How Advocacy under the Care act is being implemented

This section looks at how advocacy is being implemented in England. It is based on the survey responses of 46 per cent of local authorities, a survey of advocacy providers and 23 follow-on interviews with commissioners and providers.

Statutory and non-statutory advocacy

Some commissioners distinguished between statutory and non-statutory advocacy and as other studies have identified, are prioritising the funding of statutory advocacy including advocacy over community and other forms of advocacy. Twenty-two per cent of commissioners reported that they had either stopped commissioning or reduced access to non-statutory advocacy during 2015/16. Viewing all advocacy as covered by the Care Act was identified as one way of protecting wider forms of advocacy from budget restrictions. The majority (87 per cent) of local authorities in the study were commissioning advocacy for their area only, with the remainder commissioning jointly with neighbouring local authorities, and in a small number of instances, with the clinical commissioning group (CCG).

Watchful commissioning

It was evident, that many had approached the introduction of the duty to provide advocacy under the Care Act cautiously; using the first year to better understand the need and demand, and to develop service specifications. Four out of five local authority respondents had developed a specification for advocacy. Not all, however, had as yet gone out to tender specifically for advocacy under the Care Act at the time of the survey (29 per cent extended an existing advocacy contract and 48 per cent had gone out to tender in 2015/16). The picture that emerged was one of a ‘work in progress’, perhaps unsurprising given the timing of this study:

The contract is for another year, extension of an existing contract. We wanted to work with them (provider) in collaboration to understand impact of the cuts and how Care Act advocacy needs to develop. We’ll be going out to the market tendering for Care Act advocacy in four to five months’ time with an outcomes-based specification.

(Commissioner, interview)

It was evident from interviews with advocacy providers that some local authorities have not specifically commissioned advocacy under the Care Act and that the advocacy provider is being expected to provide increased advocacy services without additional resource:

We have always been able to provide a quick response for advocacy but currently have 50 people on the waiting list. Our advocates currently have an average caseload of 30 people but they are very experienced. We have asked for additional hours to respond to the demand but have had no response from the local authority. We are now having to prioritise but some of our waiting list is due to spending time chasing social workers.

(Advocacy manager)

Needs assessments

Seventy-eight per cent of local authority respondents had undertaken a needs assessment to estimate likely local demand for advocacy as recommended by SCIE’s good practice guidance. This, however, varied from using quite crude measures to much more sophisticated evidencing of need. Likely need had variously been estimated with reference to local and national information and guidance, for example, the number of local community care assessments, past and current use of advocacy services, and the Department of Health’s 2014 Impact Assessment. [1]

Co-production

Forty-seven per cent of local authorities stated they had involved adults with social care needs in the commissioning process for advocacy. Some who were in the process of developing their specification were involving users and carers as well as advocacy services in this, including a ‘series of co-production events from inception of delivery model to writing of the service specification’, in developing the new model, while others had engaged in consultation exercises and had relied on getting a steer from existing customer feedback mechanisms. Others indicated their intention to involve users and carers in the future:

Although the answer to this question is ‘no’, we had involved service users in the original advocacy tender for IMCA/IMHA and general advocacy. It was this contract we extended to cover Care Act advocacy. We also ensured local service user groups were aware of their right to advocacy support under the Care Act.

(Commissioner, survey)

Models of advocacy provision being commissioned

The majority (60 per cent) described the model for the provision of advocacy under the Care Act as a single provider model, that is, one advocacy service had been commissioned to provide advocacy. Another 38 per cent referred to partnerships and consortiums of advocacy services which they referred to as ‘integrated advocacy service’, ‘partnership model’, ‘framework’ or an ‘advocacy hub model’ with a range of contractual arrangements often with a lead provider acting as the gateway to other providers offering different forms of advocacy to different user groups. Spot purchasing according to need was a less common practice amongst the survey respondents than reported in other studies. [2]. Since April 2015, 27 per cent of respondents had changed advocacy provider due to arrangements being interim, learning together with the advocacy providers what was needed, and social care commissioning processes evolving, for example, to become more outcomes-focused. [3]

Evidence of variation in spending on advocacy under the Care Act

Commissioners and providers reported wide variation in the total spend on advocacy, ranging from contracts of under £25k to others over £200k. Comparing the size of contracts for 2015/16 and 2016/17 suggests a trend towards a reduction in contracts of under £25k, which may reflect the changing nature of advocacy commissioning as experience unfolds. While some local authorities are allocating relatively little resource to develop advocacy services, there was an indication that some are subsequently investing £150–£200k in advocacy. Nonetheless, concerns were expressed from providers about potential reductions in resources for advocacy alongside increasing demand.

It can be difficult to interpret this data however as some local authorities were unable to differentiate spending on advocacy from Care Act overall spend and it is unclear what the per capita spend is. As one commissioner told us: 

Our advocacy contract is a “hub” approach, bringing in all statutory advocacy provision under one contract. The contract value is £635,000 per year for IMCA, IMHA, Care Act, NHS Complaints and non-statutory advocacy. The contract specifies indicative values for the number of hours of each form of advocacy. The aim of the advocacy hub approach is to work to be flexible to meet ebbs and flows in demand, hence the indicative value approach.

(Commissioner)

Over half of providers (53 per cent) reported advocacy contracts with the local authority of 12 months or less. However, there was an indication that this is slowly changing: almost a fifth of providers had service contracts of three or more years and some future contracts were being planned to offer greater sustainability: 

The contract will be for 3+2 years. That is, a three-year contract with the potential to extend for two years…This is the first time this Council has put the voluntary sector providers through a formal tendering process. Previously a lot of it was grant-funded but providers complained they had no security.

(Commissioner, interview)

Number of referrals to advocacy under the Care Act

Many local authorities could not easily provide numbers of people who had had an advocate since April 2015. They said that this information was ‘not to hand’ or they were unable to provide an answer at this time, or simply that they did not keep such records. What was reported however, confirmed findings of earlier studies that while some areas have seen a dramatic increase in referrals for advocacy since the implementation of the Care Act, in many others rates of referral were far lower than expected. In some areas, there had been fewer than 10 referrals since April 2015, and in others over 400. 

We found no evidence to suggest that rates of referral were linked to the model of provision.  Many providers highlighted a lack of effective training for frontline staff in local authorities as causing the low number of referrals. Ninety per cent of local authority respondents on the other hand said that frontline staff in their area had been trained. However, providers were observing variation in the number of referrals between teams working with similar client groups in the same authority.

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