Worcestershire Online Referrals

To complete an online referral, please see tabs below:

Independent Mental Capacity Advocacy (IMCA) Referral

SWAN IMCA service represents and supports individuals in Worcestershire who meet all the following criteria:

The person referred has no appropriate family or friends to represent them and the referrer believes that they lack the capacity, decision specific, concerning:

  1. Serious medical treatment
  2. Long-term accommodation moves (more then 28 days in hospital/8 weeks in a care home)
  3. Care reviews
  4. Safeguarding measures within an adult protection case even where there are family or friends to consult with.

Please complete all sections otherwise the referral will be returned to you and will delay the referral being processed; this includes the monitoring questions.

Client Details

(if known)
Address at Point of Referral
(if hospital, please include ward name)
Home Address
(if different)
Do they identify as the same gender as their sex registered at birth?
Nature of illness, impairment or vulnerability
(please indicate one or more as appropriate)
Does the client have any family or close friends appropriate to support them?
(for example, communication difficulties, mental health concerns, or substance use)
Are you, the referrer, also the IMCA Decision Maker?

Capacity Assessment

We can only accept an IMCA referral when a recent, decision specific, capacity assessment has taken place AND A COPY IS RETURNED WITH THIS REFFERAL FORM. In exceptional circumstances SWAN may consider older evidence if the rationale is clearly identified.
Has this client been formally assessed to lack capacity?
*If none, then we are unable to provide our advocacy service
Will you be reviewing the person’s support plan or Care Act assessment as part of the Best Interest Decision?
If yes, please complete a Care Act referral.

Referrer Details

Address
By requesting advocacy support, you give consent to SWAN sharing information where necessary for the purpose of providing this service. All data held by SWAN is held in accordance with the current UK General Data Protection Regulations legislation.

Rule 1.2 Referral

To check eligibility for a referral into the service for a Rule 1.2 please click on the link below:

https://swanadvocacy.org.uk/services/advocacy-services/

Kindly ensure all sections of the referral form are completed, as incomplete forms may be returned and could delay your referral.

Are you asking for an advocate for yourself?

Client Details

(if known)
Address at Point of Referral
(if hospital, please include ward name)
Home Address
(if different)
Do they identify as the same gender as their sex registered at birth?
Nature of illness, impairment or vulnerability
(please indicate one or more as appropriate)
(for example, communication difficulties, mental health concerns, or substance use)
Has this client been formally assessed to lack capacity?
By requesting advocacy support, you give consent to SWAN sharing information where necessary for the purpose of providing this service. All data held by SWAN is held in accordance with the current UK General Data Protection Regulations legislation.

Independent Care Act Advocacy (ICAA) Referral

To check eligibility for a referral into the service for an ICAA please click on the link below:

https://swanadvocacy.org.uk/services/advocacy-services/

Kindly ensure all sections of the referral form are completed, as incomplete forms may be returned and could delay your referral.

Client Details

(if known)
Address at Point of Referral
(if hospital, please include ward name)
Home Address
(if different)
Do they identify as the same gender as their sex registered at birth?
Nature of illness, impairment or vulnerability
(please indicate one or more as appropriate)
(for example, communication difficulties, mental health concerns, or substance use)

Referral Category

Has this client been formally assessed as having a substantial difficulty as defined in the Care Act 2014?
Does the client have any family or close friends appropriate to support them?
An independent advocate must be appointed to support and represent the person for the purpose of assisting their involvement if these two conditions are met and if the individual is required to take part in one of the above processes. *We are unable to provide advocacy under safeguarding unless a Section 42 enquiry has been opened. **If you require our involvement in more than one process, we will require an additional referral form
Are you, the referrer, the Local Authority Practitioner involved with this issue?

Referrer Details

Address
By requesting advocacy support, you give consent to SWAN sharing information where necessary for the purpose of providing this service. All data held by SWAN is held in accordance with the current UK General Data Protection Regulations legislation.

