SPECIALIST ADVOCACY SERVICES IN NORFOLK

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1 SPECIALIST ADVOCACY SERVICES IN NORFOLK Independent Mental Health Advocacy Independent Mental Capacity Advocacy Relevant Persons Paid Representative Service Annual Report

2 Introduction This annual report provides an overview and activity levels of the first year of the Independent Mental Capacity, Paid Persons Representative and Independent Mental Health Advocacy Services provide by POhWER Norfolk in partnership with Equal Lives. The service is commissioned by Norfolk County Council to provide specialist Independent Mental Capacity Advocacy (IMCA), Independent Mental Health Advocacy (IMHA) and a Relevant Person s Paid Representative (RPPR) Service. These services are provided for vulnerable adults in line with the requirements of the Mental Capacity Code of Practice and the Mental Health Code of Practice. Our teams of advocates work across the county in a number of different settings to ensure that people in our society who experience disability, vulnerability, distress and social exclusion are provided with information, advice, support and advocacy. In this report we have benchmarked referral to our services against services in other areas. In terms of our IMHA service in Norfolk, we are on a par with referral levels in other areas and expect an increase in demand of approximately 10% per year. However, in relation to IMCA, referrals are well below what we would expect to see. Currently referrals in Norfolk are 26 per 100,000 where we would expect referral rates to be around 60 per 100,000 when compared with other areas. Given the demographic profile of Norfolk a much older population, higher incidences of dementia and a significant number of care homes in the county referral rates should be even higher, possibly closer to 100 per 100,000 population. We would like to receive more referrals for our IMCA service and are providing training for NHS staff on the Mental Capacity Act. This will help them to understand when and how to make referrals. We would be happy to provide training to other professionals or organisations if this would be helpful. We can also provide leaflets, posters and other materials to help explain the services we offer in more detail. If you would be interested in either the training or information materials, please contact POhWER our contact details are on the back page of this report. 1

3 [advocate] supported me at a ward round. He gave me constructive support, he didn t take over and gave me the choice about how I was supported. Now I am actually getting a psychologist and have a discharge date. I feel more confident about speaking up for myself now because of advocacy. Thank you (Client) We were very impressed with the attendance and thereafter the report for [client] by [advocate]. It was very detailed and comprehensive. This report was very helpful in the Hospital Managers Meeting (professional) 2

4 Independent Mental Capacity Advocacy (IMCA) The purpose of the IMCA service is to help particularly vulnerable people who lack the capacity to make important decisions about serious medical treatment and changes of accommodation and who have no family or friends that it would be appropriate to consult about those decisions. IMCAs will work with and support people who lack capacity and represent their views to those who are working out their best interests. The advocate is: independent of the person making the decision provides support for the person who lacks capacity represents the person without capacity in discussions to work out whether the proposed decision is in the person s best interests provides information to help work out what is in the person s best interests and raise questions or challenge decisions which appear not to be in the best interests of the person. In , we received 180 eligible IMCA instructions. These covered a range of issues including accommodation, serious medical treatment, Paid Person s Rep and Deprivation of Liberty Safeguards 39A. Most of our instructions were made by social workers, local authorities or health staff in organisations such as Norfolk and Norwich University Hospital, Little Plumstead, Hellesdon Hospital and the Community Learning Disability Teams in West and South Norfolk. Type of instruction Total Accommodation 60 Additional Advocacy 1 Serious Medical Treatment 28 Safeguarding 17 Care Reviews 9 Paid Person's Rep (Not 39C) 32 Deprivation of Liberty Safeguards 39A 24 Deprivation of Liberty Safeguards 39C 2 Deprivation of Liberty Safeguards 39D 7 TOTAL 180 Our referral rates for IMCA are lower than in other counties across England. In Norfolk, referrals are currently 26 per 100,00 compared with 45 per 100,000 in 3

5 Nottinghamshire, 70 per 100,000 in East Sussex and 104 per 100,000 in Hertfordshire. Jack (not his real name) was an old 70yr old man who was unable to communicate through formal communication methods and suffered from severe curvature of the spine. He had been admitted into hospital following sudden weight loss and vomiting and was diagnosed with a hiatus hernia. As Jack was unable to communicate and had no family or friends to represent his wishes, the IMCA service received a serious medical treatment referral. As Jack had other co-morbidities, the operation to remove the hernia was deemed to be very high risk, with a high likelihood of death. To try and find out what Jack would have wished, the advocate spoke to his doctor, carers, dieticians and nurses. She found out that Jack would be happier at home in a quieter and more familiar environment. His quality of life was very important to him and by returning home, he would be given small amounts of time doing various activities and he would have access to his sensory equipment that he enjoyed. The advocate also found out that Jack would have become distressed at having surgery. He would have needed to be an inpatient for longer and one nurse told the advocate he is really tired of being here. There were also ethical concerns regarding another operation, given the high risk of death. At the best interest meeting, it was decided that surgery was not an option and Jack would not have been happy with a feeding tube in his nose. Jack s carers had told our advocate that Jack would wipe or pull out anything in his nasal passages. Based on everything our advocate had learnt from talking to those closest to Jack, it was decided that he would be discharged home to receive palliative care. Our advocate was able to ensure that a Fast Track Continuing Health Care assessment was in place. She also supported the carers in making sure that everything would be in place for them to give the client the best possible care at home and for him to enjoy his life with dignity and respect. Without representation from our advocate, Jack may have remained in hospital with a nasal tube to feed him. By talking to those who knew him best from a variety of professional backgrounds, we were able to build up a picture of Jack s requirements that allowed Jack to have a better quality of life in the time that remained to him. 4

