Advocacy and the Care ActLucy Bonnerjea, Department of Health,

• We have statutory advocacy under the Mental Capacity Act for people who lack capacity

• We have statutory advocacy under the Mental Health Act for people who are detained in hospitals or on a CTO

• We have some statutory advocacy for NHS complaints• We have non statutory advocacy – locally commissioned and locally

determined

• And we will have new statutory advocacy under the Care Act!

Currently

New Statutory advocacy

• The Act requires local authorities to involve people in assessments, care and support planning, and reviews.

• In order to facilitate the involvement and engagement of people who would otherwise have difficulty, it introduces a new requirement to arrange independent advocacy for people…

• A) who have substantial difficulty in being involved/ engaged in these processes and

• B) where there is no one available to help facilitate this involvement and engagement.

This means

• It is not universal – it is targeted• It is not to do with mental capacity• It is not to do with vulnerability• It is not defined in relation to a condition (LD or dementia)

• The key issue is: substantial difficulty in being involved/ engaged. Being engaged is an active role.

• It is targeted at those who have no-one to help them to be involved/ be engaged.

Duty to arrange

• For assessments – NEW!

• For Care and support planning

• For Reviews

• For Safeguarding

• (Also applies in prisons)

Who benefits?

What do you need to do?

1. Commission an independent advocacy service

2. Map out which staff need to refer people to them and ensure they are trained to know who to refer and how to refer

Commisssioning

• Means procurement.. • Doing a spec.. • Deciding on evaluation criteria… • Balancing quality with cost… • Thinking about flexibility (no one knows how many people

will qualify…)• Running a tender..• Who will evaluate? Can you involve service users?• Possibly extending an existing contract? • Considering how it interfaces with the IMCA contract.. Can

your IMCA provider provide both?

Risk factors

• You commission something that is too small - and it runs out half way through the year

• You commission something that is poor quality, with no quality indicators

• You commission something without ensuring that staff know when to refer and who to refer – so people who are eligible do not get the help..

• You don’t monitor entitlement

• Legal challenges.. This is an entitlement for some people

Assessment

• This is the tricky part – - how do you involve advocates if assessment is by

phone?- how do contact centre staff assess whether someone

has substantial difficulty in engaging?- How do you do urgent assessments if someone is

entitled to an advocate?- How do you balance speed with thoroughness?- How do you prevent people who have significant difficult

in engaging from being turned down without an assessment and without an advocate?

Care Planning and Reviews

• Less difficult as you already know about people’s needs• If possible use the same advocate for continuity

Safeguarding

The national experience in safeguarding is that many people do not get an IMCA when they are entitled to one–

LAs need better procedures, training and better monitoring

Resources

£ millions in 15/16 prices

15/16 16/17

Total recurring costs

 

14.5m

 

34.6m

Any views?

• Will this work?• What problems can you

envisage?• What benefits can you see?

SCIE• Developing Practice Guidance

• The Social Care Centre of Excellence (SCIE) has been engaged to work on developing resources to support the implementation of the Care Act 2014, including:

• good practice guide for commissioners to ensure fulfilment of advocacy duties laid out in the Care Act 2014

• an ‘at-a-glance’ summary • a self-assessment tool for local authority use

Question

We would welcome views on whether this covers most situations where a person needs an advocate, or whether there are other situations and circumstances where advocacy would be important. For example continuing care? Also whether you see any problems.