1.1 The North West Specialised Commissioning Team (NWSCT) wants to ensure
that independent patients’ civil advocacy services are made available for all
patients receiving care and treatment as in-patients in low secure services
2.1 Advocacy services for patients are increasingly recognised as being an
essential part of modern health and social care services. This has been
reinforced in statute and policy:
Health and Social Care Act (Department of Health:2001)
Draft Mental Health Bill ( Department of Health: June 2002)
The NHS Plan (Department of Health:2000)
Mental Health National Service Framework (1999)
Independent Specialist advocacy in England and Wales:
Recommendations for Good Practice (Barnes D, Brandon T, Webb T:
June 2002 Department of Health)
3.0 Commissioning of advocacy Services
3.2 This specification focuses on the advocacy requirement for patients in xx
3.3 The advocacy service provider will be expected to provide separate gender
sensitive advocacy services to male and female patients within one overall
3.4 The future advocacy service provider’s contractual relationship will be with
Cheshire West PCT on behalf of all secure services in the North West.
Secure Commissioners will be responsible for monitoring and reviewing the
service, and for negotiating the operational provision of the service.
4.0 The Advocacy Service Provision Context
4.1 The National Service Framework for Mental Health and the NHS Plan clearly
show that civil advocacy services are an essential part of modern mental
health services. This coupled with the statutory requirement for advocacy
proposed in the draft Mental Health Act Bill (June 2002) support NWSCTs
commitment to there being effective civil advocacy available to all patients
receiving secure psychiatric services.
5.0 Service Provider Description
X provides secure mental health services to the populations of X. Care and
treatment is currently provided to a total of X men and X women in a range
of functional clinical areas both within and outside a secure perimeter
fence, to people usually aged between 18 – 65 years. The service provides
inpatient care, and community outreach support for people with a mental
disorder, coupled with a history of offending or related behaviour (mentally
disordered offenders and others with similar needs). The primary aim is to
offer high standards of assessment, care, rehabilitation and treatment for
individuals’ mental health and care needs, and to respond to these needs
and interests while safeguarding service users, staff, public and the
6.0 The Advocacy Service
6.1 NWSCT require that the advocacy service provider for this contract needs to
have at least two years experience of the provision of civil advocacy to people
receiving care and treatment for mental illness. Experience of working in a
secure residential setting is desirable . Any provider who has not worked in a
secure residential setting must demonstrate how they intend to develop this
6.2 The advocacy service provider will make available professional civil advocacy
services at X. This will be a full time service and consist of direct advocacy
service provision to all inpatients (including those on leave and to complete
any advocacy issues of patients who have been discharged) and the design
and delivery of training about advocacy to staff and patients.
6.3 The patients at X will either have been transferred from a High Secure
Hospital or admitted from prison or from local mental health services via
either acute mental health inpatient or PICU services. Some of the patient
group will have been in receipt of advocacy services prior to admission or
6.4 The advocacy service provider will be required to be a properly registered and
regulated company, or a distinct and independently functioning subsidiary.
6.5 The advocacy service will be expected to provide to NWSCT on a quarterly
basis evidence of their advocacy service provision experience to date,
including service reports, financial accounts, policies, procedures and
7.1 The advocacy service will be bound by its own confidentiality policy, which, it
is expected, will be legally accurate. The service’s policy will accommodate
and reflect the need for all case work to be regarded as being confidential
within the advocacy service, and not exclusively to individual advocates.
The advocacy service will also be bound by the confidentiality requirements
set out in the Advocacy Service Engagement Protocol and as such the
advocacy confidentiality policy set out at 7.1 is required to come within this.
8.0 Location of Advocacy Service
8.1 Office accommodation will be provided for the advocacy service on the site at
X. The accommodation will include a secure storage area, where the
advocacy service will be able to safely store case records. Case records and
other patient sensitive information will at no time be permitted to leave the
site. The office will be equipped with telephones, and have facilities for the
installation of computers. The advocacy provider will be responsible for
ongoing maintenance costs.
