Change that leads to better lives

Why doesn’t advocacy lead to transformational systemic change as often as it should?

Following a recent presentation at the Centre for Public Scrutiny’s recent annual conference on Scrutiny of Health and Social Care Judith Davey, of The Advocacy Project, reflects on why advocacy is not utilised effectively to ensure that user voices are heard during changes in policies and procedures directly effecting the users themselves.

Advocacy is a bellwether that shows what’s working and what’s not in local health and social care services. It’s an early warning system. Advocacy, whether statutory under the Care Act, Mental Health Act and Mental Capacity Act or non-statutory, can pinpoint emerging trends, gaps in service, and issues. It highlights local and systemic issues.

Local authority scrutiny committees already consider complaints data, and the trends and issues this highlights, as a way to improve services. But what about advocacy data? It’s rare that advocacy data is used in scrutiny processes or to inform transformation programmes. A real missed opportunity.

Do we have culturally appropriate and effective mechanisms for people speaking truth to power? Often not. Do scrutiny committees and NHS trust governors listen to people’s voices? Do they challenge officers on how service user input was gathered and analysed? What steps were taken to make sure all voices were heard in a meaningful way? Clearly intentions are good. But our experience, working as an independent presence within the health and social care system, is that this could be so much better. And this would lead to better outcomes and more effective use of resources all round.

Current governance structures overseeing service design, delivery and transformation don’t cut the mustard in providing culturally appropriate and effective mechanisms for people speaking truth to power. The consequence of this is that we can’t guard effectively against testimonial injustice.

What is testimonial injustice? It is a well researched concept, but is rarely considered in user involvement or scrutiny. It occurs when “prejudice causes a hearer to give a deflated level of credibility to the speakers’ word … a negative stereotype introduces prejudices that cause a credibility deficit with the consequence that a person's capacity to act as a testifier – a reliable giver of information – is impaired, or in severe cases completely destroyed”.

Often it’s associated with people with mental illness, the homeless or people engaging in substance misuse. We need to make sure we really listen to all voices. It’s simply the right thing to do. And consideration of these more marginalised and stigmatised groups can have a significant impact on the functioning and cost of the whole health and social care system.

I presented on this speaking at the Centre for Public Scrutiny’s recent annual conference on scrutiny of health and social care. I think the underlying issue is that governance structures overseeing service design, delivery and transformation do not always make sure user voice/patient voices are heard. Key questions are:

Do the governance arrangements for transformation and service delivery include assurance around user voice?
Has service user input been triangulated with other data (eg complaints and advocacy)?

Including advocacy feedback in scrutiny and service improvement initiatives is an important aspect to consider when designing or reviewing governance. Without it, the health and social care system is missing crucial information that can help to drive systemic change.

The presentation was well received, and has been picked up as a topic for further exploration. Jacqui McKinley, CEO of the Centre for Public Scrutiny, said, “The challenge about the role of user voice in governance and the role of advocacy data in scrutiny was well made. It stimulated a great discussion and we’ll return to this topic in the near future.”

Judith Davey, CEO, The Advocacy Project


Judith Davey is Chief Executive of The Advocacy Project. Proud mum, feminist, and curious person who loves to know about the world (hence the certificates in “odd” subjects like canine psychology and genetics). Passionate about human rights, equality and social justice. Judith has worked in human rights, poverty reduction and transformation internationally through her work at ActionAid and nationally through her work at a large county council, and her work at The Advocacy Project. She loves to dance Argentine Tango.

Social media handles

Twitter: @JudithEDavey, @TAPadvocacy


Facebook: @TheAdvocacyProjectUK

About The Advocacy Project

The Advocacy Project’s vision is ‘A world in which every person has a voice.’ We work with vulnerable and excluded people across London to amplify their voices and secure their rights so they can make informed choices and active decisions about how they live their lives. Inequality, stigma and isolation are some of the most prevalent issues that people we work with face and we address these issues by providing independent, confidential rights-based advocacy and user involvement services.

40% staff and 50% trustees have lived experience of the issues on which we work – things like mental health, learning disabilities and dementia. This gives us an authenticity and builds trust with service users which enables us to get to the heart of their issues We focus on building people’s capacity and increasing their agency – rather than speaking on their behalf or doing things for them.

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