SECTION 3 SPECIFICATION

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1 SECTION 3 SPECIFICATION Report No: 244/ Background Prior to the Health and Social Care Act 2012, the provision of independent advocacy for National Health Service (NHS) complaints was a legal requirement for the Secretary of State for Health under section 248(1) of the National Health Service Act 2006: The Secretary of State must arrange, to such extent as he considers necessary to meet all reasonable requirements, for the provision of independent advocacy services. This statutory service was launched on 1 September 2003 and provided for the first time a national free at point of delivery advocacy service to patients using NHS funded services. Within the meaning of the Act, advocacy services relate only to the provision of assistance for individuals making or intending to make an NHS complaint (which includes a complaint to the Health Service Ombudsman). Within adult social care, local authorities are currently, expected to make complaints advocacy services available if needed, but availability is a matter of local discretion and decision; there is no statutory requirement. The Department of Health (DH) on behalf of the Secretary of State for Health, currently commissions these services directly from Independent Complaints Advocacy providers. The current provider for the East Midlands Region is The Carers Federation. The DH has responsibility for the management of contracts, and the quality of service provided. From 1 April 2013, The Health and Social Care Act 2012 transfers responsibility for delivery of an NHS Independent Complaints Advocacy Service (NHS ICAS) to local authorities. Derby City Council is collaborating with a number of other local authorities (ICAS partnership) in the East Midlands region to procure a Service Provider to deliver ICAS (authorities as indentified in 3.4). 3.2 The Current NHS Complaints Process If an individual wishes to make a complaint about an NHS service, they should make it through the National Health Service (NHS) complaint system. This process is detailed in the Local Authority Social Services and National Health Service Complaints (England) Regulations 2009 and all NHS providers and commissioners of NHS services must comply with it. NHS organisations known in the regulations as responsible bodies must make information available to the public as

2 to its arrangements for dealing with complaints and how further information about these arrangements may be obtained. Therefore, a local hospital, trust or GP Practice should have available a copy of their complaints procedure, which should explain how to proceed. On-line information in respect of the NHS complaints system may also be found at the NHS Choices website. Briefly the process is as follows. The complainants first step will normally be to raise the matter (in writing or by speaking to them) with the practitioner, e.g. the nurse or doctor concerned, or with the organisation. Each organisation should have a complaints manager to deal with the case. This process is known as local resolution and most complaints are resolved at the local stage. There is a time limit of 12 months in which the complaint must be made. This starts from the date of the incident being complained about, came to the attention of the complainant. If individuals need assistance in making a complaint, officers from the Patient Advice and Liaison Service (PALS) are available in all hospitals. They offer confidential advice, support and information on health-related matters to patients, their families and their carers. Additionally, assistance can also be provided by the Independent Complaints Advocacy Service (ICAS). This is a nationwide service that supports people who wish to make a complaint about their NHS care or treatment. If the complainant is unhappy with the ICAS outcome at local level, a complainant can refer the matter to the Parliamentary and Health Service Ombudsman who is independent of the NHS and Government but they must have gone through the local complaints processes first. 3.3 Scope of Contract The Scope of Contract is to provide an Independent Complaints Advocacy Service (ICAS) for the East Midlands region. For this purpose, the East Midlands region is defined as comprising of the following authorities (defined as the ICAS partnership ): Derby City (lead Member) Derbyshire County Leicester City Leicestershire County Lincolnshire County Borough of Milton Keynes Rutland County Independent advocacy service relates only to the provision of assistance for individuals making or intending to make an NHS

