‘Listen’, ‘partnership’, ‘empower’, ‘share’, ‘recognise’, ‘respect’

These are terms that we are used to seeing in the context of independent advocacy support.  I have in fact picked them out of the revised Code from regulator, the Nursing and Midwifery Council (NMC). Although my own background is not in health I was familiar with the previous Code from 2008. Section 4 of that version states ‘You must act as an advocate for those in your care, helping them to access relevant health and social care, information and support’. At Dorset Macmillan Advocacy as part of the training for our volunteer advocates we had discussed how this might make health professionals more open to the support that we can offer but how it might also lead to them seeing it as unnecessary since they already act as advocates for their patients.

The revised Code has widened this aspect considerably and now says: ‘Make sure that people’s physical, social and psychological needs are assessed and responded to. To achieve this, you must: … act in partnership with those receiving care, helping them to access relevant health and social care information and support when they need it, and act as an advocate for the vulnerable, challenging poor practice and discriminatory attitudes and behaviour relating to their care.’ The NMC says that the Code has been written with the input of many patients, carers, nurses and midwives. It is shaped around four statements, which state that good nurses and midwives will:

• Prioritise people • Practise effectively • Preserve safety, and • Promote professionalism and trust.

Jackie Smith, NMC Chief Executive and Registrar, said on 31^st March: “This is a landmark day for every nurse and midwife in the UK, and for the people they care for. The Code is fundamental to protecting the public. It sets out what patients want from nurses and midwives, and puts public expectations at the centre of professional practice.” Macmillan Cancer Support have noted that ‘The changes to the code include new sections that outline professional duty of candour, and the responsibilities of all nurses and midwives to raise concerns. The focus of the revision is to drive continuous improvements in the quality and safety of care.’

I asked one of our own volunteer advocates with a unique perspective, since she is also a practising nurse, whether she felt that the revised Code would make it easier for our peer volunteer advocates to work with health professionals in supporting their advocacy partners. She said “The new Code will bring benefits regarding better communication between health staff and advocates. We now have the professional duty to facilitate communications among everyone that is taking care of a person. The new code has underlined even more the centrality of the patient, which means ‘do the best for them’, and implies cooperation among all their carers.  Another important point that for me from the advocacy perspective is that nurses have to delegate to whomever can do the best for the patient and can complete the task at the required standard, even if they are not a health worker.”

I really recommend reading the revised Code to get an insight into what the NMC has found to be the most important aspects of patient and public expectation. The Code is extremely readable and well-constructed.  We will be referring to it in our volunteer training. Indeed many of the requirements of nurses would be transferable to the role of independent advocate especially those concerning clear communication: ‘use terms that people …can understand, use a range of verbal and non-verbal communication methods…check people’s understanding’.

Most importantly for me the Code recognises for the first time that a patient may be supported by an advocate and mentions the role directly in the third section entitled Preserve Safety. ‘Be open and candid with all service users about all aspects of care and treatment, including when any mistakes or harm have taken place.  To achieve this, you must… explain fully and promptly what has happened, including the likely effects, and apologise to the person affected and, where appropriate, their advocate, family or carers.’ I feel that the revised Code will serve as a strong foundation for effective cooperation between peer volunteer advocates, their advocacy partners – the older people affected by cancer, and the clinicians delivering their treatment and care.

Kathleen Gillett, Dorset Macmillan Advocacy

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Awareness raising locally in Gateshead

Volunteers and staff from local pilot, Gateshead Cancer Advocacy, armed themselves with display stands, leaflets and posters to promote their service within the Queen Elizabeth Hospital in Gateshead.

As part of the new display we posed questions that a person wishing to access a cancer advocacy service may present – in this way they can relate to their own situation and make further enquiries about accessing the service

The purpose was to raise awareness and attract new referrals into the service. We staffed an information stall situated in the out-patients department which targeted patients attending day appointments with their consultants. The following day we moved the information stand to outside the hospital restaurant targeting the public and medical staff particularly attracting the lunchtime trade.

Patricia Lee

Much interest was evoked and many leaflets were given out by local Cancer Champion, Patricia, Volunteer Support Advocate, Anne and Project Lead, Alan. We are hopeful our efforts will result in some new referrals being received.

Alan Davison, cancer advocacy co-ordinator

A message of thanks!

I recently received a nice email from Lisa, an Assessing Officer in Gateshead Council Community Based Services (social services). We have worked closely with that department for many years and have a very good relationship with the multi-disciplinary team.

The email said:

“Just to thank you for your recent Advocacy involvement with a service user at the end stages of his life.

Alan Davison

In July, the 87 year old gentleman was admitted into the Queen Elizabeth Hospital.  He was diagnosed as suffering from Lymphoma.  He had never married, had no children or family and no close friends.  He suffered multiple health problems and following his recent palliative diagnosis and deterioration in his physical health was unable to return home to his flat in Gateshead.

I made a referral to your Advocacy Services to support the gentleman in his choice of nursing homes.  You, as the appointed worker contacted me within days of the referral being made.  I discussed the case in more detail with you and informed you of the outcome of my assessment – The gentleman required 24 hour nursing care.

You visited him in hospital very quickly to introduce yourself and after discussions with him you were able to bring nursing home brochures to the hospital to show him what was available and to enable him to choose his new home with your support.

Unfortunately his health deteriorated very quickly while still in hospital and the nursing staff on the ward contacted you to inform you of the deterioration.  You immediately re-arranged your diary to enable you to visit him in the last hours of his life.  You showed empathy and genuine regard for his care throughout the whole process and I believe he felt supported by this.” Lisa McGeary, Assessing Officer, Queen Elizabeth Hospital

The sentiments in Lisa’s email prove that we are developing a valuable asset for older people affected by cancer in our communities, working collaboratively with other agencies.  Lisa made the initial referral to Age UK Gateshead based on a good working relationship. We welcome all comments about how the project is being delivered so we can change and adapt delivery to suit users of the service.

Alan Davison, Project Lead, Gateshead Cancer Advocacy