The Psycho-Social Review from ipp-shr in Australia (they haven’t picked up the new idea of spinning logos and acronyms from British new Labour and called themselves something like ’socialpod’; it’s a research unit in Queensland) has an interesting piece on the therapeutic value of urban public space. Actually you can download a podcast about it; this goes too far for me, I’d sooner have it in writing. Anyway apparently people like peace and quiet for contemplation but also enjoy busy urbam spaces because they’re stimulating.

Applied to hospital wards and hospices, I wonder if we do not focus too much on peace and quite and not enough on stimulation. Even while you’re dying and being ill, you’re still entitled to be interested in the goings-on around you.

A new standard announcement on Southern Rail today; you know, those that have been recorded at a calm moment by some stoical standard English speaker, as opposed to the verbal incomprehensibility of harrassed Southern staff. They are offering a ‘priority card’ for people who because of age or disability are entitled to have first go at a seat to show rude youngsters to get them to give up the priority seats. According to the Southern website, people apparently don’t like asking.

This might be a sign of modern society and an unwelcome one, if it were not for the fact that quite a lot of people my age comment on the frequency with which people give up their seats even if you’re only a little bit grey.

A useful distinction drawn by Surrey County Council’s Andy Butler in the only really worthwhile paper at the safeguarding adults conference on Friday was between the Mental Capacity Act (but it equally applies to other law) as involving prohibitions for which there are sanctions; permissions, which give you powers to do things and proctective responsibilities, which give you duties to safeguard people.

He then went on to make the point that it is not only your duty to make decisions about someone’s capacity under the Act, but you then have to go on and do something about what you decided. That is, if you decided someone has capacity, how are you going to empower them to do what they have the capacity to decide? And if you decide they have no capacity, you then have to set out to protect them actively, because if they have no capacity, they will need safeguarding.

So, if you think someone does not have capacity, and you are caring for them in some way (as a CNS visiting or in a hospice), it is your duty to monitor the use of deputyship: are they actually safeguarding the patient or are they still at risk from their carer or someone else in their lives? There is a duty not to make assumptions that everything is OK, but instead people should confirm and validate what is going on. He directed this at local authority staff, but of course any professional who is visiting or involved with a person without capacity would have such a pro-active duty.

It was also clear that you had a duty to deprive someone of their liberty if your professional, clinical assessment was that they needed this, but when you did so, you must apply the safeguards. The deprivation of liberty safeguards were not intended to prevent the use of restraint where this was necessary, they are safeguards to use when you need to do it.

A session with medical colleagues about our newly renegotiated arrangements for continuing care applications. Recently, we have talked with our pcts about their application processes for continuing care funding; they claim they are all consistent with the Greater London guidelines and all use the same forms. Part of the reason why this is not so is that they are thinking about outcomes, whereas our nurses and doctors are dealing with the process, and all the pcts have a different procedures, even if (which I think is also not right) their decisions would be the same. The real reason why the system is unsustainable is that the public does not understand why they must must must contribute to local authority community care, but are not not not allowed to contribute to NHS continuing care. Our doctors, like the public also do not understand why the everyday care needs that come from an illness or disability do not get continuing care, whereas an artificial concept ‘the primary health need’ which is not too different from being unable, say, to get up in the morning because of a disability, is the only basis for getting it.

Anyway, with yesterday’s budget all this is not going to continue for long; it will be one of the easy cuts to make in the decade of holding back the public sector. It does seem crazy that because of incompetence and greed in banking, we are going to have to put up with poor and deteriorating services in the public sector for ages, and when that period of retrenchment is over, we are going to get resurent bankers and private sector managers saying that their giant par packets should not be tweaked because they’re mopre important to the economy than being decent with our old people. No banker or manager is worth more than good care for our old and dying people.

Visiting Dyscover this morning; http://dyscover.ndo.co.uk: this is a local support group for people with aphasia or dysphasia – no speech or disrupted speech, usually because of stroke or brain disease. As you talk with them, you have to wait while they find the words they want to say, and test out what you have understood to make sure you picked it up right. One interesting positive for the group was the chance to talk about interesting topics in discussion groups. At home, they have discussed everything with their spouse, and visitors often do not wait comfortably for them to take time to speak, so they don’t get the chance to spread their wings in a discussion like the rest of us do over coffee or a meal break.

I connect it with people’s response to hearing that you have cancer or you’re dying; people don’t know how to respond to you, so you become isolated. My ambition for the future: we should all learn how to take time to listen to people.

Am Equalities and Human Rights Commission report on parental leave found that it entrenched divisions between the sexes because of Britain’s long but low-paid maternal leave and weak flexible provision. What it does not go on to do is to look at caring leave; it should tie these two things together becasue caring for older people interacts in many families with caring for youngsters in the family. The report actually demonstrates that families only matter to social policy wonks when there are children, but family policy should be for all the generations.

The Report at: http://www.equalityhumanrights.com/en/publicationsandresources/Documents/Equalities/Working%20Better.pdf

Readers might know that the government is moving towards a new registration system for providers of all health and social care services, including now it seems personnel agencies, and recently got to the stage of reporting on their decisions as a result of the consultation last year. This is all because of setting up a joint regulator in the Care Quality Commission.

This provides a list of services that have to register, and will have to have a registered manager:
• Personal care
• Accommodation for persons who require nursing or personal care
• Accommodation for persons who require treatment for drug and alcohol misuse
• Accommodation and nursing or personal care in the further education sector
• Surgical procedures
• Diagnostic procedures
• Treatment of disease, disorder or injury
• Services in slimming clinics
• Transport services, triage and medical advice provided remotely
• Maternity and midwifery services
• Termination of pregnancy
• Assessment or medical treatment for persons detained under the Mental Health Act 1983
• Nursing care
• Management and supply of blood and blood derived products

In a way, this is no different from many of the provisions under the current arrangements, of course, but you can’t help feeling that setting up a general system for such disparate bodies will make the whole thing more unwieldy; no doubt we’ll have even more complicated forms to fill in soon.

The response to the consultation: http://www.dh.gov.uk/en/Consultations/Liveconsultations/DH_096991

Readers who were interested in the Integrated Care Pilots might be interested in the end of life care pilot, presumably somewhere in Northamptonshire. These projects are to experiment with health and social services working together better (or, bearing in mind some experiences, at all). They’ll get some money to try it out, and then everyone will be expected to follow suit without any money (if it works, which presumably it will if there’s extra money and they’re keen). I often think they should give the money to the everyone who doesn’t apply, on the grounds that if they’re unkeen on working together it might be an incentive. But no, this is the Department of Health.

Nene Commissioning CIC
This pilot will develop new models of long-term condition management to help patients remain independent for longer and have more choice in their end-of-life care. It will create personalised care plans for high-risk individuals and aim to reduce admissions to hospital.

Bit vague what they’re committing themselves to yet then apparently and although the announcements say end-of-life care, it’s obviously not a big factor.

Several of the others are of interest to palliative care and end of life care services because they’re about various long-term conditions.

Website: http://www.dh.gov.uk/en/Healthcare/IntegratedCare/DH_091112