Macadam A, Watts R, Greig R
The role of advocacy in supporting people who use social care services has long been a focus of UK Government policy. However, there is a lack of understanding about the evidence of its impact in social care – with anecdotal evidence of recent disinvestment in advocacy taking place without consideration of its impact. Given this, NIHR SSCR commissioned the National Development Team for Inclusion (NDTi) to carry out a scoping review to identify what evidence exists on the impact of advocacy, including around cost effectiveness.
This review scoped evidence from the UK and Ireland from 1990. It sought to identify evidence on the impact of advocacy in social care and related fields and to help understand the benefits of investing in it against a range of different factors and outcomes (with particular interest in financial impact). Evidence covered different types of advocacy for all client groups likely to be in need of social care support. The review was desk-based and utilised online literature search engines, website searches, a targeted call for evidence and with key advocacy stakeholders being contacted directly to support evidence gathering. A total of 83 articles, reports and other documents were identified as being relevant and were reviewed and analysed.
The review found an overwhelming lack of published, robust evidence on the impact of advocacy, especially regarding its cost-effectiveness, but also with regard to both quantitative and qualitative data that evidences the impact of advocacy. These findings were significantly informed by shortcomings in the robustness and quality of existing published evidence. The three main problems with published materials were: a reliance on individual stories and anecdotes without analysing common themes, a reliance on people’s views rather than empirical evidence, and no consistent basis for assessing the evidence of advocacy’s impact. These shortcomings significantly arose from a lack of rigorous, routine and consistent collection of local data on outcomes by both providers and commissioners of advocacy.
Evidence from cost benefit analysis of the financial impact of advocacy is very limited and focused on specific groups, especially parents with learning disabilities, where it reports that advocacy interventions return a net financial benefit. Other grey literature on cost benefit reports similar findings but did not publish detail of methodology.
There is a paucity of robust evidence on outcomes for individuals arising from advocacy interventions. Evidence is also not available that highlights the outcomes different types.
Some qualitative evidence exists on the process of advocacy for particular people (such as disabled children and young people and those in the care system), but there are significant gaps in the literature on the evidenced effectiveness of advocacy, particularly (though not limited to) older people and people with mental health conditions or who lack capacity.
There is a similar lack of evidence on the impact advocacy has on service delivery, design or local strategy. Literature describes positive impacts, such as on professionals’ attitudes, but this typically relies on accounts from professionals or advocates. Beyond this, it is not possible to determine whether positive developments could only have happened because of the presence of advocacy organisations. Nationally, the literature reflects a stronger sense of policy initiatives impacting on advocacy, rather than vice versa.
The review concludes that this lack of robust evidence leaves advocacy in a potentially vulnerable position. During difficult financial times, with an increasing need to demonstrate effectiveness in public spending and a downward trend in the funding advocacy organisations receive, the need for better quality, more widely quantified information on the outcomes of advocacy has never been greater.