Review finds lack of published, robust evidence on impact of advocacy in social care services



A recent report from the Improving Health and Lives team suggested that over half of the advocacy organisations in the UK provide services for people with learning disabilities. The report pointed out that given the increasing move towards personalisation and the changes taking place in the organization of commissioning, that there was likely to be an increased demand for advocacy services. The funding base for such services however has been shown to be precarious.

Given this situation, at a time when local authorities continue to face significant pressures on funding, it is important to have a clear understanding of the evidence around the impact of advocacy and to this end, the NIHR School for Social Care Research (SSCR) commissioned the National Development Team for Inclusion (NDTi) to carry out a scoping review. The aim of the review was to identify what evidence exists for the effectiveness of advocacy services, the effectiveness of such services and their value for money.


The researchers reviewed available literature from the UK and Ireland from 1990, using online literature search engines, website searches and through making a targeted call for evidence from key stakeholders including through direct contact with advocacy organisations. Their aim was 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. Given the current period of austerity, one of the particular areas of interest in the review was the financial impact of investment in advocacy services.

The researchers looked a a variety of evidence around advocacy for a range of client groups likely to be in need of social care support, not just people with learning disabilities.

As a result of the search, they were able to identify a total of 83 articles, reports and other documents that were relevant to the review which were reviewed and analysed.


Analysis showed significant lack of robust evidence on impact or cost effectiveness

Analysis showed significant lack of robust evidence on impact or cost effectiveness

Analysis of the articles and reports showed a significant lack of any published, robust evidence on the impact of Advocacy. There was nothing of good methodological quality covering either its impact, or cost effectiveness.

They identified three key problems with the existing published materials:

  • a reliance on individual stories and anecdotes with no analysis of common themes
  • a reliance on people’s views rather than empirical evidence
  • no consistent basis for assessing the evidence of the impact of advocacy support

They found very limited evidence on the financial impact of advocacy. They did find some evidence from a study of parents with learning disabilities, where advocacy interventions showed a net financial benefit.

In relation to outcomes for individuals, or the outcomes achieved by different types of advocacy they found little or no robust evidence

In relation to impact on service delivery, design or local strategy, the only evidence appeared to be descriptions of positive impacts, but these relied heavily on the accounts of the professionals involve with no verification from other sources of such impact.


The authors conclude, in agreement with the researchers from IHAL, that the lack of a robust evidence base leaves advocacy in a potentially vulnerable position.

They suggest a need for “better quality, more widely quantified information on the outcomes of advocacy’ if such services are to survive in a straitened financial circumstances.

The authors are keen to point out however that the fact that their review found a lack of robust evidence of good methodological quality on the impact and cost effectiveness of advocacy services

should not be interpreted as stating there is evidence that advocacy fails to have a positive impact, nor that it is not a cost effective use of public resources.” (emphasis in original)

As they point out, advocacy could be highly cost effective and impactful, but at the moment, the quality of the evidence base does not allow any firm conclusions to be drawn.


The Impact of Advocacy for People who Use Social Care Services, Macadam A et al, NIHR School for social care research/NDTi

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John Northfield

After qualifying as a social worker, John worked in community learning disability teams before getting involved in a number of long-stay hospital closure programmes, working to develop individual plans for people moving into their own homes. He worked for BILD, helping to develop the Quality Network and was editorial lead for the NHS electronic library learning disabilities specialist collection. This led him to found the Learning Disabilities Elf site with Andre Tomlin as a way of making the evidence accessible to practitioners in health and social care. Most recently he has worked as part of Mencap's national quality team and also been involved in a number of national website developments, including the General Medical Council's learning disabilities site.

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