Advocacy Commissioning in Tees

Transcription

1 Advocacy Commissioning in Tees Findings and recommendations for an advocacy hub Martin Coyle, Director, True Voice

2 Contents Introduction... 3 Context and Local Provision... 3 Hub and spoke model... 4 The Hub... 4 A two stage commissioning process... 5 Resources and Reasons to Fund Advocacy... 6 Commissioning of advocacy services... 7 Funding Allocation... 7 Informing the commissioning of the hub... 8 Functions of the hub... 8 Competencies of the hub... 8 Tasks of the hub in year one... 9

3 Introduction This paper sets out some of learning undertaken to support advocacy commissioners in the Tees area to consider how to maximise the benefit from their advocacy spending. Through a process of conversations, online survey, workshop with providers and conversations people who had been through similar processes in other parts of the country, we have arrived at a commissioning process and timetable that should support people across the Tees area to gain access to a wider range of advocacy provision. The document concludes with a set of requirements for the hub including a suggested workplan for year one. Context and Local Provision The need for Local Authorities to commission independent advocacy stems from both legal duties and good practice. Of particular note in the current commissioning process was the spectre of Winterbourne View. Current advocacy provision in the Tees area could not be said to respond to the challenges that arise from Winterbourne, in particular there is a lack of standing access to advocacy within residential units. Commissioners saw a number of issues relating to the current model of provision that led them to believe the current advocacy market had significant weaknesses. The relatively small amount of advocacy work happening in the area had led to advocacy being delivered by a number of small providers, no one of which had a large advocacy workforce. The specialist nature of the providers was seen to produce a disjointed structure for provision. Local engagement sessions had shown a real desire for there to be better access to advocacy for people on the autistic spectrum. However, a legacy of advocacy provision based n specialist services meant that too often this was seen to be a gap in services and there were reports that this was exacerbated by a gap in training and skills around autism within existing providers. The lack of a standing advocacy presence in several units meant that there is a risk that staff could gatekeep access to advocacy. In effect this would mean that those more likely to be in need of advocacy would be less likely to receive it. The Care Quality Commission have spoken of the need for some ongoing advocacy presence in its reports on the Mental Health Act, yet this did not seem to be notably present. As a result of these issues there was a desire to try to work on a Tees wide basis, using a hub and spoke model. Successfully implemented, this will lead to a maximisation of local resources and skills, strengthen the local advocacy market, address skills gaps and make services easier to identify.

4 Hub and spoke model Following discussion with commissioners, it was agreed that there would need to be an organisation to provide and service the hub functions of advocacy provision across the Tees region. The hub would have the function of being a central point for referral, allocation, monitoring and identifying skills gaps across the Tees region. The advocacy provided thereafter would need to meet the following characteristics: Anyone with care and support needs who may be less likely to have access to the full range of rights and choices, or who may be at greater risk of abuse, should have an ability to access independent advocacy The majority of work should be issue based advocacy with an ability to prioritise There must be scope to respond appropriately to complex situations There must be clear case closure procedures A regular presence in residential or inpatient settings is required if the issues of gatekeeping access to advocacy are to be addressed. Advocacy should link to self advocacy groups, promote people s ability to speak up for themselves and act as a mechanism for system change. Both instructed and non-instructed advocacy are required. It was also agreed that the advocacy provision should be able to draw on a range of skills from beyond the immediate area, with providers up to one hour s travel from the area being eligible to be linked to the hub. However, such outward referrals would need to be logged to identify potential training needs of tees advocacy providers. The Hub Discussions with local providers and with providers of hub functions in other areas provided useful information about the necessary requirements of an effective advocacy hub. All hubs must be able to produce effective information, take referrals, maintain contacts with providers, oversee and compile monitoring data and ensure effective payment mechanisms. It was agreed that the hub would hold a budget for the purchasing of advocacy outwith those set out in statutory services. One key task will be the establishment of a referral allocation policy. This policy and the matrix which underpins it must be created by the hub in collaboration with the advocacy providers to ensure it is both effective and equitable. Once established it should require as little human intervention as possible between review processes. The allocation matrix will need to consider the issues of specialism, prioritisation and proximity to ensure good allocation procedures. The hub will also be required to ensure some level of parity and fairness in payments for work. This will require the ability to see, understand and, if necessary, challenge the time allocated by providers for dealing with particular issues. The hub will also need to identify residential services in which it would be beneficial to have a regular advocacy presence. This should be seen as a key component of the advocacy provision if gatekeeping is to be minimised as a problem. Wherever possible this should link in with the work of self advocacy groups or patient forums.

