Lancashire County Council practice example of commissioning independent advocacy

Published: October 2014
Updated: March 2015

When Lancashire County Council became the responsible body for commissioning independent mental health advocacy services, it decided to do this for better outcomes, in partnership with people who use services and in a more forward-thinking way. The service has changed from a multitude of disparate user-group-specific services, which duplicated functions across the NHS and social care in Lancashire and Blackburn with Darwen, to a joined-up, clear and simple, single point of access. The demonstrable outcomes are:

Background

As a result of the Health and Social Care Act 2012, additional advocacy commissioning responsibilities transferred to councils. The main changes were the addition of three areas:

Councils were already commissioning statutory independent mental capacity advocacy to assist vulnerable people facing important decisions (change of accommodation or medical treatment) made by the NHS and local authorities. Lancashire County Council also jointly commissioned non-statutory generic advocacy with primary care trusts.

The council therefore worked with Blackburn with Darwen and NHS commissioners to adopt a strategy to run from 2013 to 2016. This has closed gaps in provision and ensured that statutory responsibilities continue to be met and the consistency of advocacy service quality is not lost.

The Pan Lancashire Clinical Commissioning Group Network agreed that there were inconsistencies in NHS funding and that all clinical commissioning group areas should contribute more fairly to overall existing advocacy health costs. Seven business cases for each group were produced, citing equality impact considerations which related to the Equality Act, the Human Rights Act and human rights principles of freedom, respect, equity, autonomy and dignity, as laid out in the NHS constitution.

Co-production and involvement

A provider day introduced the procurement process. People using services were involved in the commissioning process through discrete engagement days. Invitations were sent to partnership boards, user forums, carers and black and minority ethnic organisations. Almost 20 seldom-heard adults attended on the day and a discrete children and young people’s event was also organised. People participated in shaping the future of advocacy services by being asked their opinions on a series of questions. Feedback was used within the procurement service specification and to set further questions and scenarios in the tender questionnaire. People were asked to express an interest in becoming a member of the tender panel and assist with shortlisting the applications. 

Once the tender had closed, separate panels were held involving the seldom-heard adult and children and young people's representatives and they were fully engaged in shortlisting the application forms from advocacy providers, in scoring the applications and in recommending contract awards as follows:

Efficiencies and new investment

Using some of the economies of scale and over £100,000 of efficiencies generated by commissioning together, more money was subsequently invested in a new non-statutory advocacy service which closed all gaps in adult advocacy provision. This is the Non-Instructed Advocacy (NIA) and Citizen Advocacy (CA) Service which is now available for all adults with complex needs.  

The service provides specialist independent help for people who lack mental capacity to instruct an advocate with regard to specific health or social care decisions when independent mental capacity advocacy does not apply.  Alongside this, the Citizen Advocacy Service recruits and supports one-to-one volunteer advocates for people with long-term conditions at risk of social exclusion. 

The service is available to anyone aged 18 or over, whose capacity is impaired by a condition such as dementia, learning disability, acquired brain injury, physical or medical need, a mental health problem or substance misuse.

Performance

The uptake of all advocacy services is measured on a quarterly basis and at twice-yearly 'advocacy monitoring days'. Peer monitoring is being introduced with a focus on a questionnaire which measures outcomes after the advocacy partnership has been completed. Regular reporting takes place to Blackburn with Darwen, each clinical commissioning group and strategic advocacy commissioners. This information is used to develop advocacy strategy and planning in the future through twice-yearly strategic advocacy meetings which involve NHS and local government commissioners, providers and user representatives. Information is also shared with Local Healthwatch.

Conclusion

The advocacy landscape has been simplified for both staff and the public by creating a single point of access across all areas. The advent of the Care Act will further embed the role of statutory advocacy in social care assessment and care management processes. Many people with disabilities have a heavy dependence on health and social care services, and dealing with large organisations can be a daunting task. Advocacy staff and volunteers know how NHS and social care systems work and who to talk to. Advocates help people to speak up for themselves, making sure they get their views across. Our organisations must welcome and invest in this customer feedback to ensure we can learn from people’s experiences and improve services as a direct result, learning the lessons from failings such as Mid Staffordshire and Winterbourne View.

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