Social care and social work are important in end-of-life care.
Malcolm Payne's blog focuses on developments in social care and social work that affect palliative and end-of-life care. It is part of the information work of St Christopher's Hospice, London.
What with the state of the government, you wonder if it’s worthwhile looking at any government documents at the moment, because you wonder if they can carry them out, However, in the spirit of enlightenment, as always they often contain useful information and analysis; so here, over the next series of posts, goes.
Ready for the PROM?
No I don’t mean an American school graduation ceremony or the extensive series of concerts at the Royal Albert Hall, and increasingly around the country (but if you prefer that, then this is the website: http://www.bbc.co.uk/proms/2009/)
PROMs are Patient-Reported Outcome Measures, which the government is rolling our to test whether patients say they had a successful outcome of some healthcare intervention as a basis for commissioning services.
Apparently you can no longer say ‘the operation was successful but the patient died’ because the patient can’t fill in a PROM form. We mainly think of PROMs as being about hip operations and the like, but the government is using them for mental health and learning disability commissioning. Can palliative care be far behind? ‘The patient died, so the palliative care service was successful’ – hmm, could be a problem there.
However, all this sort of thing is becoming more rampant. You can see more on the Department of Health PROMs website: http://www.northgate-proms.co.uk/index.html . You can register for regular bulletins.
I take back what I said about the main asset of the latest Solace booklet being its pretty-coloured cover, because there’s a good explanation by Scotland’s Chief Social Work Inspector Alexis Jay, on how their free personal care policy is working. The England government could learn something from this. It is ‘probably the most popular measure put in place by devolved government in Scotland’ and has shifted the balance from residential to community care.
Palliative care social workers still struggling with continuing care could well look north of the border. Certainly it’s worth retiring there if you’re feeling a bit decrepit, just in case.
Free personal care is not problem-free, of course, and you can see the full picture in last year’s report from the Scottish Auditor General:
Audit Scotland (2009) A review of free personal and nursing care Edinburgh: Audit Scotland
http://www.audit-scotland.gov.uk/docs/health/2007/nr_080201_free_personal_care.pdf
Jay, A. (2009) Free personal care. in Bruce, S., Hume, D. and Jay, A. (2009) Creating Positive Outcomes through Social Work Services. London: Guardian Public: 45-9.
Ah a report on social work and not social care services? Does this presage a rethink about the role of social work in English social services? No, it’s about Scotland, where they still talk about social work.
The main asset of this booklet of short articles from the Guardian Public/Solace series is its attractive cover.
Graham Robertson from NHS Health Scotland tells us that social work has a really big contribution to health promotion, because a good health includes social well-being, They just don’t get it, these health people, do they? The point is that if you’re going to have a healthy population, you have to have good social relations in a coherent and cohesive society; that is a much more important objective for good health than any health condition. This doesn’t mean that (one of his examples) because social workers deal with loads of hopeless people they can contribute to the government’s obesity, smoking and drinking reduction targets by getting these ghastly people to improve their health too (he doesn’t quite put it that way; this is my interpretation).
To achieve a healthy society health promotion needs to stop looking at limited health targets and instead start contributing to social well-being directly through reducing inequality and improving social cohesion. They don’t do that sort of thing? Too vague and idealistic perhaps? Possibly too political? Well, they’re not going to get very far then.
Robertson, G. (2009) Promoting health at the sharp end. In Bruce, S., Hume, D. and Jay, A. (2009) Creating Positive Outcomes through Social Work Services. London: Guardian Public: 42-4.
We recently had our first CQC inspection (the new regulatory body for health and social care organizations). They were the same old people as before.
But the organization is now consulting on its future practice, including the new registration standards: this is important, there’s hundreds of pages of stuff telling you what you’re going to have to do. One of the important issues is how far they are going to deign to notice the special needs of palliative care organizations. There’s an online questionnaire to fill in.
The consultation website is: http://www.cqc.org.uk/getinvolved/consultations/consultationonnewregistrationstandards.cfm#1
I’ve previously mentioned Idea (the local government information and development agency – it used to be a training body but was privatised a while ago). It has a good website with lots of information and case studies about things relevant to social care matters.
