Innovation in commissioning improving access to advocacy
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Innovation in Commissioning Improving Access to Advocacy. Angela Esslinger Strategic Customer Quality Manager. Why advocacy is so important. Improved decision making Better outcomes Be heard and learn from complaints

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Innovation in commissioning improving access to advocacy
Innovation in CommissioningImproving Access to Advocacy

Angela Esslinger

Strategic Customer Quality Manager

Why advocacy is so important
Why advocacy is so important

  • Improved decision making

  • Better outcomes

  • Be heard and learn from complaints

  • Human Rights for those who have no voice (Principles of Freedom, Respect, Equity, Autonomy and Dignity are laid out in the NHS Constitution)

  • Equalities Act 2011

  • Partnership working

Benefits of advocacy access
Benefits of Advocacy Access

  • Simple, single point of contact

  • 0345 low cost number

  • Staffed by experienced practitioners with database for signposting

  • Time and money saved

  • 1000+ clients referred and signposted 13/14

  • Protocols supporting effective delivery agreed

Health and social care act 2012
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
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
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


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.


  • 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
Contracts from April 2013

  • 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)

  • 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
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
Cost and Efficiency

  • Overall decrease in costs of 42% 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

Decrease in costs per case
Decrease in costs per case

Overall reduction in the region of 42%

Future developments
Future developments

  • Establish:

    • take up levels

    • average hours per case

    • more accurate costs per case

  • Build actual take up into funding levels

  • Further integration

    • Merge of Non-Instructed Advocacy with statutory advocacy

    • NHS IMHA contracts in secure settings

Case studies
Case Studies





Innovation in commissioning improving access to advocacy

Why a whole systems approach to advocacy should be adopted

Simple to use services for public and professionals alike

Complaints in health and social care have a joined up 2009 process

IMCA and IMHA have similar needs for professional advocacy

Better use of scarce resources across Councils and NHS

Champion  the Human Rights of the most vulnerable members of society who literally have no voice