Improving outcomes for service users in adult placement - Commissioning and care management

Making good placements - Advocacy

National minimum standards require that adult placement service users have, if they wish, a named individual or advocate who is independent of the scheme.

At a service review, the care manager suggested that Liam might want to move from his adult placement to live in his own flat. Liam’s parents were alarmed, and Liam’s adult placement carer was reluctant to contemplate 'losing’ Liam. Liam, who has significant learning disabilities, was upset by the conflicting views about his future. The care manager commissioned an advocate from the local independent advocacy service to work with Liam to find out what he really wanted and help him explain this to the care manager, the adult placement carer and his family.

The first-stage SCIE project found that people living in adult placements rarely have an independent advocate, and many do not have a named person. (Lack of advocacy support is an issue throughout social care services, not just for adult placement.)

Discussion group issues

Project discussion groups confirmed that independent advocacy is rarely a reality. The terms 'advocate’ and 'named person’ are broadly interpreted (variously named as day service key worker, care manager, adult placement carer, adult placement worker, and family member) and widely misunderstood. Schemes reported inconsistent CSCI interpretation of regulatory requirements (NB: this finding pre-dates inspections under CSCI’s new methodology). One service manager said national and local government should 'make advocacy real’ or remove the requirement from adult placement practice.

Participants reported that free volunteer advocates are sometimes available but are usually untrained; several localities have access to advocacy services but no way to pay for them. High quality advocacy exists in some mental health services but is very limited. One exception is Essex, where the combined health, social care and mental health partnership funds and supports a number of advocacy services which are free to service users. Elsewhere, advocates may be provided via a day service or college but only for a crisis situation.

There is little awareness of and therefore little demand for advocates from adult placement service users. Adult placement carers often are aware of service users’ advocacy needs, but are both frustrated by and resigned to the lack of independent advocacy. Those participating in the discussion groups related poor experiences of advocacy. One service user was marginalised by an advocate who was quite inept - an excuse for someone who wanted to be an advocate’, and who himself had an advocate. Several service users were 'on record’ as having an advocate but in fact had almost no contact with that advocate. Adult placement carers also stressed that 'social workers have to listen to the advocate, or it’s not helpful’.

Practice points

Directors of adult social services should:

Senior managers should:

Adult placement schemes should: