Issue of the Month (December 2002)
- ADVOCACY
The feature article is taken from CareandHealth.com.
CareandHealth.comis a social work led organisation forged from an alliance
of care, technology and business professionals committed to improving
the quality of care delivered in the UK. Our underlying philosophy is
to work in partnership with all individuals and organisations dedicated
to raising the standards of care in the UK. By delivering common sense
solutions to the practical information needs of care professionals,
CareandHealth proposes to become the definitive information exchange
for the social care sector in the UK.
In 'Speaking
Up, Talking Out', Henrietta Bond looks at a London-based advocacy
project for ethnic minority communities.
Speaking up, Talking Out
A man from Chile was informed that his local doctors’ waiting lists
were full. Eventually he was seen by a GP, who told him he had a cold
and prescribed Paracetamol. Shortly afterwards the man was rushed to
hospital and died – from a virus he had brought over from Chile,
when he came to England two years before.
Many minority ethnic communities struggle to receive the health care
they need. Language barriers, lack of knowledge about how the system
works, lack of information about screening and vaccination programmes,
and the prejudices of receptionists or health professionals, keep people
from accessing much needed services. Without appropriate help the health
of individuals and communities may be seriously affected. Which is why
the King’s Fund has set up a grant programme to support health
advocacy among black and minority communities across London.
Health advocates help people to access health services by providing
information and support. They also become aware of where services are
not meeting need and can help health professionals to identify ‘flashpoints’,
ranging from the GP’s receptionist who demands to see a person’s
passport before letting them make an appointment, through to major gaps
in mental health services.
“For a number of years we received grant applications from community
based organisations for health advocacy with minority ethnic and refugee
communities, and noticed an upsurge in applications,” explains
Andy Bell, head of public affairs at the King’s Fund. 0“So
we conducted research to look at advocacy in London and found there
was a great diversity of people, often doing advocacy as part of another
role. There was often inadequate, short term funding, people had no
desk, PC or phone, and many advocates were isolated. There was also
a low level of acceptance of the advocate’s role among health professionals,
especially in primary care.”
As a result the King’s Fund is funding three major strands of
work, to give greater credibility and support to the work of advocates.
These are: the development of a new certificate of higher education
in advocacy; the creation of a network of health advocates in London;
and the development of standards for advocacy services in the NHS. The
initial research was done in 1999, the project work began in 2000 and
the King’s Fund’s involvement is scheduled to continue to
2005.
Recently the first group of people with certificates of higher education
in advocacy graduated from the university of East London. This course,
which is the first of its kind in the country, is a collaboration between
the University, the King’s Fund and East London Advocacy Consortium.
It offers a full-time, one-year programme for people working as advocates
in a paid or voluntary capacity.
“The course aims to recognise and extend the important work advocates
are doing as cultural brokers,” says Joan Fletcher, course co-ordinator.
“They are often coal-face workers with no career progression routes.
Their talent is not being fully exploited and drawn out. We also want
to increase their recognition in the hierarchical health profession
so that advocates voices are heard and valued.”
Fletcher says that advocates need to have very sophisticated communication
skills and to be ‘information investigators’. The course places
particular emphasis on the use of electronic databases and keeping abreast
of changes in policy and law.
“Central to the training is the u notion of the advocate as a
reflective practitioner,” Fletcher explains. “We want people
to take a questioning attitude to their work and see how they might
improve. Many of the people who come to the course will also have been
on the receiving end of service provision and may move back to being
service users at some point in their lives. So they have lived the experience.
That makes for professional humility and an awareness of how daunting
it can be to find your way around larger bureaucracies.”
From its initial research, the King’s Fund identified the need
to counter isolation by creating a forum that brought health advocates
together and gave them support. The King’s Fund appointed the Council
of Ethnic Minority Voluntary Sector Organisations (CEMVO) to set up
a network, led by black and minority ethnic communities, for health
advocates working within these communities.
The network’s role is to promote the growth and strategic development
of health advocacy services for minority ethnic communities across London,
to promote the sharing of good practice and to lobby for better policies
and resources. Membership is free and there are currently 160 members
from organisations and individuals involved in advocacy for minority
ethnic communities. In addition the network has appointed an advisory
body to review policies, disseminate information and set up sub-committees
to formulate responses to Government consultation documents.
Tsegai Gezahegn, who was appointed co-ordinator of this network in
February this year, explains that the network has a broad remit. ‘At
grass roots level the network is about supporting advocates to help
people access health services, and at a strategic level it is to influence
policy so that people understand and meet the health needs of black
and minority ethnic communities. Within the NHS there are issues of
discrimination and exclusion. An important part of this is that black
and minority ethnic groups don’t take part in policy making, workshops
and many of the NHS participation activities. We’d like to find
ways to help more people participate in health authority boards and
sit in the patient forums which are the new complaint procedure boards.”
The most recent aspect of the project is the development of quality
standards for advocacy. These are currently in the piloting stage but
will include standards for:
- ensuring that publicity materials for services are accessible and
presented in plain English (or minority languages where needed);
- the need for advocates to have continuous support and supervision,
with annual appraisals informed by users’ feedback;
- users being able to choose their advocate; and
- advocates having a familiarity with local voluntary and community
groups, to provide clients with ongoing information and support.
“In the King’s Fund we are now looking at work around how
advocacy can be mainstreamed,” Bell explains. “We need to
get acceptance that advocacy has a major part to play in involving patients
and tackling health inequalities – which are key Government targets
for the health service.
“Seeing advocacy as a normal part of the system and giving it
proper support could make a lot of difference to existing patients or
people who haven’t yet found their way into the system. Our focus
will be on minority ethnic communities but advocacy can be useful to
a lot of people – people with mental illness, people with learning
difficulties and older people with dementia conditions. And young people
in care, and care leavers could also benefit. There’s scope for
much wider application and it needs to be explored and developed.”
@2001health and care
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