Issue 9

UFG Meeting May 2004

Advocacy Needs at Caswell Clinic

Over half the patients in Caswell Clinic took part in a comprehensive questionnaire regarding the use of an advocate for the patients. An advocate is someone who represents a patient on an independent basis.

Most responses came from Coegnant (Intensive care) and Wyndham (assessment) ward. In Faldhau (rehabilitation) ward most patients declined to participate because at this stage of their rehabilitations most thought that there was no need for an advocate.

Excluding Faldau approximately three quarters of patients undertook the questionnaire.

Nearly 90% said that it would have helped to speak to an advocate on arrival to clarify the patients' legal position regarding the section.

Approximately 85% would want someone who is independent to explain patients' rights and medication issues; represent the patient at the CTM (Clinical Team Meeting); and to represent the views of patients on any change of policy which affects them.

75% to 80% would like to talk to someone who has been a patient. The patients would like an advocate to attend all community meetings to take up disputes on their behalf, especially for issues that appear to be highlighted up every week and not dealt with on the ward.

About 60% would like the primary nurses role explained by someone independent; would like to have contact with someone belonging to that patients religion; to write or speak on their behalf at a tribunal.

Lastly one third would like someone independent to talk to their primary nurse.

As you can see the need for an advocacy service for these people is an essential part of their care and we would be letting them and ourselves down if we didn't supply this service. To this end I arranged a conference to highlight how advocacy works in other clinics and this is highlighted below.

Howard Davis, Commissioning Manager for the North West Secure Commissioning Team gave a presentation on the commissioning of independent advocacy services. He highlighted several points including "Advocacy is about extending choice and not about resolving problems although advocacy often begins by addressing problems". Advocates need to engage proactively, it is not about waiting for a problem to arise. "Advocacy must be able to support those who lack capacity to instruct and to see such people as a priority".

Rob Harris,Director of Advocacy Matters Ltd, gave the next presentation on the Development of Quality Advocacy Services. This presentation considered how to set-up advocacy, the recruitment of advocates and project workers, the development of an advocacy service and its supervision and ongoing development. Rob Harris stressed the importance of having policies and procedures to guide the provision of advocacy. Rob Harris noted that there is no recognised qualification for advocates. Advocates should be paid a competitive salary and the recruitment process should be rigorous.

Rob Harris also strongly recommended that we should start with a development project before commissioning a substantive advocacy service. The development project would provide an opportunity to describe a policy framework whilst seeking to recruit a full time advocate and supportive project workers.

It was recommended that any advocacy service should not only serve the inpatient population but should also seek to reach out to patients in the community.

Roberta Wetherell,former National Co-ordinator of the United Kingdom Advocacy Network gave a presentation on the Monitoring and Evaluation of Independent Advocacy Services. She presented the role of Advocacy Really Works. The core principles of Advocacy were explored to help to understand what advocacy is and is not. Roberta Wetherell then explored development, monitoring, training and support issues. It is recommended that would be advocates get at least 8 days of training before taking up their role and that shadowing of other advocates or project workers should be arranged. Roberta Wetherell offered to help to identify the component parts of such a training package.

In the final session speakers were available to answer questions from the audience. Debate identified the need for external academic involvement in the research, monitoring and evaluation of any future advocacy project. Howard Davis offered to include Wales in his efforts to research the effectiveness of Advocacy Projects in England.

The workshop identified tasks that need to completed before a substantive service can be commissioned.

For further information see "Advocacy at Caswell Clinic – Who needs it?" (This Doc. has not appeared as yet when it does I'll link it here. WebEd)

RobC, Advocacy Project Worker 29th March 2004.