Briefing: Commissioning advocacy

Statutory advocacy

Statutory advocacy includes all advocacy that are required by law. The relevant legislation and statutory guidance (including codes of practice) provide the circumstances when each person would have a right to a statutory advocate. These include:

Care Act 2014 – A person has a right to a Care Act independent advocate if they do not have an appropriate person (the appropriate person cannot be engaged in providing care or treatment for the individual in a professional capacity or for remuneration) to represent and support them with needs assessment, care and support planning, revising care and support plans, safeguarding, carers assessments, support plans and revising support plans, child needs assessments, child’s carer’s assessments, young carer’s assessments, where, without an advocate, the individual would experience significant difficulty with one or more of the following:

a) understanding relevant information;
b) retaining that information;
c )using or weighing that information as part of the process of being involved;
d) communicating the individual’s views, wishes or feelings (whether by talking, using sign language or any other means).

The duty does not apply if the individual has someone appropriate to support and represent them.

Mental Health Act 2005 – a person of any age has a right to an independent mental health advocate (IMHA): if they are detained in mental health hospitals, under the Mental Health Act (MHA).

Mental Capacity Act 2005 – a person has a right to an independent mental capacity advocate (IMCA) if they lack the mental capacity to consent or make a decision, in specific situations:

• long-term change of accommodation
• serious medical treatment
• when a Deprivation of Liberty Safeguards (DoLS) authorisation is being considered (IMCA 39A)
• when a relevant person's representative (RPR) requires support (39D).

NHS Complaints – under the Local Authority Social Services and National Health Service Complaints (England) Regulations 2009, a person is entitled to representation if they are unable to make a complaint themselves.  

A complaint can be made by someone who:

• receives or has received services from the organisation or provider, or
• is affected, or likely to be affected, by the action, omission or decision of the organisation nor provider that is the subject of the complaint.

A person can complain on behalf of someone else who is directly affected as described above. This includes representing someone who is a child or is unable to make the complaint themselves due to physical impairment or lack of mental capacity, someone who has asked them to act as a representative on their behalf, or they are representing someone who has died.

The regulations include a duty for local authorities and health bodies to cooperate on complaint handling. The NHS England complaints policy (under review, at time of publication), states at section 6 that local authorities have a duty to commission independent advocacy services to provide support in order for people to make a complaint about their NHS care or treatment.

The Children Act 1989 – a person has entitlement to statutory advocacy in specific circumstances under this legislation. A child or young person’s entitlement to statutory advocacy is determined by virtue of their circumstances, namely their care status, physical and/or mental health needs, special educational needs and disabilities, or their position in the youth justice system.

At the time of publication of this resource, the current National Standards for the Provision of Children’s Advocacy Services 2002 and guidance 'Providing Effective Advocacy Services for Children and Young People Making a Complaint under the Children Act 1989' published in 2004, are in the process of being reviewed by the Department for Education. A consultation took place between September and December 2023, and updated standards and guidance are anticipated in due course.

Non-statutory advocacy

Non statutory advocacy includes any advocacy that does not fall under the statutory rights to advocacy. It can be provided for any other health, social care, education, housing or employment situation that doesn’t fall under the statutory duties.  This can include specific formal roles, such as:

• Rule 1.2 representatives for the Court of Protection Deprivation of Liberty (CoPDoL) authorisation process
• litigation friend work in a Court of Protection work

Generic advocacy where the situation falls outside the scenarios stipulated in legislation, but where a person may benefit from support and or representation. This could be support to an individual or to a group, such as:

• supporting a person with a continuing healthcare assessment
• supporting a person with a S117 reviews under the Mental Health Act
• supporting a parent with a learning disability or mental health needs to participate in proceedings about their child
• planning for discharge from hospital when there is no statutory advocacy entitlement and where there may be no social worker involved, but an individual may benefit from support
• advocacy support to carers in their caring role or to carers groups
• peer or self-advocacy groups with or without a support worker, with or without a project to work on.

Each English council has the duty to ensure sufficient statutory advocacy provision for any person in their area. This includes people who may have come from outside the area but are now in the council area (for example in a hospital, a care home or supported living).  

If a person is placed in a care home or supported living in another council’s area.  The host authority (that is the council of the area where the home is) has the duty to ensure sufficient statutory IMCA advocacy provision for that person who is placed in their area. Similarly, if a person is in a mental health hospital in an area that is outside their  home council, the statutory IMHA advocacy will be provided by the host council.  The placing council has the responsibility for commissioning independent advocacy under the Care Act and may explore commissioning this from a local advocacy provider on a spot purchased basis. 

