St Christophers
Malcolm Payne

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.

Misys Charitable Foundation

Archive for August, 2009

Assisted dying reaches the front page…of Private Eye

Wednesday, August 5th, 2009


All the debate about the assisted dying case in the House of Lords, which has required the Director of Public Prosecutions to come up with guidelines about who he will prosecute if they help someone die, has led to a lot of public comment. This week the satirical magazine Private Eye joins the club with ‘Assisted Dying latest’. Its front-page bubble photo has Prime Minister Gordon Brown asking a smiling Lord Mandelson: ‘Why have you booked me a holiday in Switzerland?’

And inside, a cartoon shows a scruff on a street corner holding a shot gun, next to a notice saying: ‘Assisted dying – cheap’.

But since I can’t reproduce these, another pic of the new St Christopher’s: you’ve crossed the road, approached the front door via the new sebra crossing, now you come to the new glossy reception area, all curvy light wood. Beyond, you can see one of the main aims of all the rebuilding, the welcoming new Anniversary Project centre:Reception

Will older and dying people be low priority for health finance?

Wednesday, August 5th, 2009


I see from my newspaper that Prime Minister Gordon Brown is supporting free access to medical care in Africa, to improve levels of health…starting with pregnant women and children.

I understand the epidemiological imperative to focus on a group that is very vulnerable healthwise, and who can often be helped with simple preventive care. However, if the political judgment is that these mothers and children should be a healthcare priority in Africa, why not in the UK? There’s an almost sentimental view that we help the children first, and as budgets tighten, what will be the attitude in health and social care for older people or disabled people or people who are dying?

Will the argument be transferred from the very poor nations of the world to us, the rich but financially struggling? Will financial pressures mean that we cannot care as we might for our older and dying people because mothers and children are more important to our economy or our emotions?

Social work education (pre and post registration) in the latest reports

Monday, August 3rd, 2009


One of the things that connects last week’s two Reports on social work is a concern for education and training.

The Select Committee Report, as usual, brings together rather well a range of views and issues, and so is a good summary of the state of the play. However, it is focused on education for children and families social workers, responding to the concern about children and families work after the various child protection anxieties of the past couple of years. Because of this and the fact that it is a DCMS committee, it tends to see children as the be-all and end-all of social work, when it is actually a small service, which does not spend as much or do as much work as adult services, which is by implication much less serious business. I think it is just as important to have good care services for vulnerable adults, older people, disabled people, people with learning disabilities and people with mental illnesses as it is to have good care services for children.

The Task Force people, as well as the usual lobbies on behalf of higher education and the employers are all heavily represented in the evidence and the commentary. However, the Task Force interim report is still at the tentative stage on education.

One area it trolls through is whether there should be specialist social work courses; this is in tension with the wish to preserve a generic social work course. Generally, children’s social care employers are keener on a specialist qualifying course for their employees than anyone else, at least partly because they think that post-qualifying training for everyone who does child protection work is a financial impossibility, because most agencies cannot afford to release staff to attend. Many people who have done the existing training or the new post-qualifying programmes do it on their own time. But we need a generic course so that people are properly prepared for the basic job of social work. Many have not made a choice at the course stage about what they want to do.

And if we stopped to look, we would find that a majority of the younger people on courses want to do children and families work. So who is asking how many people we need to do adults work? It’s a much bigger field and just as, if not more, difficult; someone needs to be thinking what we need there as well, and we need to press the Task Force to do that.

The other thing is that everyone does children and families work and everyone does work with adults. Our social workers at St Christopher’s are mainly working with older people. But those older people have children and grandchildren; our young patients (that is, those in their forties and sometimes younger with major illnesses) often have children who are the responsibility of children and family departments. Strangely enough, although you wouldn’t think it to read the effusions from the people solely focused on child protection, your parent dying tends to have an effect on the child and family. Our social workers have experience in both children and families work and adult services work, and people in adult services work often have dealings with children in the course of what they do. It is crucial that all social workers have a basic grounding in all aspects of work. I want no more local authority social workers ringing up surprised because a hospice deals with dying people.

Then, in the same way that I think that all social workers with older people need to learn how to communicate in a really skilled way with older people and their families about their impending end of life, I agree that social workers working with children, among whom I count most of ours at St Christopher’s, need to have advanced training in communication with children. In exactly the same way, it has been agreed that all doctors need specialised training in giving patients ‘bad news’ (that is, ‘you’re going to die’). It is taken for granted that they won’t get enough in their general medical courses, although of course many of them naturally have the skills and personality to do it well, even though they could use some extra tips and tricks.

Both reports make the very valid connection between the qualifying or pre-registration, course and post-qualifying education; we need to look at the whole process of lifelong professional education and experience in social work.

I think everyone is agreed that there needs to be stronger post-registration specialist education for social workers. Working in a healthcare-connected organisation, I find the different attitude to lifelong education as compared with local government very striking. Local authorities just have no tradition of educating their staff. Nurses have to get higher degrees for promotion to many senior posts, and nurse consultants do PhDs as part of the requirements for their job. Doctors take it for granted and their employers pay for fairly extensive and expensive courses. But the work they do is no less dangerous or important in its way than that of many social workers. My daughter is a newish social worker, with about five years experience and a social work masters, has recently gone to a new CAMHS job and was immediately sent on a young people’s mental health masters. This is how it should be for any specialised job, and I think there can be no doubt that child protection is increasingly a specialised job. The time is long gone when it was a routine regular part of every junior generic local authority social worker’s job.

Local government really does have to pay for this, and it should be encouraging all its social work staff, including those with adults, to develop post-qualification education. But my experience of some local authorities when I was dealing with them as a head of a university department was that they actively obstructed staff who wanted to go on advanced courses. They claimed this was because they were so hard-pressed that they coundn’t spare them, but I suspect that it was because the managers thought that all education was a holiday camp, a luxury that they shouldn’t have to pay for, and moreover it gave them ideas and evidence to disagree with the stupidities of local authority bureaucracies.

When are we going to evaluate agencies by the proportion of social work staff at every level that have achieved advanced qualifications in the work that they are doing? When are the post-registration training and learning requirements of the GSCC going to have real teeth instead of the milk-and-water current arrengements?

Another pic of the St Chrsitopher’s; a close-up of the new entrance; last time, you saw the approach:Front fr zebra