Innovation in Commissioning Improving Access to Advocacy Angela Esslinger Strategic Customer Quality Manager
Why advocacy is so important 1. Improved decision making 2. Better outcomes 3. Be heard and learn from complaints 4. Human Rights for those who have no voice (Principles of Freedom, Respect, Equity, Autonomy and Dignity are laid out in the NHS Constitution) 5. Equalities Act 2011 6. Partnership working
Advocacy in Lancashire 2003
Advocacy in Lancashire 2007
Advocacy in Lancashire 2013
Benefits of Advocacy Access 1. Simple, single point of contact 2. 0345 low cost number 3. Staffed by experienced practitioners with database for signposting 4. Time and money saved 5. 1000+ clients referred and signposted 13/14 6. Protocols supporting effective delivery agreed
Health and Social Care Act 2012 • Additional commissioning responsibilities for – Independent Mental Health Advocacy (IMHA) – Non-statutory Mental Health Advocacy services offering support to voluntary patients – Health Complaints Advocacy offering support for people to make a complaint about NHS funded treatment or care (includes CYP)
What research told us • Confusion amongst professionals and public • Guarantee of quality required • Litigation Friends often requested by courts • Half of eligible patients received IMHA • Poor IMHA access for people on CTO’s • Particularly poor take up overall for hard to reach groups • Out of area placements
Council and NHS agreements • LCC, BwD and NHS Commissioners adopt a strategy to run from 2013 to 2016. – close gaps in provision – ensure statutory responsibilities met – ensure consistency of services • Lancashire Clinical Commissioning Group (CCG) Network agreement
Engagement Two engagement days held in Oct 2012 • Seldom heard adult: partnership boards, service user forums, carers and BME organisations. • CYP: youth council and health / voluntary groups in an evening after school • Feedback used for service specifications and set further questions / scenarios for tender questionnaire.
Procurement • Separate panels for seldom heard adult and CYP representatives – short-listing the application forms from advocacy providers – scoring the applications – recommending contract awards
Contracts from April 2013 1. Generic adult social care and health advocacy, including health complaints :£490,000 per annum: – n-compass and Lancashire Children's Rights Service across Lancashire (6 CCG's , 12 district councils) 2. Independent Mental Capacity Advocacy (IMCA)/Relevant Person's Representative/6 day per week single point of access and IMHA/non-statutory Mental Health Advocacy: £500,000 per annum – Advocacy Focus across Lancashire and BwD ( 7 CCGs, 13 district councils)
New investment • Non-Instructed Advocacy and Citizen Advocacy service delivered by Empowerment across Lancashire : £100k per annum – specialist independent advocacy for people who lack mental capacity to instruct an advocate re specific health or social care decisions when an IMCA does not apply.
Cost and Efficiency • Overall decrease in costs of across health and social care systems this financial year compared with last • Saving for the Council of £140k • Better decisions and less complaints in 2013 /14 reduction from 278 to 189 in adult social care.
Overall increase in referral rates Year on year increase
Specific advocacy delivery 1200 1093 1073 1041 1000 800 701 701 620 556 2011/12 600 471 431 2012/13 384 400 299 2013/14 294 200 +26% +63% 0 Generic & Health Independent Mental Independent Mental Mental Health Complaints Capacity Advocacy Health Advocacy Advocacy
Future developments Build actual take up into funding levels Further integration o merge of Non-Instructed Advocacy with statutory advocacy (IMCA and IMHA) o NHS IMHA contracts in secure settings Care Act o advocates to work across all strands o assessments o carers
Why a whole systems approach to advocacy should be adopted 1. Simple to use services for public and professionals alike 2. Complaints in health and social care have a joined up 2009 process 3. IMCA and IMHA have similar needs for professional advocacy 4. Better use of scare resources across Councils and NHS 5. Champion the Human Rights of the most vulnerable members of society who literally have no voice
Any questions?
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