Essex: Ending Duplication and Promoting Citizen Advocacy

Published: October 2014
Updated: March 2015

Background

In 2013, Essex County Council carried out a comprehensive review of advocacy provision, a number of factors lead to this. Essex was taking on the responsibility for NHS complaints advocacy and IMHA, and its social care and mental health advocacy contracts were coming to an end.

The review included benchmarking against other local authorities, researching best practice and a consultation with users and providers of advocacy services, Essex County Council operational staff and other referrers to advocacy services.

It was a very mixed picture, Essex spent around the same as other comparator authorities and people said advocacy support was very important to them but there was no way of measuring the impact of advocacy, there were long waiting lists, a lot of duplication between paid support and advocacy and that most of the spend was on formal 1:1 advocacy. Essex was also facing significant financial challenges and needed to be able to build a case for recommissioning advocacy that would both improve outcomes and be cost-effective going forward.

Recommissioning formal advocacy

The current provider had developed a ‘prioritisation matrix’ to help determine how waiting lists should be prioritised. It was proposed that Essex should build upon this approach and develop a process for determining ‘eligibility’ for formal advocacy support. It was agreed that this approach would ensure that those that were the most vulnerable had access to support but also reduce the duplication in the system.  Formal public consultation was carried out and these areas agreed as key in determining if someone requires a formal advocate.

The formal 1:1 advocacy and Independent Mental Health Advocacy services went out as a full procurement with one contract that consisted of two lots (one for each service). Essex involved people who use services as part of the bid evaluation panels and the eventual winning organisation for the formal 1:1 service was a lead provider working in partnership with seven Essex-based providers, employing local people to deliver local services. This service has now been running since July 2014 and has delivered advocacy to 960 people in the first six months. The Independent Mental Health Advocacy service went to a large provider that Essex had worked with in the past on other advocacy-based services

The formal advocacy 1:1 service was commissioned on a ‘block’ contract for a number of cases per year (based on previous usage) with an ability to pay for additional cases should they be required. This means that if someone has the ‘need’ for formal advocacy (including NHS complaints advocacy), they can always access it.

The providers are currently further refining the prioritisation process to ensure that the right people get access to formal advocacy at the right time. Essex believes that they are the right people to do this with users – to make sure that they are able to support vulnerable people to make informed choices and have their voice heard.

When the Care Act guidance was issued, Essex looked at its plans for formal advocacy and found that the new service that it was commissioning would meet the new requirements. This would ensure that those that don’t have support or the ability to speak up for themselves during social care assessments, support planning, review or safeguarding have access to a formal advocate. It has carried out modelling around the new demand and varied the contract to meet this demand. Essex is now ensuring that social workers are aware of the new requirements.

Citizen advocacy

Essex County Council has had a citizen advocacy service in Essex for a number of years but it has had patchy coverage. The review highlighted the importance of this approach to advocacy, building long-term partnerships to support people to make choices and have their voices heard. When the Care Act guidance was issued, Essex agreed that it needed to formalise the arrangements for citizen advocacy in Essex to provide long-term advocacy partnerships for people that were likely to have a repeat need for an advocate.

Essex is now tendering for a county-wide citizen advocacy service which will support 150 citizen advocates across Essex.

This new service is due to be in place from 1 June 2015 and it is planned that if a person receives a service from the formal 1:1 advocacy route, if there is an ongoing level of need for that individual, they will then be referred to the Citizen Advocacy Service for that ongoing support. Both these models mean that Essex is in a good position to provide advocacy to the appropriate people when the Care Act regulations begin in April 2015.