In particular, there is a good site with links to official documents on adult social care ‘transformation’ (this is enthusiast code for personalisation policy and practice – you’re only transforming of course if you’re transforming the way the government wants you to; any other transforming is not transforming or alternatively is strictly outdated – and you have to be keen too, not just interested; critical is especially not allowed; how is it that a democratic government has developed that attittude to its policies?)
I recently got sent the national GP survey to fill in, like 5.7 million people. A lot of it asks questions about things that government policy is interested in, but among these are the questions to people who have an ongoing healthcare problem. If they have, they are asked:
Did the doctor or nurse take notice of your views about how to deal with your health problem? …did the doctor or nurse give you information about the things you might do to deal with your health problem? …did you and the doctor or nurse agree about how best to manage your health problem? …did the doctor or nurse give you a written document about the discussions you had about managing your health problem? …did the doctor or nurse ever tell you that you had something called a ‘care plan’?
That’s about GPs, but I wonder how many palliative care doctors and nurses would get a positive response to similar questions? Or social workers? Many palliative care teams have quality assurance questionnaires, but do they ask directly about involving the people we care for (including their families and carers, not just patients)?
This sort of thing draws attention to asking about specific things you want to know about, not just seeking general satisfaction. The risk is that you only ask about what professionals are interested in so that you never find out about things that haven’t occurred to you. But it is worth thinking about asking for specific feedback.
The national GP survey website: http://www.gp-patient.co.uk/ (you have to click ‘general information’ and scroll down to see a copy of the questionnaire).
Social workers and others who are not in this loop might enjoy (no that’s the wrong word; find interesting) the newly-published external examiners handbook for UK social work degrees:
http://www.swap.ac.uk/docs/examinerhandbook_300309.pdf
There’s database of people who are appointable as external examiners, and they are looking for practitioners and academics (current and recently retired). It pays (but not much). It’s worth signing up to make a contribution to social work education. I’m stopping doing it this year after 30 years; one of the nice things about it is to see how other people do things and sometimes to see the great work that young people coming into social work are doing (you always see some of the good stuff as well as the failing students). There is also usefully information about multiprofessional education as part of social work. The actual document is a bit education jargony and bureaucratic.
Information for non-UK readers: all university courses in the UK have outside academics and practitioners who sample the work submitted by students for assessment, including in social work reports from practice aseessors, and look at examination procedures to check that standards are being maintaine
Tuesday 2nd June (added later because I am away.)
Now to Wroclaw, where a newish school of social work has an academic relationship with Opole University and I am giving one of my lectures about St Christopher’s and palliative care. They have a stunning turn of the 20th century building, German-built since Wroclaw was Breslau then and part of Germany. The Ryanair announcer on my way here called it ‘Rocklaw’, but it’s actually pronounced something life ‘Vrotswarve’ because w is pronouned as an English v and the l has a little line through it, so it’s pronounced as a mixture of w and l. And then a couple of students took me sight-seeing; it’s a beautiful renaissance city.
At least in parts: the college is in one of the socially deprived areas, with a lot of issues to be faced by social workers, while all cities in Eastern Europe seem to have ropey blocks of apartments.
But then perhaps all cities do, never mind Eastern Europe, because I can think of some really ropey public housing estates in the St Christopher’s area. I think one of the worst aspects of dying at home anywhere may well be the poor environment that many people have because of poor housing. While they may be at home and among their family and their own things, poot quality housing often means that there is a poor quality environment in which someone has to die.
Of course, if you look at my list of links to social work organisations in palliative care (20th August 2008), you will find a link to the American Social Work in Hospice and Palliative Care Network, http://www.swhpn.org/, but perhaps if you have come late to the blog, you won’t have gone that far back (in which case you’ll have missed some of my best gems and diatribes and lots of useful information). To go back to useful information on links, you click the ‘LINKS’ tags at the top of the page. Similarly if you click ‘resource documents’ you get to the posts about my more comprehensive blocks of information and discussion. Yes I know blog enthusiasts will know this, but quite a lot of users of this blog are people who’ve never looked at a blog before in their lives.
The occasion of this reminder is that Grace Christ would like more people to know about the website, and use its resources. You can get a regular email from them, and they have useful resources for US and Canadian social workers; perhaps they need a foreign membership category.
You can also download interesting documents, including a monograph on the history and role of social work in palliative care in the US: http://www.swhpn.org/monograph.pdf