Background and methodology for commissioning advocacy under the Care Act based on emerging good practice

The Care Act 2014 requires local authorities to make independent advocacy available to eligible service users and carers. In October 2014, SCIE launched guidance to support good practice in commissioning independent advocacy. Early studies examining implementation indicated that referrals were lower than expected and therefore many of those potentially eligible for advocacy under the Care Act might not be receiving the service they are entitled to. In 2016, SCIE commissioned the Universities of Birmingham and Central Lancashire to undertake a rapid appraisal of how advocacy was being commissioned in relation to the Care Act and to identify the features of promising positive practice. This involved surveys of commissioners and providers; interviews; documentary analysis; and a roundtable discussion involving people with experience of using social care services, commissioners and advocacy providers to identify improvements in the commissioning of Care Act advocacy. The findings include practice examples, which were identified by advocacy providers and/or commissioners, or were highlighted by external organisations, as offering examples of promising practice.

Background

Advocacy has a long history and is rooted in a belief that disabled people should be able to determine what matters to them and the support they need to enjoy a good quality of life. It is broadly defined as enabling people to express their views and preferences, including supporting people and/or family carers to advocate for themselves as well as representing their views. Having an advocate to support and represent individuals’ views, can increase self-determination, inclusion and the way that services are offered, thereby supporting empowerment, independent living and full citizenship. [1] [2] [3] Access to advocacy is specifically required when people’s needs are not well understood, placing them at risk of further marginalisation and social disadvantage by their views being discounted, [4], [5] as consistently noted in relation to people with learning disabilities, people with ongoing mental health issues and frail older people.[6]

Policy context

Under the Care Act 2014, which came into force in April 2015, local authorities have a duty to promote wellbeing in everything they do and the statutory guidance highlights the importance of advocacy in achieving this. Section 3.9 of the guidance defines advocacy as ‘supporting a person to understand information, express their needs and wishes, secure their rights, represent their interests and obtain the care and support they need’.[7] However complex people’s needs are, local authorities must ensure people are supported to express their views and helped to consider what options they have, which increases individuals’ control and self-determination. The Care Act, therefore, places a duty on local authorities to offer support from an independent advocate, if required, to enable people to be involved in decisions about them and their care and support.

The duty to provide independent advocacy applies from first point of contact with the local authority and at all stages of assessment, planning, review, and in the case of safeguarding enquiry or review. Local authorities have to make a judgement as to whether an individual has substantial difficulty in being involved, reflecting on any reduced capacity for decision-making, and secondly, if there is an appropriate individual to support them. If not and the condition of substantial difficulty is met, an independent advocate must be offered if the individual is involved in any of the following processes described in the Act.[8] [9]

  • an adult’s needs assessment
  • a carer’s assessment
  • the preparation and/or review of an adult’s care and support or support plan
  • a child’s needs assessment as they transition towards adult care
  • a child’s carer’s assessment (therefore some people below 16 years of age)
  • a young carer’s assessment
  • a safeguarding enquiry or safeguarding adults review
  • an appeal against a local authority decision under Part 1 of the Care Act (from April 2016).

Independent advocacy under the Care Act 2014 (SCIE, 2015) 

Previous research studies

A previous survey of advocacy providers by the Mental Health Foundation for the Advocacy Action Alliance [10] (AAA, 2015) reviewing early implementation highlighted low numbers of people accessing advocacy in some parts of England despite the new duty. While some local authorities have implemented the independent advocacy duty well, the overall picture reported was less positive and AAA found evidence of poor commissioning practices, including a predominance of spot purchasing of advocacy services. This found a mix of contracting arrangements operating across local authorities in terms of commissioning of single or multiple providers, and different types of contract. [11]

The majority of contracts (63 per cent) were for 12 months or less which was concerning given the specialist knowledge and skills required and the importance of developing long-term relationships with services and professionals. The failure to offer advocacy has resulted in legal challenges with local authorities having to re-do flawed assessments (see London Borough of Haringey [12]).

