Pursuant to section 28 (1) of the Health and Disability Commissioner Act 1994 (“the Act”), I, Annette King, Minister of Health, hereby approve the following guidelines made by the Health and Disability Commissioner.
Dated at Wellington this 15th day of March 2005.
ANNETTE KING, Minister of Health.
Advocacy Guidelines: Revised September 2004
1. Empowerment Principle
The concept of rights is inherently linked to the empowerment principle. Advocacy is committed to the belief that consumers already have skills and experience on which to draw to assist them in resolving their concerns. Advocates are required to be a strong voice for those consumers who have limited ability to self-advocate, or who are likely to be experiencing institutional discrimination.
A consumer-centred and flexible focus with access to a continuum of empowering strategies is required to ensure the most appropriate approach for each consumer. Working in an empowering way is based on the belief that it is better to equip and support consumers to solve their own problems than to take over their problems and fix them on their behalf. The empowerment principle supports the consumer to resolve the current issue with assistance, and to learn skills and knowledge to develop confidence to self-advocate if and when similar issues arise in the future.
2. Low-Level Resolution
The intention of the Act and the Code of Health and Disability Services Consumers’ Rights (“the Code”) is to promote resolution of complaints at the lowest appropriate level. Often the quickest and most satisfactory way of dealing with grievances is for the consumer to deal directly with the actual provider of the service. The nationwide advocacy service established under the Act is therefore fundamental to this aim of low-level resolution.
3. Code of Practice
Advocacy service providers and advocates shall comply with the Code as if they were providers for the purposes of the Code, except where such compliance is inconsistent with these guidelines.
4. Interpretation of and Comment on Rights
Advocacy service organisations and individual advocates shall refer any request for interpretation of the Code to the Commissioner.
Advocacy service organisations and individual advocates shall not offer opinions about the interpretation of the Code or other rights except to refer consumers, providers or media to any relevant decisions or statements by the courts, Human Rights Review Tribunal or the Commissioner and to assist consumers or providers to understand those decisions and statements.
It is important that the quality and effectiveness of the advocacy service is monitored and evaluated regularly and that improvements to the service are made on the basis of feedback from consumers, complainants, providers and advocates.
Advocacy Practice Guidelines
6. Empowered Consumers
Consumers remain in control and take responsibility for their issues, concerns and rights. Advocates, through empowerment advocacy and encouragement, assist all consumers and other complainants to act on their own behalf. If the consumer is unable to act on his or her
own behalf or it is culturally inappropriate for the consumer to speak on his or her own behalf and requests the advocate to do so, the advocate may accept instructions to act or assist on behalf of the consumer.
7. Protecting the Wider Body of Consumers
Advocates may have concerns about a provider’s practice or any other matter that relates to the rights of health consumers or disability consumers or both (whether in relation to a particular consumer, a group of consumers or consumers generally).
These concerns may have arisen through an advocate working with a consumer who is unwilling or unable to complain, or from trends identified by the advocate in the course of his or her work, or from concerns raised by others in the community. The concerns can relate to an individual provider’s practice, a group of providers’ practice, and/or systems and processes used by the provider/s, or a combination of provider practice and the systems and processes being used. When concerns are not confined to
a specific provider’s practice or a specific system or process, it is sometimes referred to as being a “systemic” concern.
In order to protect the wider body of consumers and ensure the proper accountability of providers, an advocacy service may contact providers directly about the concerns raised, or draw the matter directly to the Commissioner’s attention.
The advocacy service can contact the provider directly in the first instance when concerns can be appropriately resolved at a low level. The service manager shall notify the Director of Advocacy of all direct contacts about systemic and non?systemic concerns made by advocates, in the absence
of a formal complaint.
An advocate shall refer systemic and non-systemic concerns that cannot be dealt with appropriately with low level resolution directly to the Health and Disability Commissioner. A referral shall also be made where the concern has been raised previously by the advocacy service, and the provider has not responded or taken appropriate action.
Persons who are least able to self-advocate, and those persons whose welfare is most at risk and who do not have an appropriate support person, are the priority for all inquiry and complaint advocacy services to consumers. Those considered as having their welfare most at risk are likely to be consumers who may experience two or more of the following:
? Very little social contact
? little or no family support
? difficulty in communicating and being understood
? living in a situation where physical, emotional, mental or financial abuse by an informal or formal caregiver is threatened or has occurred
? mental illness and/or drug or alcohol addictions that may impede their ability to reason and/or be understood or taken seriously.
It is important for advocates to establish, build and maintain positive working relationships with informal and formal providers/caregivers where the consumer whose welfare is most at risk is required to use the ongoing services of the provider or caregiver.
9. Consumer Interdependence
When working with consumers, advocates assist and encourage them to develop their own support networks. This enables them to remain in control and take responsibility for their own issues, concerns and rights. Ongoing support networks may include family, extended family, friends and neighbours, other consumers, paid professionals or advocacy groups to meet their ongoing advocacy needs and to assist in the resolution of their issues. Health and disability consumer advocacy may be used in conjunction with a consumer’s network of support people.
