On PPlog in January of this year I reported a Parliamentary debate about Independent Mental Health Advocacy.
Mr. Charles Walker (Broxbourne) (Con) said: The Act also incorporated safeguards in the form of independent mental health advocacy that would ensure that people who were being detained against their will or faced being detained against their will for mental health problems could receive the support of an independent advocate. That is crucial.
“Tim Loughton (East Worthing and Shoreham) (Con) said: My hon. Friend is absolutely right. My concern is that the Mental Health Act 2007, which represents a reform of mental health legislation for the first time in about 25 years, contains a lot of innovative, controversial and technical legislation. To have advocates in place by April, late though that is, is demanding. To have well trained and well qualified advocates in place capable of offering the service to many vulnerable people in complicated conditions is a great challenge.
The Minister, Phil Hope said: The statutory provision for independent advocates comes into force in England from 1 April, as the hon. Member for Broxbourne rightly said... We wanted to ensure that the introduction of the new advocacy service went smoothly, which has meant developing appropriate local commissioning processes and putting training arrangements in place...We have taken into account the new statutory duty when setting PCT allocations for the next two years, so I can tell the hon. Gentleman that there is money in the system to support these measures, and we will expect PCTs to fulfil the duty effectively...Under the regulations, advocates must have appropriate experience or training for the role, and the Department website gives advice on what that involves...My Department is also working with City & Guilds to develop a national advocacy qualification, which will include a specialist module for independent mental health advocates. I anticipate that this qualification and its training materials will be available before independent advocates take up their positions on 1 April, and I expect all of them to complete their training within a year of starting practice.
On 31st May I sent this to Norfolk LINk:
Hello Patrick.
I'm sending this to you as Chair of the Norfolk LINk. I have came across two issues I'd like the LINk to record as, in the first instance, evidence of service shortcomings and in the second, indications that NHS Norfolk is dragging its feet over an important service it should seen fully implemented on 1st April this year. My concerns are:
1. While working for Age Concern Norfolk I witnessed these events:
Hello.
The Department of Health says:
`From April 2009, statutory access to an Independent Mental Health Advocate (IMHA) will be available to patients subject to certain aspects of the Mental Health Act 1983. IMHAs are an important new safeguard that will help and support patients to understand and exercise their legal rights. IMHAs will be available to most detained patients as well as patients on supervised community treatment or guardianship. Other patients whose treatment is subject to the special safeguards provided by the Act, will also be eligible for the services of IMHAs.`
I can find nothing relating to IMHAs on your website. Can you please tell me what is happening in Norfolk with regard to commissioning and the required training.
I eventually received this reply:
Further to your email dated 1 April 2009 requesting information on Independent Mental Health Advocates. I apologise there has been a delay in sending this information to you due to the finalisation of the arrangements for this service which are now in place.
NHS Norfolk have made arrangements with Rethink, a well established Third Sector provider, to deliver this service to patients for whom we are responsible. Access to the service will, in almost all cases, be managed by the Mental Health Trust as patients will be under their care. Any patients placed in establishments outside of Norfolk, or in other independent facilities will also have access and discussions are ongoing regionally to understand the best way to deliver this, in the interim Rethink will also provide this service.
The Mental Health Trust are aware of the arrangements in place and will ensure that anyone who requires access to an IMHA will be able to do so.
I trust that the above information is helpful but if you have any queries please do not hesitate to contact me. Please use the above reference number in any future correspondence.
Regards
Chris MacDonald Corporate Governance Manager NHS Norfolk
I contacted Rethink who told me their Norfolk Independent Mental CAPACITY Act Advocacy Service had been commissioned to do this work. I contacted them and received this response:
We have been commissioned on a purely temporary basis (May to July) to provide an IMHA service for Norfolk PCT. During this period, the PCT will assess its longer term requirements and decide how it wants to meet them. We would be happy to provide this service on mutually agreed terms, but are awaiting news from the PCT. In the meantime, we are not making any more substantial arrangements, but I would be happy to contact you again when matters become clearer.
Ken Hawkins
Service Manager
Working Mon-Thu only
With your own knowledge of mental health law you will know that knowledge of advocacy for the MC Act is not adequate for advocacy in compulsory action under the Mental Health Act.
Can you please examine these matters and let me know the outcome.
