Throughout your training it has been emphasised that the vast majority of advocacy is conducted within a very collaborative and positive atmosphere in which the wishes of service users are seen by all concerned as very reasonable and obtainable. Indeed, we have emphasised that the major concern the advocate has to be aware of acting in or being seen to be acting in a manner in which it looks as if you are in colluding with service providers. It is always too easy to be dragged into looking as if you are another representative of that group of people who's job it is to assess the best interests of service users.

However it has to be recognised that there are some cases where conflict does arise between the wishes of the service user and the views expressed by service providers. This discussion document centres upon the issues that arise in such situations. Service providers in many instances express these views in terms of "the best interests of the user" although in an increasingly tight purchasing environment it may be in terms of obtainability. What is wanted may be no great shakes in terms of wish but may not be obtainable in terms of resources i.e. often referred to as an unmet need. It should be noted that this can be a very frustrating position for service providers who wish to obtain the best for their users but cannot afford to purchase it. Whatever the reason, sooner or later you may well be in a position where your user is in conflict with the providers and pressure will be put on you because of your position as an advocate. This pressure can come from both the service user who, not surprisingly, wants something, but also from the service providers who may think such wishes are dangerous, risky or whatever.

This is a tricky position to be in and can be distressing for all concerned because:

Everyone tends to get on his or her high horse and become rigid.

The views of the user may be legitimate and reasonable but unobtainable (in provider terms) because of a constraint, usually fiscal in nature.

The user's wishes are in the view of "professionals" such that would put the user or society a risk. The professionals have responsibility for care and may be culpable if the user's wishes are met and there is an outcome damaging to the user or society.

The advocate may understand the professional's concerns, but has to try and withhold their own opinion.

This situation can really stretch the resolve of the advocate to represent the service user, especially if service providers put pressure on the advocate in terms of the dire consequences if the user's views are put into action. Additionally you may be accused of leading the user down a particular path or that the users views are not "informed" or that the user does not appreciate the down side etc. In simple terms these pressures have to be resisted not because we just want to be antagonistic, or that there may not be a bit of truth, but because as advocates we are there for one reason and we must continue to try and maintain our role. To deviate for service providers convenience would be to undermine the whole role of advocacy within the process of user empowerment. But lets consider this a little further and look at the consequences.
Firstly we must consider our own behaviour before condemning that of others. As we consistently state throughout the training process, it is all too easy to influence service users, if not deliberately, by subtle inferences etc. You must make sure that you do not become a too powerful influence in the user's life. You must make sure that if the user wishes to make INFORMED choices that they have access to all the facts - good and bad. You should ensure that users are made fully aware of the barriers to fulfilling their wishes - especially if the providers are against a particular course of action. Overall you must make sure that your actions are not giving the impression that you are able to make it all come true just because you are involved. This is all pretty tough stuff. Saints you are not, but if you are to truly represent your user as an advocate you have to constantly question your own role.

Given all the above it will not negate the fact that you (and the user that is - don't forget them) could still be in conflict with some pretty powerful forces.

Now what you have to remember is your role and it's worth repeating it yet again:
Firstly it is to enable users to make choices and express views by informing them of their available options, etc. (not always the ones providers might want them to hear of course - but surprisingly enough in many instances they do coincide);
Secondly it is to express the users views in an appropriate manner and in relevant forums to whomever needs to hear. Usually this is non-controversial and takes many forms (although you can come across some very feisty consultants!)

However, when conflict arises you are faced with a third role, which is far trickier to run with. In "normal" circumstances (the non-conflict environment), whenever problems or views are aired and decisions that require action are made the service providers are there, willing and able, to "do the business" so as to speak. But when a service user wants something that the providers are unwilling (or sometimes unable) to supply, you may be faced with a determined service user who will want you to take on the role of service provider. Of course, advocacy is not just about voicing opinions. Often you are asked to fill out forms, accompany people to meetings, arrange services, etc. However you must be careful not to become a surrogate provider rather than an advocate! Whilst nobody will perceive such actions as a problem when everything is hunky-dory - it may well become A REAL PROBLEM WHEN THERE IS CONFLICT - FOR THE REASONS STATED ABOVE.

This may put you in a position whereby the service user cannot move forward on their own wishes because nobody can provide the sort of support that will enable the action or wish to become a reality. The service providers refuse on principle and the advocate because to do so would make them a provider by default.

On the other hand you have to be vigilant about your primary role. You have to be aware that you may be made to feel guilty if the user gets what they want with your help because you are now responsible for anything that goes wrong. You have to remember that you do NOT have a 'duty of care' and others do. If a course of action is so risky to the user or others then the "authorities" have many powers to restrict the actions of the user. This may take the form of legal restrictions, but may also be informal in nature in that they will not facilitate actions or services they deem, for instance, to be outside of a care plan. This has repeatedly happened in cases where elderly people "at risk" are "forced" into nursing homes whilst their wish is to stay at home. Advocacy has sometimes been criticised because it allows these people to have a voice to pressure providers into putting into action care plans that do enable people to stay in their own homes, often on an experimental basis. Services specialising in providing advocacy for the elderly cite these incidents as being a major area of conflict between users and their best interests as defined by the caring services.
Whilst in such cases it is legitimate to maintain a voice for the user and to support them in their desires you have to maintain vigilance on all the points raised above about your actions and how they can be perceived by both the service user and the service providers. In the example above you would have to examine your role if asked to arrange a taxi to get the user home or to arrange for utility services to be reconnected. In some cases it could be seen to be part of your role, in others not. Each case is different and the circumstances will determine the appropriate response from you as an advocate. It is essential that you ensure that your presence is needed purely to be an advocate - rather than to enable the user to do something that others should be providing.

Conflict can also be very positive. Of course probably nobody (especially your user) will win if a vulnerable person's future is put in jeopardy in an atmosphere of conflict and strife. Often conflict can lead to compromises (remember, we all have to make compromises). It may lead to an opportunity to get the providers to look again at the package of care they are offering. It may make the user rethink their own views in the light of sustained opposition. It may make you rethink the alternatives that may be viable.

Always remember that you are not deliberately in conflict. Most providers are attempting to do their best and have genuine concerns for their users - they are not the enemy, or there just to make life hard for users. Treat everyone with respect if you want to be treated the same. Do not make advocacy a game or part of a larger agenda about 'User Rights'. You are there to be used by your partner. Do it in good grace.

Such is the potential for conflict between the advocacy service and service providers, advocates are advised to always consult with their co-ordinator or manager for guidance whenever this type of situation arises. In the event that it stumps them they will talk about the issue with other advocates and managers at Asist. If in doubt - voice it. It is what we ask of our users. It's good for them and its good for Asist.