5 Finally, there is a strength in using a central allocation hub to be able to drive, oversee and interpret advocacy monitoring data. This must be used to inform health and care service providers about the issues that are frequently coming up in their services. The hub will also have a role in identifying the outcomes of advocacy work. There are a number of organisations that could fulfil the role of the hub, although each of these has their own strengths and weaknesses. Model Stength Weaknesses Local Advocacy Provider Local knowledge, understanding of advocacy Suspicion about allocations, Potential advantage in covering some core costs External Advocacy Provider Advocacy knowledge Low local knowledge, fears of takeover of local groups. Lack of local accountability Local CVS Local Advocacy Network Remote Advocacy Network Existing infrastructure, voluntary understanding of voluntary sector, no competition on service provision Natural model for collaboration. Shared training and awareness raising would fall under this remit. Skills and experience in facilitating hub functions Potentially weak advocacy knowledge Only exists informally at the moment and has no existing infrastructure Lack of local knowledge. Trust of local providers. Lack of local accountability. It was agreed that a commissioning process should be undertaken for the hub that would allow any of the above type of organisation to bid, but that the process will actively pursue how organisations will address the weaknesses of their own particular model. A two stage commissioning process Originally it had been suggested that a two stage commissioning process could be undertaken, with the hub allocating resources in year 1to build up a realistic picture of advocacy need which would inform funding allocations for advocacy commissioning in year 2. However, it was decided that this would need to be altered, with advocacy services commissioned for the financial year This will require a shorter timescale commissioning process for the hub.

6 Resources and Reasons to Fund Advocacy It is likely that local authorities will not be making any more resources available for the provision of advocacy than is currently the case. This might be influenced later in relation to real and unmet need, but there is no significant sign of a willingness to do so at present. Set up costs and initial costs of the hub will be covered, and there is a likelihood of a small amount of money from the health to support some of this work. However, the resources suggested so far do not indicate an ability to create a radical increase in the availability of advocacy. It is disappointing that this is the case. The commissioning of independent advocacy is a requirement under the Mental Health Act, the Mental Capacity Act and the Children s Act. However, it is notable that the Mental Capacity Act does not solely relate to the provision of IMCA; it instead creates an expectation that authorities and decision makers have a duty to increase the ability of people to take part in decisions that affect them. Advocacy is one way of fulfilling this duty. The former Care Minister Paul Burstow stated in a statement to the House of Commons that the provision of independent advocacy is one way in which local authorities can demonstrate that they are meeting their equalities duties. This only holds true if there is sufficient provision to meet need. The role for advocacy in increasing choice and control of older people in residential care has been established by the Older people s Commissioner for Wales. A recent amendment to the Care Bill suggests that there will shortly be a need for Local Authorities to commission advocacy in relation to social care services. Finally, the role of advocacy as an active preventor of abuse and neglect is held to be true by the Social Care Institute for Excellence and the need for independent advocacy has been flagged up by numerous abuse enquiries, from Sutton and Merton, Cornwall, Kerr Haslam through to Winterbourne View. In this context, an increase in provision of advocacy services would seem reasonable. However, working within the confines of what currently appears possible, the maximisation of access and resources becomes even more pressing. An additional problem is that charitable funding for the advocacy sector which has traditionally helped to round out the local authority advocacy commissioning is rapidly disappearing. One local service which provides advocacy to people with mental health problems and which described a highly effective working relationship with hospital managers is entirely funded through charitable foundations. A question remains what will happen to levels of advocacy provision when this funding dries up? The hub and spoke model would enable the organisation to gain some resources, but whether this will be sufficient is debatable. It is so commonly stated that there will be no new money coming into the system that it could feel like an increase in provision or access is impossible. However, there is already considerable funding in the care system which is intended to support people to make their voices heard and to have control of their own care, but which is never used for this purpose. Each placement in a care setting includes an expectation that the care provider will have in place mechanisms to support that person s voice and participation it is a requirement under CQC regulation.

