Advocacy: Partnering Service Users

Shaben Begum, Director of the Scottish Independent Advocacy Alliance spoke to Care Appointments…

Shaben Begum took up her post as Director of the Scottish Independent Advocacy Alliance just as the body came into being, almost four years ago. Prior to that she had amassed an impressive track record in her field, working as the Coordinator of the Patients’ Advocacy at The State Hospital at Carstairs and in the advocacy service at a large hospital in Nottinghamshire. The Scottish Independent Advocacy Alliance (SIAA) struck Shaben as an exciting organisation to be involved with.

“Previously there had been a body called Advocacy 2000 who had been given three years worth of funding from the National Lottery and their remit had been to establish whether there was a need for a national organisation that was going to enhance the advocacy movement and help it develop. So, when the opportunity came about with the newly created SIAA I thought it was an exciting one.”

Beginning at the beginning, we asked Shaben to explain the aims and activities of the SIAA.
“We have an overall aim that advocacy should be available to anyone who needs it – our logo talks about us ‘promoting, supporting and defending independent advocacy’, and that means that we act as advocates for the advocacy movement, but also act as a professional body in terms of enhancing good practice, helping the movement develop and grow but also to keep advocacy on the national and local agendas. We provide training for the advocacy movement, we provide training about advocacy to people outwith the movement, we provide information about advocacy through a directory available both in hard copy and on our website.

“We are in the process of developing principles and standards for advocacy and a code of practice for advocates. We provide information on advocacy to other organisations and professionals such as the Mental Health Tribunal and Mental Health Officers whose duty, under the Mental Health Act, is to tell people about advocacy.”

And does the SIAA lobby the Scottish Executive on advocacy related matters?
“We do lobby the Scottish Executive, on a whole range of issues, including development of new policy, an example of which is that we wrote part of the code of practice concerning advocacy in the new Mental Health Act. We get involved in different working groups that the Executive sets up to report on advocacy.”

So, typically, who are likely to be members of the SIAA and what benefits does membership of the body bring?
“Our main constituents are advocacy organisations from all over Scotland. As members they get access to all sorts of information about advocacy, including newsletters, directories, discounts on training, invitation to conferences and events. We send out a weekly e-bulletin which contains news about the advocacy movement but also other relevant issues such as what’s going on in the Parliament and the Executive. We have a forum on our website where people can get involved in discussions and we are also in the process of setting up different working groups so that members can be more involved.

“Our members communicate with us all the time, whether that be phoning to ask for information or advice on a particular issue or problem. For example, someone may tell us that they’ve been asked by an MHO or a Consultant to be involved with an individual and find themselves being asked to do things that aren’t strictly advocacy, such as persuading someone to take their medicine. As many of the advocacy organisations are very small they don’t have a team of people with whom they can sit down and discuss this type of situation or challenge and that’s what we’re here for.”

We asked Shaben whether the disbanding of the Executive-created and all too short-lived Advocacy Safeguards Agency had meant an increase in responsibility or workload for the SIAA?
“In some ways it has. The two organisations were set up at the same time and the idea was that they would complement each other, but we would work with the advocacy providers and they would work with those who fund and commission advocacy (primarily in the health boards and local authorities) as well as carrying out evaluations. We had a healthy relationship in terms of doing pieces of work together, attending events together – but some parts of their role wouldn’t be appropriate for us to take on, for example the evaluation role as we couldn’t be a professional body for advocacy organisations and also evaluate them.

“There are discussions going on at the moment and Hector MacKenzie of the Health Department made an announcement at our AGM that Quality Improvement Scotland would take on certain parts of the Advocacy Safeguards Agency’s rulings e, the Scottish Health Council would take on other parts and we would take on others.

“The priority for us, and for the Health department, is that there needs to be more advocacy. One of the things that has been very evident from the implementation of the Mental Health Act is that there isn’t enough advocacy. Speaking at our AGM, Eileen Davie (President of the Mental Health Tribunal for Scotland and former Care Appointments interviewee – Ed) said that the fear that lots of people have is that advocacy is concentrated on working with people at one end of the spectrum, who are facing detention for example, but that you have lots of mental health service users who don’t have those sorts of crises, who are less vocal, but who are already marginalised and are going to be further marginalised without access to advocacy.

