Growing reliance on voluntary sector health advocates working with vulnerable groups must be balanced with funding and support

The government is increasingly reliant on voluntary sector advocacy organisations to help disadvantaged individuals access the health information and services they need but the lack of a strategic approach is leading to patchy and disjointed provision, argues a research report from The King's Fund published today.

Building Bridges for Health: Exploring the potential of advocacy in London points to several pieces of recent legislation and new initiatives that task statutory bodies with ensuring access to advocacy services, including:

  • The draft Mental Health Bill 2004 proposes that all patients subject to compulsory mental health orders should have independent advocacy available to them.
  • The Valuing People white paper stresses that people with learning disabilities should be able to access advocacy support.
  • The Independent Complaints and Advocacy Service was created as part of the 2004 Health and Social Care Act and gives contracts to organisations such as the Citizens Advice Bureau. All users of health services on a regional basis have access.
  • The Choosing Health public health white paper introduces the concept of accredited community based 'health trainers' to help individuals to change their behaviour and lead healthier lives.

Advocates can help people who have trouble communicating their needs because of disability, mental illness or language problems, or because they are very young or an older person. They can meet housing needs, find a support group or act as an intermediary in communicating with medical professionals. Yet advocacy services have developed in an ad hoc way - the majority of the 450-500 projects identified in London alone by The King's Fund research are specific to particular client groups and have grown out of local need. Some areas have high levels of provision, while others have little or none. The research also found that there is a lack of awareness and identity for advocacy services, that most advocacy projects are unstable because of inadequate and unreliable funding, and that both training and quality standards are under-developed.

Report author Baljinder Heer said:

'Advocates have been seen as an invisible workforce, they work behind the scenes in the most deprived areas with the most disadvantaged people. Yet they can often be the only link between the individual, health and social services and information. Their potential for improving health and wellbeing is enormous and yet there is little recognition or proper support for their work from statutory services.'

The King's Fund chief executive Niall Dickson said:

'Government is showing an increasing interest in health advocacy and that should be welcomed. But some advocacy organisations are wary that linking up with statutory services could jeopardise their links to the communities they serve. We need to consider the big picture to find the best way ahead.'

Building Bridges for Health recommendations include:

  • Developing a strategic approach across England to ensure that various Government policies on advocacy are consistent and coherent. This could be achieved by having one piece of legislation that gives a right to independent advocacy for all vulnerable groups, as is the case in Scotland.
  • Local advocacy plans to be drawn up by local authorities and primary care trusts in consultation with advocacy organisations and other stakeholders, to ensure equity of access, appropriate specialisation and adequate funding.
  • Exploring the best way of protecting individuals and making advocates accountable for their actions through the possible use of standard setting and evaluation. 

The King's Fund research included an extensive literature review, document analysis, an exploratory questionnaire to advocacy providers in London, 32 semi-structured interviews with key stakeholders, and focus groups with a range of community leaders. In addition to pulling together lessons from the research, Building Bridges for Health provides an overview of the policy environment and includes an appendix of useful contacts.

Read the report: Building Bridges for health: Exploring the potential of advocacy in London

Notes to editors: 

1. Building Bridges for Health: Exploring the potential of advocacy in London by Baljinder Heer can be downloaded free of charge from our online bookshop.

2. For interviews with the author, with advocacy organisations which have contributed to the research for this report, or further press information please contact Beverley Cohen on 020 7307 2632.

3. The King's Fund is an independent charitable foundation working for better health, especially in London. We carry out research, policy analysis and development activities, working on our own, in partnerships, and through grants. We are a major resource to people working in health, offering leadership and education courses; seminars and workshops; publications; information and library services; and conference and meeting facilities.