Ever intrigued by what takes the Department of Health’s fancy, I read through its third annual report on simplifying itself. This is apparently about reducing the administrative burdens that it causes for organisations outside itself. And indeed it mentions the third (voluntary) sector and all it’s doing. A lot of this is about the regulatory regime, and after they’ve brought together the regulators next year, they’re going to create a single system which includes the statutory services. Notably however, considering the high proportion of palliative care provided by third sector providers, there’s no mention of them as a stakeholder group. The only mention of hospices is that they’ve been let off the smoke-free legislation. This is apparently a freedom from bureaucracy.

See the document at: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_091716

This is the title of a (free) booklet from IIP-SHR (see 14 November 2008 for a clue). This Australian publication is trying to promote better palliative care involvement in haematology services. It has a model of good (functional) relationships between the two and bad relationships, which are called refractory; possibly a bit critical of neanderthal haematology colleagues there. It suggests evolving from one to the other. The haematology example is a proxy for all the other medical specialisies that don’t relate well to palliative care principles. And the account of the functional model is a rather nice practical account of what’s involved in palliative care. Its one failing, from the point of view of this blog, is that while it emphasises the importance of family care, supporting carers and having an effective bereavement service, it fails to mention social work, to which all these things are dear. Perhaps it’s to avoid startling the horses over there in haematology.

III-SHR (no date) Haematology and Palliative Care: Toweards an integrated practice. Toowong: IPP-SHR.
You can get it on: http://www.ipp-shr.cqu.edu.au/

Several articles in the Journal of Nursing Management recently focus on emotional intelligence, and this connects with a growing interest in this idea within social work too. Lucas et al is a Canadian study that says that staff don’t appreciate the emotional intelligence of managers who have too many people to manage. Morrison is an American study that found that emotionally intelligent nurses handled conflict with a collaborative style, rather than just accommodating opposing views.

Goleman’s well-written psychological explainer is obviously having a wide impact. A fairly recent British Journal of Social Work article by another Morrison suggests that EI is an important concept distinguishing good from bad social work practice. Lately, Goleman has been focusing on social intelligence, making the same point that capacity to respond to social relationships effectively is an important skill for human beings. His blog is at: http://www.danielgoleman.info/blog/

All this is a welcome recognition that outcomes and businessification is not a universally good thing in human life, being human is.
Goleman D. (1997) Emotional Intelligence: Why it can matter more than IQ. New York Bantam.
Goleman, D. (2007) Social Intelligence: The new science of human relationships, New York: Bantam.
Lucas, V., Laschinger, HKS and Wong, CA (2008) The impact of emotional intelligent leadership on staff nurse empowerment: the moderating effect of span of control. Journal of Nursing Management 18(8): 964 – 973.
Morrison, J, (2008) The relationship between emotional intelligence competencies and preferred conflict-handling styles. Journal of Nursing Management: 16(8): 974-983.
Morrison, T. (2007) Emotional Intelligence: emotion and social work: context, characteristics, complications and contribution. British Journal of Social Work, 37(2): 245-63.

This week is becoming assisted dying week in the media. On Monday, Margo MacDonald, a member of the Scottish Parliament with Parkinson’s Disease, pursued a personal investigation about assisted dying; she has been saying for some time that she might want to commit suicide as her condition worsens. The programme was a series of interviews, which reflected a range of for and against positions. For me, it gave a sense of people talking past each other. I had the feeling that people opposed were speaking of principles, such as God-given life, which were just not relevant to the concerns of people wanting to stay in control of how their illness or physical changes were affecting their lives. These concerns were just rejected by those with principles. The relevant BBC website is: http://www.bbc.co.uk/iplayer/episode/b00fzc1x/Panorama_Ill_Die_When_I_Choose/

Then, we have had the Director of Public Prosecutions explaining why there was no prosecution of a family accompanying and helping a young man disabled in a sports accident to Switzerland to die in the Dignitas clinic. Most of the points were about the specific circumstances of the case, although some of the press were hailing this statement as making it clear that there would be no future prosecutions.

Then, Sky had a programme last night in which a man with motor neurone disease was shown actually dying in the Dignitas clinic. The BBC News reporting of this had Ilora (Baroness) Finlay, a renowned palliative care physician, commenting among other things that control of the time of death was not necessary to dignity in dying; it was perfectly possible for everyone to die with dignity.

Again, I think this is an example of people talking past each other. It seems to me that most people accept that doctors and the health service do as good a job as they can in helping people die with dignity, and we could do better if fewer went into emergency units to die. But with an increase in disabling conditions as people survive infections and other illnesses, due to the success of medicine, many people also do not see the need to prolong life when it becomes burdensome.

I’ve seen two points well-made, one by Gordon Brown in Parliament and the other by the philosopher Mary Warnock in The Guardian.