Patrick replied the same day:
Hello
Mike
I will endeavour to ask questions in the correct areas but as you are aware spevific issues relating to one patient as seen as ei=ther a complaint or compliment would need to be channeled throught the correct depart,mant of the trust or oganisation concerned, in saying that LINk can take note and ask specific question about servioes etc and investiaget in what ever manour deems fit with dealing with areas brought to our attention.
I will pass these comments to the appropriate members and will in due corse respond to you.
Once again thank you for drawing LINk to these issues.
regards
patrick
I wrote again on 1st June.
Hello Patrick.
Case examples (anonymous of course) constitute some of the best evidence for LINks returns - for scrutiny - for your Annual Report - for the Annual Health Check for instance. These are not individual complaints, they are my observations, as an ordinary citizen (call it whistleblowing if you like) of questionable practice in public services. They do not have to be referred to the organisation but reported by LINks as a matter of fact. That's why I've sent you them.
Patrick replied the same day:
Hi Mike,
Many thanks for you reply.
I think like I said we are only to pleased to recive all the information regaring any service within Social & Haelth Care that could be deemed to good positive eveidence or either ebst practice or otherwise towards us using this in either rpeorts or recomemndation. We garther as you know eveidenec from many sources within the work of LINk and have to have good qulitive and quantive eveidence where ever possible to back up what we are reporting on and use experences from either patients or carers to do this and also to have an overoveral view of the serive provided. Yes to have antidotal eveidenec isgood but we cannt be seen to take on board individual complaints etc as a project unles we have good eveidence based reports to which we can use within our work as wa whole. We do however gather all the information that is feed into us and use that where possible and when possible as we work on projects accross the county in Social & Haelth related groups.
All this information is invaluable in providing us with eveidence towards building on a conculsion and outcome at the end that we can pass on to the necassary repondants.
I hope that the information as i said before will be able to be used in a way that will give LINk a way of feeding this into our work.
Regards
patrick
I’ve heard nothing since and I’ve heard nothing from the PCT or Rethink about training. We’ll see, shall we.
Mr. Charles Walker (Broxbourne) (Con) said: The Act also incorporated safeguards in the form of independent mental health advocacy that would ensure that people who were being detained against their will or faced being detained against their will for mental health problems could receive the support of an independent advocate. That is crucial.
“Tim Loughton (East Worthing and Shoreham) (Con) said: My hon. Friend is absolutely right. My concern is that the Mental Health Act 2007, which represents a reform of mental health legislation for the first time in about 25 years, contains a lot of innovative, controversial and technical legislation. To have advocates in place by April, late though that is, is demanding. To have well trained and well qualified advocates in place capable of offering the service to many vulnerable people in complicated conditions is a great challenge.
The Minister, Phil Hope said: The statutory provision for independent advocates comes into force in England from 1 April, as the hon. Member for Broxbourne rightly said... We wanted to ensure that the introduction of the new advocacy service went smoothly, which has meant developing appropriate local commissioning processes and putting training arrangements in place...We have taken into account the new statutory duty when setting PCT allocations for the next two years, so I can tell the hon. Gentleman that there is money in the system to support these measures, and we will expect PCTs to fulfil the duty effectively...Under the regulations, advocates must have appropriate experience or training for the role, and the Department website gives advice on what that involves...My Department is also working with City & Guilds to develop a national advocacy qualification, which will include a specialist module for independent mental health advocates. I anticipate that this qualification and its training materials will be available before independent advocates take up their positions on 1 April, and I expect all of them to complete their training within a year of starting practice.
≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈
On 31st May I sent this to Norfolk LINk:
Hello Patrick.
I'm sending this to you as Chair of the Norfolk LINk. I have came across two issues I'd like the LINk to record as, in the first instance, evidence of service shortcomings and in the second, indications that NHS Norfolk is dragging its feet over an important service it should seen fully implemented on 1st April this year. My concerns are:
1. While working for Age Concern Norfolk I witnessed these events:
- a complaint about the home carer just “popping in for no more than three minutes.”
- a care management review being held in an oppressive and subtly coercive environment that disturbed and distressed my advocacy partner and rendered her unable to participate properly.
- the absence of any primary or secondary care presence at that review - a failure the care manager to “...ensure the coordinated delivery of health and social care services for people with dementia. (NICE - SCIE Guidelines)” There was no primary or secondary care input in my advocacy partner’s care and no medical or nursing supervision of a plethora of medication all with potentially distressing side effects and one drug which is effectively fatal even in overdose.
