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AGENDA ITEM

REPORT TO ADULTS’ HEALTH AND WELLBEING COMMISSIONING GROUP

DATE 24/01/18

REPORT OF INTEGRATED STRATEGY AND SERVICE DEVELOPMENT MANAGER

ADVOCACY HUB AND ADVOCACY SERVICE 18/19

SUMMARY

Advocacy services are currently delivered in Stockton-on-Tees via a Tees Advocacy Hub and a Tees Advocacy Framework both led by Redcar and Cleveland Council on behalf of Stockton and Middlesbrough. These services exist to ensure, in part, the Council is able to fulfil its statutory duty under the Care Act 2014.

The current contracts are due to end 30/04/18 and 31/05/18 respectively. The Hartlepool and Stockton-on-Tees Clinical Commissioning Group and South Tees Clinical Commissioning Group fund the Tees Advocacy Hub and Stockton Council fund towards the Tees Framework. A decision is required from the Clinical Commissioning Groups regarding future delivery of the Tees Advocacy Hub and from the authority for the Framework.

1. PURPOSE OF REPORT

This report describes the recommendations that result from the review of the Tees Advocacy Hub and Advocacy Service in Stockton-on-Tees.

The commissioning group are asked to note the recommendations proposed and agree the identified options.

Article I.BACKGROUND

The current Advocacy service was set up in 2014 to provide an accountable, accessible and independent general and specialist advocacy service in Stockton, Middlesbrough and Redcar and Cleveland (previously also included Hartlepool).

The Tees Advocacy Hub was set up in 2014 following research conducted by ‘True Voice’ on behalf of commissioners which recommended a Hub approach following concerns that there was a general lack of providers of advocacy services and risk of skills gap and misunderstanding regarding Advocacy services. The Hub manages provision of Advocacy across Middlesbrough, Redcar and Cleveland and Stockton.

There are different types of Advocacy support dependant on individual’s needs. Provision of an Advocate is a statutory responsibly in most cases.

The Mental Capacity Act 2005 introduced Independent Mental Capacity Advocates (IMCAs). An IMCA supports people who can't make or understand decisions by stating their views and wishes or securing their rights.

The Mental Health Act 2007 introduced statutory advocacy for people who are detained under the Mental Health Act or who are under a Community Treatment Order (CTO). This form of advocacy is provided Independent Mental Health Advocates (IMHAs).

The Care Act 2014 places a duty on local authorities to appoint independent advocate for individuals who have a substantial difficulty:

Understanding or retaining relevant information
Using or weighing that information as part of the assessment or care planning process
Communicating the individual’s views, wishes or feelings (whether by taking, using sign language or any other means)

Regulations require authorities to have regard to the following when determining if an individual has a substantial difficulty:

Any health condition, learning disability or other disability the individual has;
The degree of complexity of the individual’s circumstances regarding care, support and otherwise;
Where an assessment is being carried out, if the individual has previously refused an assessment;
Whether the individual is experiencing, or at risk of, abuse or neglect.

The Care Act also requires the authority to appoint an independent advocate in relation to safeguarding enquiries and reviews “to be available to represent and support the adult to whose care the enquiry or review relates for the purpose of facilitating his or her involvement in the enquiry or review”.
The authority must be satisfied that independent advocates they appoint:

Have appropriate experience;
Have undertaken appropriate training;
Are competent to represent/support individuals to facilitate an individual’s involvement in assessment/planning functions;
Have integrity, good character and DBS checked
Have arrangements in place to receive appropriate supervision

3.0 DETAIL

3.1 The current model operating across Stockton, Middlesbrough and Redcar and Cleveland for both the Tees Advocacy hub and the Advocacy Framework is led by Redcar as the lead authority. The contracts were awarded following procurement procedures and include;

A contract for a Tees Advocacy Hub delivered by Middlesbrough Citizens Advice Bureau (CAB) – The Hub manages referrals into the service, confirms eligibility, allocates to most appropriate providers, provides awareness information to those referring into the Hub on the role of advocates and how to access the service. Referrals are allocated to the provider ranked first within a Referral Protocol for the particular type of Advocacy. If they do not have the capacity it is then offered to the next advocacy provider listed.

Hartlepool and Stockton-on-Tees Clinical Commissioning Group and South Tees Clinical Commissioning Group funded the Tees Advocacy Hub in 16/17 at a cost of £11,000 per Local Authority Area. The current contract for the Hub ends 30/04/2018, within the contract there is an option to extend for 1 x 12 months to expire 30/04/19. Confirmation regarding the future funding has been formally requested from Redcar as the lead authority and a formal response and decision is pending from the two Clinical Commissioning Groups. If the decision is made by the CCG to cease funding, the Tees Advocacy Hub would end unless the decision was made by the Local Authority to fund it.

A framework for Advocacy Support which includes IMCA and IMHA services and General Advocacy including Care Act Advocacy. The contract framework in place for Advocacy service ends 31/05/18.

Stockton’s spend on Advocacy services 16/17 until end of November 17 can be seen below with projected spend for 18/19 based on the current delivery;

Advocacy Type	Spend until Nov 17	Projected Spend 18/19
IMCA	£3,000	£4,000
IMHA	£21,500	£28,500
General including Care Act	£23,500	£31,000
Total	£48,000	£63,500

3.2 Hartlepool Borough Council was involved with the Tees arrangement until April 2017. Hartlepool now has its own Advocacy Hub delivered by ‘Incontrol Able’ a Disabled People's User-Led Organisation.

3.4 All referrals for the Advocacy services listed above go through the Tees Advocacy Hub. Relevant Persons’ Representatives (RPRs) provision within the Mental Capacity Act (MCA) Deprivation of Liberty Safeguards (DoLS) function is under a separate contract in Stockton.

