More than just a fad?

The welter of policy documents proclaiming the benefits of advocacy
is testament to a new fashion in Westminster. But professionals are
still wondering whether the government’s fresh enthusiasm for
advocacy is more than just a vogue.

For vulnerable people, independent advocacy can be a vital means of
representation. Advocates become involved when clients face a major
decision such as moving house or accepting medical treatment or
when help is needed to obtain services. It is the advocate’s
job to make sure that their client’s rights and opinions are
seriously considered.

Historically, advocacy has been associated with people with
learning difficulties but it has spread to other vulnerable groups
such as young people and those with mental health problems. The
development of these services has tended to be on a small, ad hoc
basis, and as a result provision is patchy and inconsistent. Now,
with the government’s backing, it appears that a more
structured evolution is imminent.

In 2001, the government stated in its Valuing People white
paper that its long-term aim was to have independent advocacy
services available in each area so that people with learning
difficulties could “choose the one which best meets their
needs”.

More recently, advocacy has been given a prominent role in the
Mental Capacity Bill, the draft Mental Health Bill and the Mental
Health (Care and Treatment) (Scotland) Act 2003. Earlier this year,
support for advocacy was evident in Improving the Life Chances
of Disabled People,(
1)

and it’s almost certain that advocacy will be up for a
starring role in the green paper on adult social care. So why the
rush in favour of a service that has been around for a while? Is it
because the government is finally beginning to understand what
advocacy is all about?

Rick Henderson, director of Action for Advocacy, an organisation
that represents more than 200 advocacy schemes across London, says:
“Advocacy has been perceived as a problem rather than as part
of a solution. We have often been seen as troublemakers or as being
overly critical about gaps in service provision and government
policy. Often advocacy only kicks in when things go wrong and is
about raising problems. It’s very rare that someone wants you
to help them tell their social worker how brilliant they are. You
get branded as negative if all you do is raise
problems.”

Henderson has been an advocate for 15 years after becoming
disillusioned by the abuse he witnessed while working as a nurse in
psychiatric institutions. He says that it has taken a long time to
redefine the image of advocates and to demonstrate their role in
making sure service users are listened to. Some people are
sceptical about the government’s new enthusiasm, but
Henderson is not one of them. “I don’t think it’s
all talk. People do feel advocacy is a good thing but it is hard
for them to find words that can be used in
legislation.”

But now that this is changing, advocacy services will need to shape
up. With statutory duties on the horizon, their current freedom
will need to be curtailed in favour of uniformity and consistency.
Within the next couple of years (or at least by the time the Mental
Capacity Bill starts to be implemented in 2007), standards are
expected to have been introduced on issues such as confidentiality
and supervision. An advocacy charter of core principles has already
been drawn up,(
2)

covering 10 key areas such as independence from statutory
organisations, accountability and complaints. More than 350 schemes
have already signed up to it and it could well form the basis for
the eventual approved standards.

Once standards are in place, a system of accreditation and
regulation will follow, although it’s not yet clear what form
it will take. The Scottish executive has funded the Advocacy
Safeguards Agency to evaluate advocacy schemes. But in England a
system of self-regulation is more probable, with schemes
demonstrating how they meet the required standards, followed up
with visits and telephone assessments.

The expansion of advocacy will have significant workforce
implications, and so it’s important that the government
accurately calculates – and funds – how many advocates
will be necessary. This could well run into the thousands. So far,
government estimates have appeared on the conservative side. With
regards to the draft Mental Health Bill, the government anticipates
that 140 independent mental health act advocates will be needed to
carry out the functions, but this is considered a vast
underestimate. There are about 50,000 decisions under the Mental
Health Act 1983 a year, and in line with these figures each future
advocate would need to be involved in about 350 decisions. No
figure has been put forward for the number of advocates needed
under new mental capacity laws, but given expectations that there
will be about 64,000 decisions each year, there would need to be
thousands of advocates for each to have a manageable
workload.

