In a Parliamentary question, Phil MoreHope provided statistics of older people in various kinds of care homes.

This blogging program does not do tables, so you have to download it:

Care Homes 19 May 09

or go to Hansard:
http://www.publications.parliament.uk/pa/cm200809/cmhansrd/cm090518/text/90518w0023.htm#09051836000046

Well going through Hansard I just had to give this example of an utterly pointless question on 19th May followed by un utterly worthless answer:

Carers
Paul Rowen: To ask the Secretary of State for Work and Pensions what recent discussions he has had with Ministerial colleagues on implementation of the National Carers Strategy 2008; and if he will make a statement. [275467]

Jonathan Shaw: To support the implementation of National Carers Strategy objectives, Ministers from all the signatory Departments have maintained close working relationships. To support this an inter-ministerial meeting is planned for early June.

The reference, if you can be bothered:

http://www.publications.parliament.uk/pa/cm200809/cmhansrd/cm090519/text/90519w0009.htm#09051969000116

In among all the fuss about MPs’ expenses, an MP involved in the creation of the voluntary sector compact presented one of those Bills to Parliament yesterday that is designed to raise an issue, rather than actually have something enacted.

The Compact is supposed to be an agreement between central and local government that they will behave sensibly when they fund or relate to voluntary organisations, such as short-notive changes of direction. In reality the thing is entirely pointless, because many officials, central or local, don’t think they have any responsibility for the voluntary sector even though it’s providing a bunch of their services for them, or behaving reasonably (not surprisingly in view of the way their political masters behave in relation to their expenses).

Care minister Phil (I have been calling him FullaHope, because of his naively optimistic announcements, but now I’ll have to call him MoreHope in view of the amount of zany expenses he seems to have copped for). Anyway, care minister Phil, is mentioned here as the guy who ran the consultation that decided the Compact’s ‘voluntary nature and values’ was inconsistent with actually making governments do what they say they’re going to do, so here is a more sensible soul having another go.

Tom Levitt (High Peak) (Lab) …At the national level, the picture has been less clear-cut. There is a perception in the sector that commitment to, and compliance with, the compact in some—but by no means all—areas of government is somewhat patchy…

Looking at the national level, many in the third sector are frustrated that the undoubted political commitment to the compact may not have been translated consistently into Government practice. As a result of that analysis, Sir Bert Massie, as Commissioner for the Compact, was asked by my hon. Friend the Member for Corby (Phil Hope), then Minister for the Third Sector, to launch a debate on the future of the compact and the commission. The consultation concluded that the compact agreement should retain its voluntary nature and its values, rather than being replaced with a statutory version, so the Bill does not alter the status or the content of the compact.

However, a majority also recognised that significantly more needs to be done to ensure proper implementation of the compact. There was strong consensus that the most effective way to do that would be to establish the Commission for the Compact as a permanent, independent statutory body, and to give it a mandate and a limited range of legal powers to secure better implementation…

With this Bill I propose to place the Commission for the Compact on a statutory basis and confer a very limited range of legal powers to enable it to promote better implementation of the compact. Having the commission established by Parliament, with a constitution…

The new commission would have a number of functions, mainly to promote and strengthen understanding and use of the compact across all tiers of government and within the voluntary and community sector. Its limited number of new powers and duties will constrain it to act in particular ways. Those would include powers of investigation where there have been inconsistencies with compact principles, access to relevant information, and the ability to impose a duty on others to co-operate with its investigations…

Given that the compact is about better partnerships, it is fair and reasonable for the commission’s powers to apply to both sides. There are no sanctions included in the Bill, as I believe that those would be outside the spirit of the compact, other than the power of naming and shaming those who are found not to be acting in that spirit.

Well of course this is a no-hoper. For one thing, if we get a Conservative government, nice ideas for yet another quango are going to go the way of all flesh. And even if we don’t, setting up a body with no powers except to name and shame politicians and officials for not bothering about anything but their own interests is going to be completely ineffective, because nobody is going to be allowed to spend anything on anything soon, so priority for spending money to support bodies external to government is not going to happen.

However, at least Mr Levitt is aware that there is still an issue about how government treats voluntary organisations, even if he’s phrased it so tactfully, that you could use this speech as a wonderful example of not actually calling a shovel anything but an artfully decorated trowel. Did you like: ‘the picture is less clear-cut’ ‘compliance is somewhat patchy’‘undoubted political commitment may not have been translated consistently into Government practice’?

The Hansard report of the presentation of the Bill: http://www.publications.parliament.uk/pa/cm200809/cmhansrd/cm090519/debtext/90519-0004.htm#09051970000001

While I don’t mind campaigns to get the press and everyone else to see social work more positively (Community Care passim), I’ve been in social work since the 1960s and this has been unchanging since the 1970s (before that there was quite a lot of ‘I think you’re wonderful doing a job like that’ – actually there’s still some of that around).