Although there are no duties to commission non-statutory advocacy, either for people in your area, or for people who are ordinarily resident in your area but are currently located outside your area, there may be benefits from doing so.  Providers may charge for non-statutory types of advocacy under a separate contract, or on a spot purchase basis with other commissioners. This may include NHS commissioners and commissioners from other (placing) councils.

It is important to consider whether your contract will include arrangements for the advocacy provider to provide non-statutory advocacy.  As part of the contract negotiation, it will be important to agree with any commissioned provider how they will provide non-statutory roles, and whether they will offer non-statutory roles to other councils, the NHS or direct to self or peer advocates, or carers.

Councils also need to consider their information and advice duties under the Care Act to ensure that people are informed about their rights to statutory advocacy and that public information is made available about other types of advocacy and how to access each type of advocacy.  Published information should also lay out expectations for paid roles to inform unpaid, family or friend advocates of what the advocacy role entails. This will also support individuals to make decisions about taking on an unpaid representation and support role (for example, under the Care Act or as RPR for the Deprivation of Liberty Safeguards, under the Mental Capacity Act), and when to request a paid representative. It will also support the advocacy partner and their family to know what to expect of a representative, whether paid or unpaid.

All types of non-statutory advocacy contribute to ensuring representation and support. In cases where an advocate may be instructed as a generic advocate, to support and represent an advocacy partner in a process where advocacy is not automatically required by statute, the advocate will usually be instructed by the advocacy partner.

The only exception to this is when the person lacks the capacity to instruct the advocate, and the advocate works in a non-instructed capacity.

A generic advocate works with an individual advocacy partner to learn about their wishes, feelings, values and beliefs in relation to the issue being discussed. If the advocacy partner wishes, or the advocate is acting in a non-instructed capacity they may consult others that know them, to learn about the advocacy partner’s past and present wishes, feelings, values and beliefs, in relation to the issue being discussed.  

The advocate’s role is then to ensure that the advocacy partner’s wishes, feelings, values and beliefs are fed into the decision-making process. The benefits in these circumstances would be similar to the benefits of statutory advocacy. The decision-making process would be informed by the person’s wishes, feelings, values and beliefs, and these would be taken into account as much as possible, when decisions are made.   

In self and peer advocacy, it is more likely that a support worker supports a number of self or peer advocates. Part of the activity will be to support the advocates to become more confident at speaking up for themselves and others. Another important focus is to build people’s skills at speaking up for what they want. This will include supporting people to think about, recognise and understand information on a subject, deciding which information is relevant to the subject and important to the person, and thinking about the information and weighing it up to help them decide what they want to say. It will also include opportunities for them to practice saying what they want to.

By meeting on a regular basis, advocates have an opportunity to get to know each other and the support worker, and to develop trust in each other.  They can have the opportunity to discuss different topics each time, learning about topics which may be new to them, listening to other people’s views and developing and sharing their own opinions.  

With a support worker who is independent of all other service providers and independent of the person’s family, they can be supported with ground rules and a safe space, to practice how to be respectful of each other, and how to treat each other with dignity as they would wish to be treated themselves. They can also learn how to talk to people they might disagree with in a courteous manner. 

The continuity afforded by regular group meetings with peers can provide a level of ongoing security that can complement, but is not available from episodic, issue-based, statutory advocacy.  The skills gained can help the individual to inform the outcomes that they want in their own life. A person may develop skills to participate where they may otherwise not have been able to. As they develop trust in their peers, they may ask a peer to accompany and support them in meetings, which may, in turn, reduce or prevent the need for statutory advocacy.  

There may be other by-products, which may be of value in the rest of a person’s life, for example, as their confidence and skills improve so may their self esteem and sense of self-worth. As people learn to trust others, and be trusted themselves, it can further enhance the view that others will listen, and can prove a virtuous circle of particular value to people who may not have been listened to very much and may not have been treated as equal partners before. 

The skills they have learned may bring benefits in their relationships and social life, and when striving to achieve new things such as looking for a job or choosing where to live and who with. These skills can also be useful for other purposes. They can be used to help others, as peer advocates, peer educators and system advocates, lobbying for system-wide changes and changes in the community.