6 Here is some of the feedback we have received about our IMCA service from professionals: Just some feedback for [advocate] on the X case we worked on. She has been a great source of information and help and has been professional and forthcoming with opinions. As always, it is nice to work with [advocate]. She looks at what is best for the person and communicates well to all involved. Contact was excellent. Commitment to client and her needs was outstanding [Advocate] was able to identify people to consult which family had previously denied. Her assessments are thorough Advocate was informed, professional and prompt Good response time and good support for me as I am not familiar with such procedures (being a new worker). The IMCA was able to take time to explain to me the involvement of the IMCA and the relevant law in relation to interventions. Good use of Human Rights legislation with examples used from the customer s perspective. 5

7 Independent Mental Health Advocacy (IMHA) Access to an IMHA is a statutory right for people detained under most sections of the Mental Health Act, subject to Guardianship or on a community treatment order (CTO). IMHAs are independent of mental health services and can help people get their opinions heard and make sure they know their rights under the law. IMHA can make a big difference to people s experience of detention and are highly valued by people who use services. In , we received 483 referrals, almost half from professional sources and a similar number who were qualifying patients. Of those who were qualifying patients, most were in hospital, detained under section 3 of the Mental Health Act. Most of our clients were aged between18-65 with 19 clients aged 16 or 17. We completed 491 IMHA cases across the year. Our clients were supported in a variety of locations across the county. One in three clients were from Cawston Park and one in five from Hellesdon Hospital. Other hospitals where we provided the IMHA service were Little Plumstead, Julian Hospital, Queen Elizabeth Hospital and Northgate Hospital. Referrals for the IMHA service in Norfolk are on a par with the referral levels in other local authorities. Rates in Norfolk are 65 referrals per 100,000 with referrals in other areas between 55 and 70 per 100,000. Our advocate first met Tom (not his real name) at a drop in on an acute ward and a referral was made to our service by staff at his request. Tom was in the hospital under Section 2 he was detained in hospital for an assessment of his mental health and to get the treatment he needed. Tom was very nervous in the hospital as he had been attacked on a previous ward by a patient. The staff were working with him to build up his confidence, following the attack but he was very worried about meeting the patient or further attacks. He was also unaware of his rights and what he was entitled to. Our advocate worked with Tom, face to face, spending time with him to gain his confidence and understand what he wanted. She talked with Tom about the work he had done previously and his aspirations for the future. She also discussed with him about recovery hub courses which were available to Tom. He was very interested in talking to employment specialists and attending the courses so our advocate spoke with the nurse who agreed to ask the CMHT to make a referral to employment specialists and to look into the recovery hub courses on Tom s behalf. The advocate also worked with Tom to build his confidence and feel more empowered. As a result, Tom was also able to represent himself at a review meeting which he felt had gone well and they had discussed lifting the section 2 that day. 6

8 Thank you for your support. I found it useful and it was helpful to have some on my side. I managed to keep my cool throughout. I felt the meeting had gone much better than I had planned for and I had decided I wasn t going to go unless I could have you to support me [Advocate] supported me at a ward round. He gave me constructive support, he didn t take over and gave me the choice about how I was supported. Now I am actually getting a psychologist and have a discharge date. I feel more confident about speaking up for myself now because of advocacy. Thank you I was given very constructive and helpful advice. I would have liked the in-hospital service to have continued outside when discharged. A very special thank you to [advocate] for the kind but firm help and observations he made. God bless! Friendly, personable and professional. I had confidence in my advocates that s not easy to get from me!!. 7

9 Relevant Person s Paid Representative Service (RPPR) Paid Representatives are qualified advocates who have specialist knowledge of the Mental Capacity Act and Deprivation of Liberty Safeguards legislation. The Paid Representative's role is to: Visit the person deprived of their liberty on a regular basis Assist the person to understand their Deprivation of Liberty Safeguards (DoLS) authorisation and how it affects them As far as possible, assist the person to exercise their rights should they wish to do so Ensure any conditions attached to the authorisation are met and if not facilitate the address of this or refer it back to the supervisory body / DoLS team Call for a review of the authorisation where necessary, challenge the authorisation through local means where possible or ultimately refer the case to the Court of Protection Our Paid Representatives are independent from the care home or hospital as well as the Local Authority and Supervisory Body / DoLS team. The service is available to a range of service users including people with learning disabilities, dementia, acquired brain injury, mental health issues and other needs which lead to a lack of mental capacity. This also includes people with complex communication needs. Last year we received 32 eligible RPPR cases and concluded 18 cases. Some cases were withdrawn as the client was relocated out of area or discharged to their home address within days of allocation. Other cases are still on-going as the DoLS is still in place. 8

10 Registered Charity Number Company Number How to contact us: telephone (charged at local rate) minicom text - send the word pohwer with your name and number to pohwer@pohwer.net Skype - pohwer.advocacy (8am to 6pm Monday to Friday) fax post post PO Box 14043, Birmingham B6 9BL website - Our support centre is open Monday to Friday from 8am 6pm. Access to information We provide leaflets and information in a variety of languages and formats, Easy Read, audio and DVDs We have access to translation and interpreting services We use communication toolkits, Makaton and other signing techniques 9