It has been suggested by McNicoll (2015) [13] that the low figures for referral to advocacy services may have reflected severe budget cuts facing local authorities, and that as a consequence they were not promoting advocacy or simply did not have the resources needed to train frontline staff about their advocacy duty under the Care Act. Further, analysis of Better Care funding plans undertaken by VoiceAbility and presented as evidence at the October 2015 Public Accounts Committee, showed that local authorities were spending significantly less on Care Act advocacy than predicted to meet expected levels of need as indicated by the Department of Health’s 2014 Impact Assessment. [14] Furthermore, a recent review of the implementation of the Care Act for Carers found little evidence of advocacy for carers. [15]

Concerns about the impact of the introduction of independent advocacy under the Care Act alongside other types of statutory advocacy (i.e. Independent Mental Capacity Advocacy (IMCA), Independent Mental Health Advocacy (IMHA) and Relevant Paid Representative (RPR) roles under Deprivation of Liberty Safeguards (DoLS)) on the investment in advocacy in general have been raised despite encouragement for wider advocacy in the Care Act. The AAA study found evidence of reductions in overall advocacy provision in many local authority areas. This is underscored by a recent study of citizen advocacy, which found it to be seriously under threat due to a lack of funding.[16] 

Study purpose

In light of the findings of previous research and with the intention to revise its guidance for local authorities commissioning advocacy under the Care Act, SCIE commissioned this small-scale study to:

  • identify models of commissioning Care Act advocacy in England
  • identify promising practice examples
  • engage with key stakeholders in identifying the wider policy and practice implications for commissioning independent advocacy.

Study methods

The study involved a survey of commissioning and provision to identify positive practice; follow-on interviews to gather further detail on the positive practice; analysis of local evaluation reports and commissioning documents provided by respondents and a round-table event of invited stakeholders to validate and explore the findings.

(1) Survey of commissioning and provision

Two separate surveys were undertaken: (1) an anonymised national survey of local authority commissioners in England to identify the core elements of the commissioning process. The survey was distributed by the ADASS regional leads and the responses represented 46 per cent of local authorities in England (i.e. 70/152); (2) a national survey of advocacy organisations providing Care Act advocacy with 49 responses representing 64 providers recruited primarily via the Action Advocacy Alliance, a network of 300 advocacy providers hosted by the Mental Health Foundation, and the Older People’s Advocacy Alliance (OPAAL) UK.

Question areas across the two surveys were broadly similar, although tailored to the commissioner or provider context and covered commissioning arrangements; level of investment; advocacy being commissioned; access and uptake of advocacy and experiences of commissioning advocacy.

(2) Follow-on interviews

From the analysis of the survey responses, potential examples of positive practice were identified and if the respective organisations had agreed, individuals were contacted for a follow-on interview. Twenty-three follow-on interviews with commissioners (12), providers (10) and a national organisation (1), were undertaken to gather additional detail on positive practice. The lines of inquiry for these interviews covered:

  • detailed description of commissioning model for Care Act advocacy in the local area
  • who is involved in the commissioning process and how
  • effectiveness of the current arrangements for commissioning Care Act advocacy
  • criteria for assessing the success of commissioning Care Act advocacy
  • main challenges to commissioning Care Act advocacy
  • main challenges to providing effective Care Act advocacy
  • recommendations for commissioning Care Act advocacy.

Respondents were invited to send evaluation reports and commissioning documents and a web-based search was also undertaken to identify tender documents.

(3) Roundtable event

The data from the different sources was thematically analysed and synthesised and then presented at a roundtable event involving invited stakeholders representing commissioners, advocacy providers, people using social care, Department of Health and SCIE. The format for the event covered considering the findings and the extent to which they resonated with people’s experience. Participants were invited to develop recommendations for strengthening the commissioning of Care Act advocacy.

Ethical approval for the study was granted by the University of Birmingham Ethics Committee. Approval for the study was also given by the Research Group of the Association of Directors of Adult Social Services (ADASS).

Limitations

The study was limited by the time and resources available. Furthermore, as the focus was on identifying positive practice, the sample was not comprehensive and responses to the survey may reflect those local authorities where the commissioning of advocacy under the Care Act is more advanced. Finally, the findings the practice examples were not validated by data from a service user perspective.

Acknowledgments

Authors of the research which the briefing is based on:

  • Dr Karen Newbigging, University of Birmingham
  • Dr Julie Ridley, University of Central Lancashire
  • June Sadd, Survivor Consultant, Researcher and Trainer for carrying out the research

We also thank all the ADASS regional leads; Action Advocacy Alliance; OPAAL and NDTi, for their support with recruitment and promotion of this study. 

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