3 complaint. This includes any complaint against an organisation or service where the treatment is funded by the NHS. Derby City Council is the lead member in the ICAS partnership and will be the main point of contact for this Contract. However, the Provider may be required to liaise directly with other authorities on an operational basis as required Service Principles The Provider will ensure that the ICAS delivered promotes: improved health and wellbeing; independence; personalisation The ICAS will meet diverse needs, be socially inclusive and safeguard vulnerable adults. The ICAS will be underpinned by the values of self-management, individual choice and control, care and support closest to home, working and learning together. The ICAS will support the following principles, which are based on Action for Advocacy s Quality Standards for Advocacy Schemes: Independence - ICAS is not tied to, or controlled by the NHS, enabling ICAS to work solely on behalf of its clients Empowerment - ICAS empowers people by: o Providing them with information, enabling them to decide whether or not they wish to pursue a complaint about the NHS; and o Where needed, by providing an advocate to support them in pursuing their complaint. Impartiality and objectivity ICAS advocates will behave in a manner that is objective and impartial at all times. Diversity and inclusion - ICAS respects the diversity of clients and provides support appropriate to the needs of the client by: o Ensuring support is accessible at the point of contact to all, both in terms of the physical environment where it is delivered and the mode of communication used.

4 o Providing appropriate services and materials for those clients who do not have English as their first language. Accessibility: The service shall be accessible by a number of means to people from local communities. Confidentiality: ICAS treats all interactions between clients as confidential, in line with ICAS provider s confidentiality policies. Accountability: ICAS is accountable to individuals for the support provided to individuals and the advice offered. Professionalism: The Service shall conduct its business in a professional manner at all times and ensure it maintains the highest standards of public service Who the Service is for The Provider will provide ICAS across the authorities identified in section 3.4. The Service will support any adult in their own right or on behalf of a child, family member or carer with a complaint about an NHS funded service that are in need of NHS complaints advocacy and who is ordinarily resident in: Derby City Derbyshire County Leicester City Leicestershire County Lincolnshire County Borough of Milton Keynes Rutland County Information about current volumes of service for these areas can be found at the link below. /journal_content/56/10171/ /article-template Outcomes The ICAS provided will: support and empower service users to achieve a resolution to their NHS complaint.

5 support the process of Local Resolution (service users and NHS staff work together to resolve complaints at a point as close as possible to the point of service that has caused dissatisfaction) The Provider will maximise the number of service users who are able to access advocacy by: 3.4 Service Description Service Delivery o Making the service available in a number of ways (see section 3.8) including outreach into localities) o Raise knowledge and awareness of the service amongst the general public o Create partnerships with local Healthwatch and PALS organisations ensuring intelligence and information sharing arrangements are in place. o Publicise volumes of complaints and the numbers resolved. The Provider will deliver a NHS Independent Complaints Advocacy Service (ICAS) across the authorities identified in 3.4. This will include, but not be limited to: delivering support to service users including (but not limited to): o provision of self-help information; o the assignment of dedicated advocates to assist service users with letter writing, form filling etc; o attendance at meetings. ensuring service users have access to the support they need to articulate their concerns and navigate the NHS complaints system; ensuring staff have the required advocacy skills to provide practical support and direction to service users, in order to assist them in finding a resolution to their complaint; providing contact at each of the following points or activities in the NHS complaints procedure, by: o Identifying what the available options and possible outcomes are, and deciding which option to take; o Making the complaint to the appropriate Trust(s); o Deciding how to proceed with the complaint, following the Trusts initial response;

6 o Supporting clients during the local resolution phase by attending meetings or entering into correspondence; o Making a complaint to the care quality commission; o Supporting the Independent Review stage by attending meetings or entering into correspondence; o Making a complaint to the Health Service Ombudsman; o Understanding the Health Service Ombudsman s final decision; supporting service users with a grievance related to any aspect of healthcare that falls under the jurisdiction of the Health Service Ombudsman, such as complaints about poor treatment or service provided through the NHS in England. The Provider is not required to provide on-going advocacy for clients outside of the health related complaint. However, they will be required to suggest appropriate referrals for service users who require alternative, additional or specialist support. This may include referrals to PALS, professional bodies such as the GMC and to specialist support such as medico-legal advice, bereavement support, mental health support, etc Access and availability of services The Provider will ensure Service Users can directly access the ICAS. Referrals will also be accepted from statutory and other service providers and from Service Users carers, family, friends and significant others. When a Service User accesses the ICAS, the Provider will operate an initial assessment of the Service User s needs. The staff performing this function will be trained to a level that enables them to address initial queries, service eligibility, assess advocacy needs and refer service users to the appropriate advocate or other service as required. Where a service user would not benefit from the ICAS, the Provider will signpost the person to more appropriate service(s) or community facilities. The Provider will ensure access of the ICAS service through a variety of methods to include (but not limited to): Telephony, postal and The Provider will have a direct telephone/referral line in place for Service Users to access the ICAS. A postal and address should be available to Service Users for written communication.

