Criticisms of advocacy proposals start to bite as department hints at more cash

The government is showing signs that it is heeding campaigners’ calls to commit more funding to advocacy for people who lack mental capacity, reports Mithran Samuel

Last month, health minister Rosie Winterton gave encouragement to campaigners on the proposed advocacy service for people who lack capacity (Minister hints at advocacy money
, 6 April).

With fresh proposals for the Independent Mental Capacity Advocate (IMCA) service expected this month, Winterton said the government had listened to calls to expand the original plans, published for consultation last July.

Specifically, she said the much-criticised proposal to fund advocates to spend four hours on each case could be revised upwards and that the service may not be restricted to “unbefriended” people, with no friends or family to help them.

The IMCA service was seen by mental health and learning difficulties charities as a core element of the Mental Capacity Act 2005, providing a safeguard for people deemed to lack capacity in their dealings with health and social services.

Advocates would be allocated where professionals were making decisions about serious medical treatment or residence on behalf of people who lacked the capacity to consent. They would also be involved in care reviews for people in residential care where an advocate had been involved in the original decision.

There are seven pilots running now ahead of the April 2007 service start date.

Last July’s proposals were deliberately flexible. The Department of Health set a target annual budget of 6.5m, but its costed proposals totalled 3.1m. The latter involved providing a service to unbefriended people at a cost of 100 a decision, based on four hours of advocacy.

The DH suggested several ways in which the remaining 3.4m could be used, including providing eight hours of advocacy on average (an extra 2.1m) or extending it to the most vulnerable befriended people (at least 2.5m).

What it ruled out was breaking through the 6.5m barrier. This suggests there was a trade-off between making the service more intensive and extending its client base. However, there is strong support for extending the scheme along both dimensions.

Peter Edwards, of Peter Edwards Law, a legal firm experienced in mental capacity cases, dismisses the parallel between being befriended and having an advocate.

Advocacy, he says, is about putting aside prejudices and representing, as far as possible, the client’s views, adding: “Family and friends tend to see things from their own perspective. It’s a different role.”

This is illustrated by last year’s DH consultation paper. It saw a professional role for advocates who should be trained to work with people who lack capacity, capable of challenging professionals and having negotiating skills and some legal training,

Edwards also warns: “You may have people who are befriended by people who are abusing them.”

David Congdon, head of policy at charity Mencap, suggests the DH reached its four-hour target on the basis of funding limitations rather than need.

He says: “As an advocate you must get to know the individual and you’re not going to do that in four hours.”

Ayesha Janjua, policy officer for learning disability at Turning Point, says eight hours is a more realistic option, especially “if an advocate doesn’t already have a relationship with the service user or the person has very complex communication needs”.

Winterton’s comments last month suggest the DH may be prepared to commit more funding in response to these arguments, something Edwards sees as fundamental: “Without adequate resources it will fall flat on its face.”