Updated: September 2020
Last reviewed: September 2022
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 Independent Mental Health Advocacy (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.
Re-commissioning formal advocacy
The current provider had developed a ‘prioritisation matrix’ to help determine how waiting lists should be prioritised. Essex built on this approach and developed a process for determining ‘eligibility’ for formal advocacy support. It ensured those that were the most vulnerable had access to support, but also reduced the duplication in the system.
Essex carried out formal public consultation and found the following areas were key in determining if someone requires a formal advocate:
- complexity of the advocacy issue
- impact of the issue
- support network(s) and ability to access community-based resources
- individuals capacity to make decisions and ensure their voice is heard.
The formal 1:1 advocacy and IMHA 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. 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, delivering advocacy to 960 people in the first six months.
The IMHA 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 provider further refined the prioritisation process to ensure that the right people got access to formal advocacy at the right time. Essex believed they were the right people to make sure that they were 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 ensured that those that don’t have support or the ability to speak up for themselves during social care assessments, support planning, review or safeguarding had access to a formal advocate. Modelling around the new demand was undertaken and the contract varied to meet this demand. Essex also ensured that social workers were aware of the requirements.
Citizen advocacy
Essex County Council has had a citizen advocacy service 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 to provide long-term advocacy partnerships for people that were likely to have a repeat need for an advocate.
Essex subsequently tendered for a county-wide citizen advocacy service to support 150 citizen advocates across Essex.
Further service developments
Ahead of the expiring advocacy contracts (four adults’ and one children’s) in 2018, there was still a significant proportion of advocacy responding to the statutory duties. Essex noted the delivery model lacked the incentive for providers to use and support the development of self, peer and citizen advocacy. In order to further develop citizen advocacy, Essex commissioned an ‘All Age’ advocacy hub with a single provider to support all statutory advocacy duties in addition to developing volunteer and peer advocates.
The aim was to have a range of on-going citizen support that bridged the gap between statutory and non-statutory support, as well as to provide ongoing support for young people transitioning from children’s to adults’ services.
The types of citizen advocacy includes supporting:
- family, friends or someone else in the support network to speak on behalf of an individual or support them to speak for themselves
- long-term advocacy partnerships with peers or volunteers (peer or citizen advocacy)
- the development of ‘speaking up skills’ in a facilitated group situation (self-advocacy).
A service review carried out in October 2019 explored some of the successes and challenges of developing citizen advocacy. Essex has learnt some of the referrals that could be supported via citizen or peer support would require the volunteer or peer advocate to have, in some instance, detailed knowledge or experience on a particular type of support. They have had a combination of lived experienced or experience gained in professional roles. Recruiting volunteers has been slow and progressive, as many are only able to dedicate a few hours a week, so it’s been important to ensure the cases allocated to volunteers fit their work—life balance.
There has also been work to develop a number of peer groups, and the Essex advocacy hub has helped to form:
- Outhouse in Colchester – supporting members of the LGBTQ+ community
- Older people walk and talk in Southminster
- Motivating minds speaking up group in Basildon
- A group for single mums with postnatal depression in Harwich.
The main aim for these groups is to become self-sufficient after 12 months. Their objectives are to:
- improve mental health and wellbeing for members
- increase empowerment and resilience of members
- deliver the ‘Speak Up’ toolkit (developed by Rethink Mental Illness) to learn self-advocacy
- develop the skills to stand up and speak out about issues that matter
- increase skills, i.e. communication, social, listening and increased empathic understanding
- improve understanding and raised awareness of important issues within the community
- reduce feelings of loneliness and isolation for members of the community by having indoor and outdoor activities.
The recent COVID-19 pandemic also unearthed a vast number of volunteers with a range of skills, experience and willingness to support the community through the Essex Wellbeing service. Going forward, Essex would to like to encourage the development of citizen and peer advocacy support from these volunteers who now also have the lived experience of supporting the vulnerable members in their community.