Forth Valley Annual Report 2012/13 Contents Page Forth Valley Advocacy Company details 1 21 Years Old 2 Our Eligibility Criteria 2-3 Our Vision & Mission 3 Directors Report 4 Our funding 5 Statistics for people accessing our service 6-8 Manager’s Report 9-10 Senior Advocacy Worker’s Report 11 Advocacy Case Studies 12-20 Accounts 21 onwards Forth Valley Advocacy A Company Limited by Guarantee Scottish Registered Charity 2012/13 Board of Directors Margaret Cheyne David Paterson Bob Hoolachan Ravind Busgeeth Bill Bruce David Irvine Jennifer Davies Chair Vice-Chair Treasurer - resigned 30/11/12 Company Secretary Wendy Sharp Registered office 1 The Bungalows Stirling Road LARBERT FK5 4SZ Manager Wendy Sharp Senior Advocacy Worker Martine Turner Advocacy Workers Marion Robinson Loretta Murray Patricia McClay Jennifer Morgan David Harris Caroline Kingston – commenced 31/05/12 Volunteer Coordinator Margo Campbell – resigned11/01/13 Harriet Fishley – commenced 14/01/13 Company number 251723 Administrator Fiona Moore Charity number SCO34510 Web Address: www.forthvalleyadvocacy.com Incorporation date 25 June 2003 Business address 1 The Bungalows Stirling Road LARBERT FK5 4SZ Independent Examiners Wylie & Bisset 168 Bath Street Glasgow G2 4TP Bankers The Royal Bank of Scotland plc. 2 Newmarket Centre FALKIRK FK1 1JX “Getting your voice heard” 1 Forth Valley Advocacy Service 21 Years Old Forth Valley Advocacy (FVA) celebrated its 21st Birthday in 2013 having seen many changes over the years. Initially a part of the NHS based in Bellsdyke Hospital it became an independent service in 2003 with its own Board of Directors and registered as a company limited by guarantee with charitable status. Independence led to FVA delivering services on behalf of the three local authorities and the NHS operating under Service Level Agreements that ‘paid for’ individual worker(s) for each area. 2011 saw further changes as the Public Sector made the joint decision to publically tender for Independent Advocacy services across Forth Valley. In March 2012, after a concerted effort by board members, staff and clients, we received notification that we had won the tender contract to deliver Independent Advocacy across Forth Valley; funding is currently for two years with the possibility of further funding for up to two additional years. Throughout that past 21 years FVA staff and board have remained committed to ensuring we deliver a high quality, transparent service that is accountable to clients and funders alike. The fact that we have survived 21 years, particularly with the recent economic climate, is testament to the fact that we are achieving this. Our Eligibility Criteria We offer short-term, issues based, professional independent advocacy support to people over 16 who have: • A learning disability • A mental health problem • An acquired brain injury • Dementia And also with people who are: • Over 65 years of age • Vulnerable and deemed at risk • Under 16 years of age subject to action under the Mental Health Act “Getting your voice heard” 2 Our outcomes focused service is available for any person who meets our criteria and requires support with a specific issue or concern related to health, social care or the following legislation: > Adults with Incapacity (Scotland) Act 2000 > Mental Health (Care &Treatment) (Scotland) Act 2003 > Adult Support & Protection (Scotland) Act 2007 > The Children’s Hearing (Scotland) Act 2011 Importantly, a person does not need to be detained under mental health legislation to access our service. Our Vision & Mission Vision Shifting the balance of power Mission To PROMOTE the rights, freedoms and dignity of vulnerable people, to SUPPORT people to have their say and to DEFEND disadvantaged people from abuse and exploitation. “Getting your voice heard” 3 Directors Report for the year ending 31 March 2013 I am pleased to present this year’s report on behalf of the Board of Directors for Forth Valley Advocacy. This again was a busy year as the facts within this report will show. Our service continues to develop to meet the ongoing needs of our client groups. We are confident the advocacy service is delivered to a high standard overseen by our Manager Wendy Sharp and Martine Turner our Senior Advocacy Worker. Staff commitment guarantees a continually developing service as we aim to constantly improve on the quality and standard of our organisation. Over the year we have complimented our service with the addition of a robust group of volunteer advocates and are grateful for their commitment and contribution. Our Directors have been very active over the year in the many aspects of governance and planning of the service on a day to day and longer term strategic planning basis. I am grateful for the ongoing support by Board members to our advocacy service and myself over the year which, in many ways, has been challenging. As in previous years our funders are Forth Valley NHS, Falkirk, Stirling and Clackmannan Councils. In our present commercial climate we are all aware of the need to ensure a value for money service and we strive to maintain this. In conclusion I