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Department of Health

Care Act 2014: How should local authorities deliver the care and support reforms? Please give us your views


Question 19: We would welcome views on further specific circumstances where the advocacy duty should apply. In particular, we welcome views on the potential benefits and disadvantages of providing independent advocacy for people for people receiving care jointly from adult social care and the NHS.

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35 comments

  1. Anonymous says:

    Independent advocacy shoudn’t be imposed on the individual adn there needs to be an appeals process in place. Clarification is required regaridng what would be considered appropriate experience and qualifications. Clarification is also sought regarding the resources and funding available and if this would be ring fenced to meet the increased need for independent advocates.

  2. Anonymous says:

    It would make sense that independent advocacy for continuing care/joint social care and health-funded care should also be made available for vulnerable people along with advocacy under the Care Act and advocacy under the Mental Capacity Act. In terms of commissioning advocacy services with the relevant expertise and also in terms of customer access, it is likely that one organisation should be available to provide advocacy of each kind, in order to achieve the seamless continuity for the whole experience of care that the guidance refers to.

    Consideration should also be given to the wider advocacy needs of individuals in relation to benefits claims, for example, or to facilitate access to universal services, which may be outside of their specific assessed services or use of a personal budget. This could be important for prevention and early intervention for individuals.

  3. Anonymous says:

    We would support independent advocacy for people receiving care jointly from adult social care and the NHS, as this is likely to apply to more and more people, and so it has to be the direction to go. The issue is less about disadvantages and more about how to make this work in practice. For example, to be effective there will need to be local and joint agreement over the circumstances where advocacy is required and what decision making processes within the NHS can be the subject of independent advocacy, as presumably not all will (e.g. your place on the surgery waiting list). Where people are subject to combined assessments there will need to be agreement on how the need for advocacy will be handled between the assessing agencies.

    We would recommend that the duty to involve (see paragraph 7.6) makes it explicit that people receiving supported housing/housing related support are included within the definition of “living in the community”. We would also recommend that the guidance makes it clear that the need for independent advocacy should be considered when a change of care and support arrangements, including accommodation, is being considered.

    We think the attempt to distinguish between independent advocacy and advocacy required under the Mental Health Act may be difficult to interpret in practice and consideration should be given to producing some separate guidance on this, perhaps including some flow charts to assist with making clear the decision points around which form of advocacy is required.

    Our general comment is that even within the terms of the existing guidance one would anticipate that many localities will need more suitably trained and experienced independent advocates. Whilst it is accepted that professionals working with the person should not be advocates, we think there will be an imperative to think creatively about how to meet the need for a supply of suitably trained and experienced advocates. We can envisage a situation where a network or bank of local advocates is established, and in this scenario staff working in the supported housing sector are likely to have many of the skills, experiences and motivations required to act as effective advocates. It should be possible to construct sufficient safeguards to protect against conflicts of interest and Sitra would be willing to undertake some development work in this area.

  4. Anonymous says:

    The (Healthwatch Northumberland) group support Independent Advocacy but would like clarification on the criteria. The draft guidance suggests that the local authority must “consider in deciding whether an individual would experience substantial difficulty in engaging with certain aspects of the care and support process”.
    The group would like to clarify what is classed as ‘substantial difficulty’ as Healthwatch has experience of clients who would have benefited from Independent Advocacy at that time.

  5. Anonymous says:

    Councils must have a set timelimit to appoint an advocate and for giving a written response to any reports that are issued to them by advocates.

  6. Anonymous says:

    The Civil and Political Servents for the Secretary of State need to ensure that the advocates must recieve a response to any report that they may send to a local authority (and this should also include other partners like housing authorities, NHS Bodies too) then they all need to respond within a set timescale. Regulation 7 of the Advocacy Regs need to be changed accordingly. The regs need to cover the NHS Bodies and Housing as DoLS and most likly increase for adults in supported living when for example they are coming out of hospital due to the recent Chesire West case in the Supreme Court but also due to planned changes that the Gov expects to make to the law on Mental Capacity law and supported living.

    The advocate therefore need to be able to challenge all parties as they are all important players when it comes to, not only hospital discharge, but more generally in adult health and social care.