These skills can also be offered for co-production, which brings great benefits for commissioners and service providers, as well as others who may need care and support in future, as it helps services and policies and procedures to be developed that will be effective, and will work well for those that will need them and use them. In this way self advocates and peer advocates can take on leadership roles, contributing to debate and fighting for what they believe to be important, whether this is in their local community, or further afield.  

The Care and Support statutory guidance (paragraph 2.20) suggests that such interventions 'can contribute to developing individual resilience and help promote self-reliance and independence, as well as ensuring that services reflect what the people who use them want.'

For areas that invest in peer and self advocacy, there will be flourishing groups that become well-versed in sharing their opinions that commissioners can consult and who are willing to engage in co-production opportunities. Commissioners and those who develop and run services will be able to call on such groups more quickly than if co-production has to be re-designed for every new project. 

Positive habits will form on how to engage people, how to produce accessible information and how to approach co-production, which will save time and money for the system. Over time, individuals may emerge who can develop skills to operate at a more strategic level, whilst nurturing new self and peer advocates with up-to-date experience of how it is for them. Co-production can involve both people who draw on services and their families and carers, without assuming that one group has to speak for another.

Some carers organisations offer a peer support or peer advocacy approach to carers, where they can talk to others with similar experience, and support each other often with a carer's support worker to offer information and signposting. These may also develop to form the basis of co-production work. 

Commissioners may already be familiar with ensuring that specifications and contract monitoring work well for people who use services and support continuous improvement.

You may already have well-developed co-production approaches in place. These can be used for developing long-term plans to enable the local population to have stronger voices through advocacy, for agreeing outcomes to be achieved by services and for developing service specifications. People with lived experience may wish to include 'I' statements and 'We' statements to describe outcomes they expect when advocacy services are working well.

In addition to co-production, there are some national resources that set some good practice expectations about the standards of advocacy provision in England. These can be built into specifications as expectations for commissioned advocacy services.

The Advocacy Quality Performance Mark (QPM) is a quality assurance assessment scheme for providers of independent advocacy in England, Wales and Northern Ireland. It is awarded to organisations who can demonstrate that they provide excellent services in line with QPM standards and the advocacy charter. Commissioners may wish to encourage providers to hold the QPM award or be working towards it. 

The Advocacy Charter contains the ten principles of independent advocacy.  An associated code of practice provides guidance on implementing the principles in the advocacy charter. Commissioners may wish to refer to the principles explicitly in the specification, inviting advocacy providers to demonstrate how the principles are met in their service. 

People employed as statutory advocates should hold, or be working towards, the national City and Guilds Level 4 Independent Advocacy Practice qualification. Commissioners may wish to develop a system for monitoring the quality of the advocacy commissioned, including the number of employed advocates that hold the national qualification or are working towards it. 

Commissioners may also wish to ensure that there is a system of regular communication between commissioned advocacy providers and commissioners during the period of the contract, with a clear expectation that advocacy providers will feed back systemic themes and issues to commissioners.  In turn, commissioners may wish to develop a process to ensure that systemic themes and feedback raised by the advocacy provider are acted upon to improve services.

Commissioners may wish to consider how referrals will be made to each type of commissioned advocacy service, and who will make referrals in each case, including whether self-referrals are encouraged, and if so, how self-referrals should be made. Information and advice about how to self-refer to advocacy services should be made available, if required. 

Monitoring the benefits and outcomes of advocacy services

Commissioners may wish to build outcomes monitoring into their contract monitoring, to build an evidence base for commissioning future advocacy services. A number of approaches exist for this, including calculating the social value delivered by advocacy services.  

For newcomers to this approach, Social Value UK and Social Value International provide resources and background reading, including the social value principles, and why the principles are important. 

The social value approach aims to define the value or worth of an activity, in ways that are not captured through financial accounting, but rather through considering the changes or impacts achieved to wellbeing that stakeholders think are important. The approach can take as little or as much time as you have available to develop the approach and to attribute numeric values to qualitative outcomes. Social Value International recommends 'proportionate levels of ‘accuracy’' and equates this to ensuring that the approach requires 'enough precision for the decision.' 

As the social value approach can be applied to an infinite range of sectors, one of the tasks included is to find out from citizens which outcomes should be used to measure the value in each case.  This can be done locally.