wish to thank the directors, the staff and all our funders who have been so supportive over the past year and I am sure will give ongoing support to our future Advocacy Service. Please enjoy the details of this report which gives clear evidence of our service within Forth Valley. Margaret Cheyne CHAIRPERSON “Getting your voice heard” 4 Our funding Forth Valley Advocacy won the public contract for a jointly commissioned Independent Advocacy service across Forth Valley. The service is commissioned from a pooled budget by Clackmannanshire Council, Falkirk Council, Stirling Council and NHS Forth Valley. Forth Valley Advocacy would also like to thank all our supporters who have provided valuable information and training to the team as a whole. “Getting your voice heard” 5 Stats for people accessing our service In April 2012 Forth Valley Advocacy (FVA) commissioned EvolutionCS to create a Case Management System that would allow the service to capture a vast amount of statistical data about the people accessing our service. Amongst other things, this includes the number of hours delivered, the clients outcomes, the referring agency/area, age, client group and much more. The CMS became live in October 2012. For the first seven months of the year we relied upon our old method for capturing the hours delivered, which means we certainly delivered more hours than we accounted for. As the commissioners considered the first three months of the contract as ‘start-up time’, they anticipated the advocacy hours delivered to be closer to 6000 than 8,000 for year one. For the first time we and commissioners are now getting excellent and consistent statistics about the people who access independent advocacy across Forth Valley. In total Forth Valley Advocacy delivered 6670 hours of advocacy and supported 704 people across Forth Valley. Client numbers “Getting your voice heard” 6 Hours delivered Adult Support And Protection 1014.5 19.25 49.75 346.5 599 Falkirk “Getting your voice heard” Stirling Clacks NHS 7 “Getting your voice heard” 8 Manager’s Report for the year ending 31 March 2013 April 2012 saw Forth Valley Advocacy (FVA) commence delivery of our newly secured contract to deliver Independent Advocacy across Forth Valley. Our previous contract ended on 31st March and this new one started on 1st April 2013, extending the availability of independent advocacy services to a wider client group. Naturally this then meant that we had to consider TUPE for the outgoing service staff. After discussions and consultations with all, the staff decided to remain where they were which then meant we had to recruit to fill posts. In addition to recruiting new staff and delivering advocacy, the first few months were, understandably, spent addressing concerns, allaying fears and raising awareness of the new eligibility criteria. Remarkably, despite some significant changes, we have not received one complaint during this first year of the new contract. Throughout the year we have worked in close partnership with commissioners from across all three local authorities and the NHS, overseen by the Officers Monitoring & Evaluation Group for Advocacy (OMEGA). There were frequent meetings to ensure the service was on track and clearly promoted to senior managers and service users. We welcome the input and involvement of the OMEGA as its close monitoring validates our work ensuring we are fully transparent and accountable; something we always strive towards. We are also working within our new three-tier advocacy delivery model that we designed specifically for this contract. This has allowed us to clearly identify who should be allocated to paid and unpaid advocates ensuring we utilise our volunteers and staff appropriately. As part of our three-tier model, Forth Valley Advocacy established the new core position of Volunteer Coordinator and we could not be happier with the quality of our volunteer advocates. They have shown great skill, enthusiasm and commitment and are invaluable in helping us extend our service to those not necessarily covered by the eligibility criteria. This has been a year of great change and improvement within Forth Valley Advocacy and we introduced new ways for delivering our service as well as our new bespoke Case Management System which we introduced in October 2012. As we are now “Getting your voice heard” 9 paid for each quarter hour of advocacy delivered this information is vital to the survival of our service. We are collecting invaluable information that will, over the coming years allow us to further tweak and improve our service and how we deliver advocacy. All of this would not be possible without the absolute commitment, passion and willingness of staff, directors and volunteers. Far from being phased by all the changes, they have fully embraced them and continue to look at areas for improvement. As a whole I can honestly say that this is the best team imaginable to take the contract forward. It has been a steep learning curve at times but staff and volunteers have outdone themselves rising to challenges with a positive ‘can do’ attitude. Wendy Sharp MANAGER “Getting your voice heard” 10 Senior Advocacy Worker’s Report for the year ending 31 March 2013 The start of the new contract saw many changes and challenges for Advocacy as we widened our client group and worked with a change of eligibility criteria. Our new Case Management System (CMS) has made the recording of notes and stats so much clearer and accurate for staff. This system was embraced by staff and by the end of the year everyone was of the opinion “how did we manage without it?” The new contract came with a completely alien way of funding as payment was based upon the number of advocacy hours delivered. The team found this a challenge and were concerned about this, particularly with worry over delivering “enough hours”. However, it soon became apparent that all they needed to do was record information accurately into the CMS and, with the referrals continuing to pour in and caseloads remaining high; the hours took care of themselves. The weekly allocation meeting gives the staff an opportunity to share information and discuss with their colleagues any issues they feel they need support / guidance with. For me it’s about trying to ensure referrals are prioritised and allocated within the appropriate time scale yet ensuring staff still run with manageable caseloads; something that, at times, is quite a challenge. I have seen my role change over the past year as I stepped in to cover for a member of staff who became unwell, as per our new service delivery model. I have also taken on the role of delivering advocacy to patients in Loch View as this was a new location for us and I have greatly enjoyed getting to know the patients and staff. I will continue to work there and love the warm caring environment that is evident. Yet, despite the changes and challenges presented during the year I was getting more positive feedback than I had ever before at staff’s monthly support and supervision. Although we were busier than ever and the pressure was on, everyone was very happy and the team was at its best to deliver the advocacy as per the contract. Martine Turner SENIOR ADVOCACY WORKER “Getting your voice heard” 11 Case studies To follow are actual examples of client work undertaken across all areas covered by Forth Valley Advocacy, produced with permission of those involved. 1. Basic profile data a. Gender Female b. Age 50’s c. Ethnicity White d. Client group Learning Disability 2. Length of time from identifying issue to outcome 13 months 3. The Issue The client was referred due to Adult Support and Protection (ASP) concerns about financial harm. This was a difficult time for my client and I supported her at ASP meetings and throughout the process itself. One of the actions arising from the ASP process was that the local council took up appointeeship of my client’s benefits. This combined with a lack of communication left my client feeling, “as though I have done something wrong”. The client found ASP meetings very nerve wracking and at the first meeting she was made to wait for an hour before she was invited in to the discussion. At the beginning of the process she was not sent reports in advance of the meetings so she felt she did not know what was going to be discussed. 4. The Steps Taken to Address the Issue I supported the client at ASP meetings and was able to put forward her views. Prior to the third ASP meeting I contacted the chairperson on my client’s behalf. This was to raise concerns about my client being made to wait an hour before she was invited into the meeting. I also explained that my client did not feel ‘supported or protected’ by the process but felt as though she had done something wrong. The chairperson acknowledged this and said that my client would be invited in at the start of the meeting. After this, my client found the meeting a lot more bearable. The professionals around the table reiterated to my client that she had done nothing wrong and that they wanted to support her. I put forward my client’s views that she felt things had improved and the people involved in financially exploiting her were no longer in her life. “Getting your voice heard” 12 On my client’s behalf I also raised the issue of appointeeship which was still troubling my client as she felt “embarrassed to have to ask for what is rightfully mine. I would like my money back; it is making me very nervous and distressed that Social Work has control of it”. I pointed out that since appointeeship had been sought, the social worker had not reviewed whether it still needed to be in place. My client stated, “I don’t know why it was taken away in the first place as I was good at looking after it.” It was agreed by the professionals involved that the risks in terms of financial exploitation were no longer present. However, my client’s social worker felt that appointeeship was still necessary. I explained to my client outside of the meeting that another option was to contact the DWP to ask them to review whether appointeeship was still appropriate. My client stated that she would like me to do that. Over the next few months I contacted the DWP through phone calls, letters and email. Finally, I was contacted by a visiting officer to arrange a visit to see my client. 