Steep rise in NHS mental health advocacy costs for North London boroughs

Barnet, Enfield and Haringey councils have all decided to renew a tri-borough contract with a private provider, reports Joe Ives, Local Democracy Reporter

Providing NHS and mental health advocacy services in three North London boroughs is set to cost each council an extra £250,000 per year.

Barnet, Enfield and Haringey councils have all decided to renew a tri-borough contract for their mental health and NHS advocacy services – despite their existing provider hiking its fees.

Advocacy services help protect the rights of residents in NHS care as well as those under mental health orders, for their own safety. All ‘upper tier’ local authorities, including all London borough councils, are legally obligated to provide them.

A decision to extend the ‘joint advocacy’ contract with current provider POhWER to the end of March 2028 came into effect on Wednesday (20th) after being formally approved by Enfield Council’s director of health and adult social care, Doug Wilson.

The three boroughs have a policy, dating back over a decade, of signing joint contracts with a provider. They also have an agreed policy of “taking a turn” at procuring the next contract for these services when the previous one is set to end.

In 2023, Barnet procured a three-year contract with advocacy charity POhWER, which expired at the end of March this year. It was then Enfield Council’s turn to make arrangements for the new deal.

As documented in a recently-published council report, POhWER, which provides these services for all three boroughs, is increasing its fees in a move that could cost each borough an additional £250,000 per year. Exact details about this and the value of contract with POhWER are not publically available.

Nevertheless, the three local authorities wish to carry on – and improve – the service offered by their current provider.

The report states: “The tri-boroughs have been working with the provider to ensure that hours per case are sufficient and appropriate to deliver advocacy, and to eliminate, as much as possible, non-contact time.”

The document also states that each of the councils in Barnet, Enfield and Haringey wish to make sure advocacy visits to people happen over a focused, “clustered” period of time.

They also want to ensure telephone follow-ups with service users and their families “where appropriate”, as well as investment in artificial intelligence.

The report also shows that the number of referrals for these services in Enfield has been rising since 2021. It means that quality improvements – and cost savings – could be increasingly important in the years ahead.

The advocacy contract includes services that protect and support people suffering with severe mental health issues, including those sectioned under The Mental Health Act and Deprivation of Liberty (DOL) orders.

DOLs are interventions used to protect people who could be a danger to themselves. This safeguard can only be used if the person is to be placed in a care home or hospital.

The advocacy services also include support for vulnerable people to understand their rights under the Care Act and to be involved in local authority actions such as assessments, care reviews and care and support planning.

In addition, they also enable residents to access the Independent Health Complaints Advocacy Service (IHCAS) to raise complaints about NHS care they or someone they know has received.

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