3.5 The numbers seen across Stockton-on-Tees by the Advocacy providers can be seen can be seen below;

Type of Advocacy	16/17 (Q1-Q4)	17/18 (Q1& Q2)
General	225	100
IMCA	88	47
IMHA	26	19
Total	339	166

3.6 A desk top review of the main service providers on the Framework, Middlesbrough Mind and Middlesbrough CAB and was conducted in January 2018 using information provided by Redcar and Cleveland Local Authority as the Lead Authority. The information provided included financial and quality information regarding service delivery.

3.7 Desk top review information and feedback from the Social work Teams highlighted a potential issue within the Hub as Middlesbrough CAB manage the Hub and are also named on the Framework. The proportion of referrals going to Middlesbrough CAB in comparison to those going to other providers was raised as being uneven. A review of allocations was undertaken and can be seen below. CAB are ranked highest on the framework for General Advocacy which increases their allocation. In addition the allocation can be dependent on the needs of the client, skills of the advocate, location and client preference.

Type of Advocacy	Provider
	CAB	Skills for People	Disc	MIND	Total Together
General Advocacy	76%	8%	6%	10%	0%
IMCA	28%	68%	N/A	N/A	4%
IMHA	55%	N/A	N/A	44%	1%

3.8 Feedback from the Social work team suggests that capacity across Advocacy services is an ongoing issue. This feedback has been considered in options to build the market.

3.9 The feedback received from the Social work team regarding The Tees Hub was mixed, there were some queries raised with the standard of service delivered by the Hub in its current role as the Social work team have had to chase up referrals and request information from the Hub. Whether the Hub is needed in the process was raised by the Social work team as Advocacy services could be arranged directly by the Social Worker with the Provider in the absence of a Hub. The full impact of the absence of the Hub is uncertain at this time but by considering the numbers seen by the Advocacy services in 16/17 (339) the loss of the Hub could result in an increased workload for social workers at the point of referral. If the service is to continue, issues regarding The Hub service delivery could be rectified through effective contract management.

3.10 In addition to the services detailed above, Stockton CAB provide Advocacy Services to people in Stockton with a Learning Disability under a main contract for information and advice. This contract will be reviewed separately.

4.0 FUTURE DELIVERY

4.1 Adult Advocacy & Children Advocacy are on the NEPO work plan for a regional approach with a decision expected in February 2017 on who will lead the work, with a plan for a service estimated from April 2019. The options for future regional work will be considered alongside the need when this regional approach is shared.

4.2 Discussions with Commissioners and Procurement colleagues in Redcar and Cleveland confirmed that they are looking to take the available second 1 year extension period for the Tees Advocacy Hub and work to establish a one year framework for Advocacy to mirror what is currently delivered.

4.3 Middlesbrough Council are considering options and an update has been requested.

5. 0 REPORT RECOMMENDATIONS

5.1 A decision is awaited from Hartlepool and Stockton-on-Tees Clinical Commissioning Group and South Tees Clinical Commissioning Group regarding future funding of the Tees Advocacy Hub. The Adults’ Health and Wellbeing Commissioning Group will be advised of the outcome for further discussion should this be required.

5.2 The options for the Advocacy Framework from 01/06/18 are given below:

1. Procure Advocacy services from individual providers as and when required, from 1^st June 2018. This may increase the workload for Social Workers and other referrers who would need to directly arrange Advocacy Support when needed via providers. In addition, procuring direct from individual providers may limit the control we have over price and demand.

2. Procure Advocacy services via a one year framework, with an option to extend for 1 x 12 months for Stockton-on-Tees. In accordance with the contract procedure rules, obtain quotations from market providers for the provision of an Advocacy service from 1st June 2018. Procurement via a framework would allow for value for money to be achieved as the providers will be evaluated on quality and cost. As part of a revised framework procurement providers not currently on the framework could be encouraged to take part in order to increase capacity and choice.

Procure Advocacy services via a one year framework, with an option to extend for 1 x 12 months in partnership with Redcar and Cleveland Council (Middlesbrough Council once confirmed) In accordance with the Contract Procedure Rules. Redcar and Cleveland council have agreed to lead on the process. Procurement via a framework would allow for value for money to be achieved as the providers will be evaluated on quality and cost. As part of a revised framework, providers not currently on the framework could be encouraged to take part in order to increase capacity and choice. Review the situation for delivery post 30/04/19 with consideration of the planned regional approach to Advocacy on the NEPO work plan.

5.3 The preferred option for the Advocacy Framework is point 3 to support collaborative working across commissioners, ensure procurement rules are followed and to encourage a choice of providers and value for money.

6. KEY AREAS FOR CONSIDERATION

6.1 Without an Advocacy service Stockton-on-Tees Borough Council is at risk of non-compliance with the Care Act, the Mental Health Act and the Mental Capacity Act.

7. CONSULTATION

7.1 Not applicable to this update.

8. FINANCIAL IMPACTIONS

8.1 The costs for Advocacy services are included within existing budgets. There should be no financial implications unless demand significantly increases, although exact future demand is not known.

The expected numbers of Care Act advocacy predicted when the service was set up haven’t been realised but this could change in the future with legal cases or awareness.

8.2 The cost of the Tees Advocacy Hub for Stockton-on-Tees in 18/19 will be £11,000 which has previously been funded by the CCG.

9. LEGAL IMPLICATIONS

9.1 The current contracts are due to end 30/04/18 (Tees Advocacy Hub) and 31/05/18 (Advocacy Framework).

Name of Contact Officer: Jenny Collier

Post Title: Service Design and Development Officer

Telephone No. 01642 528442

Email Address: [email protected]

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