There is an overwhelming lack of published, robust evidence on the impact of advocacy, especially on its cost-effectiveness but also with regard to both quantitative and qualitative data on how advocacy works and its significance for users of social care, according to a newly-published study.
The scoping review did not find evidence that advocacy does not have a positive impact. Rather, it identified an almost complete lack of research and reliable evidence that would enable conclusions about its impact and cost effectiveness to be drawn either way – meaning that commissioners and funders have to rely on information that is mainly based on individual cases, anecdotes and personal opinions.
In the current financial climate, and given an increasing need to demonstrate effectiveness in public spending, the review concludes that this lack of reliable evidence leaves advocacy in a potentially vulnerable position, especially when funding for advocacy organisations is already on a downward trend.
In broad terms, the role of advocacy in supporting people who use social care services is to provide support, information and representation for an individual, with the aim of empowering and enabling them to express their needs and choices. While there is a comparatively large amount of published material that states the positive impact of advocacy, the scoping review found three main problems with the quality of this evidence:
- There is a reliance on individual studies and anecdotes that capture advocacy interventions without analysing common themes. Though useful illustrations of what advocacy can achieve, such evidence stands alone and does not draw a bigger picture of the effectiveness of advocacy.
- There is a reliance on individuals’ descriptions and perceptions of the impact of advocacy, rather than empirical, independently verified evidence. In addition, there is much discussion about the potential, rather than actual, quantified impact and outcomes of advocacy.
- Where information does exist, much of it reports on inputs and outputs associated with advocacy processes, rather than the different outcomes advocacy achieves.
It is likely this is the case because advocacy is a large, very diverse area which has often grown sporadically in the UK over the last 30 years, in an unplanned and uncoordinated way. It forms a complicated picture, involving many different types of provider organisation, different types of advocacy and a huge range of different people supported in different ways.
Its impact is also often difficult to separate out from different but related provision such as information, advice, service user voice and befriending.
“Advocacy as a concept appears to remain misunderstood by many and target outcomes are often viewed differently from different perspectives” says the study.
Ways now need to be sought to improve the evidence base. For instance, shortcomings in the evidence base significantly arise from a lack of rigorous, routine and consistent collection of local data on outcomes by both providers and commissioners of advocacy.
Some organisations and projects have attempted to undertake cost benefit analysis to determine the financial impact of advocacy. Where this information exists it has typically focused on specific groups, especially parents with learning disabilities whose children are subject to safeguarding procedures. Where the evidence is robust, which is in a very limited number of cases, it reports that advocacy interventions return a net financial benefit. Other grey literature reports similar findings; however, these wider conclusions must be treated with caution because there is not sufficient information to determine whether the methods for reaching these conclusions are robust or not.
Despite the overall lack of robust evidence, a strong belief remains from many different perspectives that advocacy – where it is available – has very positive outcomes for people supported, and that it also plays a significant role in promoting key tenets of current social policy and practice, such as personalisation, choice and control and helping to uphold the rights of vulnerable people.
The scoping review was carried out by the National Development Team for Inclusion (NDTi) and covered evidence from the UK and Ireland from 1990. A total of 83 articles, reports and other documents were identified as being relevant and were reviewed and analysed