Springboard and safety net: What lies ahead for advocacy in 2022?

As we start the new year, we know that access to social care support is increasingly restricted, with many councils having taken "exceptional measures" to prioritise care, the NHS is under enormous pressure, human rights legislation is in question, and Omicron has shown that the pandemic isn’t over yet. It’s a challenging context, but there are real opportunities for us to make positive change. 

Against this backdrop, I believe that there are opportunities for advocates to step up and for us to create greater impact collectively in supporting people’s voices and strengthen rights. As an organisation which champions rights and voice at its core, we must redouble our efforts to support people who draw on our services. We will join with others to push for systemic, policy, practice and cultural change and to make sure that people who use health and care services are listened to. 

The role, function and delivery of advocacy has got stronger and matured over the past 40 years in the UK. We should shape, together with people who would draw on our support, a forward-looking view about how we practice advocacy. 

Advocacy is both a safety net that protects people’s human rights, and a springboard that supports people to shape the arrangements they need to lead a vibrant full life. However, tightening local authority budgets coupled with increasing demand for services mean that advocacy is too often thought about and funded as a safety net rather than to fulfil its wider potential. We should bring alive the tangible difference to people’s lives when we support them to express themselves and shape the life they want to lead, rather than their merely inputting to decisions that others are making for them. We should show how this benefits people, families and communities and we should highlight why this needs to be supported and resourced.

We need to inspire, support and challenge each other as we seek to identify and address the root causes of inequality in our service delivery and in our organisations. We must drive forward and develop new sector-led commitments to go beyond existing advocacy standards. 

We should be brave enough to question whether the some of the fundamental, often unspoken, assumptions underlying advocacy provision really serve people as well as they should. Advocacy is focused on people as individuals. This is one of its strengths, making sure that a person’s voice is not lost amongst the views of other, often more powerful, people. But it can also be a weakness. Our focus can leave us blinkered to the very connections which can help someone have a voice and be the authors of their own life. 

We need to develop a more nuanced understanding of how we support people in the context of family and community. Every one of us is informed by a web of family, community, past and present experience. We need to find ways to advocate with people which enable them to express their full selves, involving others as is right for them. Alongside this, we need to understand how our, often short term, involvement, can support and complement long-term involvement from friends, family and community, so that the person’s voice is heard into the future. 

Across the advocacy sector, we must crystallise our collective view about how to ensure high quality advocacy. Developing and strengthening our own understanding of what advocacy is and what it offers today will help to make sure advocacy is the springboard to better lives. 

At VoiceAbility, whilst we have a clear vision that advocacy is a springboard to enable people to live a full life, we know that at the same time it must also be a consistently effective safety net especially to support people whose situations place them at serious risk. In particular, advocacy support to people with learning disabilities and autistic people who live in restrictive settings is vitally important, but highly variable in quality and availability as the CQC have confirmed.

We are shaping practice and have pushed for major improvements to advocacy since the abuse of people at Winterbourne View was revealed in 2011. In the decade that has passed it’s become clear that abuse of people in in-patient settings remains endemic, with awful abuse affecting people at many hospitals, including at Cawston Park, Yew Trees Hospital and Whorlton Hall. 

The problems are systemic and need addressing at that level. VoiceAbility have clear recommendations about how this can be responded to both in changing the overall system which consigns people to lives of restriction, restraint and risk and by commissioning and providing improved advocacy to support people.

Advocacy organisations cannot and must not wait for external change. At VoiceAbility, we have embedded our learning from how we have supported people to leave restricted settings and how we can best safeguard people who are still living in them. We have invested heavily in supporting our advocates in their professional development over recent years and will continue this investment through 2022. Over the past two years we have established a quality and practice directorate which nurtures the professional curiosity and resilience so essential to effective advocacy. Our improved training and development offer has already established vibrant advocate-led communities of practice, including in safeguarding, mental health, and mental capacity. Our practice team has also grown. We are making our quality and practice audits more effective and improving our approach to information management to back this up. 

The truth is that we must make further changes as advocates in our organisations, across the sector, and through changing expectations and the commissioning frameworks, to make sure that we are best able to support people who are at greatest risk. But as advocates, we don’t have all the answers. Sometimes advocacy by its very nature has limits to what it can achieve, especially in a health and social care system which for some people are not safe. During 2021 we were able to deepen the honest conversation between organisations about the changes we need to make in our organisations and collectively. There is still more to do and in 2022, we will press harder for the essential system changes needed, including a better approach to commissioning.

This year, there are concrete opportunities to strengthen access to advocacy in law and practice but there are also challenges with human rights legislation at risk of being watered down. 

Last year, VoiceAbility welcomed the government’s plan to reform the Mental Health Act. We were pleased to see that the white paper agreed with us that advocacy should be offered on an ​‘opt out’ basis and extended to ​‘voluntary patients.’ This year, we’ll continue to push for legislation that makes this commitment firm and make sure that people have more choice, control and support under the Mental Health Act.

We will work towards the introduction of the Liberty Protection Safeguards (LPS) to make sure that LPS deliver the sea-change required to uphold people’s human rights and dignity. Under LPS, we will have the opportunity to make sure that people who may be deprived of their liberty always have someone on their side who can stand up for their rights. We will pursue this in our responses to help shape the Code of Practice and in continuing to help advocacy organisations to work together to prepare for implementation. LPS will require changes to guidance, systems, processes, policies and resources, and this in turn will rest on us shifting mindsets and expectations so that people’s detention under mental capacity legislation is treated with appropriate gravity. VoiceAbility stands ready to support driving forward this culture change across the health and social care sector.

When turning attention to social care, there is broad consensus on the positive vision set out in the white paper, People at the Heart of Care. It paints a picture of social care which we have long held and one that offers people choice and control, promotes independence, enables people to live well as members of a community, and where people are supported when needed by staff who are valued and respected. However, while the vision may be strong, the methods and resources set out in the white paper to achieve such a transformation are limited and the wholescale reform of social care will take more than that which is articulated in the government’s current proposals. Here, and elsewhere, we will empower and support the voices of people who draw on our services and provide a perspective which is genuinely grounded in lived experience. 

How we set about delivering our purpose and expressing a collective voice with other advocates and organisations will be critical to determining the level of social impact we have through our work this year. In VoiceAbility we have a clear vision for the changes we want to see in 2022 but we are clear these changes will only be achieved through dialogue, collaboration, and a renewed commitment making sure people are heard when it matters most. We look forward to working with people who draw on our support services, other advocacy organisations, our colleagues across the health and social care sector, and with policy-makers and national bodies to make these changes a reality.