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Speaking to power

Speaking to power: Advocacy for health and social care

David Donnison
Copyright Date: 2009
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  • Book Info
    Speaking to power
    Book Description:

    Anyone working, or planning to work, as an advocate for people who need help in dealing with public services will want to read this book. Advocacy is an area of increasing importance in service provision, where new ways of working have to be found that increasingly create an enabling, rather than a providing, state. Advocacy has an important part to play in this shift. Based on the experience of real advocates, Speaking to power is written in a vivid, jargon-free style. As well as practical chapters on 'what advocates do', using case studies from Scotland where important developments are taking place, the book discusses how advocacy fits into the broader scheme of things. Donnison describes and discusses examples of advocacy, with chapters dealing with management, training and evaluation of the work. The book concludes with a thought-provoking discussion of various strategies which help vulnerable people speak to power on more equal terms. Speaking to power will be particularly helpful to advocates working with people who have mental health or learning difficulties, for doctors, nurses and social workers involved in advocacy, and for students preparing to enter those professions. It will also be of interest to students of social policy and other readers concerned about Britain's broader social and political development.

    eISBN: 978-1-84742-743-4
    Subjects: Health Sciences, Sociology

Table of Contents

  1. Front Matter
    (pp. i-iv)
  2. Table of Contents
    (pp. v-v)
  3. Why and how we wrote this book
    (pp. vi-viii)
    David Donnison

    This book was inspired by the Scottish service that provides advocacy to help people with mental health or learning difficulties. Advocacy for these and other groups began earlier in other countries of the UK, but nowhere else is there the free and independent nationwide service that is to be found in Scotland. When I first got involved, staff of the agency I joined asked where they could find opportunities for further training and professional development. Few were available. No surprise there: the academy always lags about a decade behind new developments in the field because their teachers need a shelf...

  4. Introduction
    (pp. 1-6)

    This book is about advocacy – particularly, but not only, for people who have learning disabilities or mental health difficulties. The practical experience we will draw on comes mainly from Scotland where new and important things have been happening in this field. Here are two examples of the work we will be writing about.

    The first is summed up in a big book – a Personal Care Plan, or ‘PCP’ in the jargon of social work and community nursing. Prepared by an advocate, with help from colleagues in other services, this book is packed with words, pictures, medical prescriptions, names...

  5. ONE Origins of advocacy
    (pp. 7-24)

    To understand advocacy properly – or any other new development in public policy – we should first ask: where did it come from, who created it and what were they trying to achieve? These are historical questions and some readers, who share Henry Ford’s view that “history is bunk”, may prefer to skip to Chapter Three in which we start explaining what advocates do. Others, realising that advocates help people to speak with greater confidence to power, may want to think more carefully first about the workings of power in our society. That is what this chapter is about. I...

  6. TWO Scotland gives a lead
    (pp. 25-36)

    The story we have told thus far is typical of the way a social reform takes shape. First there are economic and social changes: in this case, labour scarcities which make hospital and residential care more expensive, new drugs which make them less necessary, more jobs, more subsidised housing and more generous social benefits to help sick and disabled people survive in the community. The same things were happening in every western country. In most of them the numbers in mental hospitals peaked between 1965 and 1975. In Scotland there has been a dramatic reduction since then in the numbers...

  7. THREE What advocates do: their main clients
    (pp. 37-68)

    In this chapter we describe what advocates do and discuss what we can learn from their experience. This and the next two chapters are the ‘engine room’ at the heart of our book, showing the work that has been launched as a result of the reforms traced in previous chapters and posing questions to be discussed in those that follow.

    Advocates – paid staff and a few volunteers – brought the cases we describe to small meetings where they discussed them with their colleagues. With one or two exceptions these advocates all worked for the same Scottish voluntary agency. Each...

  8. FOUR What advocates do: questions and dilemmas
    (pp. 69-88)

    In this chapter we deal with questions that pose dilemmas for advocates – the kinds of dilemmas that it may be helpful to talk over with colleagues. In a book that will, we hope, be read by people preparing to work in this field it is important to present such dilemmas – not just the easy victories. Our discussion of each is designed to help the reader think about the puzzles involved, not to provide authoritative solutions to them. Dilemmas, by definition, do not have clear-cut solutions that everyone will agree about. Meanwhile, readers should bear in mind that the...

  9. FIVE Groups and communities
    (pp. 89-98)

    Most of the advocacy funded by the state is always likely to be focused on individuals dealing with one-off problems. But collective advocacy by groups of service users must continue alongside this work.

    Individual advocacy can help people cope a bit better with the world they live in. But it never reaches some of those who most need this help. And it may too easily reinforce the assumption – encouraged by much government policy – that each of us has to fight our own corner in the public services market place to get the best deal we can in competition...

  10. SIX Setting up an advocacy project and running it
    (pp. 99-108)
    Scott Rorison

    In Scotland, as elsewhere, advocacy projects usually emerged from organisations that gave a voice to people for whom they were already providing other services. ENABLE Scotland (formerly the Scottish Society for the Mentally Handicapped), Alzheimer Scotland – Action on Dementia, the Scottish Association for Mental Health and several smaller regional associations each gave birth to advocacy initiatives, working mainly with users of their broader range of services.

    This pattern has been repeated in other parts of the United Kingdom and beyond. In the Republic of Ireland, for example, where advocacy is still in its infancy, the lead is being taken...

  11. SEVEN Volunteers
    (pp. 109-124)

    The agency whose advocates provided most of the examples discussed in the last three chapters is typical of Scotland’s advocacy services in relying on volunteers to do a lot of its work. Four of the clients described in earlier chapters were represented by volunteers. Some volunteers join the paid staff for temporary spells to fill gaps in the service that arise when paid workers are on leave or off sick and some of them move into paid jobs when the agency can recruit more staff. Meanwhile, some paid staff work as volunteers for other agencies. So there is no clear-cut...

  12. EIGHT Making advocacy accountable
    (pp. 125-138)

    Every public service should be evaluated from time to time to make sure it is doing its job properly. But those paid by their fellow citizens to act as advocates for people who may be very frail and engaged in conflicts with powerful authorities have a special duty to show that they are doing their best to serve their clients in an independent, well-informed and skilful way, without conflicting interests. That duty weighs particularly heavily on them in Scotland where the agencies they work for usually have a monopoly of reasonably secure public funding for this kind of work in...

  13. NINE Roadblocks
    (pp. 139-144)

    Cases discussed in previous chapters show that advocates will sometimes come up against public services which, despite the advocates’ best efforts, completely fail to give their clients the help they are entitled to expect. That may be because they have run out of money, because they are badly managed, because they are hostile to the client, because they have chosen to focus on other priorities or for other reasons. It is unfair to advocates, and useless for their clients, to send them out to ask for things we know will be refused. But advocates would be failing in their duty...

  14. TEN Looking ahead
    (pp. 145-158)

    We began this book by asking where advocacy came from. We end by asking where it’s going to. As Yogi Berra, baseball coach and coiner of immortal phrases, once said: “You gotta be very careful if you don’t know where you’re going, because you might not get there”.

    People who know a lot about advocacy give two different answers to this question about its future. There are those – often inspired to play a part in the project by their own experience as users of the mental health services – who hope advocacy will reach more of the people with...

  15. Further reading
    (pp. 159-162)
  16. Index
    (pp. 163-165)
  17. Back Matter
    (pp. 166-166)