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
Provider perspectives
Commissioner perspectives
Good relationships with commissioners
Good relationships with providers
Understanding advocacy in the round
Recognising benefits of, and need for different types of independent advocacy
Flexibility to respond to demand
‘True’ co-production
Sustainable contracts
Including filtering system to ensure appropriateness of referrals
Flexible, locally sensitive provision

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 Mob: Dr Julie Ridley, Centre for Citizenship and Community, University of Central Lancashire: Tel: /