delivered.
As the drive for individualised budgets and Direct Payments increases, some
authorities such as Norfolk have recognised the need for advocacy services to
support the take up of these services by developing Direct payments
Advocacy Norfolk who:
 Provide independent advice on these issues.
 Help service users to understand decisions
 Assist service users if they wish to make a complaint
1.12 Safeguarding Vulnerable Groups Act
This bill introduces a new vetting and barring system, which enables even
people privately employing staff to check to see if they have been barred from
working with vulnerable groups.
28
Appendix 5
Summary of Local Context Performance within Gloucestershire
This section considers the performance of the Directorate, care providers,
advocacy providers and the Gloucestershire Advocacy Support Service
(GASS).
Community & Adult Care Directorate





The overall impression is that the directorate does not place a great
deal of emphasis on enabling service users to express their views with
the assistance of advocates.
With the exception of the new Mental Capacity Act, advocacy does not
feature very much in staff training.
We do not record or monitor consistently the use of advocacy
Figures from the Adult Placement team who are required by CSCI to
maintain a record of advocacy services offered to service users
indicates that approximately 20% of all service users offered advocacy
in the year 2006/7 accept this service.
The new Complaints Regulations for social care have been introduced
and staff training delivered. This training emphasises the importance of
listening to users and working to resolve issues locally. The
Complaints Service recognises that it has further work in relation to
advocacy for complainants.
Care Providers



A survey of the top 10 residential homes with the most residents
funded by Gloucestershire County Council painted a very similar
picture to the one within the Directorate.
It also shows there is a need for staff training about advocacy
especially for people with profound and multiple needs, including those
with significant communication needs.
The POPP Project will be an increasingly important way of helping
older people speak up. One of its partners, the Gloucestershire Older
Persons Assembly, is currently piloting an advocacy service in some
care homes.
Advocacy Providers
 The new IMCA service is raising the awareness of advocacy.
 There is concern about whether the advocacy groups have time to
work with people who need advocacy who are not eligible for an IMCA.
 Service users have been involved in developing a new contract for
advocacy for people who are subject to the provisions of the Mental
Health Act 1983 (MHA 1983). This has been awarded by the
Partnership Trust.
 Other gaps in service provision identified by the providers are the lack
of advocacy provision to older people in care homes and a parent carer
link at the time of transition between CYPD and Adult Care.
 The grant monitoring arrangements between the Directorate and
groups providing advocacy have not been effective in producing the
information that is needed to measure performance.
29


Although the 2006 Advocacy Service Review said, “County Council
staff and the providers greatly value its (GASS) advocacy accreditation
scheme and its training and support functions.” When the national
qualification is introduced in 2008 this training will not be needed .
The Care Services Improvement Partnership is publicising the Action 4
Advocacy “Quality Standards for Advocacy Schemes” so QuAD is
unlikely to be needed in the way that it works currently. The
Partnership Trust has already adopted the Action 4 Advocacy
standards in their contract for advocacy for people with acute mental
health problems so there is now an issue of consistency by
commissioners.
Collective or group advocacy
It is not the aim of this Strategy to replace the Service User and Involvement
Strategy or our other work on engagement. However, it is interested in
helping groups to have a stronger voice. We think that LINks will contribute to
identifying needs related to group advocacy.
 A range of different training is being provided to help members of
groups speak up but we do not know how good it is.
 There is more work for commissioners and providers to do to make it
easier for people to have a say in how services are developed.
 The Gloucestershire Service User Forum (GSUF) and Carers
Gloucestershire have been active in helping more service users and
carers to have a voice in an increasing number. The Forum has
provided training to its members to enable them to speak up with the
Directorate. The Forum has acted as an access point for a range of
public sector services wishing to access groups who are seldom heard.
 GSUF has used Valuing People funding to deliver “Speaking Up
Together” training for the 18 representatives elected by the district
Locality Groups that feed into the Learning Disabilities Partnership
Board. This training will help the representatives to speak up for others
in Partnership Board meetings and other similar forums.
 The new Participation of Older People Project (POPP) project is
creating an increased role for older people in decision making.
Potentially there is scope here for group advocacy. The current project
working with GOPA on advocacy in care homes is not due to report
until 2009.
1.13 Relationship to Children & Young People’s
Services
Advocacy providers, funded by C&ACD, have told us that they are providing
advocacy for adults who need help with their involvement with the Children &
Young People’s Directorate (CYPD) – for example parents with learning
disabilities who are subject to child protection procedures and parent carers
with children who are in transition from children’s to adults services. CYPD
currently provides advocacy only for looked after children but is reviewing the
need to extend this provision. It is worth noting that Rotherham advocacy has
allocated a worker who exclusively works with school leavers and works with
them in developing person centred plans at the time of transition into adult
services.
30