7 The Provider will ensure access to translation and interpretation services is available for Service Users without English as their first language. Online access The Provider will provide access to the ICAS via the internet and by the use of tools such as online contact forms, ensuring compliance with statutory requirements. Any website used should: be easy to navigate using a variety of navigation methods and a comprehensive search have a clean design that focuses on content, using plain backgrounds for all text highlight sub-sections of pages using a consistent method of headings and sub-headings have standard layouts for content pages and promotional pages avoid jargon - or explains jargon when it needs to be used have concise paragraphs for ease of reading use 'Contents' sections for all longer pages use colour in a way that does not make it difficult for customers with colour-blindness, and other sight impairments, to read. use alternate text for all content images to allow screen readers to present this information. Alternate texts are not used where it is not necessary, for example, on decorative or layout images ensure all links are presented using meaningful text that makes sense when read on their own. Face to Face The Service Provider will have offices/bases from which they can deliver the ICAS Service to Service Users face to face. The offices/bases used must ensure coverage to Service Users across the authorities identified in 3.4. The offices/bases used must comply with the Equality Act 2010 and any other similar legal requirements. Outreach

8 3.4.3 Systems Report No: 244/2012 The Provider will provide ICAS services in local community based settings. The Service Provider will be responsible for any rental or hire fees incurred in the use of these settings. The settings used must comply with the Equality Act 2010 and any other similar legal requirements. Service users in secure environments The Provider will ensure access to ICAS by service users in secure environments (such as prisons, secure units etc). The Provider will have an appropriate case management system in place to record, track and monitor advocacy cases Marketing of the ICAS service and provision of information The Provider will develop and implement a marketing plan to promote the service to Service Users across the authorities. The Provider will be responsible for developing and distributing all marketing material for the service. The Provider will publish Information about the service in a range of formats such as the internet, leaflets etc. Such information should be suitable for a range of service users and include, as a minimum: information about the range of support provided, who the service is for how to access the service opening times and contact details. The Provider will make all information available in accessible formats as required Demand Management The Provider will agree response and service commencement targets and any waiting list criteria with the ICAS Partnership prior to Service commencement. The Provider will keep Service Users informed of any delay in response times and give a clear idea of how long they will have to wait to access a service. The Provider will identify outcome-focussed goals with every service user and timescales for completion, against which the service delivery can be reviewed. Due to the change to local commissioning of the service and introduction of local Healthwatch organisations, it is anticipated that this

9 may lead to increases in demand over the duration of the contract. Demand management and caseload weighting will form part of the regular contract monitoring arrangements. Details of the current levels of demand for ICAS can be found in section Leaving the Service The Provider will end the services provided to Service Users through consultation with them and, in most cases, in agreement with them. The service should routinely capture the service user s experience of the service at point of exit Charges The Provider will not charge service users for the advocacy services provided under this contract. The ICAS will deliver a free, independent, professional support service to clients wishing to pursue a formal complaint against the NHS Relationship building The Provider will build and maintain relationships with local Healthwatch and PALS organisations in the region, ensuring intelligence and information sharing arrangements are agreed and in place. As a minimum, the Provider will share any apparent emerging health service quality issues with the local Healthwatch organisations that may have transpired from the nature of complaints taken forward. 3.5 Management and Staffing The service provider will ensure that adequate management arrangements are in place to ensure delivery of the ICAS including, but not limited to professional supervision where required; regular staff supervision; annual performance appraisals for all staff; adequate out-of-hours and/or lone working arrangements TUPE The Transfer of Undertakings (Protection of Employment) Regulations 2006 (TUPE) will operate to transfer staff employed by The Carers Federation (the current contracted provider of ICAS).