    The advocates MUST be take all reasonable steps to ensure that the advocates can do their jobs properly and also to explain what their jobs are about to members of the public and service users. 1 advocate cannot be appointed to two people who may or may not lack mental capacity. This is NO WAY to go about this matter as the advocacy relationship is not sustainable in this manner and councils will just consent to this, even with clear conflicts of interests, due to financial implications in the short term.

    Finally I would defo agree with people who may potentially lack mental capacity must be given alternatives to support them and treatment their difficulties if possible, just like the principle of least restricted option being considered for those under the Mental Health Acts. This cannot just be a power for councils but a DUTY.

    The independent advocates must be able to have dispute resolution mechanisms in place to challenge not only the council but the NHS Bodies too.

  7. Anonymous says:

    I strongly believe for the call for an independent advocate (IA) for all care [service] user/s (CU/s). The Secretary of State/Care Minister (SoS/CM) must ensure that local authorities (LAs) (i.e. local councils) and other relevant public authorities (e.g. NHS bodies etc) are under a duty to consider a request for an IA to be appointed if CU makes a request for one and they have mental capacity and they are not deemed to have “sufficent difficulty”. As per the calls by ADASS and SOLACE, this term needs to be objectivly defined in the draft Statutory Guidance (dSG)and Regulations (Regs) The dSG also needs to be changed to reiterate the need for public authorities to adhere giving CUs IAs as per their duties under reasonable adjustments, them having “due regard” under the Public Sector Equality Duty (PSED), the positive requirements and respecting the spirit of the Human Rights Act 1998 (ECHR/HRA) and also for them adhering to the common law definition and spirit of natural justice (NJ).

    The draft IA Reg needs to change in particular places:

    . Section 2(3)(a) as how can LAs be on the one hand determining the independence of the people that are supposedly challenging them [and others like NHS bodies too]. The SoS/CM must consider in my view to fund the IAs and their agencies centerally themselves as the Department of Health did prior to giving community advocate [against NHS providers] contracts to LAs to commission, through the Health and Social Care Act 2012, in April 2013. This section will not bode well politically at local levels with the public, considering the inefficencies of advocacy services laid out in the Sir Francis Mid Staffs Inquiry. The IAs need to be also sufficently trained and geared to take, if necessary, complaints/appeals to regulators (Ofsted/CQC and professions ones too such as HCPC in England for social workers). The IAs also need access to independent legal expertise and advice if they are to succesfully challenge the role of LAs and NHS Bodies (later where relevant) otherwise their roles are diluted further than that of Independent Reviewing Officers (IROs) in children social services. Their case levels should also be defined in the dSG as like with IROs as they are performing at times similar functions.

    . Section 3(1)(b) of the draft IA Reg needs to include a definition of what is meant by the term “learning difficulty” as in education law context this can appear to releate to SEN issues. Regardless, the term should not be constituted for learning disabilities. 3(1)(f) also needs changing to include harm already the CU/s have experianced where this is still having or likley to have an effect (of any level) on them.

    . Section (4), subsections (3) and (4) need to be changed to be inclusive of the fact that the IAs are not removed simply by CUs recieving support from NHS Bodies (e.g. through NHS Continuing Care etc) AND where CUs do not lack mental capacity. Subsection (5) does not like many parts of the draft Reg include provision where CUs have “substantial difficulty” or are provided with IAs regardless, under their other duites, and they have mental capacity. The draft Reg, as with the dSG and other Regs are poorly drafted.

    . Section 6 does not have any details with how LAs if having responsibility for IAs are to deal with misconduct etc or general complaints from CUs. Would an IA need to be appointed to support CUs to complaint about the inital IA. I know many CUs being in this very difficult situation and thus lacking the necessary support to deal with this. Section 7(2) and 7(3) need amending on grounds of compelling issues (e.g. breach of confidentiality amongst one of them) between 2 individuals and the relationship strain this has then with the IA. Who represent who in this scenario?

  8. Anonymous says:

    In a combined assessment, an advocate may be needed for one or more of the people involved. Carers and the people they care for should have access to separate advocates if needed.
    Organisations commissioned to provide advocacy should specifically be required to ensure staff are trained in understanding the needs of carers, and consideration should be given to specifically commissioning advocacy services for carers.
    There should be an advocacy duty where any person is either considering by themselves or is being considered by others for permanent admission to residential care and has substantial difficulty (LD, MH, capacity), regardless of whether there is someone the local authority regards as suitable. It is not unreasonable to assume that there is the potential for a conflict of interest with any “appropriate” person so the advocacy duty should be obligatory for local authorities in every case. It could then be for the advocate to determine if a conflict of interest does exists and if not step back to enable the appropriate person to assume the support role.
    The personalisation of health and social care services necessitates the provision of advocacy for those receiving joint services. To provide anything other than that would be counter-productive and de-personalising.

