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Commissioning the IMCA service
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Last modified date:9 February 2007
The Department of Health has estimated the cost of the IMCA service at £6.5m per annum and is making this new resource available through the annual local authority settlement. A population based formula has been used to allocate the new resources between local authorities, and local authorities will receive population based allocations.
This paper identifies some of the issues for local authorities to consider when deciding how to commission the new IMCA service.
Step one: identifying local advocacy providers
Local authorities may want to use a number of different ways of identifying local advocacy providers:
Some local authorities will already be commissioners of advocacy services and will, from the tendering process, have details of local or regional advocacy providers;
Some local authorities will already be working with advocacy services which are funded through sources such as Lottery funding, and can be identified through heads of service for older people, learning disabilities or mental health;
Existing Advocacy organisations may be registered with the National Council for Voluntary Organisations; may be on the University of Durham list of mental health advocacy organisations; on the Action for Advocacy list of advocacy organisations, or may be found on other lists.
If, having searched these lists, some local authority areas still have few or no local advocacy organisations, then commissioners may wish to explore the following:
- regional advocacy organisations;
- national advocacy organisations;
- capacity building small local voluntary organisations who might wish to develop new advocacy services.
Optional step two: Pre-qualifying organisations
Some local authorities may wish to do an initial national advertisement to identify those organisations who wish to apply to provide IMCA services. They may also wish to write to the organisations already identified, drawing their attention to the ad. These can then be assessed on pre-qualifying criteria, such as whether they already have engagement protocols, complaints procedures, or clear accountable annual reports. This is a useful stage if there are large numbers of potential advocacy organisations from which the local authority may wish to choose 8 or 10. It is also a useful stage if there are few or no advocacy organisations, and commissioners wish to capacity build in the local voluntary sector to develop local advocacy. It is least useful if there are sufficient but not excessive numbers of local providers.
Step three: developing a specification for an IMCA service
Most if not all local authorities will already have standard specifications for commissioning services from the independent and/or voluntary and community sectors. These need to be developed to fit the requirements of the IMCA Service and also to reflect local circumstances. The DH IMCA website (available mid June) will also have an outline specification which can be adapted for local use and other supporting materials to assist both commissioners and potential provider organisations.
IMCA services for very small populations may be too small to commission from one local authority. A regional approach involving several local authorities may be much more cost effective and provide a better service. Local authorities considering this should start discussions with adjacent authorities as soon as possible.
IMCA services for a small population need to carefully planned. IMCA advocates need to respond quickly to referrals, to avoid delayed discharges or delays in serious medical treatments. Commissioning one full time advocate for an entire area will not provide advocacy 52 weeks in a year - whereas two or three part time advocates might. Similarly, two neighbouring local authorities commissioning a service from several part time advocates may receive a more flexible service that one commissioner can get from 2 full time advocates. There may also be advantages to having IMCA services provided by an advocacy organisation which already provides advocacy in the same area - since this may allow individual advocates to mix the provision of IMCA advocacy, which is issue specific, with the provision of longer term advocacy. Potential IMCA service providers need to be able to demonstrate how they will provide the service within the available financial resources.
The larger local authorities are likely to have the larger IMCA budgets and be more able to commission flexible services. However they may need to plan carefully to take geographical distances into account.
One of the key features of an IMCA service is the requirement that it must provide advocacy for a wide range of client groups, including people with learning disabilities, mental health needs, dementia and brain injury. Commissioners need to satisfy themselves that advocacy organisations applying to provide an IMCA service are either already providing generic advocacy or have clear plans on how to develop the skills for generic advocacy, particularly to work with those care groups with which they are not currently familiar.
The Department of Health recommends that the development of the specification and the subsequent tendering process is carried out jointly with local health partners through existing partnership commissioning arrangements where they exist. This is because the IMCA service must receive referrals - and respond to referrals - from both health and social care professionals. While some PCTs are also commissioners of advocacy, many are not. The joint commissioning process is a learning experience for both local authorities and health trusts, enabling both to discuss and agree engagement protocols, clarifying their understandings of ' independent' advocacy and the development of constructive feedback to individual professionals and service managers. The underlying aim of the IMCA service is to protect individuals and improve health and social care
The tenders need to be let for a reasonable length of time, considering it will take some time to get the new service established and embedded. Three year contracts may be appropriate. An annual review should be built into the final service and funding agreement.
Advertising, interviewing, selecting.
National advertisement of the IMCA tenders is encouraged, unless there are well established tender arrangements based on preferred partner status. This is to enable a wide range of organisations to see the ads and be able to apply. Many authorities already involve users and carers in interviewing and in selecting service providers and report that this is useful.
The selection of the provider of the IMCA service marks the end of the selection phase - but also the beginning of the IMCA service development.
The Department of Health's regional development centres, CSIP, will have staff in place to assist local authority commissioners and contact can now be made with Lucy Bonnerjea at the Department of Health and by telephone on 0207-972-4310.
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