A single provider model in Cumbria
Commissioning Care Act advocacy as part of a block contract from a single provider was ‘paying dividends’ in Cumbria, where this was seen as a ‘cost-effective’ and appropriate way to deliver ‘seamless advocacy provision’ across diverse localities. A separate contract is held by another organisation to provide IMHA services. Critical to success in providing advocacy under the Care Act was the successful organisation having a good understanding of local issues:
The hub model wouldn’t work in this area, it didn’t seem feasible for us. From previous experience we knew that spot purchasing from a large number of providers for a proportion of the population over a wide geographical area might lead to services which were not cost-effective, could be fragmented and might lead to instability in the market.Commissioner, interview
A local advocacy organisation already commissioned to provide a generic service won a four-year contract through competitive tendering to provide a package including Care Act advocacy, NHS Complaints advocacy, IMCA, and Healthwatch advocacy. The contract has some inbuilt flexibility allowing the provider to move funds between different types of advocacy depending on actual demand and subject to agreement with the commissioner. Past experience of delivering generic advocacy meant the contract with this provider ‘naturally transformed into providing Care Act advocacy.
There is now no formal commissioning of non-statutory advocacy, apart from individual arrangements for some individuals, for example, when the courts have requested it. Bespoke advocacy was also recently commissioned for a group of people adversely affected by the flooding in Cumbria, in recognition of the impact on their services.
Success factors of its ‘thriving local offer’ from two providers (including the IMHA service) were the availability of a pool of people in the area willing to train as advocates, and the understanding and track record of the successful providers.