Health and social care advocate: Do I need one?

This article explains what is a health and social care advocate and mental health advocate and how they can help you get the care you need and navigate the NHS and adult social care system.

Key Points

• A health and social care advocate is an independent professional who ensures your rights are upheld and you understand your care options.
• There are several types of advocates including Independent Mental Capacity Advocates (IMCAs) and Independent Mental Health Advocates (IMHAs).
• Advocates help individuals understand care assessments, make informed choices about care homes or other support and challenge unfair decisions.
• Advocacy services are free. You can find local advocates via Advocacy QPM website or explore care options on carehome.co.uk.

What is a health and social care advocate?

The video above from Voiceability explains what is an advocate.

A health and social care advocate should:

• Ensure that your voice if you require healthcare and /or social care is heard.   
• Represent your interests to make sure you are heard.
• Ensure your wishes are respected.
• Help you understand your rights.
• Explain your health and care options.
• Help you make informed choices about your care and support.
• Not make decisions for you.
• Help you plan what to do next. This is especially crucial if you have difficulty communicating your care needs or feel your concerns are not being taken seriously.
• Be trained.
• Be independent.
• Not work for the council, the NHS, care homes or home care providers.  

What is a mental health advocate?

A mental health advocate in the UK is a professional who can support you if you are facing mental health challenges to ensure your voice is heard and your rights are upheld.

This can involve helping you understand your care options, participate in decisions about your care and challenge decisions if you disagree.

An Independent Mental Health Advocate (IMHA) is a specifically trained advocate in England with a legal right to support ‘qualifying patients’ who are detained under the Mental Health Act 1983. They explain your rights under this Act and how to use them.

In Wales, you have the right to an IMHA if you’re a ‘qualifying compulsory patient’ or a ‘qualifying informal patient’.

IMHA’s can see any medical, social care or other records about your detention, treatment and aftercare. An IMHA can only do this with your consent, unless you lack capacity to consent.

What is a Independent Mental Capacity Advocate (IMCA)?

If you’re not able to understand information or make certain decisions because you lack the mental capacity, you’re legally entitled to an IMCA.

• In England, your local authority appoints IMCAs.
• In Wales, your local Health Board or other NHS body appoints IMCAs. 

Who can have an advocate?

If you’re thinking of arranging care for yourself, a relative or friend, advocacy can help.

Some individuals must be offered the chance to have an advocate by law.

• This includes people who are being treated under the Mental Health Act 1983. The Act outlines advocacy’s role in supporting people receiving mental health services. 
• People who cannot make their own decisions because they lack mental capacity. The Mental Capacity Act 2005 includes advocacy guidance for these individuals. 
• The Care Act 2014 mandates independent advocates for people with substantial difficulty understanding and engaging in care processes, if there is no appropriate person to support them. There is a duty on the local authority to consider and provide advocacy under this Act from the start of their dealings with the person. They must also consider this in safeguarding (abuse and neglect) inquiries and reviews. 
• In Wales, an individual has a right to an independent professional advocate if they are unable to participate in the care and support process or have their views and wishes represented and have no one else to help them. Wales’s Social Services and Wellbeing (Wales) Act 2014 makes advocacy provisions. Scotland’s Mental Health (Care and Treatment) (Scotland) Act 2003 gives people the right of access to independent advocacy including for people with a mental illness or a mental health condition, those with learning disabilities, autism and/or dementia.
• Northern Ireland does not have a direct equivalent of the Care Act 2014 that mandates advocates. The Patient and Client Council (PCC) is the independent body representing the public in health and social care.

Who can be a health and social care advocate? 

Advocates can be:

• Professional advocates employed by specialist organisations.
• Volunteer advocates trained to support individuals on a one-to-one basis.
• Family or friends. Being your advocate is a different kind of relationship to being your family member or friend. You should agree with them beforehand what you both understand the role to mean and agree what your boundaries are.

Other types of advocates

• Peer advocates. This person has a lived experience of, for example, a mental health condition or addiction, and can offer advice based on their own experience. 
• Group advocacy. This is also known as collective advocacy. It involves a group of people with similar experiences supporting each other.

What does a health and social care advocate do?