5. The Outcome – the difference advocacy made The outcome after a visiting officer had been to see my client was that her benefits were returned to her. My client was extremely happy about this and thanked me very much for the support I had given her. A couple of months later I contacted my client to see how things were going. She said, “I am really happy and I am coping well with having my money back”. The ASP meetings were also brought to an end as it was felt that the risks had dissipated. My client now had a support worker going in a few times a week which has given her a lot more confidence. My client started attending a local social group for people with learning disabilities. This increased involvement in the local community meant my client was less socially isolated and less vulnerable to exploitation by others. 6. The Challenges and how they were met The challenges were trying to make my client feel more empowered by the ASP process rather than feeling punished by it. By supporting my client at the meetings and putting forward her views, my client felt more involved in the process. The biggest challenge was trying to get social work to reconsider appointeeship. In the end my client chose a different option and we contacted the DWP directly. It took a while as there was no clear system in place to ask the DWP to review appointeeship. However, after many calls and letters the DWP finally sent someone out and my client’s benefits were returned to her. “Getting your voice heard” 13 The social worker then called me to express her concern that my client would not be able to manage. I reminded the social worker that my role is to advocate on behalf of my client and not to make judgements about what is best for her. 7. Conclusion My client now has full control over her finances and is managing her money well. She is more confident and more involved with the local community and less socially isolated. 1. Basic profile data a. Gender Female b. Age 40s c. Ethnicity White d. Client group Mental Health 2. Length of time from identifying issue to outcome 5 – 6 months 3. The Issue Client was admitted to FVR on a s44 as her mental health (bipolar diagnosis) was believed to have deteriorated. She unsuccessfully appealed a s44 and a CTO application was made but subsequently withdrawn, and client was discharged from hospital to IHTT. She has a young daughter who was placed in the care of her father; client is separated from her partner. Various unsubstantiated claims that before admission to hospital client had been drinking, lost her temper in a public place with her daughter, and her child was considered as not being properly supervised. Client recovered well on her discharge, but Children and Families Social Work reluctant to give her unsupervised access to her daughter. Client desperate to see her daughter returned to her care. 4. The Steps Taken to Address the Issue Prepared client for and supported her at meetings with Social Work, including Core Group Meetings. 5. The Outcome Client felt very much alone, and that Social Workers were listening to her ex-partner but not to her own views. She found Core Group Meetings particularly stressful and felt only her advocacy worker was on her side. 6. The Challenges and how they were met It was clear that client would require considerable support and encouragement through the long, slow process towards getting unsupervised access to her daughter. By helping her to remain calm when she was under stress and the scrutiny “Getting your voice heard” 14 of Social Workers, client was able to demonstrate her restored mental health and parenting ability. At the same time her ex-partner came across as increasingly controlling towards client, and distrusting of services. 7. Conclusion Client now has her daughter live with her 4 days and 3 nights a week. Whilst she would like to have an extra night with her daughter, the compromise avoids the need to go to court until her daughter is old enough to make up her own mind about where she wants to live. Client has moved house, is in a new relationship and returning to self-employment. Expressed thanks for all our help during a difficult period. 1. Basic profile data a. Gender Female b. Age 94 c. Ethnicity White d. Client group Older People 2. Length of time from identifying issue to outcome 5 months 3. The Issue Very frail not been coping at home, was in hospital got out for 4 days and was put on emergency respite looking for a full time care placement but client wanted to go home. She was feeling very pressured by family to go into long term care and needed help to get her voice heard. Full capacity to make her own decisions. Update from March: Case under investigation under Adult Support & Protection regarding physical harm to client. 4. The Steps Taken to Address the Issue Visited with client Discussed views and options Client moved to alternative care placement of her choice 5. The Outcome Client spoke of how she is pleased to be having her affairs in order Client was supported to make decisions on future care placements. Client chose not to return home, but go into care home for safety reasons. Supported to view “Getting your voice heard” 15 alternative long term care placements. Client chose placement. 