Advocacy Skills for Health and Social Care Professionals

Neil Bateman

• Publisher: Jessica Kingsley Publishers
• Year: 2000
• ISBN:
  9781846421570
• Topic: Scienze sociali
• Subtopic: Lavoro in ambito sociale

Most professionals working in health or social care will be required to act as advocates as part of their work. A social worker or community nurse may need to obtain extra benefits or a particular service for a client; a housing official may need to help a tenant whose benefit has been delayed thus placing them at risk of homelessness; a voluntary body may decide to challenge a statement of special educational needs for a child.

This is a practical guide to advocacy skills specifically written for those in the health and social care professions. Neil Bateman examines the function of advocacy within these professions and how to interview, negotiate and self-manage successfully. He provides a structure for advocacy, a guide to the ethical implications and advice on litigation and legal matters. Accessible and comprehensive, Advocacy Skills for Health and Social Care Professionals will be an essential resource for all those wishing to improve their practice.

Part 1

Contexts

1

What Advocacy is, Why it Matters and Why It Happens

Definitions

It is important to be clear about what we mean by ‘advocacy’ as there is a lack of certainty and much debate about what the word means. Debate about the meaning of advocacy, with an inevitable lack of universal agreement, arises out of the recent and controversial history of advocacy in social and health care and the role of people working in these fields as advocates.

The difficulties associated with agreeing a definition also arise because different models of advocacy have developed in the welfare state. As a result, the word ‘advocacy’ means different things to different people. A lawyer will think of advocacy as the art of speaking in court and examining witnesses and it may be narrowed down further to the extent that legal advocacy is often claimed to be the primary preserve of barristers rather than solicitors. This type of advocacy has been described as ‘a standing invitation to be clever at someone else’s expense’ (Harvey (1958) in Pannick 1993). Consequently, books on advocacy for lawyers will concentrate on the combination of professional duties, legal rules and human skills involved in courtroom work.

Social care workers and health professionals can also act as advocates. Some, such as social workers, will often have a clear responsibility to act as advocates for their clients. For others, advocacy arises as an inevitable consequence of their work with people who are disadvantaged in some way. A doctor or a nurse could be motivated by a sense of injustice or concern about the effects on a patient’s health to write to a landlord about the patient’s housing conditions or to try to persuade colleagues that a particular course of treatment is needed. This is advocacy, but it may not be recognised as such by those involved and can be (wrongly) regarded as marginal to the main task of a medical practitioner. Despite such marginalisation, the improvement in housing and health that may follow such actions could be more effective than anything available on prescription.

A voluntary body may want to challenge a statement of Special Educational Needs for a child. A housing official may be motivated by a combined need to improve his or her employer’s cashflow and concern for the affected individual when taking up a case of late payment of benefit to a local authority tenant with rent arrears. Similarly, a social worker may want to obtain extra social security benefits or a particular service for a client for several reasons. Advocacy will be used as the means to do so, although the process involved may not be thought of as advocacy.

In recent years the influence of citizen advocacy has been profound. Developed in the Netherlands and the USA, citizen advocacy has formed a distinct identity and provided credibility for the idea that service users have rights about the way that professionals treat them.

Often citizen advocacy concentrates upon the way that services are provided by and in institutions. This reflects the fact that citizen advocacy first developed as a way of helping people with learning disabilities to influence the services they receive.

The advocate engaged in citizen advocacy may be concerned with an apparently mundane matter, for example the choice of clothing for a person with a learning disability. However, such matters are of inestimable importance to those whose appearance is decided by others. Parents and institutions may have oppressive and outdated views on what clothes should be imposed on a person with learning disabilities. Citizen advocates try to help those people express their wishes, thus helping them to become full citizens.

It is already clear that different people will be engaged in different forms of advocacy: from the quasi-legal to the very personal. There is, however, a set of core skills that is common to all forms of advocacy. In addition, the tasks that the advocates undertake have a common theme: helping another person obtain something from someone with power. Sometimes what is being sought is clear and structured – for example, extra social security benefits governed by legal rules; at other times it is unstructured and without clear boundaries. The work of citizen advocates and nurses is often concerned with the latter situation. One could characterise advocacy on the first type of problem as ‘hard’ advocacy and as ‘soft’ advocacy on the latter type. Whatever the type of problem, the advocacy must be structured if it is to be effective.

Dictionaries can help us define what we mean by advocacy. The Concise Oxford Dictionary defines advocacy as ‘function of an advocate, pleading in support’. It is perhaps obvious that advocacy is the function of an advocate while, paradoxically, it is sometimes unclear that in undertaking advocacy, one acts as an advocate for the service user. So this amounts to a clear instructional relationship. The second part of this dictionary definition takes us further. ‘Pleading’ is meant in the sense of reasoned argument rather than pleading for mercy. This is the way that lawyers construe advocacy and such a definition is consistent with the ‘softer’ forms of advocacy on unstructured problems.

The Concise Oxford Dictionary’s definition of advocate is also interesting. It reads: ‘one who pleads for another, one who speaks in favour of’. Clearly this implies that advocacy involves arguing on behalf of another rather than on one’s own behalf. Indeed, there are many successful advocates who readily admit that they make poor self-advocates. Perhaps the inevitable subjectivity and self-doubt involved when acting as one’s own advocate undermines one’s efforts. For such reasons, it is particularly important that people working with groups which are marginalised in society are prepared to act as advocates on their behalf. At the most extreme, it is interesting to note that even solicitors charged with criminal or professional offences usually employ another lawyer to act for them.