10 Under TUPE, when a work or business changes hands from one employer to another the principal terms of employees rights are protected. The regulations are designed to protect the rights of employees in a transfer situation enabling them to enjoy the same formal terms and conditions, with continuity of employment. This means that employees employed by the previous employer (the transferor ) when the transfer takes effect automatically become employees of the new employer (the transferee ) on the same terms and conditions. The TUPE regulations provide limited opportunities for the transferee or transferor to vary with the agreement of the employee concerned, the terms and conditions of employment contracts. Harmonisation of terms and conditions of employment is not lawful. The Provider must abide by TUPE regulations and all statutory regulations and guidance governing transfers of staff. In relation to employees that transfer through the operation of TUPE, the Provider is required to provide continued access to pension arrangements for those employees that are currently members of LGPS. That provision may be through the Provider applying for admitted body status to LGPS or by offering access to a Provider scheme which, inter alia, is certified by the Government Actuary's Department as being broadly comparable with LGPS. The Provider is liable for the following principal terms of employment for each member of staff who will transfer under TUPE: Probationary period if any Retirement age Pension arrangements Periods of notice Current pay agreements Any agreed pay settlements yet to come into effect Working hours Annual leave entitlements Sick leave arrangements Maternity/paternity leave arrangements Special leave arrangements Terms and conditions of transfers Any relevant collective agreement Facility time and facilities provided for trade union officials and Health and Safety representatives Staffing During the Contract the Provider will: employ sufficient, appropriately trained, qualified, experienced and supervised staff to ensure that service

11 delivery is maintained at a level consistent with this specification and complies with its obligations under the contract; ensure that staff have access to continuous professional development opportunities and are suitable for and properly prepared for the tasks that they undertake; ensure that organisational and contractual objectives are reflected in team and individual staff objectives and monitored accordingly; take proactive steps to attract and employ staff from diverse backgrounds to reflect the demography of the region and the clients for which the service is being provided. Ensure all relevant staff have CRB clearance Ensure staff promote independence, dignity and quality of life for service users Ensure 100% advocates have generalist skills Ensure that at least 25% advocates are able to offer specialist knowledge or skills that would allow them to support clients with more complex needs, such as those suffering with mental health problems, those with learning disabilities, communication difficulties, sight or hearing impairment, residing in a prison or clients without English as their first language. Support Service Users in secure environments Ensure that advocates have access to professional medico-legal support if required Training requirements The Provider will be expected to provide all staff members with: Job description and person specifications for their role; an Induction programme; individual training plan linked to an annual personal development plan;

12 training programmes that are in line with legislative requirements; training on identifying issues and making appropriate referrals in line with national and local policies in relation to Safeguarding of Vulnerable Adults Advocates will be expected to: be qualified to at least Level 3 Certificate in Independent Advocacy or to be working towards this qualification within the first six months of service delivery; 3.6 Record keeping and governance Keeping Records The Provider will ensure that accurate records are kept of all interactions with service users or service user representatives; store records securely to ensure the confidentiality of the service user relationship; ensure that service users have access to their records upon request; comply with the requirements of the Data Protection Act Governance The Provider should have in place an appropriately qualified and experienced management structure, supported by the wider organisation. Where services are provided by a voluntary or not-for-profit organisation, they should have an overall management committee which: Is duly elected according to the governing documents; Has representation of service users; Oversees the sound financial management of ICAS; and Ensures the organisation adheres to charity and company law.

