1. Is free, confidential and totally independent
Applies the principles of the Advocacy Charter
Takes a strength based approach
Provided by experienced, qualified professionals
Partnership delivery – Care Act, Health Complaints, Generic, IMHA and IMCA

2. Single Point of Access Tel: 01753 415299 Text/SMS: 07713 711999
Web:
In Person: 27 Church St. Slough
Trained, knowledgeable Referrals Coordinator

3. What is Advocacy?
Advocacy is taking action to help people say what they want, secure their rights, represent their interests and obtain services they need.
Advocates work in partnership with the people they support and take their side.
Advocacy promotes social inclusion, equality and social justice

4. Generic Advocacy Is a non statutory service Issue based Short term
Preventative
Outcome focused
Empowering
Housing
Access to Services
Social Care
Equipment
Finance/
Debt
Employment

5. Independent Health Complaints Advocacy (IHCA)
Is a statutory service
Supports people with a complaint about any NHS funded service – hospital, GP, community care, mental health services, dentists, pharmacies, opticians
Information and support with the statutory complaints process from informal, local resolution and the Ombudsman
Does NOT include privately funded treatments
CANNOT assist with litigation
Medications; Referrals
Safety
Admissions; Waiting times
Staffing – attitudes, communication, knowledge
Standards of Care
Diagnostics; Discharge

6. Care Act Advocacy
Under the Care Act 2014, the statutory duty to provide independent Advocacy, from April 2015 applies to
4 groups of people
Across 4 decision making processes
With 2 eligibility conditions

7. Care Act - Eligibility PEOPLE Adults who need care and support
Carers of Adults (+young carers)
Carers of children in transition
Children approaching transition into adult services
PROCESS
Care assessment
Care and support planning
Care and support review
Safeguarding – enquiries and adult safeguarding reviews
CONDITIONS
The person has SUBSTANTIAL DIFFICULTY in being fully involved within assessment, care and support planning, review or safeguarding AND
There is no-one appropriate and available to support and represent their wishes

8. Carers A Carer can be eligible for support in their own right if –
They have needs because of caring responsibilities
As a result of those needs, they are unable to achieve 1 or more defined outcomes
As a consequence, there is a significant impact on their wellbeing

9. Substantial Difficulty

10. Appropriate to Support?
Paid people cannot undertake this role
It is not enough to know the person well or to love them deeply
The appropriate person must agree to offer their support
Must be able to offer the support (the family member/friend may have a disability themselves)
Must be appropriate – no suspicion of conflict or abuse
Must be able to help the person put forward their own views/wishes and disregard personal feelings

11. The Role of Care Act Advocate
To offer support to the individual in-

12. Supported Decision Making
The Advocate supports a person to make their own decisions
Draws on others to offer support
Supports to gather, understand and consider relevant information
Helps people to take calculated risks
Helps people know what is best for them
Promotes rights and empowers

13. Assessment Process
At the point of FIRST contact the local authority MUST consider if the person should be offered Advocacy support. The assessment must be provided to everyone who appears to have some care and support needs regardless of their finances or whether LA thinks needs are eligible
Involvement
Needs
Arise from illness or impairment
Outcomes
Results in person not able to achieve defined outcomes
Wellbeing
Likely significant impact on wellbeing

14. Advocacy Role within Assessments
The Advocate will listen to the person & ask questions to understand their personal circumstances
The Advocate will help the person understand the process – face to face assessment/ supported self assessment/ carers assessment/ joint assessment/ online or phone assessment
The Advocate will ensure the person is fully involved in their assessment and that their needs, wishes and feelings are communicated and heard
The Advocate will ensure the full range of defined outcomes are explored
The Advocate will support the person to understand all aspects of their personal wellbeing in order to contribute to an effective assessment

15. Care and Support Planning
Person centred
Flexible and proportionate
The Advocate will
Ensure the person is involved - their needs, wishes, values, aspirations and feelings heard
Support the person to take an active role in the decision making
Support the person to write the plan themselves

16. Advocacy role in Care and Support Planning
The Advocate helps the person to focus on meeting, needs vs receiving services and will help the person to ensure all the following are included in the final plan –
Needs identified at assessment
Whether and to what extent needs meet eligibility criteria
Needs that LA will meet and how
Outcomes for person needing care
Outcomes for the Carer
Personal budget
Info on direct payment
Info and advice on prevention and reducing need

17. Planning for people without capacity
Principles of the Care Act and the Mental Capacity Act apply
Capacity must be assumed unless otherwise established
All practicable support must be offered
Advocate will represent the person
Advocate will gather information to inform the plan on behalf of the person
People have a right to make unwise decisions
Advocate will ensure decisions taken promote best interests of the person

18. Reviews All care and support planes must be kept under review
Initial review 6-8 weeks
Planned review no later than 12 months
Unplanned review can be requested by person/family/advocate

19. Advocacy Role in Reviews
The Advocate supports to person to-
Express change in circumstances/need
Discuss what works, what doesn’t, what may need to change
Review achieved outcomes and consider new ones
Reflect if personal budget meets needs and outcomes
Address any changes which might lead to abuse/neglect
Decide if there is a need for re-assessment

20. Safeguarding
Under the Care Act, the LA has a statutory duty to arrange, where appropriate for an independent Advocate to represent and support the adult who –
Has needs for care and support
Is experiencing, or is at risk of abuse or neglect
As a result of their care and support needs is unable to protect themselves from either the experience or risk of abuse or neglect

21. Advocacy Role in Safeguarding
The Advocate can assist the person to-
Decide what outcomes/changes they want
Understand behaviours and actions and their impact
Access help and support to avoid recurrence and recover

22. Independent Mental Health Advocacy (IMHA)
Under the Mental Health Act 2007, ‘qualifying patients’ have a statutory right to access an IMHA.
Qualifying Patients are defined as:
Those detained under Section 2,3,37,47,48,49
Those people subject to Section 7 Guardianship or Section 17A Community Treatment Orders (CTO)
An informal patient being considered for section 57 treatment (psychosurgery).
An informal patient aged under 18 and being considered for section 58a treatment (ECT).