  9. Anonymous says:

    This section of the guidance seems to cover the requirements for advocacy. it is very important that this role is available at any point where a vulnerable person needs help in expressing their needs. it may be necessary to have an advocate when family members are at logger heads. Advocates should never experience a conflict of interest by representing more than one person in the same care group. It should be clear that advocates should have the same training as the current IMCA’s. The service will need to be funded.

  10. Anonymous says:

    We support the principle and concept of advocacy for a wider group of people than just those covered by the IMCA role. However, we have concerns in relation to the reality of providing a well staffed advocacy service; and covering the costs of such a service. A potential benefit from using an independent advocate to cover both health and social care aspects, reduces the need for additional numbers; and benefits the person in that they relate to only one advocate. The potential disadvantage may be the limitations to the skills and knowledge of the advocate to advocate in both areas. Joint funding of this service would be of benefit. It would be helpful to have clarification around the expectations of the advocacy process in relation to CHC, eg. Is the expectation that the LA seek to provide the advocate when joining Health with an assessment for CHC?

  11. Anonymous says:

    The draft guidance and regulations need to clearly articulate the roles and responsibilities surrounding independent advocacy, particularly regarding the relationship between advocates and social workers. Greater clarity is needed around the dispute process: would the advocate be put in the firing line and, if not, who would? Further clarity is also required on what status an advocate should have in terms of, for example, qualifications and experience, along with information on how this new advocacy function will be funded.
    One specific area which the final guidance and regulations must address is the interchange between independent advocates and hospital discharges. Annex G of the draft guidance relates to the process for managing transfers of care from hospital. This process is time specific and delayed discharge fees will be charged if schedules are not adhered to. Should a local authority have to arrange for an independent advocate or a specialist assessment for a patient due for discharge, that authority would have to arrange an interim placement for the patient (at increased cost) simply to avoid incurring such a fee. The draft guidance does not cover this eventuality nor does it specify whether local authorities will be allowed additional time within the discharge process when appointing an independent advocate.

  12. Anonymous says:

    I have worked as an advocate since 2007 in three different locations.Many clients get lost between the access criteria of Heath and Social Care particularly where they have a Mental Health Issue. It has appeared over the years that different departments can sometimes spend a significant time in communication over who is responsible for a persons care and in this time sometimes no packages of care is provided even if the client has been apparently eligible under the FACs criteria. Advocacy is essential to enable people to understand the process of eligibility and assessment . Many people struggle to communicate all of their needs due to fear of stigma this seems particularly so for those who have a learning disability and/or a mental health issue Due to the trust advocates can build with a client it often enables better assessments as it clients feel more confident to talk.
    People receiving a joint package of care and wanting direct payments can also face difficulties both at the start and at review stage of packages. Advocates enable people to be at the centre of decision making processes rather than the process being driven by the system. Where there are issues of communication breakdown between services advocates with their clients often assist in getting the process moving and enabling people to focus on their lives rather than battling the different Health and Social Care Systems

  13. Anonymous says:

    Advocacy should be provided for anyone being considered for or admitted to a learning disability assessment and treatment, or private hospital provision of any sort. This should also include people with autism.

    People receiving joint care from NHS and ASC will have complex needs and often unstable conditions resulting in fluctuations in capacity and the ability to become involved in their care, and should have access to advocacy.

    This is a really positive approach to advocacy but with potentially significant resource, coordination and planning implications that are difficult to cost.

  14. Anonymous says:

    Totally support the use of independent advocates but where are all these people going to come from and where is the money to fund them?

  15. Anonymous says:

    I would endorse all the comments of the response posted on 12 August at 10.49a.m.

    In general if someone receiving services from both the NHS and a local authority and qualifies for independent advocacy under the Act then the advocacy should cover all the services that they receive and should be provided from a single source.