6. The Challenges and how they were met Ensuring client fully understood risks she faced if she chose to return home. 7. Conclusion Client very happy in long term care home, which was chosen by her. Advocacy supported client to arrange solicitor to come to care home and have personal affairs put in order. Mid and final reviews have taken place and client now feels able to voice her opinions in the care home should the need arise. 1. Basic profile data a. Gender Female b. Age 34 c. Ethnicity White d. Client group Mental Health 2. Length of time from identifying issue to outcome 4 months 3. The Issue Change of Social Worker- “She doesn’t listen to me, I cannot work with her.” Children’s Hearing Panel- “I can’t keep my emotions under control. These people judge me. “ 4. The Steps Taken to Address the Issue Letter sent on behalf of client asking for a change of social worker. Met with client before any Hearing Panel and supported her during them. 5. The Outcome New Social Worker- “My kid’s would have been taken off me if I still had her (previous social worker).” The previous social worker was recommending that my clients children be adopted permanently. The new social worker had a different view on this. Supported client through the Children’s Hearings process and went from the children being in foster care to being back in my client’s full time care.- “I am now just wanting to get on with my life with the boys. Finally we can move on from this, “Getting your voice heard” 16 thank you for your support.” 6. The Challenges and how they were met The first challenge I had to support my client with was a change of Social Worker as the relationship had broken down beyond repair. After this was achieved I helped the new Children and Families social worker to understand my client’s mental health issues and the impact it has on her behaviours. Supporting my client to understand decisions and gain trust in professionals was the main challenge. Once she achieved this, she was able to work alongside the social worker and concentrate on the best interest of the children and getting them home again permanently. 7. Conclusion Before advocacy input my client was unable to sit through an entire meeting about her children in an appropriate manner. With advocacy support her understanding and self-confidence grew and in return she was able to contribute to meetings and accept praise where it was due. My client made it clear that without this support she would not have managed this. Her new found self-empowerment, hardworking and co-operation with professionals has allowed her to get her children back in her care full time; a scenario unimaginable before advocacy support. 1. Basic profile a. Gender Female b. Age 57 c. Ethnicity White d. Client group Learning Disability 2. Length of time from identifying issue to outcome 6 months 3. The Issue Susan was referred to our service by the LD community team. They stated that they had a duty of care to regularly review everyone they work with to ensure that their needs are being met. Recently a new supported accommodation placement had come up in a neighbouring area and the LD team wondered whether or not this would be a more suitable place for Susan to live as it was a much smaller unit. Advocacy was asked to be involved to try and ascertain Susan’s wishes and views regarding this. “Getting your voice heard” 17 4. The Steps Taken to Address the Issue I was aware upon referral that Susan had some communication needs so I made contact with her key worker to try and gain some insight that might help me with my first visit. I was informed that Susan did not talk but could make herself understood by her hand gestures and by her facial expressions. On my first visit a speech and language therapist was present trying to communicate with talking mats but Susan would not engage with him or me. In fact when her key worker asked if she would like to meet with us to try and explain my role and why I was there she turned her back on both of us. After a few more visits, it became clear that Susan would not be able to give me instruction on whether she would like to move house or not. Therefore, my role would be one of non-instructed advocacy adopting a safeguarding role following the principles of the AWI Act and working within our non-instructed advocacy procedures. I visited Susan many times after this to carry out observations and to ascertain whether a move to a new home would benefit her as she was unable to voice this herself. Every time I visited her I observed her to be very relaxed. She loved to throw her shoes off and lie along the settee watching telly or listening to her music. Another favourite was sitting in her well maintained garden. On one unannounced visit she was getting pampered in the living room by a therapist giving her aromatherapy treatments. I spoke to staff who stated that she loved visiting her local