10. Role of Advocates
An advocate provides information, facilitates, and makes it as easy as possible for the consumer to pursue and resolve his or her concerns and issues with advocacy support. An advocate provides assistance to consumers to pursue a complaint through any informal or formal procedures, including proceedings before a health professional body.
An advocate assists a consumer to gain knowledge, and offers skill training to assist the consumer to develop confidence to represent herself/himself. This is so that the consumer is supported to resolve the current issue with assistance and to resolve future issues, where possible, using the skills and knowledge gained through working alongside an advocate.
When assisting a consumer, advocates shall not offer opinions as to whether there has been a breach of the Code. The advocate represents or assists the consumer to resolve issues. While advocates may need to obtain information about a consumer’s concerns, they shall not investigate or adjudicate on issues raised, nor act as an impartial mediator.
If resolution is not achieved, the advocate shall, if requested by the consumer, assist the consumer in finding an appropriate forum where issues raised may be mediated or complaints may be investigated. This can involve the advocate in supporting a consumer through the Health and Disability Commissioner complaint processes and/or the Director of Proceedings processes.
11. Advocates’ Role with Providers
Advocacy services and advocates support consumers who believe their rights under the Code have been breached. Advocates convey the consumer’s issues, concerns and/or complaints, not their own. Advocates are on the side of the consumer and may present some challenging situations to the provider, but this does not prevent them from being fair, considerate and professional in all their dealings with providers.
Advocates do not offer an opinion as to whether there
has been a breach of the Code, nor are they impartial mediators, investigators or adjudicators. Advocates give free presentations to provider group, on advocacy services, the Health and Disability Commissioner role, the Code, and the complaints processes available to consumers. Presentations should, where possible, be in a format appropriate to the needs of the audience.
Advocacy services and advocates shall not make
statements to the media, or in presentations, or in
personal communications that identify individual consumers or providers, nor comment whether specific actions by providers, either real or hypothetical, are or would be in breach of the Code. Advocates shall comply with the Advocacy Service Organisation’s media policy, which upholds this guideline.
Management Practice Guidelines
13. Consumers’ Needs and Accessibility
Subject to the priorities imposed in Guideline 8 of these guidelines, advocacy service providers and advocates shall take positive steps to ensure that they are able to meet the needs of any particular person or groups of persons for whom they have contracted with the Director of Advocacy to provide services. Advocacy service providers shall therefore take positive steps to ensure advocacy services are equally accessible to all groups of consumers.
Specialist nationwide advocacy services may be contracted with the Director of Advocacy to provide consumers with specialised advocacy. Advocates shall inform consumers of the availability of such nationwide advocacy services and any existing specialised community support groups.
14. Advocate Support
Advocacy service providers shall ensure that appropriate support systems are in place for individual advocates. This may include induction, training, performance management, peer supervision via support and review, risk management procedures, physical safety and appropriate specialist support.
15. Relationship of the Service Provider to Consumer
Advocacy service providers, rather than individual advocates, are contracted to provide services to the consumer. Consumers shall be advised that the advocate is providing the service as an employee of the advocacy service provider.
16. Referrals to Other Agencies
Advocacy service providers shall establish and maintain effective links with relevant agencies, including community groups, and refer consumers to those agencies as and when appropriate.
17. Information Systems
The collection, accurate recording and transfer of information pertaining to the services provided by advocacy organisations, including trends in consumer issues, assists in the efficient and effective management of advocacy services. It provides valuable information as to the present and future needs of consumers and the need for any improvements to the service.
Reporting requirements in line with contractual obligations shall be facilitated by the use of information systems approved by the Health and Disability Commissioner.
18. Publicity and Promotion
The integrity (principles and professionalism) of the advocacy service is maintained by ensuring consistency in all publicity provided about the Health and Disability Commissioners’ Advocacy Service.
The Health and Disability Commissioner will provide all generic promotional and educational material, about the Code and the role of the Commissioner, directed to consumers and providers. Promotional and educational material will, where possible, be in accessible formats for consumers. Any specific promotional and educational information produced by individual advocacy service providers will be sent to the Director of Advocacy, prior
to publication, for comment. Formal public speaking engagements and papers for publication by advocacy service providers and individual advocates will be notified in advance to the Director of Advocacy for comment.
The first Health and Disability Commissioner’s Advocacy Service Guidelines were approved in 1996. The Minister
of Health approved the revised and updated guidelines
on 24 February 2005 following a comprehensive consultation process where opportunities for comment
were extended to a wide range of people and organisations that included representatives of health consumers, disability services consumers, health care providers, disability services providers and professional bodies.
The revised guidelines reflect the development and maturity of the nationwide advocacy service and have taken into account the responses received during the consultation process. The new guidelines also clarify the distinction between governing, management and advocacy practice guidelines.
Free copies of the guidelines will be available to the public on the Health and Disability Commissioners’ web site http://www.hdc.org.nz or directly from the Health and Disability Commissioner, the Director of Advocacy or from any of the three advocacy organisations providing Health and Disability Commissioner’s advocacy services by phone (0800 11 22 33) or email requests (email@example.com).