13 3.7 Performance and Quality Service user involvement in service planning and delivery The Provider shall actively seek service user views and maintain appropriate records of service user feedback including any comments, complaints and/or compliments arising from meetings with service users, questionnaires, focus groups etc. The Provider will demonstrate how such feedback is shaping service delivery and how service users are fully involved in service planning and decision making across the service provider/s organisation Quality Standards The Provider and the ICAS partnership are both responsible for monitoring the quality in service provision. Evaluation will include: Feedback from service users, including at the end of each individual advocacy engagement period. Reviewing individual outcomes and their successful achievement. Evaluating the service deliverables against the service specification. Monitoring complaints, serious untoward incidents, safeguarding incidents Reference to written policies, procedures and records for service users, staff and volunteers. The findings of any monitoring will be shared between the service provider and the commissioning organisations to inform continuous improvement in service delivery and planning. To ensure consistent quality standards, the service provider will be monitored against the following quality standards, which are based on those developed by Action for Advocacy (Quality Standards for Advocacy Schemes): Independence from commissioning organisations, preferably from all service provider agencies, and as free from conflicts of interest as possible. Empowerment support for self-advocacy wherever possible; where people are unable to speak for themselves the advocate takes on this role from the service user s point of view and on the service user s terms. Service users are empowered to influence how services are delivered and run. Impartiality and objective advocacy services are impartial; they should not be seen to be judgemental or taking sides, but representing their service users views as the service user states those views to them.

14 Inclusion advocacy services will recognise the diversity in our communities and ensure that people are not excluded. Accessibility advocacy should to be provided free of charge to eligible service users. Confidentiality individual service user-advocate discussions are confidential. Accountability advocacy services have systems for effective monitoring and evaluation. Professionalism - advocates will be trained, supervised and supported in their work. The Provider will be required to comply with the ICAS Advocate Core Code of Practice as set out below; ICAS advocates must ensure that clients understand; The core service principles of independence and confidentiality; What they can expect from the service and what the service expects from the client, through the early completion of the client/service contract when appropriate; Limits of what ICAS can achieve; What they can expect from the NHS complaints procedure and where other advocacy/support services can provide more specialist advice; When and how the advocacy service can be contacted; They can request to meet with an advocate to talk in confidence to them (except when other staff have to be present for reasons of safety or security); They can make a complaint about any aspect of the ICAS service and how to do so ICAS advocates must: Only act or speak on behalf of a client if they request it; Discuss options with clients providing full and balanced information to enable then to make decisions and choices; Help clients access the information they need; Where it is appropriate to the client, try to contain face-to-face advocacy requirements to no more than two meetings per client, and where further contact is needed, discuss how these could be best met with their supervisor. General practice: At all times, advocates must: Act, honestly and courteously, treating clients and NHS staff with respect;

15 Work within the law; Adhere to the organisation's confidentiality policy; Not disclose information about a client to others without consent; Not sign anything or accept any verbal or written information that allows them to know information about a client which they cannot disclose to that client; Not give anything away in negotiation without the consent of the client; Not hold documents, money or valuables belonging to clients; Not accept gifts from clients or other stakeholders. Advocates as employees should: Avoid conflicts of interest, but where they do occur, they should be declared to their supervisor and options for action explored; Work to the ICAS standards and code of practice; Seek to continuously develop their practice and to contribute to the development of the service. Relationships with Stakeholders: Advocates should seek to develop constructive working relationships with all stakeholders Performance Indicators and Targets The Provider will meet quarterly with the ICAS partnership to review the service over the previous three months and to agree service development for the forthcoming three months. The Provider will be expected to provide details of: service users accessing the service; the progress of their support; issues relating to individual service users and overall service provision. The Provider will also be expected to report on engagement activities undertaken and the outcomes from those for individuals, on service delivery and input into strategic processes and likely long term changes in services. The Provider will monitor their service delivery to the following performance indicators, based on Action for Advocacy s work on outcomes (ref. Lost in Translation, April 2009):

