This article was first published at Social Care Innovation

As many social care service users know, being able to explain one’s care needs and how they might fit within the broader context of one’s life is essential to securing a suitable care and support package. Indeed, social workers are required to take into account what the individual considers to be important when making care arrangements — something that would be impossible without the person’s input.

However, there are occasions when an individual might find it difficult to fully participate in decisions about their care in the absence of additional support. They might have a learning disability, mental health condition, communication impairment or another potential disadvantage that could prevent them from engaging in the process. In these situations, the Care Act 2014 requires social services to ensure that there is a suitable person involved in the decision making who is able to support the individual and, if not, appoint an independent advocate.

Enabling empowerment

Advocacy is grounded in the belief that people should be able to express what matters to them and decide what services they need to achieve a good quality of life. Advocates aim to represent and advance their clients’ views in order to empower the individual by increasing their personal autonomy, encouraging their inclusion and improving access to services that might not otherwise have been offered to them.

Helping people to self-advocate as much as possible should be the ultimate goal of professional independent advocacy services. However, there is strength in numbers, and group advocacy gives people the opportunity to influence policy and service provision. Peer advocacy provided by trained volunteers who have been in a similar situation can lend additional potency to an individual’s voice. Advocacy has many different forms and a mixed approach ensures that everyone’s needs are served.

The Care Act’s advocacy duty applies from the first time someone makes contact with the local authority and at any subsequent stage of their care assessment, planning and reviews as well as during safeguarding enquiries and adult safeguarding reviews. Council officers must consider whether the client is likely to have substantial difficulty in making their own decisions in relation to four distinct areas:

• Understanding relevant information
• Retaining information
• Using or weighing information
• Communicating views, wishes and feelings

The Act specifies that the advocate cannot be a professional who is already providing care or treatment to the person, someone the person does not want to have supporting them, someone who is unlikely to be available to provide adequate support or someone who has been implicated in a case of abuse or neglect in the past.

Surveys conducted during the early phases of implementation suggest that relatively low numbers of people have been accessing advocacy in some parts of the country, implying that some local authorities are failing to offer advocacy services to everyone who needs them. Some commentators have argued that financial constraints on local authorities have meant that they have not been able to offer these services or do not have the resources to train frontline staff on the advocacy duty.

However, the failure to provide advocacy can also be costly, resulting in flawed assessments and legal challenges. In 2015 a landmark ruling determined that the London Borough of Haringey had failed to provide an independent advocate to an Afghan asylum seeker suffering from post-traumatic stress disorder who also had no understanding of England, and ordered that she must be reassessed.

Uneven provision

A survey on the commissioning of advocacy involving nearly half of English local authorities was conducted last year by the University of Birmingham and the University of Central Lancashire. The survey found that the rigour with which the advocacy duty is being applied varies widely. Only 48% of local authorities had tendered contracts for the provision of advocacy services since April 2015. While in some areas there have been fewer than ten referrals for advocacy since the introduction of the Care Act, others have seen over 400 referrals. Just 47% of councils involved service users in the commissioning process.

The researchers found that councils were using different tools for estimating likely demand through a combination of local and national information and guidelines, some of which were insufficient for the task. Service providers that also took part in the study said that arrangements for referral often do not work, partly because of a lack of understanding among frontline staff of the duty to refer.

The evidence indicates that councils have yet to come to terms with the full implications of the advocacy duty. An understanding of advocacy and the different forms it can take is important, not just in the most critical cases where the person lacks the capacity to make decisions regarding their care and support, but also to ensure that those who are capable of making such judgements are able to do so. Councils must provide training to help staff discharge this complex responsibility.

Effective advocacy support must be rooted in the aspirations of the person being supported. Local authorities should establish organisational structures and promote a culture that gives advocacy a central role in services. Service users and carers should be involved in commissioning services from board level down.