‘Care Act right to advocacy being undermined by chaotic commissioning and lack of resources’

By Kath Parson, chief executive, OPAAL UK

Since 1 April 2015, under the Care Act, local authorities have had to provide access to advocacy for those who would otherwise have substantial difficulty in being involved in care and support processes and have no appropriate person in their life, be that a carer, family member or friend, who can support their involvement.

The Older People’s Advocacy Alliance (OPAAL) UK has long campaigned for independent advocacy access for all older people and welcomed the Care Act’s strengthening of the entitlement to independent advocacy; however commissioning practices for Care Act advocacy are threatening its effectiveness.

Chaotic commissioning

“Access to Independent Advocacy lies at the very heart of the Care Act”, Social Care Institute for Excellence (Scie) chair Michael Bichard states in Scie’s guidance on commissioning care act advocacy, and yet the experience of our members suggests that commissioning for Care Act advocacy has been chaotic, and they fear it is being under resourced.

A review carried out by OPAAL at our member’s hub meeting earlier this year highlighted the inconsistency in commissioning decision-making.  All ten members who offered feedback from their local areas highlighted a different experience of Care Act advocacy commissioning.

Following the Cheshire West ruling in March 2014, which effectively lowered the threshold for a deprivation of liberty, Dols cases have increased exponentially. Yet funding for IMCAs to work in these cases hasn’t changed to meet this demand.

Following the AJ ruling in May this year, councils have struggled to find suitable family members or friends to act as relevant person’s representatives for people subject to Dols. This is forcing them to turn to paid RPRs, who are usually sourced from local advocacy services. Yet there are not enough professionals to take on the role of paid RPRs for people subject to Dols, and members questioned how Care Act advocacy will be resourced in this context.

Multiple resource issues

Resource issues arise in other areas. One provider traditionally funded for generic advocacy work has been asked to provide Care Act advocacy with no additional funding. In another area the Care Act advocacy work had been “lumped in” with a contract to provide information and advice services. In other areas, commissioners appear not to have made any link between the funding on offer and the numbers of people likely to be entitled to Care Act advocacy, and some areas were quoting commissioning arrangements based on two hours of advocacy time per Care Act case.

Members noted the Department of Health impact assessment for Care Act advocacy suggests an expectation that the number of assessments and reviews requiring Care Act advocacy support will double in 18 months then double again in following 18 months.

Need vastly underestimated

Members agreed this seems to be vastly underestimating need. Following the Cheshire West ruling providers are rightly concerned about how services will meet demand where demand for Care Act advocacy services has not been fully explored.  Members were also agreed that the two hours quoted per Care Act Advocacy case “only gets you to the front door”.

As Lord Bichard goes on to say in his introduction to the Scie guide on advocacy: “Good commissioning is about more than ticking a box. It is about complying with duties and targets with the genuine engagement of people who need care and support, as well as providers and voluntary, community and user-led organisations.”

OPAAL members have found that this has not been the case with commissioning for Care Act advocacy. To this end, OPAAL, together with our members, have developed a set of asks of the government. We urge this government to support independent advocacy and amplify older people’s voices; putting them in control of their health, care and support.

Five-point plan for government

Our five asks are:

1. A national voice for independent advocacy – a commitment to resource a national body to promote and support the independent advocacy community.
2. A commitment to support the local provision of appropriate resources, funding, information and awareness raising to support independent advocacy for older people.
3. A commitment to drive up standards in commissioning including to urgently investigate current commissioning practices around Care Act advocacy.
4. A commitment to consult with and involve the Independent Advocacy sector and the older people who use independent advocacy services in new strategic initiatives, including any initiative to develop a system of registration for independent advocates.
5. A commitment to ensuring the robust monitoring of the take-up of statutory advocacy to ensure that vulnerable adults including older people are getting access to advocacy.

Letter to Jeremy Hunt

In seeking to engage with government around these five key asks OPAAL wrote to Jeremy Hunt at the end of June setting out members’ concerns. As many Care Act commissioning arrangements have been made on a short-term basis OPAAL wanted to try to influence longer term Care Act advocacy commissioning plans. OPAAL has received a response to this letter which states that the Care and Support Reform Programme Board, jointly run by the Department of Health, Local Government Association and Association of Directors of Adult Social Services, will shortly publish a report on local authorities’ ability to provide adequate advocacy services. This report will likely inform future commissioning practices.

Tens of thousands of older people have substantial difficulty in being fully involved in decisions relating to their care and support. They have a right to the support of an independent advocate. We must not forget that this right lies at the heart of this act. Amidst tendering and commissioning processes, new policies and new services appropriate resources must be committed to ensure people can access this vital service that they are entitled to.

For more information about OPAAL contact Angela Broadbridge at angela@opaal.org.uk or 07854 880 675, or visit OPAAL’s website.