As a social worker my experience tells me to worry about the point that Gordon made at Prime Minister’s questions, emphasising that these are complex personal and family decisions. He said: ‘It is necessary to ensure that there is never a case in which a sick or elderly person feels under pressure to agree to an assisted death or that it is the expected thing to do. That is why I have always opposed legislation on assisted death’. See the full answer at: http://www.publications.parliament.uk/pa/cm200809/cmhansrd/cm081210/debtext/81210-0003.htm

As a concerned citizen, I think many people would accept Mary Warnock’s point that it is a ‘frivolous distinction’ to accept that in reality people who want assisted suicide can trail off to Switzerland but that we cannot accept assisted dying in te UK. That is, I would mention the practical point, if they can find someone to help them go to Dignitas, but not if they can’t, which is another inequality, because it’s saying if you have the money and the motivation you have this freedom, otherwise you put up with British law. There is a wide range of comment on the Guardian website.

Warnock, M. The legality of euthanasia need urgent clarification The Guardian 11th December 2008: 43. http://www.guardian.co.uk/society/assisted-suicide

6th December 2008 – added later

And then to an award ceremony at London Metropolitan University for the last run of their post-qualifying course in practice teaching. The last run because it is being replaced by the practice education element of the new post-qualifying schema. I hope this doesn’t mean that not having a standalone qualification will turn people off from practice teaching. It is one of the most satisfying jobs in social care, and probably in any other profession, and constantly renews your belief in social work because students almost invariably are enthusiastic and committed to helping others; working with them makes you feel good about the future of social work. Meeting them is a tonic to the tired and jaded.

I see from a photo in a seriously boring Skills for Care glossy Update London that someone at one of their conferences was wearing a sweatshirt that said ‘care ambassador’ on the back. They were taking part in a ‘Moving on up Cafe’ (after lunch, not during). Do we really have to retitle the good old group discussion in this way to get anyone to participate? I’ll answer my own question: yes, when you see what they had to discuss: the mind-bendingly plonking topic: ‘How can we together improve care in a rapidly changing social care environment?’

But I like the idea of care ambassadors. What do they do, do you think? Silly answers only please: click the ‘Comment’ button below.

You can check out the social services stars and the relevant reports for the areas you cover, always presuming you think that the way they decide on your local council’s performance makes it worthwhile:

http://www.csci.org.uk/care_professional/councils/council_star_ratings_for_adult/search_council_star_ratings.aspx

A nice paper in BMC Public Health points out that research ethics committees bureaucratise ethical review into a tickbox process, with a 68-page form designed mainly for clinical and pharmacological research obstructing population-level and non-clinical research.

Edwin R. van Teijlingen, Flora Douglas and Nicola Torrance (2008) Clinical governance and research ethics as barriers to UK low-risk population-based health research? BMC Public Health, 8:396 doi:10.1186/1471-2458-8-396

Find it at: http://www.biomedcentral.com/1471-2458/8/396/abstract

Baby P was the child killed in the recent child abuse scandal in Haringey; the Ofsted/Healthcare Commission/HM Inspectorate of Constabulary report came out last week. Of course, this has (sigh with relief) nothing to do with palliative care. However, reading through the report does suggest some things to think about in how anybody in the care for human beings trades do their jobs. Just because it’s not our field doesn’t mean we can’t learn from it.

Lack of independence in the people chairing the decision-making bodies. The senior manager responsible chairs them – it seems logical really, she knows most about it and ought to have a view about where we’re going – but (my thought: the report does not say this) she is perhaps only too well aware of how difficult it all is and is focused on her agenda for moving things on positively. I recollect in my social work days an assistant director of social services, with serious experience in the pre-1970 child care system, whom we all hated because if she found some failing in your case records, you were torn apart in public. All very managerially not quite the ticket, but it made sure you never failed to do what was required again. And she was meticulous: six months after I had moved on to another local authority and there was an unanswered query about a case, she was on the phone to me about what I remembered.

Lack of robust, critical analysis in decision-making bodies.

Lack of consistent, thoughtful, critical supervision; yes these wishy-washy social workers are always going on about not getting supervision, but…

Illegible notes signed by not-quite-sure.

Good records where the child (for ‘child’ read ‘patient’) is seen, but obfuscation where they weren’t. All experienced social work managers can identify the records that show that the worker wasn’t quite there or can’t remember what happened.

Staff say that something or other (in this case it was the computer system) is difficult to work with, but the managers don’t immediately pick up their concerns and sweep into action to change things. Wingeing is not just wingeing; it’s a clue to the trouble you’re going to get in if something goes wrong. The trouble is, you can easily be lulled into a false sense of security because most of the time things don’t go (seriously) wrong.

The report at: http://www.dcsf.gov.uk/publications/haringeyreview/docs/Ofsted%20Joint%20Area%20Review.pdf