23. Accessing the IMHA service
Qualifying patients should be informed of their right to an IMHA, and a referral facilitated by professionals involved in their care.
Responsible Clinicians, Approved Mental Health Professional (AMHP) or Nearest Relatives can refer qualifying patients to the service.
People can refer themselves.

24. What does an IMHA do? An IMHA will:
Spend time with the client and ask them questions to get to know their views and wishes.
Visit the client in private, if that is appropriate.
Support the client on ward rounds and attend meetings they have with the professionals involved in their care and treatment, if you would like them to.
Visit and speak to any person who is currently professionally concerned with their treatment, provided it is for the purpose of supporting them in their role as their IMHA.
Assist the client to understand their rights, and enact them
Work under instructions (as long as they have capacity)
This includes Informal Patients and Patients under emergency holding powers e.g. S4,S5,S135,S136

25. A quick recap on capacity
The five statutory principles of the Mental Capacity Act state that:
A presumption of capacity
Individuals being supported to make their own decisions
Unwise decisions
Best Interests
Less restrictive

26. Two-stage Capacity Test
Stage 1. Is there an impairment of or disturbance in the functioning of a person’s mind or brain? If so,
Stage 2. Is the impairment or disturbance sufficient that the person lacks the capacity to make a particular decision?

27. Assessing Capacity
The MCA says that a person is unable to make their own decisions if they cannot do one or more of the following:
Understand information given to them
Retain the information long enough to come to a decision
Weigh up the information
Communicate their decision

28. The Hierarchy of Decision Making1
The Capacitous Person 2
An Advance Decison 3
Lasting Power of Attorney 4
Court Appointed Deputy 5
Best Interests

29. Best Interests Decision Making
The Act provides a non-exhaustive checklist of factors that decision-makers must work through in deciding what is in a person’s best interests.
Part of this checklist includes the views, wishes, values and beliefs of the person, which the person determining capacity/making a best interests decision must consider.
In addition, people involved in caring for the person lacking capacity have to be consulted concerning a person’s best interests.
The more serious a decision and its consequences, the more robust the process must be.

30. An IMCA must be appointed
When to appoint an IMCA IF
A person has been assessed as lacking the capacity to make a particular decision at the required time
AND
There is no one else appropriate to consult
AND
Decision is one of accommodation move, serious medical treatment or DoLS
An IMCA must be appointed
An IMCA’s role is decision specific - once the best interests decision has been made the role ends.
There must be a separate instruction per decision.

31. Other roles for an IMCA
An IMCA may also be appointed for Care Reviews (Accommodation reviews) if a Best interests Decision was made to move them (usually after three months and then annually)
An IMCA may also be appointed in Safeguarding Adults Procedures if the person has been assessed as lacking the capacity to consent to one or more of the protective measures proposed. The normal rule about their being people appropriate to consult does not apply.

32. What does an IMCA do? Meet with the person in private
Interview people who may know the person
Look at the various options available
In SMT, possibly ask for a second opinion
Access relevant health and social care records
Maximise the individual’s participation in the process
Ensure that the person’s rights under the MCA are protected
Write a report, that the decision maker must be consider
Be informed of the best interests decision
Challenge the decision, either informally or formally if they believe it is not in the person’s best interests

33. DoLS, IMCAs and paid RPRs
Prior to a DoLS being granted, an IMCA will be involved under the 39A role.
After a DoLS is granted, if there is no one willing or able to act as the Relevant Persons Representative a paid RPR may be appointed.
If there is a delay in appointing the RPR, a 39C IMCA can fill this short term gap.
If the relevant person, or their (unpaid) representative would benefit from some support, then a 39D IMCA would be appointed.

34. The role of the RPR To visit the relevant person on a regular basis
To monitor any conditions attached to the DoLS
If the conditions vary, or the persons restrictions change, to call for a review.
If the relevant person continues to object to the DoLS, trigger a review or take the case to the Court of Protection
To act as an ‘appropriate to consult’ person in care planning, reviews, or renewals of the DoLS.
The RPR does not replace eligibility for an IMCA in other non-accommodation related issues, for example a serious medical treatment decision
The role of the RPR ends when the DoLS authorisation ends

35. Community DoLS
Normal DoLS only apply to registered care homes and hospitals
In people’s own home, or supported living, a DoLS can only be granted by the Court of Protection.
The Local Authority must apply to the CoP, and include the name of the person willing to act as the Relevant Persons Representative (RPR).
Once granted by the CoP, the role of the RPR is the same as a standard DoLS.

36. Litigation Friend
A Litigation Friend is someone appointed by the courts to conduct a case on someone’s behalf
The official Solicitor is the litigation friend of last resort
Litigation friends are often qualified IMCAs
The LF can access appropriate records, instruct solicitors and access legal aid.
The LF must take into account the views of the person, and must make the court aware of these.
The LF must try to maximise the person’s involvement and understanding of the court process
However, there is an expectation that the LF must form their own opinion about what is in the persons best interest, even if it conflicts with the person’s views
The LF opinion carries significant weight in the court deliberation