Advocacy delivery in relation to PHBs and health funded support

This report and executive summary outline the findings of an NHS England and NHS Improvement funded scoping exercise exploring current arrangements for delivery of independent advocacy in relation to health funded care and support.

The report covers the following 12 key findings in detail, comes to 4 main conclusions and highlights areas for further consideration.

Findings

1. Most 3^rd party, one to one advocacy is provided under existing statutory duties.
2. Existing legislation, guidance and best practice advice does not ensure that advocacy services are available to people who are accessing or wanting to access health funded support.
3. Rights to advocacy under the Care Act, Mental Capacity Act and Mental Health Act enable some people to access advocacy support at various points in their care and support ‘journeys’ in relation to health funded support but, this can come to a ‘sudden end’ and feel quite rigid and or episodic.
4. There is nothing in current legislation or guidance which triggers a right to advocacy support for all individuals accessing NHS Continuing Healthcare (NHS CHC), Children and Young People’s Continuing Care (CC) , Section 117 mental health aftercare, Personal Health Budgets or Personal Wheelchair Budgets.
5. Joint strategic planning may not be taking place in line with the intentions set out in the National NHS CHC Framework.
6. Most Local Authorities and CCGs do not commission specialist advocacy for people going through NHS CHC, CC, PHB or PWB processes over and above the statutory roles introduced within the Care Act and Mental Health Act. Where they are commissioned, these services are seen to be highly impactful, with positive outcomes for people.
7. Minimal data (if any) is being kept or recorded at a national level on what advocacy is being commissioned and on whether people are accessing or using advocacy, including in relation to young people.
8. Little evidence was found in relation to the commissioning or delivery of advocacy to children and young people in supporting them with Continuing Care, Personal Wheelchair Budgets, or S117 aftercare. Some local authorities identified that IMHA services are only commissioned for people over 18 which is worrying.
9. There is a lack of strategic commissioning of advocacy, across the country, for people accessing and using health funded support. Whereas some local commissioning arrangements ensure strong and robust advocacy provision is available, there is inconsistency across the country both in what is commissioned and by whom (CCG or local authority). There are examples of commissioners/local authorities believing that advocacy is available where it is not.
10. Advocacy accessed within NHS CHC and s117 aftercare processes through statutory advocacy can be restrictive and is limited by strict criteria resulting in ‘episodic’ advocacy which focuses on single issues rather than holistic person-centred approaches. This results in people having access to advocacy for some part of their journey (i.e. assessment) but not others (i.e. planning). It also contradicts and undermines the principle of personalised care.
11. Where advocacy services hold IMHA, IMCA and Care Act Advocacy contracts and used ‘multiskilled’ advocates or integrated models of advocacy the advocate was able to stay with the individual for more of their journey through services, effectively moving from IMHA to IMCA to Care Act Advocate. This was helpful particularly when the advocate was already present to support the individual to access NHS CHC or PHB processes.
12. Advocates and advocacy services didn’t always have a good understanding of individual’s rights and entitlements in relation to health funded support or where their current roles would allow them to provide advocacy support in this regard.

Download or read the executive summary here

Download or read the full report here