But I think the question to ask is why certain newspapers and columnists are like that and whether it matters. My view is that they’re like that because of their right-wing politics. Highly individualised, they think everyone should look after themselves and their families and not require the state to spend money to help them through problems, so they have an in principle objection to social work; it’s a sign of being pathetic if you need such help. There’s also the personal ideology which doesn’t believe in personal and psychological help. Just bring your good old stiff upper lip along.

Years ago after a bout of such social worker bashing, I heard a senior minister at a conference say that people of judgement don’t hold such extremely limited views. And some decision-makers don’t think much of social work, some are prepared to look at the evidence and some are positive; it will probably always be thus. Looking back, our experience of the Thatcher era (while not an altogether unsympathetic woman personally by all accounts, she would have held to this kind of political position, I guess) social work got quite a lot of jobs to do, and was not regularly reorganised out of existence like the NHS and teaching. Some people thought this was because we were not important enough. But I think it had a lot to do with the reality of Conservative policies that they always generate a lot of social troubles, and they’re mostly against doing anything constructive about them, and so they need lots of social workers to cope with the fall-out. I reckon we generally do better under the Tories than Labour for this reason. Labour thinks they can actually do something about social ills directly, so they’re much less inclined to support a profession that mainly deals with theconsequences of social problems than their causes.

A commentator asks if there is a Twitter site allied to this blog. You can follow me (MalcolmPayne) on Twitter, which is not a St Christopher’s project, and I tend to make more personal comments there, and only do it occasionally.

I originally took up Twitter because an executive of a major American palliative care organisation announced you could follow her and I took this up to see what it was all about. When I’m ready I’ll comment further in this blog. But there are a number of palliative care and social work people on Twitter, and one or two organisations that make a big effort to put stuff up there. Really, it’s about people promoting their organisations through providing information. Can be useful.

A really nice idea was an apparently giant American conference on palliative care (you know, one of those where you cannot go to numerous parallel session) got Tweeters to post 140 character comments on the session that they went to, and I thought this was a really useful thing to do with the technology.

A recent commentator asked whether there was any update on the various documents that form the basis of social work education (see 25th February). In fact the health and social care occupational standards are being re-written at the moment; there has been a consultation and you can see this and further updates at:

http://www.cwdcouncil.org.uk/nos/health-and-social-care

This actually illustrates a tendency not to focus on social work (the health and social care omnibus is lumbering along, with its engine healthcare not social work) and for the work to be done by either the adults social care or children’s social care lot. As I’ve said before, but I’ll say it again, so much of social work practice is shared that at the qualifying level and at the level of basic practice, this government division between services, which is incurring loyalties to divided elements of service, is unwise and will lead to problems in the long run.

The Guardian has again published Chris Woodhead’s preference for throwing himself off a cliff when his multiple sclerosis becomes too far advanced rather than going to Dignitas in Switzerland and talking to ‘bearded social workers’ (originally quoted also in the Guardian as ‘a bearded social worker’). He, you will remember, was the long-serving school chief inspector a few years ago. I’m sorry he has this debilitating and horrible illness, and I understand why he feels like this, as our medical and nursing colleagues have been so successful in maintaining the lives of people with very severe disabilities that it does make people in his position think that they’re not sure they want to go the whole way. It’s good that he its still achieving things with his life (all this is about plugging a book) as a result of their success and also the care he is getting from his wife and probably lots of other people. I wonder what all of those carers think about the expressed intention and the part that they will probably have to play in his achieving it – who’s going to be driving him to the top of the cliff? Intended suicide does not only affect the person who does it.

But what are we to think of the ‘bearded social worker’ stuff? One thing a guy with Chris’s experience should know is that most social workers are women, and that only some of the few men are bearded (I speak as a resolutely non-bearded social worker).

The Times has a more extensive quote:
“The truth is that I would be more likely to drive myself in a wheel-chair off a cliff in Cornwall than go to Dignitas and speak to a bearded social worker about my future.”

A bearded social worker? “I know from watching the recent documentary about Dignitas on Channel 4 that, although the doctor responsible for Dignitas doesn’t attend the actual suicide, a representative of the organisation does go along. In the documentary this representative was a bearded chap, a social worker type. He didn’t administer the injection: you have to do that yourself or drink a lethal mixture – which is problematic in terms of timing for MND patients – but he was there to help look after you.

“This bloke, it was reported, had once sung Beatles songs on such an occasion. Well, I’m sorry, but that’s not my idea of a final rave.”

It’s good to know that The Times actually queried the point; a pity that the Guardian didn’t or at least didn’t print the query.