Hello.
The Department of Health says:
`From April 2009, statutory access to an Independent Mental Health Advocate (IMHA) will be available to patients subject to certain aspects of the Mental Health Act 1983. IMHAs are an important new safeguard that will help and support patients to understand and exercise their legal rights. IMHAs will be available to most detained patients as well as patients on supervised community treatment or guardianship. Other patients whose treatment is subject to the special safeguards provided by the Act, will also be eligible for the services of IMHAs.`
I can find nothing relating to IMHAs on your website. Can you please tell me what is happening in Norfolk with regard to commissioning and the required training.
I eventually received this reply:
Further to your email dated 1 April 2009 requesting information on Independent Mental Health Advocates. I apologise there has been a delay in sending this information to you due to the finalisation of the arrangements for this service which are now in place.
NHS Norfolk have made arrangements with Rethink, a well established Third Sector provider, to deliver this service to patients for whom we are responsible. Access to the service will, in almost all cases, be managed by the Mental Health Trust as patients will be under their care. Any patients placed in establishments outside of Norfolk, or in other independent facilities will also have access and discussions are ongoing regionally to understand the best way to deliver this, in the interim Rethink will also provide this service.
The Mental Health Trust are aware of the arrangements in place and will ensure that anyone who requires access to an IMHA will be able to do so.
I trust that the above information is helpful but if you have any queries please do not hesitate to contact me. Please use the above reference number in any future correspondence.
Regards
Chris MacDonald Corporate Governance Manager NHS Norfolk
I contacted Rethink who told me their Norfolk Independent Mental CAPACITY Act Advocacy Service had been commissioned to do this work. I contacted them and received this response:
We have been commissioned on a purely temporary basis (May to July) to provide an IMHA service for Norfolk PCT. During this period, the PCT will assess its longer term requirements and decide how it wants to meet them. We would be happy to provide this service on mutually agreed terms, but are awaiting news from the PCT. In the meantime, we are not making any more substantial arrangements, but I would be happy to contact you again when matters become clearer.
Ken Hawkins
Service Manager
Working Mon-Thu only
With your own knowledge of mental health law you will know that knowledge of advocacy for the MC Act is not adequate for advocacy in compulsory action under the Mental Health Act.
Can you please examine these matters and let me know the outcome.
Patrick replied the same day:
Hello
Mike
I will endeavour to ask questions in the correct areas but as you are aware spevific issues relating to one patient as seen as ei=ther a complaint or compliment would need to be channeled throught the correct depart,mant of the trust or oganisation concerned, in saying that LINk can take note and ask specific question about servioes etc and investiaget in what ever manour deems fit with dealing with areas brought to our attention.
I will pass these comments to the appropriate members and will in due corse respond to you.
Once again thank you for drawing LINk to these issues.
regards
patrick
I wrote again on 1st June.
Hello Patrick.
Case examples (anonymous of course) constitute some of the best evidence for LINks returns - for scrutiny - for your Annual Report - for the Annual Health Check for instance. These are not individual complaints, they are my observations, as an ordinary citizen (call it whistleblowing if you like) of questionable practice in public services. They do not have to be referred to the organisation but reported by LINks as a matter of fact. That's why I've sent you them.
Patrick replied the same day:
Hi Mike,
Many thanks for you reply.
I think like I said we are only to pleased to recive all the information regaring any service within Social & Haelth Care that could be deemed to good positive eveidence or either ebst practice or otherwise towards us using this in either rpeorts or recomemndation. We garther as you know eveidenec from many sources within the work of LINk and have to have good qulitive and quantive eveidence where ever possible to back up what we are reporting on and use experences from either patients or carers to do this and also to have an overoveral view of the serive provided. Yes to have antidotal eveidenec isgood but we cannt be seen to take on board individual complaints etc as a project unles we have good eveidence based reports to which we can use within our work as wa whole. We do however gather all the information that is feed into us and use that where possible and when possible as we work on projects accross the county in Social & Haelth related groups.
All this information is invaluable in providing us with eveidence towards building on a conculsion and outcome at the end that we can pass on to the necassary repondants.
I hope that the information as i said before will be able to be used in a way that will give LINk a way of feeding this into our work.
Regards
patrick
I’ve heard nothing since and I’ve heard nothing from the PCT or Rethink about training. We’ll see, shall we.
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