Playing
the role of advocate has never been easy, and as Toby and David Brandon
explain, it only seems to be getting harder.
Social
care has always had mixed feelings about its advocacy role, a major reason why
contemporary courses pay so little attention to it. Clement Attlee, the only
Prime Minister with social work experience, wrote in his book The Social
Worker, published in 1920, that advocacy was at the core of social work.
In
1895 the first health-related social worker, Mary Stewart at the Royal Free Hospital
in London, had a responsibility to protect hospital managers from patients
"causing a nuisance" - the opposite of advocacy.
Today
advocacy is a growing movement. It is a favourite ingredient of the new
joined-up services and has a special, if somewhat vague, place at the heart of
the government's mental health policies. The NHS Plan states that by 2002 a
nationwide patient advice and liaison service (Pals) will be established in
every NHS Trust, and although Pals are not advocates as such, they may have an
advocacy role in aiding patients with hospital complaint procedures. The
government is also committed to spending £1.3 million over each of the next
three years on advocacy for learning difficulties.
The
current trend seems to be to focus on the advocate rather than on advocacy.
However, we would like to see that trend reversed. The number of independent
advocates is still relatively small, but the number of people involved in one
way or another in the whole advocacy process is immense. This includes those
with a disabled family member; disabled people themselves; concerned citizens;
and service professionals, such as the readers of Community Care.
There
is a great danger of building up a few hundred independent advocacy services at
the expense of undermining the huge and vigorous advocacy process.
Service
professionals face varying challenges in their advocacy role. For those
representing clients about social security issues, there is little risk of a
clash with their employer. However, for those in the fields of housing and
direct social services, the risk of conflict is much higher.
Modern
social work can be divided into three strands: treatment, use of state
authority, and advocacy. It is a considerable understatement to talk of the
inherent tensions between these roles. Fundamental is the tension between doing
"what is best" for the client and doing what he or she asks to be
done -Êbetween giving instructions and taking them.
But
the tensions are not confined to whether service users get what they want, or
what we think they need. Organisations and professionals have their own
interests to protect, which may in practice seem more important than the
interests of clients.
The
litmus test for advocacy is whether it helps an individual to get what they
want, and whether cumulatively it contributes to changing oppressive systems.
In
social care we still struggle with "knowing what is best" for people
in disability and poverty, as our founding fathers and mothers once did. There
are some clever new versions of the 19th century "deserving and
non-deserving" paradigm. Advocacy has no truck with this.
We
don't know how others ought to live; which ways of behaving are mature and
immature; what are personality disorders and what are not. It is no part of the
role of an advocate to know what is best for clients.
In
the broth of social care things are complex. Our particular paradoxical recipes
force us to work with disparate and often clashing ingredients. Social care is
a heady mix of informal counselling, chunks of legislation, topped up with
offers to mediate and advocate. That can make an almost undrinkable brew.
The
potential for conflict is massive, but crucial if genuine change in systems is
to take place.
It
is hard to be optimistic about the role of advocacy in social care.
Organisations - whether private, voluntary, or statutory - find increasingly
effective ways of defending themselves against both insiders and outsiders, who
are being perceived as the enemy. They use gagging clauses in employment
contracts; improve skills in public relations; and develop managerial cultures
based on loyalty to the organisation, rather than duties to clients and
relatives. The whistleblower is presented with an outer face that professes to
value his or her activities, but also by an inner face that is increasingly
hostile and getting considerably cleverer at dealing with dissidents.
Anna
Coote, director of public health at the King's Fund, argues that health advocates
can help the socially excluded "gain access to basic health services,
training health professionals to deal more competently with minorities, and
helping individuals to stand up for themselves". They also leap over tall
buildings!
After
many decades of neglect, we must be wary of those who would suffocate us with
laurel wreaths, as well as completely unrealistic expectations. CC
David
Brandon is visiting professor in social work at Nottingham Trent University.
Toby Brandon is senior research fellow at the University of Durham and senior
lecturer in disability at the University of Northumbria.
David
and Toby Brandon's new book is Advocacy in Social Work, Venture Press,
June 2001.
Social care advocacy involvement
Representing
clients directly
Micro: advocate for a client trying to access social security benefits;
writing to a housing office making a casefor housing transfer.
Macro:
whistleblowing about deficiencies in services (for example the Waterhouse
inquiry); lobbying or collectively advocating for improved welfare rights,
better facilities for immigrants and changes in social legislation.
Supporting
advocacy indirectly
Micro: supporting self-advocacy, backing up a client complaining about
services; working with a self-advocacy group; factoring in an advocacy
component to care planning - basing the plan more on what the client wants than
on some notion of need.
Macro:
helping neighbourhood groups to express deficiencies in the collection of
rubbish, and repairs after damage by vandals.