In England some co-production work has been done in identifying outcomes to measure the benefits achieved by advocacy services. NDTi, who run the national Advocacy Quality Performance Mark (QPM) scheme for England, Wales and Northern Ireland, has published an assessment outcomes framework and an associated toolkit.  

The framework can be used by commissioners or providers to consider the outcomes that are achieved by advocacy service, in addition to the outcomes that each individual advocacy partner hopes to achieve from their advocacy support. The framework includes four domains of impact:

• changes for individuals
• changes to the health and social care sector
• change to the wider community
• change to the advocacy service.

For each domain the framework gives examples of outcomes, suggested indicators and sources of data.   

Legal duties to commission sufficient statutory advocacy are laid out in the relevant legislation, as described in the previous section.
 
Each council will have arrangements agreed for making referrals to advocacy services and should make information on this available to advocacy partners and their families.

It is usual for practitioners and professionals across health and social care to make referrals to an advocacy provider (after seeking the person’s consent if the person has capacity in relation to consent), and for that provider to check eligibility for the type of advocacy proposed, prior to accepting the referral.  In some areas, commissioners and providers agree an 'automatic' referral process for IMHA services, and in these arrangements an IMHA visits the person to offer the service to them. Referrals are usually made to a commissioned provider, which is normally a registered charitable provider.

In some areas referrals may be made directly to an individual advocate.

Where statutory advocacy is required, the eligibility will be in line with the statute. For other types of advocacy, the commissioner should have agreed and made clear in the contract what non-statutory advocacy the contract covers and what eligibility criteria should be used for these types of advocacy.

Where funds are limited, there may be some flexibility built in, so that the provider can use prioritisation tools, waiting lists or waiting times to manage workload. If a referral is declined, this fact and the reason should be clearly communicated to the referrer. 

When a referral is accepted, the advocacy provider will decide which advocate to allocate the referral to. Most advocacy providers will request specific information at referral to enable the referral to be allocated to a suitably trained advocate. This may involve checking if there is someone who can represent and support the person.

The advocate should confirm to the referrer that they have been appointed as the advocate for the referral. The advocate should also make contact with the advocacy partner to let them know they have been appointed, to explain their role and to discuss what the advocacy partner wants to happen and how they want the advocate to support and represent them. 

Only in cases where the advocacy partner lacks the mental capacity to instruct, or would have substantial difficulty instructing, the advocate, should the advocate take instruction from anybody other than the advocacy partner. In these cases, the referral is usually made by the decision maker or a colleague on their behalf (such as an administrator). The decision maker will have the responsibility to make a decision, for example, in the person’s best interests under the Mental Capacity Act, or to support the person under the Care Act 2010, and will need to take into account the person’s wishes, feelings, values, beliefs and rights when making the relevant decision.

In these situations, the advocate should contact the referrer or, if it’s a different person, the decision maker, to consult them on the decision to be made, bearing in mind the legislative framework for the particular decision, and also to understand, where relevant, what the available options are. This will give them a framework for communicating with the advocacy partner about their wishes, feelings, values, beliefs and rights in relation to the specific matter to be decided. The same process would be used for generic (non-statutory) advocacy when a one-to-one advocacy relationship is required. 

Where the referral is to a non-statutory group service, such as a peer advocacy group, a carers support group or a self-advocacy group, the referral may be a self-referral, from the person themselves, or from a professional or practitioner. The advocacy provider should acknowledge receipt of the referral to the referrer (when not made by the person themselves), let the person and their representative know whether there is available space in the group for them and provide introductory information to enable them to take part.

In group services, rather than an individual advocate being appointed for each advocacy partner, there is likely to be one or more advocates (or support workers) who are responsible for supporting the group. By definition, such groups are person-centred and members of the group are usually supported to decide what subjects they wish to discuss and make representations about, so that the group is also person-led, by the members of the group.

The support worker(s) role will include making sure that each person has the opportunity to contribute, and that the group agrees some ground rules to ensure that the principles of the Advocacy Charter are adhered to.

It will be useful to ensure that health and council staff have a shared understanding of the duties to commission, and local processes to refer and instruct advocates in locally commissioned services. This will include a collective understanding of where advocacy support falls outside statutory advocacy, what a local contract(s) expects from local advocacy providers, and when the NHS may be required to spot purchase or contract for advocacy support separately from the council commissioned service.  

It will be useful to have a shared understanding across children’s and adults’ services, for clarity on the interface between separately commissioned services, and to be clear when in a person’s life it would be expected that a children’s advocacy service may withdraw, in favour of adult advocacy services, in common situations. 