“The work that it is anticipated that we will do will be around developing new advocacy, looking at gaps, making sure that the advocacy that is available at the moment is funded properly. Proper funding has to be for a three year period at least – there are lots of advocacy organisations who are in situations where they get funding only from year to year. That makes it difficult to hold on to workers who have bills to pay like everyone else and who need a little bit of stability.”{mospagebreak}

We asked Shaben to define for us just what stage in its development the advocacy movement in Scotland is right now.
“Ten or fifteen years ago there were a handful of advocacy organisations dotted around who were part of a pilot scheme to see if advocacy could work in Scotland so advocacy. In fact we have a number of members who have just celebrated their tenth anniversaries. So advocacy is pretty established as part of the voluntary sector in Scotland but it still has a long long way to go in terms of everyone understanding what advocacy is. Our board and staff had a couple of days of discussion last week and one of the most common views aired was that we’d like advocacy to be understood by people in the street – we are nowhere near that situation at present.

“Today, a really good aspect of advocacy is that every geographical area in Scotland is covered – the Western Isles have an advocacy service, Shetland has an advocacy service, Edinburgh and Glasgow have several, and so forth. “However, the down side to that is that you or I could not access the advocacy services in Edinburgh or Glasgow because their funding is arranged in such a way that they can only provide services to people who meet certain very rigid criteria. Whereas, if you or I lived in Dumfries and Galloway we could access advocacy without any trouble at all if we were having an issue with our Consultant or GP or whatever. For us as a body and as a movement that is the ideal situation.

“Any of us can be vulnerable, can find ourselves in hospital and don’t feel that things have been properly explained to us or explained sufficiently clearly ad we should be able to access advocacy if we feel we need it. The advocacy service in Dumfries just happens to have evolved that way, whereas in many areas, in order to attract funding, advocacy services have to provide services to very narrowly defined groups of people.”

So, in order to get from this situation to one where advocacy is freely available to all who need it, what has to happen?
“Everyone says the answer is money, bat that is only one aspect. There’s also a cultural shift that has to take place – it’s that typically British situation of going out to eat somewhere and afterwards saying wasn’t that awful?’ but not wanting to complain. There has to be an element where people get used to saying ‘I’d like better service’. There is a massive element of education that has to take place among the general public but also, for example, among people who work within the NHS.

“For me advocacy isn’t just about health – our remit, as an organisation, is to educate people that advocacy isn’t just about health related issues, it can be about the level of housing you’ve got, it could be about your education. You’re average advocacy organisation who receives funding around health will also do advocacy around other issues.

“As a movement we need to tell people what advocacy is about, full stop. Advocacy is something that happens every single day – it’s something that you and I will do for our families or for strangers in the street, without even thinking about it. An example we use a lot is that if you do don’t know very much about cars you go and take your car to the garage and the mechanic starts raising his eyebrows and taking deep breathes, but you don’t know whether what he tells you is true or not – you could go to another garage down the road an they might fix your car for a fraction of the cost. It’s the same principle as a trade union – you don’t understand the complexities of employment law so you join a trade union in order that, if things get difficult, you call upon them.”

So what of the interaction between advocates and those working within the wider care sector? How does Shaben feel they interface with one another?
“Sometimes, key workers, consultants, MHOs and so on feel that advocacy is interfering, they see it as a threat, see it as disruptive. Also, advocates sometimes get accused of putting ideas into people’s heads. The flip side of this, of course, is that it’s the job of the advocate to help the individual – who might not be used to having choices or to making decisions – to think about all their options. Often the advocate can help smooth out the lines of communication and help the individual speak to their care worker or key worker and tell them what they want and the way in which want it. It’s about those professionals being open to different ways of thinking and different ways of doing things”

Should advocates then be considered to be a part of the wider care team?
“I wouldn’t go that far. One of the dangers is that advocacy is seen as part of the system, part of the way things are done. There has to be a degree of tension in that relationship because the advocate could be challenging people’s thinking, could be challenging the way things have been done in the past. Your advocate is going to be the person who is right next to you – to look at it in graphic form is to imagine you have a team of people all around you who are doing things ‘to’ you, whereas your advocate is the person who is standing right beside you, who is helping you. As an advocate you don’t have an agenda, you don’t have financial constraints.”

More information on advocacy in Scotland and the work of the Scottish Independent Advocacy Alliance can be found at www.siaa.org.uk