New guidelines for Advocacy

The National Institute for Health and Care Excellence (NICE) is set to publish its guidelines for ‘Advocacy Services for adults with health and social care needs’ in November, and the consultation on a draft document has just finished.

We’ve been submitting our feedback to this important and comprehensive publication on the commissioning and provision of advocacy.

Here, Business Opportunities Lead at The Advocacy People Alan Wright summarises our response to the consultation.

The guidelines are intended to influence how local authorities, health and social care providers, and providers of statutory and non-statutory advocacy services, undertake the wide range of actions and duties associated with advocacy: ensuring that people who might otherwise struggle to have their voices heard are able to access the support they’re entitled to receive.

The 70-page NICE document also makes several recommendations on how advocacy provision could be enhanced and improved.

Our advocacy team managers have spent time looking carefully at the draft document, and as an organisation we’ve given some constructive criticism to the National Guideline Alliance, who’ve been developing the content.

We are on board with the thrust of the document and most of its recommendations

in principle - and we strongly agree with certain elements of the draft guidelines.

But we have to be clear that we also disagree strongly on certain points.

Importantly, we feel that in several places, the wording of the guidelines does not go far enough, is not strong enough, or leaves too much room for interpretation by those holding the purse strings. Some of the guidelines as they stand could lead to confusion over where responsibility for a certain action ultimately lies.

We’ve also asked the question: will these guidelines for advocacy, and the research and evidence which supports them, be expected to influence future Government policy – and if so, how will this happen?

Here’s a closer look at the feedback we gave:

As an overarching comment, we support nearly all the guidance and recommendations that NICE is proposing.

We strongly agree that ‘an advocate should be involved in all discussions (both before and after meetings) to ensure that the person that they are working with has understood fully what decisions have been made, and the impact these decisions may have, and so that they have opportunities to challenge decisions and to raise any concerns’.

We believe that the long-term benefits of providing advocacy support in ALL discussions and meetings need to be promoted, so that commissioners understand the value for money that proper investment in advocacy services can yield.

We would like to see stronger language used where there are references to organisations needing to fulfil their legal obligations – making clearer distinctions between good practice guidelines and statutory duties.

Some clarity is needed, in certain sections of the document, around whether it is advocacy providers or health + social care providers who should be responsible for some of the required or recommended actions.

Many of the activities and actions identified as recommended responsibilities of an Advocacy service actually point to resourcing issues.

For example, we argue that advocacy providers can only give their staff access to quality training, qualifications, or time for CPD, and can only deliver a high level of culturally appropriate advocacy, or provide a full opt-out IMHA service, if properly funded to do so.

We feel that where commissioners are asked to “consider the benefits” of advocates holding professional qualifications, or advocacy providers holding the NDTi Quality Performance Mark (QPM) – this phrasing could make these appear optional. This potentially opens the door for less competent organisations to win contracts, and to be more financially competitive against providers who do make high quality training available to their staff and who do undertake the 3-yearly QPM assessment process.

We believe the social and economic benefits of non-statutory and community advocacy should be promoted much more, and commissioners must be obliged to properly fund these services in all Local Authority areas.

We disagree with the suggestion that advocacy providers should report to Safeguarding Boards on other agencies’ fulfilment or non-fulfilment of their statutory safeguarding duties. Actions taken after a safeguarding alert has been raised are confidential, and further information should not be disclosed to the independent advocacy provider – who will therefore not know how well other agencies are fulfilling their statutory obligations.

We feel that the draft guidelines miss a few important things out!

The Department of Health and Social Care is not mentioned in the document – although it ought to have a pivotal role, in reviewing the effectiveness and weaknesses of current legislation impacting on advocacy, and proposing amendments.

The role of Healthwatch is not covered in the document – despite its close, intrinsic links with advocacy services.

We would urge NICE and other influential bodies to put pressure on Universities and Colleges delivering Social Work courses to include advocacy (and the legislation that underpins it) as a mandatory part of the curriculum.

We believe the Care Quality Commission (CQC) ought to have a role in monitoring and enforcing Local Authorities’ and healthcare/social care services’ responsibilities around ensuring advocacy is promoted and understood, and that everyone entitled to receive it does so – with powers to hold Councils and providers to account if they do not comply with their statutory duties.

In short, the NICE guidelines on Advocacy Services ought to provide a very useful reference document for advocacy providers, local authorities, health and social care providers and professionals.

The intention and direction of the guidelines is something we welcome and support – but the devil will be in the detail.

The Advocacy People’s Team Managers welcome the publication of this draft document. We’re keen to know what actions will be taken from the outcomes of the consultation, and what results we should expect?