9.0 Model and Type of Civil Advocacy Service Required
9.1 The advocacy service will provide a service which channels, rather than filters
patients’ views. Their primary commitment must be to supporting service
users in developing towards a position of self-advocacy.
9.2 An advocacy service provider is being sought that can provide a model of
professional civil advocacy that is proactive, by ensuring that each patient is
personally made aware of the availability of the advocacy services on a not
less than six monthly basis. Commissioners would wish advocacy services to
be available to support patients in making reports on their experience of
receiving their care and treatment plans as part of Effective Care Co-
ordination (Department of Health, October 1999). This will be complimented
by a reactive service to referrals by patients, relatives/friends and clinic
staff. It needs to be stressed that the responsive element of the service
must not predominate the proactive elements. A policy for the management of
this is expected to be submitted as part of the service proposal.
9.3 Not all patients will be able to instruct advocacy services. The advocacy
service will have in place policies that address the delivery of advocacy, and
prioritisation of those individual patients who may lack capacity.
9.4 The advocacy service is not expected to provide 24/7 response to requests, or
react to emergency calls. Neither will the advocacy service provide “expert
witness” or be expected to function as “appropriate adults” (Police and
Criminal Evidence Act, 1984).
9.5 It is expected that the advocacy service will take account of the weekly
routines of patients, and not limit itself to providing advocacy solely at the
times that patients would be undertaking work and therapy programmes.
Therefore an ability to work flexibly will be expected and efforts made to see
patients during their free-time on evenings and at weekends.
9.6 It is expected that advocacy will be delivered mainly on an individual basis
with patients. Resources allowing, the advocacy service will be available to
support patients’ individual expression within group meetings or other
collectives such as ward based community meetings. and will be expected to
chair the ward user forums and the site user forum.
9.7 The advocacy service will set out a clear process for monitoring collective
concerns and will agree a protocol for dealing with collective issues. The work
to develop this protocol will be facilitated by the NWSCT and is expected to be
in place within two months of the commencement of the service.
9.8 The advocacy service will be expected to provide advocacy training to both
staff and patients on a not less than annual basis. The advocacy service will
be required to maintain records of training given and numbers of
staff/patients who have attended. The training will cover both general
awareness raising about advocacy, as well as specific training about the
particular service/s available, utilising suitably anonymised case work
9.9 NWSCT are commissioning advocacy services to ensure that all patients will
have access to professional advocacy support. This will not prevent
individual patients from making their own arrangements for civil advocacy
support. To assist patients in having a choice, the advocacy service will
update and maintain a library resource of other known advocacy services,
concentrating on those that support people with particular
9.10 The advocacy provider will give consideration to the diverse range of abilities
amongst the patient population. It is expected that the advocacy service, in
liaison with a designated senior manager who will identify areas where
advocacy development work is needed to enable individual patient’s growth
9.11 The advocacy service will have a contractual obligation to become accredited
as an Independent Mental Health Act Advocacy Service (Mental Health Act
bill June 2002) at such a time as this becomes necessary and when
practicable to do so.
9.12 The advocacy service will have or be working towards achieving the
Community Legal Services Quality Mark.
10.0 Issue Resolution/Complaints
10.1 Issues raised with the advocacy service by patients can most effectively be
resolved at a local level through informal negotiation with the individuals
directly concerned. Advocacy has a very important role in supporting
patients in achieving this. A complaint emerges if the patient is unhappy
with the outcome of this process and wishes to take the matter further,
verbally or in writing. Patients may seek advocacy support to do so.
10.2 Evidence of understanding and practice consistent with 10.1 and 10.2 is
expected to be detailed in the submission accompanying the service proposal.