Independent Mental Health Advocacy (IMHA) Referral

To check eligibility for a referral into the service for an IMHA please click on the link below:

https://swanadvocacy.org.uk/services/advocacy-services/

Kindly ensure all sections of the referral form are completed, as incomplete forms may be returned and could delay your referral.

Are you asking for an advocate for yourself?

Client Details

(if known)
Address at Point of Referral
(if hospital, please include ward name)
Home Address
(if different)
Do they identify as the same gender as their sex registered at birth?
Nature of illness, impairment or vulnerability
(please indicate one or more as appropriate)
(please indicated eligibility)
(for example, communication difficulties, mental health concerns, or substance use)
By requesting advocacy support, you give consent to SWAN sharing information where necessary for the purpose of providing this service. All data held by SWAN is held in accordance with the current UK General Data Protection Regulations legislation.

Continuing Healthcare (CHC) Referral

To check eligibility for a referral into the service for an CHC please click on the link below:

https://swanadvocacy.org.uk/services/advocacy-services/

Kindly ensure all sections of the referral form are completed, as incomplete forms may be returned and could delay your referral.

Are you asking for an advocate for yourself?

Client Details

(if known)
Address at Point of Referral
(if hospital, please include ward name)
Home Address
(if different)
Do they identify as the same gender as their sex registered at birth?
Nature of illness, impairment or vulnerability
(please indicate one or more as appropriate)
(for example, communication difficulties, mental health concerns, or substance use)
(please indicated eligibility)

Continuing Healthcare Advocacy Referral Checklist

Have reasons for this referral been discussed with the client?
Have reasons for this referral been discussed with the client’s carer or family?
Has the Eligibility Checklist been completed?
Is there a current package of care in place?
By requesting advocacy support, you give consent to SWAN sharing information where necessary for the purpose of providing this service. All data held by SWAN is held in accordance with the current UK General Data Protection Regulations legislation.

Independent Health Complaints Advocacy

SWAN supports Worcestershire residents to make a formal complaint to any NHS organisation in England, about the care of service they received. This includes the NHS GPs and surgeries, hospitals, pharmacies, opticians, dentists and other health care practitioners – but excludes private treatments.

To check eligibility for a referral into the service for an IHCA please click on the link below:

https://swanadvocacy.org.uk/services/advocacy-services/

Kindly ensure all sections of the referral form are completed, as incomplete forms may be returned and could delay your referral.

Are you referring for yourself?

Patient Information

(if known)
Address at Point of Referral
(if hospital, please include ward name)
Home Address
(if different)
Do they identify as the same gender as their sex registered at birth?
Nature of illness, impairment or vulnerability
(please indicate one or more as appropriate)
(for example, communication difficulties, mental health concerns, or substance use)
By requesting advocacy support, you give consent to SWAN sharing information where necessary for the purpose of providing this service. All data held by SWAN is held in accordance with the current UK General Data Protection Regulations legislation.

Independent Social Care Complaints Advocacy

SWAN supports Worcestershire residents to make a formal complaint about Adult Social Care services provided by Worcestershire County Council. This includes issues relating to care assessments, support plans, safeguarding processes, and the delivery of social care services. The service is independent, free, and confidential, and does not cover complaints about private care providers unless commissioned by the Council.

To check eligibility for a referral into the service for a Social Care Complaints please click on the link below:

https://swanadvocacy.org.uk/services/advocacy-services/

Kindly ensure all sections of the referral form are completed, as incomplete forms may be returned and could delay your referral.

Are you referring for yourself?

Client Information

(if known)
Address at Point of Referral
(if hospital, please include ward name)
Home Address
(if different)
Do they identify as the same gender as their sex registered at birth?
Nature of illness, impairment or vulnerability
(please indicate one or more as appropriate)
(for example, communication difficulties, mental health concerns, or substance use)
By requesting advocacy support, you give consent to SWAN sharing information where necessary for the purpose of providing this service. All data held by SWAN is held in accordance with the current UK General Data Protection Regulations legislation.