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Planning for the IMCA Service
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Last modified date:8 March 2007
The Department of Health has commissioned seven advocacy organisations to run pilot IMCA services during 2006. These advocacy organisations are in different parts of the country; they differ in size, previous experience and approach to advocacy. But they have been all meeting once a month to share experiences and identify lessons for national implementation in 2007.
Early lessons learnt for LAs and PCTs
1: The IMCA Service cannot operate without widespread awareness raising and publicity within the health and social care sector it serves. This needs to be done primarily by health and social care managers - with the assistance of the IMCA service provider.
- Senior managers need to have a good understanding about the MC Act generally and the IMCA clauses in particular.
- Senior managers need to identify all the staff who will be responsible for making referrals to the IMCA advocates. Particular attention needs to be paid to situations where it is not individuals but multi-disciplinary teams who take decisions.
- These staff all need to be trained to be fully aware of their responsibilities under the Act about when to make referrals to the IMCA service. The staff need to have internal guidance about when and how to make referrals and held accountable if they do not.
2: The publicity needs to be supported by adequate information, such as :
- training information on the Act;
- engagement protocol for health and social care staff working with advocates;
- leaflets for different kinds of staff: named nurses, doctors, social workers;
- clear guidance on eligibility criteria for an IMCA advocate;
- a phone number and referral form for all referrals;
3: It is recommended that engagement protocols are developed. These should typically address: the aims and objectives of the IMCA service; who will make referrals and how; access to information and confidentiality issues; arrangements for monitoring and evaluation; procedures for challenging health and social care decisions; procedures for dealing with complaints about individual advocates and the IMCA service; IMCA reports and outcomes.
4: Procedures for assessing capacity need to be made available to all staff who are expected to refer to the IMC advocates. The MC Act introduces 'situation specific capacity assessments', which should be widely publicised.
5: Very clear arrangements need to be made for early referrals from staff involved in discharging patients from hospitals to other forms of long term institutional care. Referrals do not lead to delayed discharges if they are made sufficiently early.
6: Very clear arrangements need also to be made for referrals where homes are being closed and clients resettled. This is an area where the use of advocates is familiar; but the use of IMCAs nevertheless remains important.
7: Each health trust or hospital may want to assist doctors with procedures for discussing what is and what is not ' serious medical treatment' and for recording this in the patient's case files. The Code of Practice provides some information but not a definitive list. Health procedures should indicate how doctors can get peer advice, on a case by case basis, where they wish to have the benefit of further advice. Doctors need to be clear that they are accountable for decisions not to refer to an IMCA.
8: Doctors working with patients with acquired brain injury are amongst the ones who may be least familiar with independent advocacy and will need targeting to clarify the IMCA role.
9: The DH IMCA website will have information on assessing the 'unbefriended' criteria.
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