  16. Anonymous says:

    Q19 There should be an advocacy duty where any person is either considering by themselves or is being considered by others for permanent admission to residential care and has substantial difficulty regardless of whether there is someone the local authority regards as suitable. It is not unreasonable to assume that there is the potential for a conflict of interest with any “appropriate” person so the advocacy duty should be obligatory for local authorities in every case. It could then be for the advocate to determine if a conflict of interest does exists and if not step back to enable the appropriate person to assume the support role.
    The personalisation of health and social care services necessitates the provision of advocacy for those receiving joint services. To provide anything other than that would be counter-productive and de-personalising.
    7.16 The duty to provide independent advocacy if required from first contact is likely to be problematic where local authorities use telephone based contact centres. Many older people, in particular those with hearing loss, struggle to use such services effectively and there is genuine concern that many older people faced with this means of accessing services decline to do so. In addition, local authority delays before needs are assessed can lead to long term denial of services when there is an urgent need. There need to be appropriate (and regulated) mechanisms in place within local authorities to ensure speedy and appropriate assessment of a person’s ability to be involved in decisions affecting them.
    7.31 It is our view that no advocate should ever be expected to support two people living in the same household. They cannot meet the advocacy support needs of two people without impinging on their relationship with each. The potential for conflict of interest is too great for this ever to be considered appropriate.
    7.32 We have concern over the local authority’s ability to decide fairly if someone is appropriate to support the person with substantial difficulty when it is the local authority’s duty to fund any subsequent advocacy support. There would appear to be an intrinsic conflict of interest since it would be in the local authority’s best interest to almost always find the person to be appropriate as that would save them money.
    7.34 Where a potential deprivation of liberty is identified a full exploration of the alternative ways of providing care and/or treatment MUST be undertaken with those responsible for care planning, not SHOULD.
    7.44 There needs to be a regulated timeframe for local authorities to provide a written response to a report from an advocate which outlines concerns about how a local authority has acted or what decision has been made or what outcome is proposed.
    7.45 The local authority MUST engage with the advocates to support awareness raising to ensure a better understanding of the advocates role. This duty should not be optional.
    7.47 The local authority MUST take reasonable steps to assist the advocate in carrying out there role. Too often local authorities are obstructive.
    7.53 Local authorities need to be required to be aware of and build on the current availability of independent advocacy services in its local area. This should not be optional.

  17. Anonymous says:

    This would be appropriate and of value to the person as clearly if there is substantial difficulty in being involved it is crucial that the duty to provide an advocate applies in any areas associated with the delivery of care and support particularly where health and social care needs are evident as these are often complicated and challenges can arise where health and social care may not agree.  The advocate would have to challenge both organisations as appropriate and when required.  The dilemma will be ensuring that assessments, reviews etc happen on a multi-disciplinary basis.

  18. Anonymous says:

    Current practice does cover arranging an independent advocate where people have substantial difficulty in being involved and where there is no one else to be involved e.g. I the case of a service user with learning disability regardless of whether they lack capacity or not.  The duty to involve statutes current good practice and clarifies important stage when as advocate should be involved.  Clarifying the four areas to inform judgment on whether an individual has substantial difficult or not is helpful and reaffirms principles of the mental capacity act.  Careful consideration needs to be given to process and procedure in arranging advocacy  relating to other areas or where an individual is moving into a LA area and this will need to be considered and factored into contractual arrangements

    This would be appropriate and of value to the person as clearly if there is substantial difficulty in being involved it is crucial that the duty to provide an advocate applies in any areas associated with the delivery of care and support particularly where health and social care needs are evident as these are often complicated and challenges can arise where health and social care may not agree.  The advocate would have to challenge both organisations as appropriate and when required.  The dilemma will be ensuring that assessments, reviews etc. happen on a multi-disciplinary basis.

    Specific reference or examples of how this could work in supporting transition would be beneficial. 7.25 indicates but could be strengthened. This would support the requirements both in the C and F and Care act.

  19. Anonymous says:

    Section 67(5)Care Act 2014 elaborates for the LA when they are not bound by the duty to provide an advocate. However it concerns the issue of another person, not involved or paid for P’s care, may take on this job. The reality is that this other person may not want to take on the role of advocate for P. The Ind Advocacy Support Reg should include the duty that if this person is not willing, wanting etc to take on the role of advocate then the duty under 67(2)of the Act. Section 4(4)(b) of the Ind Advocacy Support Reg should be ammended or a new subsection introducted, which would include for the scenario that P does actually have mental capacity, an area that as the way the Act is currently written mentions, but P would like the involvement or the LA believes P would nonetheless benefit from it then the LA must provide P with the independent advocate.