So where are these advocates going to come from? Estimates suggest
there are about 800 advocacy schemes in England. Many of the new
roles are likely to be filled by people already working as
advocates (although this may not be as straightforward in Wales
where there are far fewer advocates, particularly working in mental
health). To this end, there has been some relief over the
government’s recent change to support independent mental
capacity advocates rather than opting for a different, independent
consultant role.

“We didn’t want them to create a new service that is
divorced from or undermines existing advocacy services. We expect
independent advocacy to be delivering support under the Mental
Capacity Act,” says Richard Kramer, co-chair of the Making
Decisions Alliance, which has been lobbying the government on the
issue.

But it is not just under the Mental Capacity Act that independent
advocacy services may be providing support, and it is important
that the different advocacy threads do not overlap, otherwise users
with multiple needs could end up seeing several different
advocates.

Kramer says: “The government is introducing advocacy in
several forms and that does need to be integrated into a national
advocacy strategy. It is important that the government joins up the
different strands.”

To carry out the new roles, existing advocates may need to
undertake more targeted training. At present there is no
standardised training route for advocates. Some will only have
received a few afternoons’ training while others may have
attended one of the few full-time, year-long university courses.
Some advocates may already have a relevant degree or professional
qualification, but this is by no means a requirement. As advocates
are increasingly required to deliver statutory functions, a
standardised curriculum is likely to emerge. But this is
contentious, as many people believe that the key skills needed to
advocate, such as open-mindedness and the ability to listen, cannot
be taught conventionally.

The future of advocacy is certainly bright. For too long, services
have struggled to meet demand with just a few staff and a
short-term budget. If the government’s rhetoric is anything
to go by, then times are soon to change. Advocates and users will
be keeping their fingers crossed that this is one fashion that is
here to stay.

(1)

Prime Minister’s Strategy Unit, Improving the life Chances of
Disabled People, January 2005

(2)

Advocacy Charter at

www.aqvx59.dsl.pipex.com

‘THE INFORMATION WAS ALL GIBBERISH TO
ME…’
“I don’t know where I’d be without advocacy, it’s made
things much better for my life and I don’t want it to go. I think
everyone should have an advocate. When I first had advocacy I was
amazed at what I could and couldn’t get in terms of my old life,”
says Rosemary Edwards (below, left), who has learning
difficulties.

For just over a year she has been meeting once a week with Gail
Petty (below, right), a senior advocate from Advocacy Partners. The
meetings usually take place in Edwards’ home, and in between visits
the pair keep in touch by phone.

Petty has been helping Edwards with the adoption proceedings
involving her daughter and her housing situation. In so doing she
has helped Edwards communicate with her solicitor and care
manager.

“I was given the details but it was all gibberish to me. I didn’t
understand why or what was happening. I didn’t know whether I was
coming or going. Gail talked to me about what they could and
couldn’t do, and spoke to people for me and gave me a voice. I
would discuss things with her and say what I wanted and she would
contact social services. It takes me a long time to trust people
and to come out of my shell, but when I met Gail I wasn’t
frightened or scared,” she says.

‘THERE ARE SO MANY WAITING FOR ADVOCACY’
Gail Petty studied for a degree in learning
difficulties and has been an independent advocate for three and a
half years. She has been working with people with learning
difficulties for 16 years but chose to go into advocacy so that she
could focus on helping people to be heard.

“Previously I felt my ability to advocate was compromised at some
point or other because of the nature of the job. I always got
frustrated. If you work for social services and social services do
something that is not in the best interest of the person you’re
working with then you find your hands are tied as to how far you
can support someone.”

Petty works with about a dozen people at a time and believes there
should be a right to advocacy and enough resources allocated to
independent advocacy services to provide a responsive service to
the people who need it.

“We’re often quite limited even when we are able to offer a
service. There are an enormous number of people waiting for
advocacy at the moment and most people are in urgent situations.
We’re not always able to respond in a timely fashion due to the
demand on our resources.”