Advocate responsibilities: 

• A health and social care advocate’s main role is to represent your interests.
• Ensure that you are receive fair and equal treatment when it comes to your care and support.
• Make you aware of your rights under the Care Act 2014 and Mental Capacity Act 2005 are respected.

• Help you make informed decisions about your care and support.
• Support you during meetings about your care and support.
• Accompany you to medical appointments to ensure you are cared for correctly.
• Be a point of contact for people in need of information from you.
• Help you understand care assessments, care plans and reviews. This ensures your preferences, needs and feelings are understood.
• Assist you in creating a care home care plan and reviews it to ensure it aligns with your specific needs.
• Help you explore care options.
• Provides independent advice when choosing between care options or care homes.
• Assist you in making formal complaints about care services or decisions.
• Help you write letters, complete online forms to apply for benefits etc.

What don’t they do?

An advocate must not:

• Offer counselling.
• Offer befriending.
• Offer legal advice.
• Tell you what to do.
• Give their personal opinion.
• Make decisions for you.

Do I need an advocate for a care home?

Anyone requiring advocacy needs to know about it, be able to access it easily and get it as early as possible.

Many people do not know they can have an advocate, or they find it hard to get help when they need it.

You don’t always need a health and social care advocate, but having one helps particularly, if:

• You struggle to communicate your wishes or understand complex information.
• You’re struggling to understand a care plan or financial assessment for care home funding.
• You want independent advice before choosing a care home or signing a care home contract.
• You believe your rights or preferences are being overlooked.
• There’s a disagreement with a care home provider, social services or healthcare professionals.

Advocacy in a care home setting empowers residents to express their views, uphold their rights and ensure their needs are met.

There are a range of issues advocates can address, from challenging financial abuse, changing living arrangements to upholding end-of-life wishes. 

Examples of advocacy

Protecting end of life wishes

A Spanish-speaking man living in a care home had difficulty understanding English. This prevented him from being involved in his care.

The advocate explained to the care home that an interpreter might be able to help and the resident. As a result, the advocate helped voice the resident’s end of life wishes.

The care home resident’s wish was for his body to be taken back to Spain. The advocate supported the resident in getting money from his dad (appointee).

The advocate contacted the resident’s dad and relevant people involved in his care. They helped the resident’s dad understand that the money he had taken legal responsibility for was to help fulfil his son’s needs.

Helping you claim benefits

Paul Hunter had the help of a health and social care advocate arranged by the charity VoiceAbility.

“It’s taken me 53 years to get benefits support, which I should have had from birth. I cannot thank VoiceAbility enough for what they’ve done for me and my son” says Paul Hunter.

Are advocates free of charge?

You do not have to pay for an advocate. Health and social advocates are free.

Referring a person to independent advocacy does not cost anything. The cost is funded by local authorities and the NHS.

How to find a health and social care advocate near you

You can find local advocacy services by contacting:

• Your local authority should consider whether someone has any difficulties that mean they should have an advocate. It must provide an independent advocate for you if you have a substantial difficulty in understanding and getting involved in care assessments, care planning etc. You must have an advocate, if you have no one else appropriate to support you. 
• The Advocacy Quality Mark is the UK’s quality mark for organisations providing advocacy services. Here’s a list of organisations with the mark on the Advocacy QPM website.
• VoiceAbility, a charity that provides independent advocacy services.
• POhWER is a charity that advocates for people who find it difficult to express their views due to disability, social exclusion, illness or other challenges.
• Age UK is a charity providing advocacy services, although availability can depend on the local branch.
• Wales’s Dementia Advocacy Project provides independent, advocacy support to adults with a diagnosis of dementia in Wales. Contact agecymru for details on 0300 303 44 98 or email dementiaadvocacy@agecymru.org.uk.
• Scotland’s national intermediary organisation for independent advocacy is the Scottish Independent Advocacy Alliance (SIIA). 
• In Northern Ireland, you can get a health and social care advocate by contacting the Patient and Client Council for free support on 0800 917 0222.
• The Commissioner for Older People for Northern Ireland offers advocacy and legal support for older people on 028 9089 0892. 

How can an advocate find me a care home?

Advocates can help you explore care options. It is easy to search for care homes, compare them, find guidance on funding and read verified care home reviews on carehome.co.uk.