The Department of Health has published its annual report on advisory boards. You can see all the boards it has, their aims, who chairs and manages them and how much they are paid. It includes:

Commission for Social Care Inspection (CSCI)
Commission for Patient and Public Involvement in Health (CPPIH)
Council for Healthcare Regulatory Excellence
General Social Care Council (GSCC)
Health and Social Care Information Centre (Working title NHS Information Centre for Health and Social Care)
Health Protection Agency (HPA)
Healthcare Commission (Commission for Healthcare Audit and Inspection)
Leadership and Race Equality Action Plan (LREAP) Independent Panel
Mental Health Act Commission (MHAC)
National Clinical Audit Advisory Group
National Commissioning Group (NCG)
National Institute for Health and Clinical Excellence (NICE)
National Specialised Commissioning Group (NSCG)
Patient Information Advisory Group

Find it at: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_092395

It’s good to see some thoughtful critiques of personalisation policy coming out of people in central government, because we get so much naïve sloganising.

Two comments from central government people at a conference pointed out that you don’t get bespoke tailoring at high street prices, so there is a tension between cutting costs and personalisation in social care. And another point is the difference between services that you can deliver in a fairly routine way at high volume, and ‘relationship services where more personal assessments are needed’. Any social worker could have told you that.

Guardian Public (2008) An equitable life for all. Public December 2008: 30-1.

Another Solace (the Society of Local Authority Chief Executives) booklet on the importance of place in people’s lives, which I think the development of hospices says so much about.

One interesting paper by Jonathan Flowers and Janet Horton has a nice diagram which sees wealth creation as something that a local authority helps with, connecting its local remit with the wider world, while building excellent local services. In doing so, it thinks about the connection between the wealth creation and business world and the distinctive people, community and place that it serves, and tries to use business and wealth in ways that reflect the needs of that distinction community and place. This is a useful analysis of the limitations in the role of business in local affairs and in the state.

However, just plain wrong, sloganising from Hazel Blears, currently the Secretary of State for communities and local government, who starts off her piece with: ‘The political history of Britain is characterised by the history of power being forced from the centre…’ Her examples are Magna Carta, the Civil War and votes for women with the most recent example her speechmaker can think of is the creation of the Scottish Parliament (the Welsh and Northern Ireland don’t get a look in). In reality, Britain is the most centralised state in Europe, and in healthcare we get all this nonsense about postcode lotteries, which is political code for central government control so that everyone is the same. We ought to accept that services in every locality are different to respond to the needs of that place and its people, just like Flowers and Horton say in their paper.

Blears, H. (2008) Empowered communities.
Flowers, J. and Horton, J. (2008) Delivering a new agenda.

In Haines, T. (2008) Prosperity, People and Place. London: Solace Foundation, 50-2 and 45-8.

A paper in Ethics and Social Welfare, which perhaps most palliative care colleagues will not see, containing a case study of the ethics of discharge from a hospice, and also commenting on clinical ethics committees in hospices.

The case was of an older woman who said (probably rightly) that she would die more quickly if discharged from a hospice to a care home. See my post about a research article on the same subject on 4th September 2008. The paper tells you about a framework for looking consistently at ethical issues, ETHICS: in summary:
– enquire about the facts
– think through the options
– hear views from those involved
– identify principles
– clarify meaning and implications of values
– select a course of action and present the arguments for and against.

You might have to do this last move several times for different courses of action.

Gallagher, A. and Sykes, N. (2008) A little bit of heaven for the few: a case analysis. Ethics and Social Welfare. 2(3): 299-307.

One of the interesting exchanges in a debate about NHS world-class commissioning and social care personalisation policy was between Jon Glasby (the Birmingham health policy academic) and Jeff Jerome (the new social care ‘transformation’ tsar). Glasby pointed out that trying to improve service quality by using the power of money in the commissioning process (the NHS approach) was inconsistent with giving priority to service user wishes by giving them the money or the budget to spend on services they preferred (the social care approach). We have already seen people saying that service users’ focus on their own priorities means they may not provide for the development of staff training and skills, health promotion policies and anti-discrimination objectives.

Jerome pointed out that this would lead to the NHS aiming for improvements that met policy and professional aims for a ‘world-class’ service while the social services couldn’t aim for the same things unless their users wanted it. This was, he said, a tension.

Peter Beresford, the service user guru, in another part of the debate, squared the circle, by saying that it wouldn’t be world-class unless it responded to what service users wanted. This is obviously true, but could only be said in social care, because the NHS is too politically important for policy and professional judgement not to play a strong part.

Community Care (2008) Commissioners must unleash creativity. In M Samuel (ed.) World Class Commissioning in Social Care. Supplement to Community Care 29th November 2008: 8-10.

This also affects cancer and palliative care. Cancer is one of those healthcare areas where really high-quality medical intervention makes a major difference to outcome, so obviously ‘world-class’ commissioning is going to focus on medical priorities. But palliative care aims at ‘holistic’ care with a strong social and spiritual element, aiming to be responsive to what people want when they pass beyond the cure priority. You can’t help feeling that this will mean that the NHS will need to spend most of its cash on word-class cancer treatment in high-tech hospitals and will have less to spend on good palliative care afterwards. It’s a compliment to the cancer plan and later policy documents that there has been something of a focus on palliative care in the face of this pressure.

However, I wonder what will happen when, as my newspaper proudly trumpeted this morning, the majority of hospitals are now foundation trusts. The fuss when the government tried to tell foundation hospitals earlier this year that, like all others, they must have a deep-clean reminds me that the government has not yet found a way of getting foundation trusts to comply with political or public priorities.

As someone who wanders about the Internet, I occasionally come across strange uses of the idea of palliative care. It’s nice to know that palliative care is part of everyday discourse, and here are some examples of its appearance in rather strange company.

A.A.Gill, the Sunday Times attack dog restaurant columnist (he’s even got the jargon here, is this a secret insider?):

I can tell the difference between a terminal carcinoma palliative-care outreach professional and a French bulldog. http://www.timesonline.co.uk/tol/life_and_style/food_and_drink/eating_out/a_a_gill/article4457278.ece

The question to ask is: why would you need to?

On the rugby world cup, David Hands writes in the Times 15th March 2008:
Hurt England set out in hunt for pain relief. Two teams in search of a palliative meet at Twickenham today… http://www.timesonline.co.uk/tol/sport/rugby_union/article3555682.ece