“I think people can be prioritised based on need more a combined model.. It’s sometimes difficult for users to hear that they can’t get help from the advocate who is helping someone else because they have to access a different service.” “Lower priority - longer waits, more frustration, for non-priority individuals. Ultimately will they lose the service altogether?” “This may lead to frustration and anxiety for some clients. A prospective timescale should be provided as far as possible.” “The impact will be people waiting longer for advocacy and not getting a service at all.” 2b. Would any of the following suggestions help to minimise any negative impacts? Select all that apply Table 4 shows that the majority of respondents selected all of the suggestions provided. Over three quarters (76%) of respondents selected ‘Better service promotion so that people are referred into the non-statutory service earlier and before reaching a crisis point’ as a suggestion to help minimise any negative impacts resulting from more flexible waiting times for non-advocacy provision. There was little variation to this question based on the respondent type (table 5). Table : Number of responses received for each option in question 2b Count % of respondents selecting this option Better service promotion so that people are referred into the service earlier and before reaching a crisis point 35 76% Increased knowledge of the Health Advocacy Services by health, social care and other professionals so that they refer or signpost people to services earlier 34 74% Making self-referral routes available so that people don’t have to wait for a professional to make a referral 33 72% Providing toolkits and other self-help information to support people to self-advocate whilst they are waiting for an advocate from the service provider/partnership 29 63% Regular updates and contact from the advocacy provider about when the advocacy service will commence, so people are not left waiting indefinitely. 29 63% Advocacy Service volunteers making contact with the client/keeping in touch with the client to understand any changing circumstances 28 61% Other, please state: 11 24%
The following suggestions were provided by respondents who selected ‘Other’ to question 2b: “Communication and promote self-help by boosting knowledge and confidence” “Have used self-referral at Warwick Hospital. It worked well” “I think they have the knowledge but not the time to educate” “Mine keep in regular contact with each other” “Not sure what are the 'suggestions'!!” “Please do not promote unless you have invested enough money to provide enough advocacy time” “Self-referral may result in people who are able to speak up for themselves asking for help and taking the time of advocates that should be given to patients who are more seriously ill unless a lot more money for advocacy is available so that all patients can be reached” “The statutory NHS and independent advocacy are both required to help mental service users” Table : Number of responses received for each option in question 2b by respondent type A current Health Advocacy service user (n=6) A former Health Advocacy service user (n=10) A member of the public – has not used advocacy services before (n=14) A health or care professional /referrer (n=12) Someone who looks after or cares for an individual (n=9) Other (n=11) Count and % of cohort selecting this option Count and % of cohort selecting this option Count and % of cohort selecting this option Count and % of cohort selecting this option Count and % of cohort selecting this option Count and % of cohort selecting this option Better service promotion so that people are referred into the non- statutory service earlier and before reaching a crisis point 5 (83%) 5 (50%) 11 (79%) 12 (100%) 7 (78%) 5 (45%)
5 ‘Is there anything else you want to say about joining the three Health Advocacy Services together?’ Of the seven responses to this question, four were broadly positive (“Give it a try, worth giving it a go”; “I think it’s a good idea”; “Hope people with LD have a good service”; “The nurses help you”). Two responses expressed concern about the possible effects of changes (“I think it’s alright but it means jobs will go and there will be cuts”; “Ensure it doesn’t mean staff cuts!”) One person suggested that “a complaints service would be useful”. Mental health forums The forums included 21 service users and 2 co-production staff. Table 12 summarises the key themes that emerged against each of the key consultation proposals. Table : Key themes from mental health forums Service proposal Key themes Combining three contracts into one contract General agreement that combining the three contracts would: Simplify the referral pathway Prevent confusion However, some comments referred to: Concerns about impact on staff workload Concerns over perceived lack of provision in the North Working hours - shouldn’t be 9-5 Wide spectrum of services - could one provider realistically do all 3? Service promotion Suggestions promotional methods included: Linking with the CAVA Directory More outreach work by Advocacy staff Information should be provided on discharge from hospital Promotion in GP surgeries Structured education for GPs Information to be provided online There was also agreement about the need for more clarity for professionals on provision, referral, eligibility etc.
Links with Healthwatch Individuals were generally supportive of the proposed plan to develop the partnership with Healthwatch The link to Healthwatch provision needs to be clearer as some individuals think they provide advocacy Flexible waiting times Agreement that prioritisation would be effective and appropriate Market engagement Three organisations requested to attend the market engagement day on 19 July 2017, with two further organisations responding to the market testing questionnaire. Table 13 summarises the key themes that emerged against each of the key consultation proposals. Table : Key themes from market engagement Service proposal Key themes Combining three contracts into one contract Providers were in agreement with combining the three services into one integrated service. Agreement that combining the three contracts would result in the following positives: Seamless access for service users, continuity Integration Clients will tell their story once One easy point of contact More efficient triage Better value for money – resource allocation, more efficient 1 service manager – to allocate clients to relevant advocates – triage Opportunity for a partnership/consortium approach Utilise volunteers more Highlighted risks included: TUPE