Previous reference: Minute 18 (2017/2018)

The Strategic Director, Health and Wellbeing will submit Document “AJ” which outlines the recent commissioned Independent Advocacy that was jointly commissioned by the Council and the Bradford Districts Clinical Commissioning Groups (CCG).

The report also sets out the wider context of advocacy and what other services are available across the District and how future services might be shaped.

Recommended –

That the report be noted.

(Kerry James/Sasha Bhat – 01274 432576)

The Strategic Director, Health and Wellbeing submitted Document “AJ” which outlined the recently commissioned Independent Advocacy that was jointly commissioned by the Council and the Bradford District’s Clinical Commissioning Groups (CCG).

The report also set out the wider context of advocacy and what other services were available across the District and how future services might be shaped.

The Contract and Quality Assurance Manager addressed the meeting and explained that the purpose of the re-commission of the service was to ensure people had greater choice and control over how their health and social care services were delivered through a new joint approach to funding advocacy services. 

Previously advocacy services had been provided by five Providers under 15 arrangements some of which were joint funding arrangements with the NHS and some of which were in the form of Council grants.  

Document “AJ” revealed that the new two contracts had commenced in April 2018.  Statutory and Non Statutory advocacy was provided by Voiceability. 

Self and Group Advocacy, Capacity Building and Volunteering was provided by Equality Together sub contracting to People First Keighley and Craven and Bradford People First.

A representative of Voiceability addressed the meeting to provide a flavour of the advocacy provided and how that was delivered.  He explained that the majority of the work undertaken by his organisation was statutory and had evolved from the statutes and associated regulations and codes of practice from The Care Act 2014; The Mental Capacity Act 2005, including the Deprivation of Liberty Safeguards (2009); the Mental Health Act 1983 (amended in 2007); The Equality Act 2010 and The Health and Social Care Act 2012.  The report set out the various advocacy service roles that were required in relation to statutory advocacy services.

Members were advised that anyone who had been sectioned under the Mental Health Act, because they had been deemed to have had their capacity taken from them, had the right to have an advocate to support them through the section process or an appeal.  The service acted as the voice of the person concerned and did not judge.  Other services were required to assess what was in the best interest of the person and the advocate would act to voice that person’s opinion. 

Examples of the work of Voiceability included situations when people lacking capacity had difficulty when assessing care needs were supported to make decisions about their care.  The service was often involved in long term decisions about accommodation or if serious medical treatment was required and a person lacked the capacity to accept or decline that treatment.  People could be supported through safeguarding processes and were generally helped when there was no one else to support them.  If it had been deemed that someone should be in residential care but they did not want to go the advocate would work to look at other options and may be able to engineer a plan to keep that person in their own home.  Personal situations where the advocate had been able to get to the route of issues of which other services had been unaware were also discussed.   It was reported that people often confided in advocates and that the service remained independent whilst supporting people through tough situations. 

A representative of Equality Together discussed aspects of their work which included developing self-empowerment for people to take control of decisions and to tell others what they wanted.  It was explained that whilst addressing issues other problems also came to light and they were able to help people to address those issues and prioritise plans.  Work was carried out across non protected areas with vulnerable people with long term health issues.

A particular issue faced by the service had arisen following welfare reform with people suffering with ill health experiencing further anguish dealing with potential changes to their circumstances.  Group advocacy sessions were particularly useful for people who were new to a situation and empowered them to address their issues through peer support.

It was explained that user voice and engagement was a big part of the contract; service users were listened to and regular meetings, focus groups and large events were held to allow people to gain information. 

It was felt that the expectations of service users was increasing, however, through peer support and experts across the district people were empowered to take control of their own situations.   It was explained that the service was under resourced and required more partnership working.  As they moved to the second year of the contract it was hoped to create more clusters of organisations to self empower. 

Following the representations a number of questions and issues were raised to which the following responses were provided:-

·         People were referred by professionals involved with patients under the acts referred to in Document AJ.   People also contacted the services directly to self refer.

·         Voiceability had a presence on hospital wards where people had been placed under the Mental Health Act and that allowed them to make approaches for help directly.

·         Telephone enquiries about non statutory issues often came from friends or family members.

·         It was hoped to have more outreach work during the second year of the contract as the services had become more established and recording systems became better established.

·         Since the contract had commenced Care Act Referrals had increased by up to 20 per week.

·         People who experienced Deprivation of Liberty were visited every four to six weeks to ensure the sanctions were proportionate and realistic.

·         The contracts had been awarded for three years with an option to extend by a further two.

