Why is it that so many professional initiatives in palliative care, and for all I know healthcare in general, involve ‘tools’? Of course, this blog has been a bit nasty about ‘decision-support tools’ in the continuing care system, but the trend is widespread. The image is of the doctor or nurse rolling up at the bedside, with their little black bag, and opening it up to reveal a hammer, chisel and saw – the traditional surgical implements. ‘Ah yes, I will just hammer this nail into your arm to make the connection with your vein for this helpful syringe driver’. Perhaps nowadays it would be a smart electronic gadget, like Mr Spock’s or Dr Who’s equipment. Or the social worker tooling up (as they used to say in cowboy novels) to the home situation, with a fast-draw genogram.

But it’s all spin, of course. We say ‘tools’ to avoid having to mention that most of them involve filling in a form, sometimes a multi-page form, having asked some questions. It wouldn’t seem quite so professional to be coming up with another set of forms as a result of a research project into developing practice, so it’s toolboxes not tickboxes.

The House of Lords had a debate yesterday on end-of-life care; this allowed Lord Warner to ask for support for the Dignity in Dying charter for dignity at the end of life. This allowed their Lordships to canter round the same topics as the Westminer Hall MPs a week or so ago. As a member of the British Humanist Association, Warner, of course, seeks to argue for people’s rational control of decisions, and therefore, supports Dignity in Dying’s aim to promote assisted dying.

Warner, experienced both in social care (as a former Director of Social Services) and health care (as a minister) also mentions the importance of advance care planning and open communication between health and social care staff; these factors also promote rational decision-making and got wider support in the debate.

The point is that social care staff have long-standing relationships, sometimes years of caring services, with people at the end of life and ought to be well-placed to respond to their concerns about planning for their death.

However, end-of-life care is so medicalised that they do not understand it as their role to make sure that these concerns are picked up and dealt with. The end of life care strategy rightly picks up the need for better training in social care, firstly of social workers who have the complex assessment and review role, and then of everyday carers, who can pick up and respond appropriately to end-of-life worries.

Read the debate at: http://www.publications.parliament.uk/pa/ld200708/ldhansrd/text/81118-gc0001.htm#08111883000002

The Department of Health has published a guide to doing equality impact statements for service developments; this is part of meeting the duty on public bodies to promote equality and avoid discrimination. Voluntary sector hospices do not have this duty, but they would want to ensure equality etc, too. Wouldn’t they? EqIAs (the jargon abbreviation – you should learn this one, you know you’ll be better for it) involve looking at new developments to make sure they do not discriminate and do promote equality.

The trouble is that voluntary sector organisations do not have the staff or resources to spend the time to do this for everything they do. So a free gift from me: I think the most important tip contained therein is the suggestion to think about possible effects or impacts on equality before you start doing anything and incorporate equality thinking into everything you do, so that it becomes as natural as British Summer Time (that was a joke). Then you’ll focus before you start on doing things to promote equality. It might not be as good as an EqIA, but it’s cheaper and better for the soul.

If you want to learn how to do them, though: Department of Health (2008) Equality Impact Assessment: Summary: Tool and Guidance for Policy Makers. London: DH.
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_090396

Did you know that local authorities had a general power to promote the well-being of their populations? No, neither did I. Apparently, local authorities were pushing the envelope of all sorts of specific powers, so, in 2000, the government gave them a general power to do good. But people said they didn’t use it, hence an evaluation.

The actual report Evaluation of the take-up and use of the Well‑Being Power: Research Summary (at http://www.communities.gov.uk/documents/localgovernment/pdf/1061446.pdf) is not terribly helpful, because it doesn’t actually tell you what was possible; it’s mainly about making senior people in local government more aware. The interesting point is that you have to tell the top people in local government about something new, as well as the grass-roots. Another point is that they did economic and environmental things first, and only moved on to social things later – who knows what, it doesn’t say.

You have to look at the practical examples report published at the same time for more useful information, although merely knowing about the power might help some local organisations. This is at: http://www.communities.gov.uk/documents/localgovernment/pdf/10614461.pdf. Even this is fairly summary, but it includes getting a ’symbolic’ share in a community partnership project and help to a community hospital.

Two things about this: one is that too many public authorities focus on economy and environment when they could make a real difference to the social, if they thought about it more often. The second is that people might think about it more often if useful practical examples are around, so the second document is a useful adjunct to the first.

There might be more information in the detailed academic publications, which are cited in the reports. You might be able to get your local authority to use this power to do something useful, n’est-ce pas?

For some reason, an MP asked how many older people there are in the main seaside towns. The answer is an interesting table, which shows that Sidmouth wins the prize. Presumably such statistics as these might give us a clue to needs in different towns for end-of-life care, since most people in the end-of-life phase are elderly.

The answer here or look in Hansard: http://www.publications.parliament.uk/pa/cm200708/cmhansrd/cm081117/text/81117w0054.htm#08111833000013

A recent Parliamentary answer from care services minister Phil (fulla-)Hope (I’ve renamed him for the optimism of his answering style and in the cause of better alliteration) identifies the main planks of the government’s plans for the future in social care. This is slightly edited; see the full thing at: http://www.publications.parliament.uk/pa/cm200708/cmhansrd/cm081117/text/81117w0052.htm#column_231W

Phil Hope: In ‘Putting People First’, (2007), the Government, and their partners in the sector, set out their commitment to transform social care to meet the needs and expectations of those who need support and their families.

We have provided £520 million through the Social Care Reform Grant to help councils undertake the necessary reforms…a new National Director for Transforming Adult Social Care [Jeff Jerome] has been appointed to help councils achieve a systemic shift in adult care towards user control, prevention and enhanced information and advice services.

…the Office for Disability Issues published the Independent Living Strategy in March 2008… a five-year plan that seeks to realise the Government’s aim that all disabled people should be able to live autonomous lives, and to have the same choice, freedom, dignity and control over their lives as non-disabled people.

The Department, together with the Office of Disability Issues, is leading work on the ‘Life Chances’ commitment that, by 2010, there should be a user-led organisation (ULO) modelled on existing Centres for Independent Living in every local authority area with Social Services responsibilities. ULOs are led and controlled by disabled people and are key to both delivering personalisation and achieving independent living for disabled people.