Short-term contracts hamper take off for advocacy services

Half of advocacy groups commissioned to provide services for people who lack the mental capacity to make decisions have only been given year-long contracts, research by Community Care has found.

A poll of 28 councils across England revealed 14 contracts for Independent Mental Capacity Advocate (IMCA) services were for one year only, while just seven had awarded one lasting three years. Department of Health guidance does not require local authorities to draw up three year arrangements. Instead it says they “may be appropriate”.

However, the government’s third sector review, published in July, said three-year funding relationships between the state and the voluntary sector should become the “norm rather than the exception”.

The news comes ahead of the implementation of much of the Mental Capacity Act 2005 on 1 October (see “Mental Capacity box”). The IMCA service, which was introduced under the act, was implemented early in April.

Bill Freeman, director of development at the National Association for Voluntary and Community Action, said longer contracts enabled voluntary organisations to be financially sustainable and added: “If we are in this situation the same time next year that would be worrying.”

Saskia Daggett, compact manager at the National Council for Voluntary Organisations, said: “We need more voluntary groups to challenge short-term funding, locally and nationally – this is the key to improving the relationship. Short-term funding should be a thing of the past.”

Sue Lee, advocate at Speaking Up, which has a year-long IMCA contract with Cambridgeshire Council and one of the highest referral rates in the country, said: “It’s not a very secure environment. It makes it very difficult for providers to work, as we are aware all the time that the contract could be limited.”

Under the Mental Capacity Act, councils were allocated a share of £6.5m this year to provide an IMCA service for people who do not have family or friends to support them in making decisions about their accommodation and medical treatment. Councils and the NHS may also involve an IMCA in adult protection cases and care reviews.

The Department of Health said 2,500 referrals were made to the service from April to the end of August this year. It estimates that the number will rise to 16,000 a year once the system is properly established.

Advocacy groups in the areas surveyed by Community Care had dealt with between two and 90 referrals. Many organisations said there was a misconception that the service was coming into force in October and predicted a rise next month.

A project manager from one advocacy group said: “I’m not sure how we would cope with a surge of new referrals with only seven trained IMCA workers,” adding that it would be forced to turn people away.

Community Care’s research found that 77 of 574 referrals by the councils surveyed to IMCA were inappropriate, some of which should have been dealt with under mental health legislation.

Several advocacy organisations said most of their referrals came from social care workers and that hospitals were not doing so because medical professionals were not used to referring people to the voluntary sector.

Most referrals have been for accommodation-related decisions.

Advocacy – The Facts

– 2,500 referrals received from April to August 2007

– DH aims in the long-term to have 16,000 referrals annually

– £6.5m allocated for IMCA services in 2007-08

– £8.65m allocated to councils for Mental Capacity Act training in 2006-2008

– DH aims to train approximately two million people in the Mental Capacity Act

– 500 people have been given IMCA training

– £3.8m additional resources available to meet increased social care costs of the Mental Capacity Act in 2007-08

What the advocacy agencies say

“There is still a lot of work to do around IMCA. People don’t realise they have a legal right and health staff lack education.”

“We’ve experienced a steady flow of referrals we’re hoping it’s not going to be a flood in October. The resources are not huge but we’re able to manage them.”

“The training of grassroots decision makers is only just taking place. I think once they have done that there will be a sudden surge of referrals.”

“Training has been slow to roll out, certainly in hospital trusts. It will take some time for doctors to call in the voluntary sector it’s a cultural thing.”

“The feeling amongst providers is that many people didn’t have IMCA services in the first six months.”

Mental Capacity

Mental Capacity Act provisions coming into force on 1 October 2007, include

● Lasting powers of attorney
From 1 October people will be able to appoint an attorney to act on their behalf in case they lose capacity in the future. Lasting powers of attorney (LPAs) can be used by people in relation to property and financial affairs, as well as health and welfare. LPAs must be registered with the Office of the Public Guardian.

● Court-appointed deputies
Court-appointed deputies will be appointed to take decisions on welfare, healthcare and financial matters, as advised by the Court of Protection. But they will not be able to refuse treatment to lifesustaining treatment for a person who lacks mental capacity.

● Court of Protection
A Court of Protection will deal with decisions and orders affecting people who lack capacity. It will make decisions about health and welfare, as well as property and financial affairs. Courts will be based across England and Wales, with a central administration in London.

● Public Guardian
The Public Guardian will be the registering authority for LPAs and deputies. They will work with agencies such as social services to respond to any concerns raised about the way an attorney or deputy is operating. A Public Guardian Board will be appointed to scrutinise the way the public guardian discharges his functions. Former chief executive of mental health charity Mind Richard Brook is the Public Guardian designate. The Public Guardian will produce an annual report.

● Advance decisions to refuse treatment
People may make a decision to refuse treatment in advance if they should lack capacity in the future. Where an advance decision concerns treatment that is necessary to sustain life, strict formalities must be complied with in order for an advance decision to be applicable. The decision must be in writing, signed and witnessed. The person must also state that the decision stands “even if life is at risk”, which must also be signed and witnessed.

Guide to Mental Capacity Act 2005

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Further information
More on IMCA

Contact the author’s
Sally Gillen
Caroline Lovell

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