11.0 Advocates’ Competencies/skills
11.1 It is expected that all advocates will be skilled and competent for the task,
and will be willing to undertake further training and development. The
advocacy service provider will be fully aware of current best practice in skills
and competencies for professional civil advocates outlined in the
“Independent Specialist advocacy In England and Wales: Recommendations
for Good Practice” (Barnes D, Brandon T & Webb T June 2002: Department
11.2 The Advocacy Service Provider should note that all advocacy staff working at
X will have to undertake their induction training and annual refreshments in
health, safety, security, and other areas as deemed necessary in order to
work safely within a secure healthcare setting as detailed in the Advocacy
Services Engagement Protocol. (See also Section 14 below)
12.0 Patient involvement and Feedback
12.1 The advocacy service will be required to show evidence of having taken
account of patients’ views about the service, particularly in respect of
accessibility and impact. The advocacy service provider will be expected to
negotiate with the NWSCT and X on the methods to be used to obtain this
feedback. Advocacy service proposals will be required to set out their plans
for ensuring this requirement is met.
12.2 Part of any service proposal submitted needs to describe how service user
views will be gained and used.
13.0 Delivery of the Advocacy Service
13.1 A draft protocol for establishing the way in which advocacy services will be
delivered will be agreed between the NWSCT and X within two months of the
commencement of service. It is envisaged that the advocacy services will be
accountable for operating at all times within this protocol and will participate
in an annual review of it within the quarter 3 contract monitoring meeting.
Once a protocol has been agreed then any breach of its terms and conditions
will be regarded as a breach of contract and will be subject to immediate
review by the NWSCT, which could result in the withdrawal or suspension of
the advocacy service.
14.0 Supervision & Performance Appraisal
14.1 Supervision and advocates’ professional development is seen as an essential
component of the service. The advocacy service provider will be expected to
hold regular, not less than monthly team meetings at which casework is
shared and discussed. This will be seen as a critical activity ensuring quality
and consistency of service provision. NWSCT will be paying particular
attention to ensuring that this happens.
14.2 Each advocate will receive not less than monthly individual management
supervision with their line manager.
14.3 The service will be expected to retain the services of an external group
supervisor to facilitate monthly/individual group supervision sessions for
members of the advocacy service.
14.4 Each advocate will have a personal/professional development plan that is
assessed, implemented, and evaluated on an annual cyclical basis.
14.5 Reporting on the delivery of supervision, uptake by advocates and the
generation of individual personal development plans will form part of the
reporting requirement to NWSCT.
14.6 The advocacy service provider will describe their practices around staff
training and appraisal.
15.0 Advocacy Service Staffing Profile
15.1 The advocacy service at X will consist of X dedicated advocacy
15.2 The advocacy service provider will be expected to make every reasonable effort
to ensure that the makeup of the advocacy service staffing closely reflects the
ethnic diversity and gender split of the patient population.
15.3 However, it is recognised that the advocacy service will not be able to employ
a sufficient number of advocates to meet the range of requests for advocates
from specific ethnic, religious and other groups. Therefore it is expected that
links will be built with other specialist advocacy services across the North
West region, to increase the choice of support that can be made available to
When recruiting staff the advocacy service provider will ensure that it takes
into account the range of communications skills and abilities of the patient
population. This will ensure that no patient is excluded from accessing the
advocacy service. The advocacy service may be required to have access to
signers and language interpreters, and have information available in other
forms than just written English.
16.0 Case Records and Case Record Storage
16.1 The advocacy service will be required to keep comprehensive records of client
contact. Record keeping should focus on enabling quantitative and
qualitative analysis, and on producing a record, which is open and accessible
to service users. It is expected that the advocacy provider will produce and
operate to a policy that accommodates these requirements and reflects that in
limited circumstance these case records may be subpoenaed by the courts.
16.2 The advocacy service will have policies and procedures for making and
maintaining records of engagements with patients. The policies and
procedures will be expected to detail standards for recording patient
information, internal audit and quality monitoring, storage, cataloguing,
archiving, and destruction. There will be a procedure for handling and
storage of third party information.
16.3 The advocacy service provider will be expected to keep records about all
advocacy awareness training sessions delivered and noting attendees.