7 This money rarely reappears in the form of active, independent support such as advocacy. Sometimes this is said to be for reasons of principle that it would create an impediment to the independence of advocacy for the care provider to commission it directly. One solution to this would be to identify the proportion of a care package that is expected to go towards advocacy provision and to repatriate this for allocation at a local or regional level. Such a step would support the smooth flow of resources to advocacy, address the problems of advocacy being commissioned in-house, and would mean that access to advocacy was not dependent on the preferences of the care provider. This would not require new money, simply using existing money for the purpose to which it was originally assigned. Commissioning of advocacy services The advocacy services which will be explicitly commissioned will be the IMHA, IMCA and Children s advocacy service required by legislation. These will form separate tender processes, though they will be required to report referrals through the Tees advocacy hub. Non statutory advocacy providers will be identified by the hub using a preferred contractor model. This would allow the hub to plan the use of its budget, being able to identify in advance the hourly costs of different advocacy providers. There is currently very little non-statutory advocacy commissioned across the Tees area. This is unlikely to increase as a result of this commissioning round. Existing advocacy provision which is currently provided through a combination of contract and spot purchasing should be maintained in this commissioning process, although precise commitments on funding have yet to be finalised. Funding Allocation In the initial year it would require too much of a financial turnaround to go from payment in advance for the quarter to payment in arrears for work completed. Such a move would destabilise the market that the commissioners are attempting to strengthen. This can be overcome by the advance purchase of a certain number of hours of advocacy, which would include those of standing advocacy presence o n residential units. Time keeping and recharge arrangements could then be set in place to ensure that delivery has taken place, and quality monitoring undertaken to ensure that it has been of sufficient quality. This should enable a provider to plan its funding with reasonable certainty whilst providing an incentive to quality delivery. It is this quality monitoring role that takes on more of a priority for the hub. This will require a clear framework of quality to be used. TO be effective it would require a view of both organisational/procedural robustness and of activity and outcomes monitoring. The former could be achieved by linking to the Quality Performance Mark framework.

8 Informing the commissioning of the hub Clarity on the functions, competencies and tasks of a service are essential if a commissioning process is to achieve its desired aims. This section aims to lay out the areas which would be required of an effective advocacy hub for the Tees region. Functions of the hub To support effective and accessible advocacy provision across the region. To support and raise the quality of advocacy provision in the region. To strengthen the local advocacy market To allocated good quality and relevant advocacy provision for people eligible or desiring advocacy in the Tees region, where necessary bringing in advocacy provision from outside the region. To negotiate and hold a common protocol for advocates accessing service users on other people s premises, Development and use of an allocation matrix to identify who will get access to advocacy services Budgetary responsibility for delivery of representational advocacy services Allocation of advocacy funding to ensure regular presence in care settings Development of shared referral and publicity information Collection and analysis of monitoring data Presentation of trends in issues, outcomes and implications for H/SC service delivery Use of advocacy monitoring data to ensure effective use of resources Identification of skills gaps and training to address these Development of links with advocacy providers outside the area to ensure an effective bank of contacts when specialist skills are required. Development of service agreements that include the requirement to interact with self advocacy/patients groups Competencies of the hub Knowledge and understanding of independent advocacy An ability to work effectively with local advocacy providers Track record of effective publicity and referral management Strong monitoring skills including the ability to robustly test time monitoring data Financial competence and organisational financial robustness Capacity to respond to phone calls within office hours for all referrals and enquiries across the Tees region Knowledge of statutory advocacy eligibilities and roles A methodology for devising and maintaining the advocacy prioritisation matrix Knowledge of the local makeup of care and health services

9 Tasks of the hub in year one Establish a set of providers who can deliver a range of advocacy provision in the region from June 2014, including the prices at which services will be delivered. Bring advocacy providers together to establish the places at which an regular advocacy presence should be maintained. Identify the strengths and boundaries of each advocacy provider, sourcing alternative means of provision where appropriate. Identify a training programme to address skills gaps amongst local providers, the ability to work effectively with people on the autistic spectrum being the first priority. Develop a single, shared engagement protocol which supports an accountable and regular advocacy presence in relevant services, including the requirement for advocatgs to be able to meet people in their regular care environment. Develop a standard referral form which will allow effective prioritisation and allocation of new referrals. Develop guidance on case closure and a case closure form to support this. Ensure the referral and case closure forms support the monitoring of advocacy issues, outcomes and time input. Provide a clear referral mechanism including a dedicated phone line and online presence. Develop publicity information that can be used across the Tees region. Hold regular meetings to review the allocation matrix and to highlight trends in quality. Provide quarterly reports to advocacy commissioners and relevant senior managers in the health and social care sectors on recurrent issues in advocacy provision.