Where health commissioners or providers become aware of a shortage of advocacy services, this should be raised with the local authority. In the case of statutory services, it will be the role of the local authority to respond to this issue and to work with the provider to resolve issues.   

Council contracts should include expectations for providers to monitor their capacity, demand and any unmet needs, so that providers can feed back on capacity issues to the commissioner and agree with the commissioner how to respond.  In the case of non-statutory services, it may be that the council and local health bodies may choose to work together and to involve people who draw on advocacy services to develop new services to meet advocacy needs of their citizens.  

Local advocacy providers may also be key partners in considering feasible options for delivering new services. These may be commissioned from existing providers, or separately under new contracts. See 'Jointly commissioned advocacy involvement.'

Where there is no statutory duty to provide advocacy, each council will need to decide whether to cover the costs of each type of advocacy within a contract.  Where costs are not covered by an existing contract, individual advocacy providers may choose to offer a requested advocacy service on a spot purchase basis to the commissioner.  

The commissioner may be the host council or may be a social care commissioner from outside the local area, or a health commissioner from either inside or outside the local area. There is no obligation on any provider to provide non-statutory advocacy roles.  

If they do accept non-statutory referrals, each provider will need to ensure that their service has sufficient capacity to continue to provide their statutory services.  

Examples of this include:

• paid relevant persons representatives (RPRs) for people placed in the host area by other supervisory bodies. Under the DoLS scheme: councils often commission the local statutory advocacy service to provide paid RPR roles. These are not IMCA roles so are not included in the 'host' local authority statutory advocacy commissioning duties. Often the RPR role can be taken on by family or friends, but where it is not, the supervisory body will usually commission a paid RPR.  If a paid RPR is required and the local service is unable to provide one, the placing council will need to commission this from elsewhere.
• independent advocates under the Care Act for people placed in the host area by other placing authorities.
• in deprivation of liberty cases in supported living settings, where the authorisation must be provided via the Court of Protection (sometimes referred to as CoPDoL cases), a representative role referred to as is the Rule 1.2 representative can be required by the court. This role is appointed by the court, and the Rule 1.2 representative may be required to submit witness statements to the court at the initial application stage, and at renewal, and may visit at regular intervals during the authorisation period, to enable them to provide a witness statement to the court, if required. If there are any issues with the care and support during the period of the COPDOL authorisation, the Rule 1.2 representative may submit a witness statement during the authorisation period. The costs of such representative roles fall outside the statutory commissioning duties of the council, and councils will need to be clear about whether they will fund these roles, either within the contract, or on a spot purchase basis. Where the person is living in a service that is not commissioned by the host council, the commissioner would be either the placing council or the integrated care board (ICB), for example, in the case of services funded by NHS continuing healthcare.  
• parents with a learning disability, autistic parents and parents with a mental health issue who are facing child proceedings, are not eligible for statutory advocacy support.  This is an area where existing advocacy services may be able to provide support to enable a better outcome for both the parents and the child, on a spot-purchased basis.

Where there is no local authority duty to commission an advocacy service, local health bodies and councils may choose to jointly commission advocacy services for the area, or for a specific service. This may include, for example:

• non-statutory advocacy services for inpatients
• generic advocacy services to support people participating in continuing healthcare (CHC) assessments and reviews
• S117 reviews under the Mental Health Act
• Rule 1.2 representatives for Court of Protection applications
• other generic advocacy services, including advocacy support for people participating in housing applications, disabled facilities grant applications, wheelchair services assessments, community therapy services assessment and planning, learning disability annual health checks with the GP, specific self or peer advocacy groups or support, systemic advocacy.

This may be taken forward under a place-based commissioning strategy, and in the case of peer and self advocacy may also include support for co-production initiatives to support the design and development of future services, including public health, health, housing education and social care services. 

It will be important to establish how much funding each organisation will provide, and which commissioning team will do the commissioning and contract on behalf of the partners. Health and social care (both adults and children’s services) may choose to use a S75 agreement to cover this work, enabling an ICB to meet their responsibilities to meet population needs, bringing integrative approaches to advocacy support. 

Opportunities can also be offered for people with a learning disability and autistic people to co-produce the specification for the service and to be involved in the selection of providers. The co-production can include agreeing how contract compliance will be monitored.
 

