More than ever before Advocacy needs to address the issue of a lack of a robust evidence base to support what all advocates know to be the case that advocacy and in particular ‘independent advocacy’ can change lives. In short it leads to improved outcomes for the most vulnerable amongst us and is money well spent.
The publication by the School for Social Care Research of a summary of the evidence of the impact of advocacy has important implications far beyond the advocacy community. The core conclusion is that there is a worrying lack of evidence of the outcomes or impact of advocacy and of its cost effectiveness. It reports that most published reports are individual case studies or personal opinions that it is effective. IT describes how stories of individual success are important, but unless common themes and lessons are drawn out about how and why individuals were helped by advocacy, that ‘evidence’ is not replicable, nor properly understood and so cannot be viewed as robust evidence of advocacy’s positive impact. If the simple question is asked ‘Can we show that spending money on advocacy leads to improved outcomes for people and is money well spent’, the research evidence does not say “yes”.
BUT, it is also really important to stress that the answer is not “no”. Simply put there is insufficient evidence either way. The small number of studies that are robust do show positive impact and cost effectiveness, but they are so few and cover such defined situations (e.g. parents with a learning disability) that general conclusions cannot be drawn from them.
Advocacy should be a readily available resource available and accessible to all who need support to be heard in difficult times. Whether that means self, peer, independent or other advocacy, it should be seen as part of the infrastructure of a local health, education and social care (and beyond) community, to ensure people get a fair deal. The government would seem to agree. One of the phrases from their health and social care reforms is ‘nothing about me without me’.
I have been working in advocacy for the last fifteen years, in my experience this is simply another in a long line of reports that conclude there is insufficient evidence of advocacy’s impact on those we support. So what do we do about it? We need to arm ourselves with irrefutable evidence commissioners and other funders simply cannot ignore. So how do we do this? One way is for us all to work together in open transparent and true partnership.
OPAAL knows about partnership, our member organisations will tell you it is the lead that runs through our pencil, it is what makes us tick and has earned us the reputation we have for working well with colleagues, finding ways to move forward together to better serve older people in need of a voice. We’ve worked hard to earn the trust and respect of our members and other national partners willing to work closely with us to achieve jointly agreed aims and objects. We know that effective partnership work requires commitment, common ground, shared vision of a better future and a real will to achieve change.
However most importantly it requires more than all these things put together, it requires £ investment. Money to pay for collaborative approaches, in this case money to pay for commissioners and providers to sit at the same table as service users and identify meaningful ways of measuring impact to everyones satisfaction. Placing the service user in the centre in line with the governments health and social care reforms that is ‘nothing about me without me’ and recognising that advocacy services and commissioners too have their desired outcomes is a good place to start.
Beyond the provision of statutory advocacy for children or those entitled to a mental health or mental capacity advocate as yet there is no policy expectation that local commissioners fund advocacy as part of local infrastructure. In the current economic environment funders are under no pressure to fund non statutory services, even innovatory ones that may well pay for themselves in the long run with the savings they make supporting independent living by enabling people to live at home and keep people away from expensive public services like hospitals and nursing homes for longer.
It is in all our interests to prove that advocacy works, service delivery organisations need to be able to evidence that they are delivering effective advocacy and value for money, commissioners and other funders need to be supported to demonstrate they are getting good outcomes for what they choose to commit money to. I believe we will only be able to find the evidence we need with sector investment that is highly unlikely to come from national or local commissioners. It will be left to funders like Big Lottery to recognise the deficit and fund the partnership initiatives that may yet provide the evidence breakthrough we all need if we are to continue to provide much needed advocacy services.
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