Another definition in the Concise Oxford Dictionary is that for the verb ‘to advocate’: ‘plead for, defend, recommend, support’. Advocacy is therefore a positive statement: the advocate’s role is to argue positively on behalf of another, pleading the best case possible and presenting the facts in the most favourable light.

Chambers English Dictionary has similar definitions. Advocate’ is defined as ‘an intercessor or defender; one who pleads the cause of another, one who recommends or urges something’. Again the theme emerges of the advocate being someone who acts positively on behalf of someone else. This raises a number of interesting ethical issues which will be discussed later. One common definition which is not in the dictionary is ‘to advocate’ in the sense of ‘to give voice to’. The difficulty with this definition is that it assumes that there is no need for advocacy when a person is able to voice their own concerns.

A helpful definition of advocacy is that it is a ‘device to influence the balance of the needs/rights of the group in the favour of the needs/rights of individuals, especially those on the social margins’ (Brandon 1995).

The examples given earlier show how many people working in different jobs in health, housing and social-care settings can find themselves acting as advocates and the situations described are entirely consistent with dictionary definitions of advocacy.

There are other definitions which are important in advocacy. These include:

•client

•the other side

•negotiation.

The first two are examined in Chapter 2. Negotiation is discussed later in the book, in Chapter 7.

Different approaches to advocacy

The different approaches to advocacy partly reflect the different historical roots of various professional groups within the welfare state as well as the different roles played by these groups. They are also a reflection of the differing demands of clients. Doctors will obviously advocate about medically related matters, whereas social workers will cover a broader spectrum of issues, thus reflecting the range of people and situations they address.

The mental health charity MIND has helpfully identified three main forms of advocacy (MIND 1992). These are:

•self-advocacy

•citizen advocacy

•legal advocacy.

Self-advocacy

‘Self-advocacy’ is defined as ‘a process in which an individual, or a group of people, speak or act on their own behalf in pursuit of their own needs and interests’. All of us are self-advocates to a greater or lesser extent. We go into shops and ask for particular products; we ask our manager to arrange a training course; we make our desires known daily in a variety of situations.

These are perhaps the most mundane forms of advocacy and, important as they may be for people’s ability to survive in modern society, one may question whether such actions are consistent with the definitions of advocacy discussed above where a third party acts on behalf of another.

There are, however, many interesting examples of self-advocacy undertaken on a collective basis where the sum of the whole becomes greater than the sum of the individual parts: tenants’ groups that organise collectively to take action on housing conditions; homeless families who act collectively to challenge the actions of housing officials; parents of children in care who form a group to support and act with other parents to challenge the actions of social services departments; and trade unions at grass roots level where members take collective action to secure improvements in pay and conditions.

Indeed, it is easy to underestimate the influence that the collective power of groups of otherwise voiceless people can have on the welfare state and some in senior positions may try to encourage this by portraying it as a market-based concept of ‘customer needs’.

Trade unions were influential in formulating proposals for a comprehensive welfare system in the 1940s. Contemporary accounts of the popular acclaim surrounding the publication of the Beveridge Report in December 1942 show how there was genuine, deep, public and cross-party support for such ideas, which developed from the collective notions that took hold among the wider population during the Second World War. Collectivism has been much undermined by the push towards individualism in modern society, but its roots still penetrate the far reaches of the British national psyche.

In 1997 and 1998 Whitehall sourced leaks to the media suggested that the important universal benefit, Disability Living Allowance, might be under threat, possibly through a transfer to local authorities or by means testing. The newly elected government was conducting a review of disability benefits and it became clear that such options were being given serious consideration. A broad coalition of disability and welfare rights interests coalesced around the threat and undertook effective lobbying as well as direct action which included the now infamous pictures of severely disabled people chaining themselves to the gates of Downing Street and dowsing themselves with red paint in full view of the assembled media. This event became one of the defining moments of the New Labour government. The collective efforts were successful in halting government moves to restrict Disability Living Allowance – indeed, shortly afterwards, eligibility to the benefit was extended.

An earlier example was that of ‘The Piggeries’. In the mid-1970s, Liverpool council tenants in a badly built block of flats colloquially known as ‘The Piggeries’ (so called because of the appalling state it was in) organised themselves with the aim of having the slum demolished. Not only did they publicly protest but they mobilised radical lawyers to challenge the council on housing law. The result was that ‘The Piggeries’ was emptied, the tenants rehoused and they established useful case law for use by other tenants.

Further back in history, in the 1920s and 1930s, the National Unemployed Workers Movement not only organised benefit take-up initiatives among unemployed people to counter the obfuscation of local benefit officials but also combined representation at the then equivalent of tribunal hearings with collective protests in order to challenge refusals of benefit (Hannington 1936).

Another example is the actions of the Anti-Poll Tax Union in the 1980s, which took much of the credit for showing how unworkable the community charge was by a combination of mass action and legal advocacy. Rigorous examination in Magistrates’ Courts of council attempts to recover unpaid local taxes led to many embarrassments for officials as advocates, many of them unpaid and amateur, unpicked the mysterious legislation during court hearings. At the same time, council meetings were picketed and demonstrations held to give a popular momentum to the organisation.

In the developing world the clergy have taken much of the lead in organising collective self-advocacy. Synthesising populist methods of organisation and Liberation Theology, landless peasants in Central and South America have formed a bulwark against those countries, such as Guatemala and El Salvador, where the military has had enormous political and economic power. Traditional crafts have survived and indigenous culture and language have been preserved as voiceless groups have asserted themselves. However, this has not been without costs – witness the well-documented human rights abuses carried out when indigenous people in South America have acted collectively.

Such actions have much in common with the actions of the Civil Rights m...