We here at The Advocacy People contributed to this paper. It is pretty clear that many organisations like ours have some similar experiences to share, and it’s great that the LGA and NDTi have pulled them all together so clearly. As someone working in the advocacy world, it also leaves me thinking that there is a lot of work still to be done!
Here I’d like to pick up on one element the report highlights.
There is a need for enhanced knowledge about the advocacy role and function across sectors including amongst social workers, Safeguarding Adult Board members (SABs), commissioners of advocacy and others. The high turnover of personnel in these roles means that advocacy organisations need to rebuild relationships and raise awareness about the role on an ongoing basis. This requires significant resource.
We all know that budgets are stretched, and, like other statutory services, we are as susceptible to this as the next organisation. Budgets are in the most part set by our commissioners based on the numbers of people who had an advocate the year before, leaving little time and money for us to spend time making sure the people who should be making referrals are doing so. Of course, we do what we can and will continue to do so, building local relationships, participating in SABs, sharing referral information, attending staff meetings, and so on.
As an advocacy provider, we know the power of advocacy (please read our other blogs) and can encourage people to make referrals until we’re blue in the face, but I just don’t think that’s enough. To put it rather bluntly, how can we better uphold people’s rights to advocacy which upholds people’s rights when decisions are being made about their care and treatment?
The Mental Capacity Act 2005, after 13 years of being in force, should now be embedded in the practice of all health and social care practitioners working with, and making decisions for, people who do not have the capacity to make their own decisions. Yet despite this we know that the processes set out, including the mandate to refer to advocacy when certain decisions are being made, is not always followed. Indeed, the CQC interim report this month into advance decisions provides evidence that inappropriate DNACPRs remain in place – sadly, this is not news to us, our advocates do find, in the course of their usual work, evidence of DNACPRs in place without the required consultation having taken place which they then challenge. But, of course, in the current pandemic we cannot visit care homes and review records.
Advocacy referrals for safeguarding have only become mandatory under the Care Act 2014 so, with evidence of how the MCA has (or has not?) been embedded, is it any surprise that advocacy referrals aren’t routinely made when the criteria are met?
But do we know why the clear processes set out in the MCA and Care Act are not being followed?
Why don’t professionals automatically think about making an advocacy referral within their day-to-day work? The rules are there for a reason – to protect the most vulnerable in our society who have no one else to stand in their corner and speak up for them. It seems straightforward to me.
So rather than placing the responsibility for driving referrals and raising awareness of advocacy largely onto the advocates and advocacy providers, we should be working with the health and social care sector from the point of training the future workers, through to ongoing CPD, to embed knowledge and understanding, make sure their decision-making staff understand the importance of independent advocacy as a supportive measure, not a threat to their own practice, and hold them to account when the right to advocacy is not upheld.