  20. Anonymous says:

    I strongly believe that all service users should have access to independent advocacates and independent supporters. It is of paramount importance for the Secretary of State to at least descibe through the regulations what substantial difficulty might actually mean in practice. At the current rate it may only apply to those who lack mental capacity but those who have capacity struggle too; though this would be contray to the purpose in the Reg that P has mental capacity. As others have pointed out so do their family, neighbours and friends. It is therefore vital that the Minister gets this right. My main fear that advocates will not then be readily available to those who really need it.

  21. Anonymous says:

    An appropriate family member whois supporting the person may not be able to understand the process and they must be able to secure advocacy support.

  22. Anonymous says:

    Not sure whether my last comment posted (it was very long!)

    Perhaps the most important point is:
    2) I am concerned about the limits of the statutory advocacy role. I think it is fair to say that referrals to the advocacy service I work with cover many different issues. These include making decisions about moving home, supporting parents with substantial difficulty in understanding to understand the child protection process and even helping people decide whether to write a will. I worry that the limits on the scope of statutory advocacy in the bill will mean advocacy services will not be funded to do much of the work their clients are currently requesting. I feel that placing such limits on the scope of advocacy may result in it being a less personalised service (the service user only being eligible when they are making a care plan, having a review etc.). I think this is a particular concern given that one of the aims of the bill is to provide more personalised services.

  23. Anonymous says:

    Please find below some comments on the changing role of advocacy in the care act:
    1) I think it excellent that the government is responding to the increasing demand for advocacy by making it statutory. I am also glad they offer guidance on some of the ways the local authority should co-operate with the advocate, as I believe this will enable advocates to be even more effective in working with their clients.
    2) I am concerned about the limits of the statutory advocacy role,however. I think it is fair to say that referrals to the advocacy service I work with cover many different issues. These include making decisions about moving home, supporting parents with substantial difficulty in understanding to understand the child protection process and even helping people decide whether to write a will. I worry that the limits on the scope of statutory advocacy in the bill will mean advocacy services will not be funded to do much of the work their clients are currently requesting. I feel that placing such limits on the scope of advocacy may result in it being a less personalised service (the service user only being eligible when they are making a care plan, having a review etc.). I think this is a particular concern given that one of the aims of the bill is to provide more personalised services.
    3) Although the act acknowledges that an advocate may need to spend considerable time with an individual, I wonder how this will work in practice? For example, a social worker may start to arrange a care review 2 weeks before the review date. Assuming the advocate has a fairly weighty caseload, it may be difficult to have the several meetings it might take to get some client’s informed views in this time.
    4) I am pleased to see the need for appropriate experience and training for advocates mentioned in the act. It is suggested that advocates complete a formal advocacy qualification within a year of starting work. I was wondering, given that advocates have relatively low incomes, and advocacy organisations generally are on very tight budgets, whether funding for this would be included in the money that the government is allocating nationally for advocacy? I was also wondering if the status of people who have been working in the sector for some time could be clarified. Would they be expected to complete the qualification? And if so, in what time frame?
    5) The act states that where an individual is not able to challenge a decision, the advocate must challenge any decision that does not promote an individual’s wellbeing. I have a question as to whether this is the case even if the individual themselves is happy with their care arrangements? As things currently stand advocates must report safeguarding concerns, but would not be acting professionally if they reported anything else that affected a client’s well-being that the client themselves would prefer not to change. The importance of the advocacy role is that the advocate can be completely on their client’s side. They do not currently have to consider ‘best interests’ – that is the role of other professionals. If the advocate has to consider ‘wellbeing’ even if the client is happy, doesn’t this threaten the ability of the advocate to always follow the client’s wishes, even if these wishes are not in their ‘best interests’?
    6) The criteria for the IMCA role and the advocacy role outlined in the care act seem very similar – which is deliberate, according to the statutory guidance. Arguably all the case studies offered could be of people who lack mental capacity to make a decision. It is good to see that the guidance is very clear that people with capacity but who have ‘substantial difficulty’ in being involved in the process of assessment, planning and reviews are included. I feel however that it could be made clearer through case examples who might have ‘substantial difficulty’ without lacking capacity. Otherwise the act may leave many people who are vulnerable but do not lack capacity without a service.
    7) It looks like there will be an increased demand for IMCA’s under the new bill. This is because it is recommended that IMCA’s are appointed to work with people who may lack capacity on non-IMCA issues just in case an IMCA issue (e.g. a change of accommodation) crops up. Will advocacy organisations be funded to send staff on training to qualify as IMCA’s?

