Commissioning Care Act advocacy

1. Commissioning Care Act advocacy Dr Karen Newbigging, Dr Julie Ridley and June Sadd 2016

2. Context • Care Act 2014 - duty to offer advocacy • Impact of austerity • Previous research (e.g. AAA, 2015) • Evidence of low referral • Legal challenge • Importance of awareness, understanding and attitude • Good commissioning is key SCIE study 2016 To undertake a survey of LAs and identify examples of promising practice

3. The project • Two surveys: Anonymised survey of English LAs (responses represent 46% of LA, ie 70/152); Advocacy Providers (49 responses = 64 providers) • Interviews (21): commissioners (10), providers (10) and a national organisation • Thematic content analysis • SCIE Roundtable – 23 June • Briefing paper

4. What is Care Act advocacy? “We think the distinction of CA advocacy is unhelpful. It doesn’t help to isolate it so we define everything as CA advocacy if they meet the threshold and it’s about their life, they get an advocate. The threshold is that there must be a communication difficulty and they are unfriended. I think there is a mix-up about advocacy-it’s not just about the law. We call it social care and community advocacy. It is difficult to define but if someone needs an advocate they get it.” (Commissioner, interview)

5. The commissioning process: a ‘work in progress’ • 78% LA estimated demand • from basic to sophisticated • 47% LA had involved users in commissioning • from consultation to co-production • 80% had CA advocacy service specification • Majority (47%) went out to tender 2015/16 • 29% extended existing contract; 8% spot purchase; 16% ‘other’

6. Investment in Care Act advocacy • Both commissioner and provider data illustrates variation in total spend from <£25k to >£200K • Comparison of provider data 2015/16 and 2016/17 shows a trend towards a reduction in contracts <£25k • Commissioner data is difficult to interpret because resources for Care Act advocacy can be difficult to differentiate from overall spend on advocacy and it is unclear what the per capita spend is • Indication that a number of Commissioners are investing between £150 - £200k in Care Act advocacy • Concern expressed about potential reductions in resources alongside increasing demand

7. Investment in Care Act advocacy “Our advocacy contract is a 'hub' approach, bringing in all statutory advocacy provision under one contract. The contract value is £635,000 per year for IMCA, IMHA, Care Act, NHS Complaints and non-statutory advocacy. The contract specifies indicative values for the number of hours of each form of advocacy. The aim of the advocacy hub approach is to work to be flexible to meet ebbs and flows in demand, hence the indicative value approach.” (Commissioner)

8. Contract length • No contract: 5% • 0 - 11 months: 17% • 1 year: 31% • 2 years: 26% • 3 years: 16% • > 3 years: 3% • Not known: 2%

9. What is being commissioned? • Evidence of positive practice but several LA adopted a ‘wait and see’ approach • 60% had (initially) commissioned a single provider • 38% commissioned integrated advocacy service/hub • With lead provider or partner with 2 or more other advocacy providers; • range of sub contracting arrangements • Described as consortium, frameworks • Only one LA commissioned as need arises • Around 25% had changed provider since April 2015

10. Access and referral for CA Advocacy • Over half of providers considered arrangements for referral as not working, attributing this often to frontline staff’s lack of understanding of their duty to refer. • Many LA could not easily provide numbers: • ‘Info not to hand’ • ‘Unable to answer’ • ‘Not recorded’ • Broad range – 10 or less to over 400 since April 2015 • 90% LA reported training frontline staff – broad spectrum • Referral and access not necessarily linked to model

11. Effective commissioning

12. Barriers to effective commissioning • Limited needs assessment and consideration of diversity • Lack of understanding of advocacy (adult social care teams, commissioners) • Reliance on spot purchasing • Out of area clients – who takes responsibility? • Increasing demand in light of reducing resources • Complexity of advocacy landscape • The market – limited choice of provider(s)

13. “ A constant battle to make sure statutory service understand what Care Act advocacy is about. Also there’s a level of dumping by social workers: ‘oh we’ve got a service here that we’ve paid for, its not going to cost anything, we ‘ll use that’. But they misunderstand what advocacy is and that its about getting people’s voices heard. Their issue is with closing cases and having somewhere else to send people to. For example, safeguarding closure when they haven’t referred during safeguarding process when advocacy would have been appropriate not at the end”. (Provider)

14. Improving commissioning of Care Act advocacy • Improve needs assessment based on co-production • Enhance equality and diversity • Potential of market shaping and incentivising providers • Single point of access for all advocacy • Co-produced training about advocacy • Multi-skilled advocates • Focus on outcomes • Implementation of wider Care Act agenda • Include wider advocacy offer e.g citizen advocacy, self-advocacy

15. Further information or questions? Contact: Dr Karen Newbigging, Health Services Management Centre, University of Birmingham Email: K.V.Newbigging@bham.ac.uk Mob:07974 929367 Dr Julie Ridley, Centre for Citizenship and Community, University of Central Lancashire: Email jridley1@uclan.ac.uk Tel: 01772 893402/ 07817 024568