With Help the Aged claiming that the government will not meet its statutory duty to eliminate fuel poverty among older people, I wonder how much end-of-life care services think about fuel poverty – only when nurses or other visitors find patient shivering with cold, I guess. The government’s fuel poverty advisory group sets poverty at having to spend more than 10% of your income on fuel (Help the Aged dismisses government fuel cost help (Community Care 17 April 2008: 8).

Pics of memorials in St Nick’s churchyard, Sutton.

Adass (the Association of Directors of Adult Social Services) is complaining that the National Framework of last year on continuing care is not being implemented consistently (Directors fear framework fudge, Community Care 17th April 2008: 5). Not surprisingly, as they allowed local deviation from their National Framework: how is it then a national framework?

As a result, Bureaucracy Central (BC), my name for the Greater London Strategic Health Authority, got its continuing care leads (bureaucrats in charge are called leads, nowadays, in recognition of how the managers collar them and keep them on a string) together to invent their own DST (‘decision support tool’ in Department of Health-speak, I call it the ‘delay support tool’). This has 27 wonderful pages, although one of these is the record of their decision, as against 16 for the national form. Then there is the Greater London fast-track form, or ‘hold-back form’, as it should be properly called, which in London has 7 pages as against the national 1 page (that’s not a typing error, I said ‘one page’ from the Department of Health – but Greater London BC can do better). The question: is BC getting 7 times more effective decision-making from their hold-back form than the PCTs outside London or just 7 times longer delays?

New tree memorial

Pics of memorials in St Nick’s churchyad, Sutton

Since L (cleaner) is here this morning and I am working at home, I went out to Café Nero in Sutton for a couple of hours to read a PhD thesis that I’m examining soon; I’m not allowed to say anything about the examination, but the thesis is about the shift in government views of probation from a social work/clinical view to a punishment perspective.

It set me off thinking about attitudes to social work in palliative care. As I see it, social work’s overall aim is to help create solidarity and resilience in society, doing the practical part of social change. In Victorian times, the social workers were the people who went out and did things to help, as opposed to the social reformers who campaigned (Shaftesbury et al) and social researchers who did investigations (Charles Booth et al). It became clinical with the advent of psychology in the twentieth century and the success of medicine as a professional model.

Any welfare system molds social work according to its social and political views. Britain’s current social policy has created a particularly mechanistic social work, Anything that the government gets harried about, it organizes some special agency to target the problem. Previous generations saw that social problems all interacted with one another and it is inept to target one, but not to think about the social whole that the problem is part of.

One of the things about palliative care is that Dame Cicely Saunders, who pushed it along at the right moment in the 1960s, thought that you had to work on the social, emotional, spiritual and other aspects of a medical condition that was leading to your death. Healthcare only gets you to the point that you are managing your own health problems again; but what do you have your pain and symptoms controlled for? So that you can live your life. Social work is crucial to that bit, rather than the healthcare, which is only the instrument of living, whereas social participation and solidarity is the reason for living.

On my way back home, as usual, I pass through St Nick’s churchyard, and take some pics of memorialisations, which I’ll put in the blog for a few days.

Intrigued by the heading of an email invitation to a conference; I really want to go to a gin conference. The email still gives no clue, so I follow up to the associated website. It turns out to be the Guidelines International Network and their 5th international conference, but what does it mean by guidelines? You would think that if someone is sending out stuff to publicise something it would be clear what they’re publicising. I go to the organisation website (http://www.g-i-n.net/) to find that it has loads of guidelines on various healthcare topics that presumably, if you were a member, you could filch. Bit disappointing: do I really want to go to a three-day event about guidelines, and in Helsinki in February? – likely to need the gin to keep warm. I decide to pass it on to the quality assurance officer.