Gaps may be noted where councils have not considered some of the points in this briefing. Some examples of gaps are:

• where autistic people and people with learning disabilities are attempting to access mental health support but are not deemed detainable under the MHA. They are not therefore eligible for an IMHA service. They would only be eligible for a Care Act advocate if they are subject to an assessment, a review or care planning under the Act, have nobody suitable to represent and support them and have substantial difficulty participating. If generic (non-statutory) advocacy services are not commissioned locally, there may be no independent advocacy available to them. 
   
• where one type of advocate is due to cease supporting an advocacy partner, and a different type of advocate is due to start supporting the individual for a different matter, the advocacy partner may have to tell their story to the new advocate and may feel severely impacted by a loss in continuity of support. 
   
• where individuals are not eligible for community mental health team (CMHT) input but are bordering on a 'crisis', generic, non-statutory advocacy could be an offer that enables support for individuals who are trying to navigate a complex system and need someone to help them access and develop plans for support from both health and social care.  
   
• even where generic advocacy is commissioned, information and advice may not be easily available to inform the person how to self-refer or how to request a referral. 
   
• where a young person aged 16 or 17 is a looked after child, but lacks the capacity to make decisions about their care and support, and the child and young persons’ advocacy services do not employ an IMCAs, and the local IMCA service does not have staff who are experienced in child and young person’s services. 
   
• where parents with a learning disability, autistic parents and parents with a mental health issue are facing child proceedings, and there are not services locally with the knowledge to offer a spot-purchased service. 
   
• where block-contracted services do not have capacity to take on any additional spot-purchased work.

In any situations where it is not possible for a statutory advocate to continue under the same legal framework, it may be possible to agree among local commissioners to fund generic advocacy, over and above any statutory advocacy, either on a spot-purchased basis or under a jointly commissioned contract arrangement, to provide advocacy in non-statutory situations and to cover potential gaps in provision.  

It is also helpful to consider having advocates trained in a range of legislative frameworks, so that although there may be a change in the legal framework under which the person is provided with advocacy, it may be possible for the same person to provide the different types of advocacy, and there may be no need for the person or their family to have to repeat their story, or to wait for the availability of a new advocate.

Mental health hospitals provide a specific example of how different types of advocacy may be required at different times in a particular type of setting.

A number of inquiries and reports, including the independent report and recommendations from Baroness Hollins, CQC’s 'Out of sight - who cares?' and the Safeguarding Adults Review on Whorlton Hall, have highlighted that the quality, effectiveness, and the independence of advocacy provision for people with a learning disability and autistic people who are inpatients in mental health settings can and should be improved.

NHS England commissioned a review of advocacy available to people with a learning disability and autistic people who are inpatients in mental health, learning disability or autism specialist hospitals, published in October 2023.

The full report considers both statutory and non-statutory advocacy and includes a chapter on commissioning advocacy, recognising the duties of councils to commission statutory advocacy for these settings, but noting an inconsistency in the way independent advocacy is commissioned from one local authority to another, particularly non-statutory advocacy, such as self, peer, family and community advocacy.  

It notes that in some areas, other funders 'plug the gap.' In other areas, it may simply not be available. The report emphasises that people with a learning disability and autistic people wanted to access support from people who have been in the same situation and can relate, and that peer and self-advocacy can do things statutory advocacy 'just can’t' and gives examples.

There may also be a risk of a gap between distinct types of statutory advocacy services. For example, where a person has been detained under the Mental Health Act and has had the benefit of an IMHA, but is in the process of becoming, or is already, an informal patient, preparing for discharge, they may be waiting for the involvement of a Care Act advocate or a child and young person’s advocate to help plan for their services post-discharge.  

If they lack capacity in relation to their care, support and accommodation, they may be awaiting an IMCA to support with a change of accommodation decision. There may be a gap in time between the end of an IMHA support episode and the start of a different advocacy episode, which can leave people feeling vulnerable, overwhelmed and frightened at a time of major change. 

Advocacy services for adults with health and social care needs, NICE guideline [NG227], 9 November 2022

Commissioning independent advocacy under the Care Act, SCIE, October 2014, updated October 2022.

Care and Support Statutory Guidance, DHSC, last updated 28 March 2024

Code of Practice: Mental Health Act 1983, DHSC, last updated 31 October 2017

Mental Capacity Act Code of Practice, Office of the Public Guardian, published 2007