16 Number of people accessing, and taking up, the service, including the number of people supported to exercise their statutory right to advocacy Demand management and response times. Service user profile, including all strands of protected characteristics, to reflect demographics of the local population of the region and the demographics of people who use services (recognising that these may be different to the general population). Satisfaction levels of service users. Staffing supervision and training Sample File Audits Increase in people being heard - the extent to which people feel confident to speak up for themselves and to be heard as a result of the advocacy intervention. Increase in knowledge about people s rights the extent to which individuals know their rights and can make use of them. Increase in service accessibility - the extent to which people are able to access services appropriately as a result of the advocacy intervention. the proportion of people who feel they were appropriately empowered to take their complaint forward. The details of these metrics shall be agreed with the ICAS partnership and the Provider. The information provided must be able to be broken down into reports by each authority within the ICAS partnership and reports may need to be provided directly to each local authority Reporting The Provider is required to: Give feedback on the outcomes for service users when requested by the commissioning organisations. Seek service users views about the service provided on an ongoing and annual basis. Complete performance and activity returns as requested by the commissioning organisations. Feedback issues raised by individual service users to the commissioning organisations so that services can be constantly improved. The ICAS partnership will use these reports as part of their contract monitoring. The ICAS partnership may also undertake independent

17 monitoring of the service, for example through service user surveys and inspection of records and interviews with advocates and service users Monitoring Monitoring may include inspection of documentation including that relating to service users, staff files, insurance documents and any other relevant paperwork. Monitoring arrangements will also include feedback from service users and other stakeholders. In addition to the performance indicators identified in the section on Performance Indicators and Reporting, there will be monthly reporting which will cover the following areas: Monitoring and actively checking on the quality of support provided including monitoring and reporting on the performance indicators and targets set out above. Activity, service user profiles and waiting times. Number of training courses attended by staff, volunteers and service users. Number of surveys or other forms of service user consultations Number of complaints or serious incidents or Safeguarding Adults incidents recorded and details of what actions were taken and any outcomes Details of how outcomes for service users have been met with evidence to support this. Monitoring may also take the form of unannounced checking of service delivery. Information supplied by the service provider may be audited to ensure its accuracy and reliability. This may be done through site visits, spot checks or other forms of audit. Failure to provide information (all or part of that requested) without reasonable explanation, will lead to a notice being served on the provider for non-compliance with a request from the commissioning organisations for information Measuring success Performance management of this contract will focus on three strands. Delivery of outcomes measuring how well outcomes are being achieved and what impact the service is having on service users Quantitative the numbers of service users served and services delivered

18 Qualitative the quality of the service(s) provided The Provider must have systems and mechanisms in place to evidence success across these three broad domains Incident reporting Adverse incidents (sometimes referred to as serious untoward incidents or significant events) should be reported to the ICAS partnership, investigated and analysed to establish lessons to be learnt and to identify changes that will lead to future improvements and prevent reoccurrence, in compliance with the commissioning organisations policies in use during this contract. The Provider should have a policy and culture that encourages and supports staff to report adverse incidents. All incidents should be reported and recorded Safeguarding The Provider must contact the Police where it is thought a criminal act may have been committed. The Provider must adhere to the relevant authorities Safeguarding Vulnerable Adults and Children policies and procedures. This requires an alert to be made to the local authority safeguarding team immediately that they are aware of any incident of abuse, maltreatment or neglect of a vulnerable person Complaints The Provider must have a complaints policy and operate a complaints procedure to deal with any complaints in relation to any matter reasonably connected with the provision of services under the agreement. This must be publicised Equality and Diversity The service provider must ensure that the service is culturally sensitive and appropriate to the diverse needs of service users and flexible enough to meet the requirements of different people. All statutory obligations must be met including the Human Rights Act 1998 and the Equality Act Where a service user requires additional communication support e.g. where English is not their first language or they require information in a different format, the Provider will ensure methods are in place to manage these communication needs.

19 3.8 Policies and Procedures The Provider will have (as a minimum) written policies and procedures covering the following: Employment Policies Complaints/Disputes Health and Safety Equal Opportunities Disability Discrimination Act 1995 (re Equality duty) compliant Equality Act 2010 compliant Criminal Record Bureau Checks (Vetting and Barring) User/Carer involvement Lone working Confidentiality and Data Protection Act 1998 Information Sharing Policy Freedom of Information All staff employed to deliver the service will be aware of and comply with the requirements contained therein. Any policies and procedures which are not in place at the start of the contract will be expected to be put in place within a timescale to be agreed with the Provider and the ICAS partnership.