Orphan problems

In its report on the future delivery of public services, the Christie Commission highlighted the activities of a recovery consortium based in Hamilton as an example of good practice. Commissioners visited the initiative and had been impressed by its work. The Lanarkshire Recovery Consortium (LaRC) embodied the principles the Commission would outline. Those involved had identified a need that was not being met. Unmet needs are not uncommon in public services. One key reason is that needs are often orphans without a supporting voice in what often appears to the public, especially the vulnerable public, to be a jungle of public institutions. Everyone is sympathetic to the orphan’s plight but none is willing to take responsibility.

LaRC was able to identify a key need that was falling between the cracks and set out to address it. This third sector group understood this need because LaRC volunteers had first hand experience of drug ad alcohol problems.

jm blog

From the Christie Commission Report, p.31

Five years on and LaRC is worth revisiting. It still exists, works hard and continues to innovate. It would have been easy to continue with the work that impressed the Christie Commission but it has built on this and identified a further orphan.

The silo-based nature of public services means that those with multiple needs have to navigate themselves through an institutional jungle of public bodies, often with little support. Once more, LaRC was able to identify the problem from close involvement and came up with a solution. There was often a lack of professional advocacy support. Research had identified the considerable burden on family members affected by a relative with drug problems. Advocacy was a key form of support but this has been patchy. There have been examples of good practice across Scotland, including the Voice of Carers Across Lothian (VOCAL).

LaRC’s approach has been a classic example of tertiary prevention. It may be far downstream in the preventative approach that Christie advocated. But there was never any doubt that all negative outcomes could be avoided and late interventions are still essential. The road to recovery is long and difficult and the investment in advocacy can pay back many times over in savings to the health, justice and other sectors. The need for qualified advocates who fully understood what was involved led the to the idea of providing that was professional and personalized advocacy training. The idea was that those who had benefited from such a service might themselves go on to train as advocates ensuring maximum empathy in advocacy while offering a route forward for those in long-term recovery. LaRC took the initiative and proposed their REACH Advocacy Award for those affected by addiction and mental health. After many iterations it received Scottish Qualifications Agency (SQA) accreditation. This issue now is funding.

There are a number of arguments for embedding advocacy as a right that lie behind LaRC’s recent initiative. The aforementioned allusion to tackling negative demand should appeal to those conscious of the challenges ahead in public finances. However, this case highlights a key challenge in the funding of preventative approaches. Upfront investment is required but identifying where that should come from is far from straightforward especially when successful savings accrue across a number of institutions and to an extent that is impossible to predict and thereby measure with precision. Measuring the impact of public policy interventions is fraught with difficulties given the vast array of other factors affecting outcomes and measuring what might have been had an intervention occurred takes us into even more difficult territory.

Who pays for preventative measures? The logical answer is those who benefit but the paradox is that it becomes increasingly difficult to gain support with increasing numbers of beneficiaries. There is a free-rider problem. Everyone holds back in the hope that someone else will pay.

A strong case has been made by the Scottish Independent Advocacy Alliance (SIAA) to view advocacy as a right. Currently, those with a mental disorder have advocacy rights but this does not extend to those with addiction issues.   The SIAA powerfully relate the case for advocacy to the Human Rights legislation.

LaRC continue to be an example of an innovative group. Its latest work highlights key challenges in achieving outcomes proposed by Christie. We still have a long way to go to overcome barriers to prevention and overcome the silo-based institutional jungle. The challenge for public bodies will not only be to find a way of supporting this initiative but ensuring that such impediments are not longer systemic.

 

Professor James Mitchell, Academy of Government.

James Mitchell was a member of the Christie Commission on the Delivery of Public Services.

tweet@ProfJMitchell

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