These records will form the basis for reports as required below in Section
17.0 Service outcomes and Quality Monitoring
17.1 All service outcomes will be derived from, and related to the overall service
aim of ensuring advocacy is provided to support patients in making known
their wants, views and experiences arising from the receipt of care and
treatment, within the context of supporting growth to self-advocacy for all
17.2 All patients will be made aware of the advocacy service and offered support
on not less than three monthly basis. One of these occasions will precede
the patients “Effective Care Co-ordination” (Department of Health, 1999)
review. Sufficient time will be allowed for the submission of a report by the
patient, supported by advocacy on their experience of the receipt of the
planned for care and treatment.
17.3 All ward based staff, other clinical team members, and service managers will
be offered advocacy awareness training on no less than a six monthly basis.
The service provider is to describe how they will meet this, providing
supporting evidence of previous experience.
17.4 The advocacy provider will be expected to be committed to reflective and
evolving practice. Evidence of this will be demonstrated through the service
having an ongoing programme of audit of service delivery, through which
service deficits are identified and plans are set into place to address them.
This will lead to the service having a regularly reviewed development plan.
17.5 NWSCT will regularly monitor the quality of advocacy service provision. The
findings that will be made known at the quarterly review meetings and
formally presented in advance of the annual review.
17.6 Quality monitoring will be based on reports submitted to NWSCT by the
advocacy provider. Monitoring should include patient feedback and random
sampling of advocacy case work encompassing interviews with advocates,
17.7 NWSCT will initially discuss the findings of its quality monitoring with the
advocacy service provider, and X as specified in the advocacy engagement
17.8 NWSCT will expect to be informed about pre-planned staff/patients
advocacy awareness training sessions and will reserve the right to attend
18.0 Managing the Advocacy Service Provision
18.1 As stated above the advocacy service will be directly accountable for its
operations and performance against the specification and contract to the
NWSCT. The contract and service will be subject to annual review. In
advance of annual review, the advocacy service provider will be expected to
provide an annual report covering:
A quantification and description of the activities of the last year
a summary of the issues raised by patients
evidence of, and reflection on service achievements
report of annual accounts
This annual report will need to be presented in such a way that it is fit to be
circulated to patients, and other interested parties.
18.2 The annual report process will include formal discussion of the report
between NWSCT, X and the advocacy service provider. Once agreed, the
report will be formally presented to the North West Catchment Group.
18.3 In addition to the formal annual report, quarterly meetings will be held
between NWSCT, X and the advocacy service provider. There will be a
standing agenda for these meetings and the advocacy service provider will
be expected to provide progress and state of service reports.
18.4 NWSCT will encourage the advocacy service provider manager and
the service senior manager to meet on a regular basis (monthly) to discuss
operational issues and to raise issues on behalf of patients.
19.1 NWSCT would expect that the majority of issues arising from operational
practice will first be addressed through the regular meetings held between
the advocacy service manager and the service senior manager. Where
matters are found to be irresolvable via this method, NWSCT expect that
these will immediately be bought to their attention by either party, and
preferably both. If resolution then cannot be achieved, NWSCT will appoint
an independent person/body to investigate and arbitrate.
19.2 NWSCT does not see that it has a role in arbitrating on individual patient
issues unless they specifically come within commissioning core
responsibilities. For patients whose services are commissioned by other
NHS / Local Authority agencies, NWSCT will act as the first point of contact
for the advocacy service provider, and facilitate their contact with the
appropriate commissioner thereafter.
20.0 Contract terms
21.1 The contract will be awarded to the successful provider for an initial one year
period, subject to satisfactory performance and compliance with terms and
conditions as set out in the specification and contract. It will be possible for
the resourcing of the advocacy service to be re-considered on an annual basis
as part of the formal annual review process.
21.0 NWSCT Resource
22.1 To enable the delivery of the independent advocacy service NWSCT have
identified annual revenue of xxxx (exc. VAT), payable quarterly in advance.