To see ‘Wizard’, a musical at the Apollo Victoria, since M has free tickets. Musically undistinguished (I always think Lloyd Webber musicals only have one tune in them endlessly repeated, this has no tunes in it endlessly repeated). Good production values though and this is an anti-racist musical. It is about how the wicked witch of the west in the ‘Wizard of Oz’ became a wicked witch. And it all comes from discrimination. Cast your mind back to the film: the wicked witch was green, and was widely rejected until her talents were recognised by the baddies, who turn out to be the wizard himself and his female oppo. Recollecting the film again, he was a little man working a loud machine to maintain his power, and in ‘Wizard’ he aims to keep all the population of Munchkinland in subjection; one of his ways is to target all the animals as inferiors,and stop them from talking, which of course they all do at the start. The proto-wicked witch decides on freedom of speech for the animals and on ‘regime change’, but the wizard appoints Glinda as his press relations officer, even though she’s no good at magic. Because they are in control of the press, they make Glinda, who is blonde, the ‘good’ witch, and casts the green witch as wicked. A good example of deviance amplification leading to racist stereotypes.

I am invited to a webinar (a new word for me, the web equivalent of a seminar apparently). This is from the Lean Enterprise Institute, an American self-promotion exercise for a Jim Womack, whose neatly grey-bearded photo and cv is offered alongside the blurb. I suppose the thing about a webinar is that you can have some involvement even a long way away from wherever it’s happening (precisely what involvement is not clear, or what a webinar involves come to think of it).

Lean thinking is an idea promoted for the profit of the originators beyond its calling. You can tell how management speak it is by the title of this webinar (I keep repeating it because I can’t get used to it): ‘The Power of Purpose, Process and People’. You just know you’re getting a man making a lot of money through management consultancy when you get a title like that.
However, it is not a wholly bad idea: the website is: http://www.lean.org/ To reproduce the basic principle:

The critical starting point for lean thinking is value. Value can only be defined by the ultimate customer. And it’s only meaningful when expressed in terms of a specific product (a good or a service, and often both at once), which meets the customer’s needs at a specific price at a specific time.

In other words, what you do in lean thinking is work out what the person you’re ultimately helping would most value, define what you need to do to get it to them, when and how and at what quality of service. All to the good, but it’s hard to see that this is actually going to change the social services world. Why do people who use management training need all these chavvy concepts in order to think useful thoughts? But then, I’m not going to bother to go to the webinar.

Somebody asked: ‘why is the person who’s supposed to guard patient confidentiality in a health and social care organisation called a Caldicott Guardian?’ Dame Fiona Caldicott’s name has been forever linked with a tribe of information bureaucrats, or at least linked until the next report or reorganisation. She chaired a committee that reported in 1997:

Department of Health (1997) Report on the Review of Patient-Identifiable Information. London: DH. http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4068403

I’m being the Hospice’s Caldicott guardian today at a meeting with a local hospital. The email comes from the ‘PA to KGC and Risk’. I had to look to see what this is: ‘Knowledge, Governance and Communications’; fancy having a job title like that with Risk added to it. You could turn this round and become the director of Grack. We’re hoping to come to an agreement to share information between the hospice and one of our local hospitals.

You don’t know what a Caldicott guardian is? This is serious stuff. Basically, I’m supposed to speak up for confidentiality and privacy of the Hospice’s patients and clients in the Hospice’s management forums. Health and social care agencies are all supposed to have one, including social services departments. When I was given this extra job role and registered with the guy who keeps the national list, I was welcomed to the Caldicott community (but only by email, so it wasn’t a socially exciting welcome, not even a peck on the cheek). It seems that’s about the extent of the community.

However, if you want one, too, you can go to the Department of Health Caldicott website: http://www.dh.gov.uk/en/Managingyourorganisation/Informationpolicy/Patientconfidentialityandcaldicottguardians/DH_4100563. this contains a manual of good practice, largely a list of other websites, and quite a nice paper of examples of good practice.

Every so often, House of Commons researchers produce a summary of social indicators for MPs to use, and this is published on the internet: http://www.parliament.uk/commons/lib/research/rp2008/rp08-037.pdf. Nothing about end of life care, but a range of interesting statistics, including community care provision and some comparisons with similar European countries, where UK health expenditure is not particularly strong, but a higher proportion of it is in the state sector than most other countries.

I see from a circular from the Higher Education Academy that they’re now referring to people with ‘learning differences’, rather than learning disabilities. Could this be just because in higher education you’re supposed to be competent at learning before you go, or does it presage a new euphemism? I think we should be told.

The European public health portal: lots of useful links: http://ec.europa.eu/health-eu/index_en.htm .

In the hiatus between events at Uncle Don’s 90th birthday party, another useful article from Ethics and Social Welfare http://www.tandf.co.uk/journals/resw . This one asks whether we have got to the point that the New Labour obsession with partnership has made partnership between professions, organisations and patients/clients/users an ethical requirement. Can you organise partnership rationally, or is it a matter of making relationships work appropriately?
Parrott, L. (2008) The ethics of partnership. Ethics and Social Welfare. 2(1): 24-37.

Pics of memorials in St Nick’s churchyard, Sutton

Stone memorial

An interesting paper from Australia in the latest edition of Ethics and Social Welfare: http://www.tandf.co.uk/journals/resw . Ethical decision-making has four features: accountability (a structure so that you are), consultation (looking for the people who need to be and consulting them), cultural sensitivity (systematically making sure you take different cultural values into account, I would say not only ethnicity by different professional and social class cultures) and critical reflection (questioning yourself rigorously about what you’re doing). This leads to a process in which you first define the ethical dilemma, then clearly map the legitimacy of the people involved in the decision. Should they be involved and should there be others? That’s because we often assume who should be involved rather than thinking it through. Then gathering information, looking for alternative approaches and possible actions. My view is that if you haven’t found alternatives you probably haven’t been looking hard enough. TINA (there is no alternative) is not allowed. Then critical analysis and evaluation.
McAuliffe, D. and Chenoweth, L. (2008) Leave no stone unturned: the inclusive model of ethical decision-making. Ethics and Social Welfare 2(1): 38-49.

Pics of memorial in St Nick’s churchyard, Sutton

Seat Memorial

Like some of the social services authorities round St Christopher’s, Devon County Council is separating its service-fixing function from its community care assessment. This looks efficient, because from the Council’s point of view, they can deal with the easy cases by bureaucracy. However, from the service user’s point of view it means that once an assessment is made, they lose continuity of service from a care manager. And from an end-of-life care service point of view, there’s no care manager with a continuous knowledge of what’s happened to a patient. So further along the line, the service user does not get the benefits that come from continuous service. And it goes against the research, which says that the ‘travel agent’ model of care management, where the care manager just fixes the services, does not work as well as the ‘travel companion’ model, where they stay with the service user throughout the process (Rapp, C. A. and Roscha, R. J. (2004) The principles of effective case management of mental health services. Psychiatric Rehabilitation Journal 27(4): 319-33). Never mind the research, this is common sense: it just doesn’t feel caring if you get a succession of people dealing with you instead of a continuous involvement.

Pics of memorials in St Nick’s curchyard, Sutton