A new opportunity to protect and improve patient advocacy

Statutory advocacy has only existed in England since 2003 and most services are much more recent. For many patients, advocacy represents a very effective “reasonable adjustment” and there is growing awareness among clinicians that a professional independent advocate trained to support people with communications needs can enable effective dialogue.

As the largest advocacy service in England, handling 50,000 enquiries last year, POhWER carried out a survey on complaints and advocacy, to which just over 1,000 people we have helped with a complaint responded. Many of them were NHS “frequent fliers”.

Our response to the recent Commons health committee’s inquiry on complaints and litigation in the NHS was based on the patients’ responses. Its report, which is awaiting a government response, endorses the value of independent advocacy and picked up on many of the issues we highlighted.

First of all, patients need more information about their care/treatment and help to understand it. This could lead to fewer complaints.

In our survey few people recalled being given clear explanations or written details of their treatment plans. Many said that they would not have needed to complain had clinical staff taken more time and been better able to communicate with them.

Most patients finally got to talk about their needs and worries when they obtained the support of an advocate. Many were frustrated to find they could have had advocacy support much sooner had their concern been registered as a complaint if it remained unresolved after one day. No new resource is required to achieve this change – indeed it may save money – but for it to happen the NHS must do more to increase awareness of statutory advocacy among staff and patients.

Second, there should be action to resolve problems as they arise, rather than waiting for more reports about failures.

On-the-spot resolution

Reports about poor care often identify similar failings. Patients want greater effort to prevent and solve problems. This need not require new guidance or resources: the NHS complaints system already provides for on-the-spot resolution through patient advice and liaison services and for matters unresolved after one day to be recorded as complaints, triggering the right to statutory advocacy support. Again, awareness is the key.

Serious clinical complaints need a fast route to the ombudsman. The ombudsman is the only part of the complaints system to provide independent clinical advice, but it can take two or more years. Patients are concerned about the people who are exposed to risk in the meantime. Like patients, the ombudsman recognises the effectiveness of advocacy support in increasing the likelihood of cases being accepted by her office.

Patients agree with the health committee that the kinds of cases that could benefit from early referral need to be identified and offered advocacy support. This could be achieved by refocusing existing advocacy resources.

Patients with complex needs should be provided with advocacy across the health and social care spectrum. Many of these patients have difficulty communicating. Boundaries between systems and the absence of advocacy are further barriers. Many reports of NHS failures point to poor coordination.

These difficulties mean that the NHS and related systems are deprived of the opportunity to tackle such problems and to learn how to avoid such failures. The proposed transfer of responsibility for commissioning the Independent Complaints Advocacy Service (ICAS) in the NHS from the Department of Health to local authorities in 2013 gives us an opportunity to refocus and extend the right to statutory complaints advocacy across the whole health and social care system through a better use of existing resources.

Finally, more support should be given to patients when highly critical reports are published that might deter them from entering hospital or seeking treatment. Calls to our information centre rise considerably each time a critical report is published, with many patients expressing worry about their care and treatment. ICAS could provide even more effective support if access to advocacy were to form part of the communications plans that accompany the release of such reports.

There is a greater appreciation of the role of independent advocates and now a new opportunity for even better service and better use of resources. The ombudsman is clear about the value of advocacy and, on average, each complaint about the NHS where a patient was supported by POhWER leads to three changes in practice. Standards improve.

If the responsibility for commissioning all statutory advocacy services transfers to local authorities in 2013 as proposed, for the first time there will be the opportunity to review services in the round. We urge government, local authorities and the new HealthWatch England to show real commitment to the principle of “no decision about me without me” by taking this opportunity to protect existing resources and use them to provide and promote the professional advocacy support that is so valued by the most vulnerable of their service users.

• Read more: changing the approach to complaint handling in the NHS