Short Submission to the Joint Oireachtas Committee on Health and Children on the
Development of Advocacy Services
26th November 2015
1. Introduction.
Sage - Support and Advocacy Service for Older People, welcomes this opportunity to engage
with the Joint Oireachtas Committee on Health and Children on the issue of advocacy services
and thanks the Chairman and members for their invitation to address the committee.
Sage has its origins in the response of the HSE to the Leas Cross Nursing Home scandal in 2005
and since July 2014 is being developed under the governance of Third Age Ireland with
funding from the HSE and The Atlantic Philanthropies. Sage is working to expand access to
support and advocacy services in all care settings and wherever ageing poses a challenge for
individuals. This would include locations such as homes and primary care settings, nursing
homes, hospitals, hospices and hostels and people challenged by ageing relatively early in life
because of specific conditions as well as the ’oldest old’.
Sage is working to build a team of people capable of tackling the most complex support and
advocacy challenges presented by older people. We have a core staff of 15 WTEs and
currently have 138 active volunteers and a further 11 volunteers who have legal and financial
expertise. A commitment to a model of development based on core staff and trained
volunteers is a founding principle which has to be pragmatically put into practice taking into
account the availability, commitment and capabilities of volunteers and the capacity of staff
to support and supervise their work.
The redevelopment of a support and advocacy service for older people in the last year has
coincided with commitments by the HSE to develop a National Volunteer Advocacy
Programme as part of a wider response to the Aras Attracta scandal, a commitment by the
Minister for Health to develop a National Patient Advocacy Service and a recommendation
from the Ombudsman for the development of independent advocacy services, involving
volunteers, in hospitals. There are also a number of other organisations active in an advocacy
role in the fields of patient experience, intellectual and physical disability and mental health
some of them represented here today.
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Sage: Short Submission to the Joint Oireachtas Committee on Health & Children re Advocacy on November 26th.
The right of a person to have support in expressing their wishes and preferences or to have
another person act independently of service providers, family members and systems
interests, to advocate on their behalf is widely recognised in the developed world.
Independent advocacy must be distinguished from the work of staff responsible for
complaints and from the day to day work of professionals and health and social care providers
who can advocate on behalf of an individual up to the point where a conflict of interest may
arise.
For vulnerable people, whether old or with a disability, or both, there are often considerable
barriers to having their wishes and preferences addressed. The lack of formal legal
recognition for the role of advocacy is sometimes used as a means of resisting involvement
of independent advocates.
Any person or service purporting to provide an advocacy service should be well trained and
supported, and be guided by standards, policies and operational guidelines. Sage has
developed Quality Standards for Support and Advocacy Work with Older People. These six
standards are: Respect; Social Justice; Competence and Compassion; Accessibility;
independence; Accountability
2. Framework for Development
A Frame work for the development of support and advocacy services must address some key
issues:
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The fragmented and sometimes reactive nature of developments to date and the need
for collaboration and coordination.
The need for standards, training, support, recording and monitoring of activities and
assessment of outcomes.
The need for a clearly stated rationale for the development of support and advocacy
services as part of the wider pattern of response to the health and social care needs
of citizens.
The need for an assessment of the likely resources required to provide effective
independent advocacy in the health and social care sector.
Sage has in its detailed opening statement provided a framework for the development of
support and advocacy services. Specific suggestions by Sage include:
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A process of stakeholder and public consultation is required to inform the
development of future legislation which would guide the development and provision
of advocacy services. A statutory power to support advocates in gaining access to
people, information, premises and meetings.
Services funded from public sources should have, as a clear requirement of that
funding, an obligation to provide and promote access to independent advocacy for
the benefit of service users.
Support and advocacy services funded from public sources should be required to
engage in formal structures of coordination and collaboration.
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Sage: Short Submission to the Joint Oireachtas Committee on Health & Children re Advocacy on November 26th.
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A process of collaboration and coordination could be encouraged by the formation
of a liaison group for relevant support and advocacy services in the context of the
formation by the HSE of the Inter-Sectoral Committee for Safeguarding Vulnerable
Adults.
There needs to be an assessment of the desirability of the separate development of
support and advocacy services for people with disabilities and for older people.
A small piece of independent research should be commissioned to assess the likely
resource implications of developing support and advocacy services to an adequate
level of provision.
The development of public sector volunteering policy and guidelines to ensure that
value can be added to the lives of people using services provided by citizens who
wish to make a contribution without impinging on the role and responsibilities of
professionals.
The extension of the jurisdiction of the Ombudsman to include administrative and
organisational aspects of clinical care and the simplifying and further development of
existing complaints systems as recently outlined by the minister for Health.
The development of the Decision Support Service as an independent agency. This
new service will have the potential to act as a catalyst for developing standards, and
promoting good practice and collaboration across support and advocacy providers if
it can be allowed to develop its own distinct culture and approach.
Clarification is required regarding the role of the recently announced National
Patient Advocacy Service and we suggest that the development of independent
support and advocacy services in hospitals be informed by the approach outlined in
our detailed opening submission.
The development of a major public campaign to promote the advantages of advance
planning for future life events involving Advance Healthcare Directives, Enduring
Power of Attorney and the ‘Think Ahead’ resource enabling people to record key
information and their wishes and preferences in the event of emergency, serious
illness or death. Financial incentives should be developed to support this initiative.
In effect the state would be promoting pre-planned self-advocacy for when people
are no longer able to speak for themselves.
The development of an oversight and accountability mechanism, chaired by the
Ombudsman to link the work of independent providers of support and advocacy with
the work of the Joint Oireachtas Committee on Health.
Ends.
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Sage: Short Submission to the Joint Oireachtas Committee on Health & Children re Advocacy on November 26th.