The latest newsletter from the British Humanist Association (www.humanism.org.uk) again demonstrates their overwhelming focus on schools and education. Healthcare ought to be just as important an area to represent the needs of people who are not committed to religion as the main form of spiritual insight. It’ all very well to welcome humanist chaplains in a university, but more people in great difficulties could benefit from non-religious spiritual care; palliative care with its emphasis on the spiritual, but where Christianity still holds sway, ought to be an important site of this.

Just to make the doctors feel better, there’s an anti-social work interview in The Observer this week is about Jacqueline Walker’s book Pilgrim State (Sceptre), Louise Carpenter ‘Who are you calling a bad mother?’ Observer Woman 28: 54-7. Walker ‘saw her mother die after years of poverty, racism and mental illness. But behind her struggle was the tragic story about one woman’s battle with the social services’. She collected up official documents that said her mother was a very loving, devoted mother: ‘whenever social services swooped in, they looked to find blame in Mrs Brown…rather than recognising that her problems were born from the immensely difficult, isolating and threatening circumstances she had found herself in…’. Carpenter, the journalist, says Walker was not writing out of bitterness or revenge, like ‘many memoirs born out of our current culture of blame’. Why use the word ‘swooped’, then, Louise? The reports show that the children were at risk; yes they were happy in their chaotic living conditions, and loved by the mentally ill mother who is not to blame for her circumstances. Any social worker can tell you about dozens of similar lives in which the priority is to protect the children. That’s what the law says and what common sense and good practice requires. It’s not about blaming the parents or persecuting the children, as Carpenter makes clear when she quotes from the reports, so why is she so keen to blame the social services?

The big story in The Observer this week is how GPs are missing diagnoses of cancer, so that the delay in treatment leads to unnecessary premature deaths (Denis Campbell: ‘GPs’ cancer delays: the cost in lives’ The Observer: News: 21). Mike Richards the Cancer Tsar, is mainly saying that younger people (i.e. the under-50s) are missed because cancer is so uncommon ‘survivors of teenage cancer say it was four or five times for them’ Cancers of the ovaries, bowel, uterus and pancreas are likely to be missed. A missed diagnosis leads people to feel ‘enormously let down by their GP or whichever part of the NHS failed to diagnose them immediately’, leading to a lack of trust of medical services. Of course, you hear this story again and again in palliative care services. I’m inclined to wonder whether the loss of confidence spreads further than the patient to the whole family and beyond. It produces all sorts of myths about the NHS that hang around for years and make it difficult for people to trust their healthcare workers, when actually these cancers are hard to detect in the early stages. There is just too high an expectation of medicine; doctors are human.

One of the reprints from the New York Times that appear weekly in The Observer (NYT in The Observer p 5) David Carr’s ‘You want it, you click it (Waiting is not an option)’, describes seeing the generations at the Virgin Megastore in NY. Over 40s browse the CDs, under 40s are trading headphones to check on music they are going to download later.

Later at Sutton Library to occupy the girls (grandchildren A and E – this is the first time I’ve realised they are a casualty unit) for the morning, M picks out a children’s book on the anthropology of Death Rituals (Jon Mayled (1986) Death Customs Hove: Wayland) to buy from the continuous booksale of old stuff they’ve never been able to get anyone to borrow. Lovely colour pics of various approaches to funerals from various religions. Looking through the shelves of the actual children’s library, there is quite a lot of children’s content on death, dying and funerals but nothing on social work. A market there for educating the young ones on the wonders of social work. Lots on health, nothing on social welfare. What does this say about the national curriculum?

With the invoice for membership of the London Voluntary Service Council a free copy of the seventh edition of their ace guide to the law for voluntary organisations Voluntary but Not Amateur by Ruth Hayes and Jacki Reason (LVSC, 356 Holloway Road, London N7 6PA). Pleased with this freebie until I see that it was published in 2004 (old history when you’re looking at the law) and they’re probably just getting rid of copies in preparation for the new edition to be published next year. If you’re thinking of it, I should wait until then, or since I’ve had a freebie, perhaps you could ask for one too.