What is advocacy in health and social care? Who can get an advocate

Advocacy in health and social care is independent support to help a person understand information, express their wishes and secure their rights. In England, the council must arrange an independent advocate under the Care Act 2014 when someone would have substantial difficulty taking part in an assessment, care plan or safeguarding enquiry and has no suitable person to help. Other statutory advocates cover mental capacity and mental health law.

At a glance

• An advocate supports and represents the person. They do not make the decision for them.
• Care Act advocates must be arranged by the council where a person has substantial difficulty being involved and no appropriate person can help.
• Independent mental capacity advocates (IMCAs) support people who lack capacity for certain major decisions and have no one suitable to consult.
• Independent mental health advocates (IMHAs) support people subject to the Mental Health Act in England.
• NICE also recommends offering advocacy to people who fall outside the legal entitlement but would struggle to be heard.

What does an advocate actually do?

The statutory guidance to the Care Act describes advocacy as supporting a person to understand information, express their needs and wishes, secure their rights, and obtain the care and support they need. An advocate might help someone prepare for a needs assessment, attend meetings with them, read and explain a care plan, or challenge a decision on their behalf.

Independence is the key feature. NICE guidance says advocacy providers should maintain independence from any other organisations the person is in contact with, and that advocates are independent of any provider service. That means an advocate is not the person’s social worker, the care home manager or the NHS team, and is not employed to protect those organisations.

An advocate is also different from a family member. Relatives often act informally as advocates, and councils should consider whether a willing friend or relative is appropriate before arranging a formal one. An advocate is different again from an attorney under a lasting power of attorney, who has legal authority to make decisions for someone who lacks capacity.

What types of advocacy are there?

NICE distinguishes statutory advocacy, which the law requires in set circumstances, from non-statutory advocacy such as peer, self, family and group advocacy.

NICE says advocacy should be offered to people outside the legal entitlement when they would otherwise struggle to express their views or influence decisions with a substantial impact on their wellbeing.

Who qualifies for a Care Act advocate?

Under section 67 of the Care Act 2014, the council must arrange an advocate who is independent of the council if two conditions are met. First, the council must be required to involve the person in a needs assessment, carer’s assessment, care and support plan, support plan or a revision of one. Second, the council must consider that without an advocate the person would have substantial difficulty with one or more of the following:

• understanding relevant information
• retaining that information
• using or weighing it as part of being involved
• communicating their views, wishes or feelings, by any means including sign language

The duty does not apply if the council is satisfied that a suitable person is available to support the individual and that person is not providing their care or treatment professionally or for payment. The person must agree to that support if they have capacity, or if they lack capacity the council must be satisfied it is in their best interests.

Section 68 applies the same test to safeguarding enquiries and safeguarding adult reviews. If an enquiry must start urgently, it can begin before the advocate is in place, but the council remains under the duty. The statutory guidance says councils should consider advocacy from first contact or referral, so it is worth asking at the start of the process. See our guide to the Care Act 2014 and your rights and how to prepare for a care needs assessment.

When must an independent mental capacity advocate be involved?

An IMCA is a safeguard for people who lack capacity for a specific decision and have no family or friends who are willing and able to be consulted. Government guidance says the NHS or council must instruct an IMCA in two situations:

• Serious medical treatment, where the benefits and risks are finely balanced or the consequences are likely to be serious (with exceptions for emergencies and certain mental health treatment).
• A long-term change of accommodation arranged by the NHS or the council, which the guidance describes as a hospital stay likely to exceed 28 days or residential accommodation likely to exceed eight weeks. Sections 38 and 39 of the Mental Capacity Act set the 28-day and eight-week tests for NHS and council arrangements.

Councils and NHS bodies also have a power, not a duty, to instruct an IMCA for care reviews and for adult protection cases involving alleged abuse or neglect. An IMCA gathers the person’s wishes, feelings, values and beliefs, can see relevant records, checks that all options including the least restrictive one were considered, and can challenge a decision. They do not make the decision.

You would usually not get an IMCA if an attorney or court deputy can decide the same issue, if the person has nominated someone to be consulted, or if family or friends can support them. Learn more in our guides to mental capacity assessments and deprivation of liberty safeguards.

How does advocacy differ in Scotland, Wales and Northern Ireland?

The Care Act sections above apply in England. Elsewhere in the UK the law is different:

• Scotland: section 259 of the Mental Health (Care and Treatment) (Scotland) Act 2003 gives every person with a mental disorder a right of access to independent advocacy, and councils and health boards must make services available.
• Wales: the Social Services and Well-being (Wales) Act 2014 code of practice requires a local authority to arrange an independent professional advocate when a person can only overcome barriers to taking part in assessment, planning, review or safeguarding with the help of an appropriate individual and none is available.
• Northern Ireland: has its own legislation and Health and Social Care Trust services, so ask the trust what is available.

Our guides to paying for care in Scotland and in Wales explain the wider systems.

How do you ask for an advocate?

1. Contact the adult social care team at the person’s council and say that the person may need an independent advocate. Do this at the start, before the assessment.
2. Explain which of the four areas the person finds difficult: understanding, remembering, weighing up information or communicating their views.
3. If the person is in hospital or a care home, ask the ward or care home manager to contact the council or NHS body about an IMCA or IMHA.
4. If the council says no, ask for the reasons in writing and ask which suitable person it believes is available, then use the council’s complaints process if you disagree.
5. If the person is not entitled to a statutory advocate, ask the council or local charities about non-statutory advocacy.

Frequently asked questions

What is the difference between an advocate and a carer?

A carer provides practical or personal support. An advocate helps the person be heard and have their rights respected, and is independent of the care or treatment being provided. They do not make decisions for the person.

Can a family member be an advocate?

Informally, yes. For the statutory Care Act duty, a friend or relative can fill the role if the person agrees (or it is in their best interests), the council considers them suitable and they are not paid to provide care.

Who pays for an independent advocate?

For statutory advocacy the council or NHS body must arrange it, so you do not need to find or hire one yourself. Charges for non-statutory services vary, so ask the provider.

What is an IMCA?

An independent mental capacity advocate supports a person aged 16 or over who lacks capacity for a major decision, such as serious treatment or a long-term move, and has no suitable family or friends to consult. They represent the person but do not decide.

Does advocacy cover complaints about care?

Statutory duties focus on assessments, care planning, reviews and safeguarding rather than complaints. Ask the council or local charities whether complaints support is available, and see our guide on how to complain about a care home.

Where to get help next

If you are arranging care, start with our guide to your rights under the Care Act 2014, and if you want to raise concerns, see how to complain about a care home. For related decision-making support, read about person-centred care, then use our care finder to compare local services.

Sources

• legislation.gov.uk: Care Act 2014, section 67
• legislation.gov.uk: Care Act 2014, section 68
• GOV.UK: Making decisions, the independent mental capacity advocate service
• NICE: Advocacy services for adults with health and social care needs, recommendations
• legislation.gov.uk: Mental Health (Care and Treatment) (Scotland) Act 2003, section 259
• Welsh Government: Part 10 code of practice (advocacy)

Reviewed by The Care Panel team on 9 November 2026. This guide is general information about care in England, not legal, medical or financial advice. Rules and rates change; check with your council or an adviser before making decisions.