    Hope the above feedback and questions are useful,

    Regards,

    Will Leifer.

  24. Anonymous says:

    It clearly makes absolute sense to include care provided jointly from the NHS and Social Care. Hopefully as more joint work and pooled budgets are implemented joint care will be seen as the norm and thus advocacy should apply to those people who need it who are or may receive joint care and support. It of course would be good to have a duty to provide advocacy to people being assessed for health support, but I suspect that would not be covered by the Care Act. I am not clear where that leaves assessment for health continuning care?

  25. Anonymous says:

    Involving independent advocates in assessments and planning for joint provision by social care and NHS would help to ensure that people are not disadvantaged by lack of understanding of the criteria for CHC and would provide the support to appeal a judgement that CHC does not apply leading to the joint provision.

  26. Anonymous says:

    Concerning a specific duty to support carers through advocacy, this will have resource implication. Previous advocacy duties have had a grant to accompany from central government, I was unable to identify this in the document.

  27. Anonymous says:

    There should be a duty to provide advocacy where requested, for people who have not had a support plan agreed which they have self directed. In appropriate use of panels leads to people becoming part of a system, which many people decide is to complex for them to negotiate and challenge, and abandon hope of have greater choice and control of their lives.

  28. Anonymous says:

    IN response to question 19:

    Independent advocacy is crucial where there are joint funded packages. It is my experience that many people who should be CHC i.e their primary need is health care funded are instead funded jointly. Citizens are not aware that if their primary care is health then the support should not be financially assessed and free at the point of delivery; and therefore do not understand why they should appeal.

    This guidance should be explicit about the giving of accurate information prior to a CHC assessment, what this means and there right of appeal.

  29. Anonymous says:

    The guidance does not define ‘substantial difficulty’ very clearly; at the start of the Guidance it refers to the test of ‘substantial difficulty’ as being those unable to retain, understand, weigh and communicate however by the end of the guidance, it is referred to as being a separate test i.e. that people with capacity but have substantial difficulty. The Guidance needs to be clearer in its definition of substantial difficulty.

  30. Anonymous says:

    An Advocate involvement is vital to any individual finding themselves in these type of situations. “Independence” is the vital keyword. We don’t only give them a voice but more importantly we dissect information and give the person a list of options to enable them to make an informed decision. My job currently as an IMHA (advocate) involves coordinating/communicating the separate agencies involved in a persons care and treatment as this seems to be problematic between ASC and the NHS as a whole. Social workers appear to be over- stretched and therefore not to have the time to get to know a person and their circumstances; this leads to old information been used and therefore this leads to any progress/ change in circumstances not been accounted for.

    • Anonymous says:

      Jan Saunders states a sad and true reality – in fact I will go further – the majority of social workers never accept the intervention of, or involvement of anyone who may have valid information and or comment,let alone outside agencies – no matter what their relationship is to the end-user of the service. Unfortunately some so called independent advocates do not work in the best interest of the client / end-user either, my experience is that they forfeit the family life and friendships already established to meet what they believe is in the best interest of the end user without giving a damn so long as they control the situation and can pat themselves on the back as ‘job well done’ regardless it appears of the consequences on families or individuals. The damage they can inflict is immense and should be stopped – reeducate at the very least.

  31. Jan Saunders says:

    A Social Services worker will never welcome the intervention of an outside agency. Social Workers are a law unto themselves and their word is final, no review or comments are acceptable to them. We need to change the mindset of the Social Worker to educate them that they are an Employee of the state and must work alongside the Client not just override the Client’s opinions and requirements.

    • Anonymous says:

      An advocate is vital but must not be used as a tick box by LA. Also they should be adequately funded jointly by the LA and CCG as many of the cases will fall in between. The role of the advocate should be very clear from the start so that families and carers are aware of them and can challenge if an advocate has not been involved.