shop on a daily basis; she also did cookery and crafts and really enjoyed her weekly bus trip. She also enjoyed her weekly visit to her church which was just next door. As part of our non-instructed advocacy procedures I contacted Susan’s brother who stated that he was very worried as he felt a move for his sister would ‘just be terrible’. He stated that he felt it might have benefited her when she was younger but not now as her life was good and that she had made many good friends where she was and although the new accommodation was smaller his sister actually enjoyed the buzz of where she was. Staff also stated that they were concerned as Susan had taken a long time to settle in her placement and were worried a new placement may unsettle her. All my observations were recorded at different times and in different situations and settings. As the visits went on, Susan became more comfortable with me being there and although she could not instruct me, my role was to uphold her rights and I “Getting your voice heard” 18 genuinely believed that if Susan where able to express her wishes she would choose to remain where she was. 5. The Outcome – the difference advocacy made– use quotes At a meeting held regarding whether or not Susan should move to the new placement, her social worker took on board all my observations and comments. I explained that I had used non instructed advocacy to come to the conclusion that Susan had a really good life where she was. Every time I visited her she appeared very comfortable and at home. Staff had also informed me that it had taken a long time for Susan to settle in when she first arrived there and I felt it would be unfair for her to have to do this again if she moved. At every visit staff interacted appropriately with Susan and I observed it was a relaxing atmosphere for Susan to live in. The social worker took on board my observations and Susan was allowed to remain where she was. 6. The Challenges and how they were met The social worker took on board everything I had to say but perhaps without the evidence from my formally recorded non instructed advocacy observations it might have had a different outcome. 7. Conclusion Susan continues to live happily in her supported accommodation with staff aware that, if she needs advocacy in the future, they should not hesitate to contact our service. 1. Basic profile data a. Gender Male b. Age 85 c. Ethnicity British White d. Client group Older People (dementia) 2. Length of time from identifying issue to outcome August 2012 – January 2013 3. The Issue Mr D had come into emergency respite care following two failed discharges at home where his wife had struggled to cope with his increasing frailty and advanced dementia. Mrs D was not British and the main issue was in relation NOT to his incapacity, but in her understanding – her English was excellent but the cultural differences caused a gap in understanding (e.g. “that is not how we do things in my country”) and there was also a breakdown in the relationship with social and medical services. Furthermore, due to their religious beliefs the couple had strong views in relation to medical interventions. “Getting your voice heard” 19 The Council were looking at Guardianship and asked for Advocacy to be involved. This was a ‘safeguarding’ role due to the level of Mr D’s dementia and involved meeting the client, his wife and also liaising with the MHO and social work department. 4. The Steps Taken to Address the Issue When the case was allocated, I was chosen partly due to the fact that I am fluent in Mrs D’s mother tongue. This helped establish a rapport and we were able to build up a trusting relationship, particularly once she could see that advocacy was on their “side” and that she could use me to help explain some of the terminology and jargon which was being used. We met together on many occasions (client, wife and myself) and worked with staff in the Care Home to help Mrs D understand her husband’s illness and how the care plan could be written to optimise her husband’s quality of life in the time which remained for him. She agreed to personalise his room with reminders from home and she listened to other advice from professionals working in the field of dementia. It was hard for her after almost 60 years of marriage, to hand her husband’s care to others. 5. The Outcome – the difference advocacy made A compromise was reached regarding the Guardianship and a joint application was made so that Mrs D continued to feel involved in decision-making regarding her husband’s care. Advocacy was the link that kept everyone communicating and helped Mrs D feel she had not lost all control in a very difficult situation. 6. The Challenges and how they were met The main challenge was Mrs D’s resistance to outside help and this was due to the cultural barriers. Relationship-building led to working in partnership as she came to see that the professionals were trying to help them both, not trying to take her husband away from her. 7. Conclusion The client settled well and his wife felt supported, involved and listened to. “Getting your voice heard” 20