·         To deal with diversity and equality in Bradford additional interpreters and female advocates were required.  At the last recruitment drive there had been no female Asian speaking applicants.

·         Advocates utilised other skills other than talking to understand people’s needs.

·         Performance Indicators revealed that 85% of the time of advocates was spent with service users although different types of advocacy could take longer. 

·         Advocate skills were used to create action plans and to agree outcomes.

In response to the issues about recruitment a Member referred to the help that all Councillors could provide if details were forwarded to them.

A Co-opted Member referred to concerns which had been expressed to her by a previous advocacy provider.  She explained their concerns that reductions in provision had resulted in people falling through the cracks in the system.  They felt that because of the number of people with complex needs and with the changes to the welfare system needs were not being met.  It was suggested that a review of provision should be undertaken and budgets increased to meet demand.  It was acknowledged that the report confirmed that statutory duties were being met but it was believed that additional support to that defined as statutory was required.  She questioned how many people used the advocacy services; how many approaches were made and the number of people who could not be assisted.

In response a representative of Voiceability acknowledged that there were areas of concern particularly around Personal Independence Payments.  People often dreaded the assessments they were required to undertake and the service did not have the remit or capacity to support them.  It was stressed that support at that level could make a big difference and prevent further distress and interventions.  The number of people who could not be helped was reducing from two calls per day last year.  It was considered that may be due to people knowing that they would not be supported so not making those initial requests. 

A representative from Equality Together confirmed they had to turn down requests for help two to three times a day.  Universal Credit was a major issue which some people did not have the capacity to understand.  Approaches were made about welfare reform approximately 6 to 12 times per week.  As the service was not funded to support people through the assessment process, and there were only three advice workers for the district, the advice team aimed to provide focused sessions.  Members were assured that the service would not cast people adrift and that they could go back to the service if they felt they were not supported elsewhere. 

In response to questions about future funding cuts it was explained that measures to reduce reliance on the public purse were being pursued.  

Work with the Black Ethnic Minority (BME) communities was questioned and how discussions about individuals were handled.  It was reported that data protection rules were explained so residents could understood the way in which the service was operated.  Checks were undertaken to ensure people had the authority to speak for other people or family members.

How a person’s capacity or lack of capacity was determined was discussed and Members were assured that this was done by professionals before statutory advocacy services were requested.  Once a lack of capacity had been established by a senior health professional the first question asked by the advocate was were they likely to regain capacity and could they be kept well until that time.  It was reiterated that it was not the advocates’ role to advise but to allow people to make their own informed decisions.   The role of advocate was likened to that of a ventriloquist’s dummy. 

In response to questions about people who did not want the help of self and group advocacy it was explained that the situation would not arise as people self referred to that service.  It was often found that once people requested help a number of underlying issues would come to light. The service would develop relationships and over time other problems could be addressed.  Community Connectors worked with hard to reach people and their people- centred approach reduced barriers.

The way in which the effectiveness of the service was measured was questioned and it was explained that the Contract and Quality Assurance Team held regular meetings with the two providers separately.  Regular email discussions occurred on day to day casework and performance information was provided.  As the contracts entered their second year arrangements were in place to compare with previous providers and with the performance of the first year of the contract.

A Co-opted Member raised concerns that the value of the proposed new contracts had been significantly higher than the current contract costs and questioned if funds to deliver advocacy had been reduced.   In response it was explained that funds had been retained for services for people out of the area who remained the responsibility of Adult Services. Increased expenditure had also been required for work around Deprivation of Liberty safeguards.  Members were assured that only a small contingency had been retained and it was expected that half of that would be spent shortly.

In response to a question it was confirmed that the services did attend multi disciplinary team meetings with regard to patients with long term health conditions. Decisions such as when a patient would return home from care or future medical needs often required discussions with several agencies.

It was questioned how the services were benefitting people in the criminal justice system who, with acute and high level needs, were suddenly told they must be work ready but may have impaired capacity.   It was maintained that better initial decision making would be less costly in the future and it was stressed that information on outcomes; achievements and lack of achievements was required to assess the performance of the new services.  More evidential reports including connections to other services were requested and the potential to invest to save was discussed.

The Assistant Director, Commissioning and Integration, confirmed that the data could be gathered and quality of outcome measured in future reports. The need for wider connectivity was acknowledged and would fit well with the strength based empowering work in Adult Services.

Resolved –

That Independent Advocacy Services in the Bradford District be added to the work programme for 2019/20 and to include the presentation of performance information and outcomes; and consideration of demand for services, cultural competency and diversity.

ACTION; Overview and Scrutiny Lead