Guidance for Unpaid Carer Advocacy in Scotland

Managing conflict of interest

Principle 3: Independent Advocacy is as free as it can be from conflict of interest

What is a conflict of interest?

These may be, but are not limited to, the following scenarios:

• a service provider attempts to direct or control the actions of an advocate
• the cared-for person attempts to exert influence over what views they wish the carer to express in relation to the carer's own needs
• the carer wishes their advocate to express the cared-for person's views as well as their own
• an advocate is requested to withhold information from the carer receiving advocacy, for example, by a professionals or by the cared-for person
• an advocate is asked to give their own opinion or advice rather than representing the view of the carer
• there are several people involved in the care of the individual. For example, two parents looking after an adult child with a disability. The advocate is asked if they can advocate for both parents.
• an advocate feels drawn into a mediation role between the carer and service user
• there is an expectation on the advocate, either from the carer/service user or other professionals, to take on responsibilities outwith the advocacy role
• an advocate discovers they have a personal connection to their advocacy partner
• the advocate is involved in providing a different service to the carer in addition to their advocacy role
• there is an expectation on the advocate, from parties outwith the advocacy relationship, to withhold information from the carer

The advocate should ensure that the carer's rights are upheld and their actions only directed by the carer's needs, interests, views and wishes. In order to do this successfully and avoid any conflicts of interest it is necessary for both the organisation and the advocate to have clear guidelines for best practice.

The organisation:

• should have clear guidance and procedures on how they declare a conflict of interest, including to their funders and commissioners and how this will be managed. The purpose of having such a policy is to highlight and illustrate the potential conflict situations, some of which are not obvious. The policy should also set out which conflicts can be managed (and how they can be managed) and those which the organisation considers unmanageable (and therefore cannot allow).
• and/or the advocate should identify and document any potential conflict of interests, noting how these are managed
• must in extreme cases restrict an advocate from pursuing an activity which creates a fundamental and unmanageable conflict of interest
• must provide an advocate with appropriate training for their role, including understanding of the policies and procedures in place which set out what advocates should do when presented with situations which may pose a conflict of interest for them
• must ensure the provision of advocacy to carers is kept separate from advocacy for the service user. This may be done by using a dedicated carers advocate, either based within an existing advocacy project or employed by a carer support organisation.

The advocate:

• must be free from conflicts of interest or perceived conflicts of interest that could adversely influence their judgment, objectivity or loyalty to the organisation or their advocacy partners
• may take part in legitimate financial, business, charitable and other activities outside their advocacy role, but any potential conflict of interest raised by those activities must be disclosed promptly to their manager. Examples of such activities could be that the advocate fulfils an advisory role elsewhere. This should be subject to on-going review.
• should be aware of any relationships that might conflict or appear to conflict with their advocacy role, responsibilities, or the interests of the organisation. Examples of this may be that the advocate has a relationship with another professional who they may come across in their advocacy role. An advocate may have a relationship with another organisation which must be declared in case they are seen to recommend it or face a conflict of interest if their advocacy partner wishes to complain about that organisation.
  
• should be aware that even the appearance of a conflict of interest can cause concern and can damage the employee and the organisation's reputation if they are not already aware of it and/or have procedures in place to manage it.
  
• must not enter into any agreements which unduly direct, influence or restrict their advocacy role. This includes agreements, informal or otherwise, with other professionals who may be involved in their advocacy partner's situation.
• should be clear during discussions with third parties that they are obliged to pass on to the carer any information which is disclosed. An advocate is unable to withhold information from the person they are supporting. This is because making a judgment about what information should be passed on could be considered to be giving an opinion. Equally, withholding information might be seen to be not supporting the carer.
• in circumstances where there is more than one carer involved in caring for an individual, the advocate must agree who they are advocating for. Where more than one carer in these circumstances requires an advocate, a second advocate will need to be identified.

Cases where a carer support organisation offering advocacy also offers other support/advice services

"In order to be able to ensure the individual's views are heard and understood and that they receive support to ensure their rights are not infringed, advocates have to be structurally and psychologically independent of the service system^[6]."

In some cases carer advocacy services are provided by organisations which deliver a range of services and support to carers, in addition to the advocacy service.

In these circumstances it is essential that organisations develop measures to minimise the potential for conflict of interest that can arise as a result of being both service providers and delivering an advocacy service.

The Carer Advocacy Service should endeavour to maintain its independence of action with separate governance and service management arrangements, the development of specific workplans and targets, and dedicated funding to support the development of advocacy support.

In addition, the service should aim to promote best practice and address any potential conflict of interest through:

• the development of advocacy-specific policies and procedures to support the independent work of the service
• asking advocates to declare any potential areas of conflict, both before they take on the role and throughout their employment or volunteering role
• keeping roles separate and ensuring advocacy workers do not provide other support services
• providing training, support and supervision to make advocates aware of the need to keep a separation with other services provided by the organisation and ensure they are able to recognise and minimise conflicts.
• ensuring agreements around funding and service provision protect the ability of the service to challenge the activities of the funder
• ensuring that when carers are referred to other services and supports, that the carer is supported to explore all available options. This may include referring to other services within the organisation and externally where appropriate.

Case study

Elaine is an advocacy worker employed by a carers support service that offers several types of support for carers, as well as advocacy. The advocacy service has just recently started, and Elaine is the first and only advocacy worker.

As a lone advocacy worker, Elaine has been feeling a bit isolated, and her manager feels that it would be beneficial for her to attend the team meetings so that she can get the support of her colleagues. At the first team meeting that Elaine attends, it is agreed that boundaries are necessary in order that Elaine is not put in a position which may be a conflict of interest. This could happen if she unwittingly hears discussion regarding one of her advocacy partners, which she would then be obliged to pass on to them.

For example, at the team meeting one of Elaine's colleague's, Susan, a carers support worker, mentions that she has received information regarding one of the carers she supports. Susan has been told by a social worker that they have concerns the carer is not physically coping with providing the level of care her husband needs. The social worker has said they intend to look into what options are available to support the carer and broach the subject with sensitivity. However, Susan did not want this mentioned to the carer at the moment as it would cause undue stress and anxiety. Elaine recognised the carer as one of her advocacy partners and is now privy to information about her advocacy partner, which as an advocacy worker she has to pass on to her.

To avoid this type of difficulty, all the staff agree that the meeting will be split into two parts, one where Elaine can freely participate and receive information and where general carers' issues can be shared. Elaine will then leave before the second part of the meeting where case-specific issues may be discussed. However all staff agree that caution is still needed to ensure even general issues are not attributable, including during informal discussions in a shared office. In addition to the one-to-one support and supervision meetings held between Elaine and her manager, it is agreed that Elaine will research other forums where she can meet with advocacy workers to share advocacy specific issues.

Cases where both the carer and service user have a separate advocate:

In these cases:

• it is particularly important to be aware of and manage the potential for conflict of interest when both the carer and service user have their own advocacy worker. It is possible that these advocates may be from separate carer/service user led organisations, or from the same organisation and based in the same advocacy office.
• where it is the case that there is more than one advocate involved in a situation it is important to not disclose details of individual cases or share information, including electronic information, between advocates
• the importance of the separation of these advocacy roles should be explained to both the carer and service user, and boundaries maintained, irrespective of whether the views being expressed on behalf of the two advocacy partners appear to be similar or not
• such cases highlight the importance of supervision, effective management and the need for clear policies and procedures to be in place