Well, I would not want Beatles songs sung at my dying either, but I might like some favourite music, and the point in the documentary was presumably that you had some choice about how it was to be. Many people at St Christopher’s who know they are dying choose to have their favourite music playing; music is important to me, I would be playing lots of music in any period of illness and, if I can, approaching my death. I also regularly review the music I want at my funeral. My wife, who thinks funerals are for the people left behind, goes with this, but she and others will decide on the rest, because I don’t really care what they say and do; it’s the music that’s important to me.

But what we have here is not a comment about social workers per se but a comment about a type; this seems the point to query. The context shows that Woodhead does not think much of the things social workers do, and associates them with beards.

Is it the helping other people he’s against? He’s free not to seek personal help, but this political or philosophical position that nobody should need or want help is a poisonous stance inappropriate in any society; the whole point about a society is that we should help and support one another, particularly at the worst times of life. And also, from watching the same documentary, I know that one of the jobs of the Dignitas man who attends is to ensure that the organisation does it in a way that complies with Swiss law. Helping people through a difficult time and making sure they do it without transgressing the law or appropriate processes is not an unreasonable task to be done in life. Social workers have this role in all sorts of situations, and thinking people know that these are roles that each society needs to provide for. You could wish that, even suffering the emotional fallout of having an extremely unpleasant illness, a leading professional in a related field could have been more thoughtful in the way he expressed his position; it reveals a routinised prejudice that demeans him and that he should not propagate in public. We should all be thoughtful and respectful about what we say.

But what’s wrong with beards? Viewers of The Apprentice see Sir Alan Sugar and his beard. Does that make him a dependency-creating helping hippy? One of our doctors wears a beard – is it inappropriate for a professional? You may recollect that in the early days of new Labour at one time it was said, I don’t know with what truth, that Blair told senior people to get rid of their beards, because it was not consistent with 21st century zeitgeist; this is said to be why Mandelson debearded himself and Frank Dobson was applauded by some because he didn’t and came across in a fatherly way. I think this tells us that beards, indeed all aspects of personal appearance, are OK for some people and not for others and do reflect their personality and role.

But health and social care professionals are not into political spin. One of our groups of bereaved carers recently had a discussion about what professionals should wear; one of them said that all that should be necessary was that people were clean and tidy, while others clearly thought that a reasonable degree of traditional smartness was required. We’re all familiar with the way junior doctors seem to need to carry their stethoscopes round their necks while senior doctors don’t. Do only the juniors do the listening or is it a public presentation of role and do neither really need the stethoscope permanently at the ready? As a nurse said to me recently, they’re probably carrying more infection round on those things than on their hands that they clean so assiduously all the time. Does the beard mean that we’re not really professionals? Or does it mean that, whatever profession we are members of, we’re too kindly for people with the attack dog reputation (quite possibly unjustified, although perhaps rather enjoyed) of people like Chris Woodhead?

So the beardy comment is against kindness and helping in society. I’m for kindness and helping, especially in health and social care, and I think Chris Woodhead should be for it too.

Someone commented to me about the different US and UK covers of Margaret Reith and my book on Social Work in End-of-Life and Palliative Care (see 5th May 2009). One point is that they both use pictures of nature, leaves and so on. Does this reflect a graphic design or marketing view that palliative care needs to be presented as part of calming natural processes? In the various options that the American designer offered he actually preferred a human beings picture, but we couldn’t find one that really expressed what we wanted. A completely abstract design seems to be unfashionable among my publishers; out of focus colour photos seem to be the norm nowadays.

The frost-edged dead leaves of the British edition have also aroused comment; people have said this is perhaps not what end-of-life and palliative care is about. Cicely Saunders talked about living until you die. Margaret and I played no part in this design and it is an attractive picture. But if you’re looking for metaphor, our advice is to go for the hard-back. Because of the cropping of the photos, the slightly more space on the hardback cover discloses a green shoot. And we certainly would say that one of the things about end-of-life and palliative care social work is that for many people ‘dying well’ does renew the life of those who are left behind.

Seeing Michael Caine as an elderly magician in the new film Is anybody there? was a good experience; it portrayed a lovely relationship with a boy obsessed by and learning to cope with death. Thinking about it though, why did we have to have a film set in a 1980s care home? Perhaps because the small-business style of the home made it more personal, so you could personalise the problems, when nowadays they are often big chains.

More to the point, while I welcome some campaigning about the need of older people in care homes, why are we often showing the problems of running them, rather than what you can achieve. It’s another example of the ‘good news isn’t interesting’ syndrome. But I think Slumdog Millionaire showed that you can make an interesting and ‘feel-good’ movie about someone overcoming disadvantage, and older people can use their experience to overcome barriers in their lives.