Part 2e - Working with and through others

Working with and through others

Working with the voluntary sector

The voluntary sector has much useful experience to share from working with people both as users of their services and as volunteers. Voluntary groups often have the flexibility to work in innovative ways.

Advantages:

May be expert in their particular field
May have a structure to support participants and canvass wider views
May have access to particular groups of people you would not otherwise easily reach

Consider:

The politics. There may be are a number of organisations that relate to, for example, physical disability, with different perspectives. Are they all represented?
Not everyone is represented in formalised umbrella groups. You will still need to engage with individuals who are not part of a group
Voluntary groups are not neutral - they have their own agendas
Group may be reliant on funding. It can be difficult to 'bite the hand that feeds you'
A large sector with groups of various sizes and in different stages of development. Many will not have the resources to participate without your support

The voluntary sector is often perceived as being democratic, and controlled by its members, but this is not always the case. A study conducted in 1995 found that while voluntary organisations supported the involvement of users in control of the organisation, few had clear policies, progress was slow, and fear of the consequences of increasing user control was a substantial block to progress⁴⁴

Working with user, carer and support groups

These may be small and unique to your area, or part of a national organisation

Advantages:

Knowledgeable and engaged in their subject area
Relatively easy to make contact with
Way of making contact with users and carers to invite their participation
Ideas can be tested with the group before developing them further

Consider:

Groups may be limited in membership and range of views
May have a very specific agenda

Working with existing community groups

For example, pensioners' groups, groups around a particular religion or culture

Good for:

Making contact with a range of people who might otherwise be hard for an agency to reach

Advantages:

Opportunity to get a range of views
People may appreciate agency coming to them, and be more prepared to enter into dialogue
Improves power in-balance - people feel more confident in their own territory/setting

Consider:

Group may not share agency's agenda and resent hijacking of personal time/space
May produce lots of anecdotal, non-specific information that is hard to use in positive way
Lack of an immediately visible outcome may affect your future credibility with the group

Working through liaison or link workers

Dedicating resources to outreach work was an effective way of contacting service users from more marginalised groups.55

Appointing individuals who can act as a link between all parties is widely recommended.

There is the potential for role conflict - is the individual neutral, or working to an agency agenda? This is often minimised by the voluntary sector or body such as the Community Health Council holding the funding and the worker's contract. Service users or past users might be employed to help develop and promote involvement.

Link workers can:

Develop knowledge of a particular sector, group or area
Improve communication and co-ordination between statutory and voluntary organisations and user groups
Make links with individuals and groups that agencies find difficult to engage with
Provide training for service users and staff
Support individuals and groups in participation

Development workers

Can seek out and reach people who don't participate through other channels
Can act as a resource to local individuals and groups as they develop, providing advice, support, practical help with funding, administration, printing

Consider:

Such workers have the power to set agendas. They need real awareness of power relationships and self-reflection
They can become viewed as the expert when what they are trying to develop are the skills of others
There can be the danger of creating dependency on an individual

Bringing in external facilitators or consultants

Good when:

There is no time to develop the required expertise locally
An issue is particularly sensitive or contentious

Advantages:

It can be valuable to obtain an external, independent perspective
They may be perceived as more trustworthy than the organisation involved
Recommendations may carry more weight
Can provide a learning experience for the establishment or agency

Consider:

Often seen as putting off dealing with an issue
They need a very clear brief in order to be effective - by which time you may have done much of the work yourself
The organisation may lose opportunities to develop its own skills, and experience from 'first hand' contact with participants
Their work can be more easily compartmentalised, and viewed as a one off activity rather than a sustainable process of development
Can make it harder to avoid acting on conclusions - can you deal with their recommendations?

Advocacy

"Advocacy means making the case for someone or a group of people or helping them to express their own views, usually to defend their rights or promote their interests. The concept has special relevance for people who are disadvantaged in some way and as a consequence are less able to speak for themselves."⁵⁶

The 1986 Disabled Person's Act gave individuals the right to appoint an advocate, and local authorities a duty to develop advocacy schemes. Although the Act was never fully implemented, it is good practice that the right to an advocate, and access for advocates to service users, is written into service specifications.

Advocacy for patients is included in the NHS Plan

"...it is consistent with the aims of basing service provision on the needs and wishes of users that those who are unable to express their views..[should] be supported in securing independent representation."57

Forms of advocacy might include:

Self-advocacy - service users acting individually or collectively in their own interest
Peer advocacy - the support of someone with a similar personal experience, for example, of disability or mental illness.
Citizen advocacy - trained volunteers act as impartial witnesses and supporters, or represent other, usually vulnerable, people
Professional advocacy - representation by a paid, independent person such as a welfare rights advisor or legal representative

Some would include practitioner advocacy, but there is debate about whether practitioners, who are influenced by professional or organisational agendas, can truly act as advocates for service users in a disinterested way.

Advocacy has the potential to allow those whose voices might not otherwise be heard to make their views and preferences known, and to influence policy and practice.

"If ..advocacy were to be recognised as a means of empowering .... users (by advocates accompanying them to meetings), then many more of them would have a physical presence at formal events, rather than having their views represented by someone else while they stay at home.."58

The Health Advisory Service59 suggests:

"Advocacy may be a means of ensuring that users' views are brought into planning processes generally" as well as ensuring their voice in individual care.

The report proposed the development of a consultant advocate role, a paid professional who specialises in representing the interests of users and carers. (In this case for mental health services, although the principle could apply to other service sectors). The report suggests consultant advocates should have an understanding of mental disorder, service provision and management, planning and purchasing and relevant legislation. They should be independent of the service, linked through a national network, and have recognised training and accreditation. They could supervise other advocates and support service user involvement in the planning process.

The Royal Commission on long-term care for older people recommended that local advocacy schemes were developed that would provide an 'independent intermediary' for people in care.⁵⁹ See 'Engaging older people'

A review of advocacy ⁶⁰found that successful advocacy was promoted by awareness at all levels of what advocacy is, and what it can do. Another factor was well trained, supervised and supported advocates with time and skills to build good advocacy partnerships, but the insecurity of short-term funding of projects could limit the ability to recruit volunteers and provide ongoing training and support.