Most hospices will know that the old schemes for reporting and checking up on people who may have abused children or vulnerable adults have been combined under the Independent Safeguarding Authroity. the new vetting and barring scheme has been introduced, to much concern about people giving friends children lifts to football matches. For professional organisations things have mostly been streamlined. But in case you didn’t know:

Forms and information: http://www.isa-gov.org.uk/

The GSCC has published a ‘research’ report on how social workers might stick to their professional boundaries better. Prepared by a user advocacy organisation called Witness, which seems from its website to be in administration (ie broke), it contains some good sense.

However, as a piece of research it is lacking: there is no clue about how or why it was commissioned, nothing about who these people are who are telling us what to do, unchecked and unquestioned user views presented as gospel and the height of perceptive analysis. It seems to have been mainly about people with the rather specialised experience of social workers in community mental health teams, but this is generalised to apply to everyone in social care. This is in the tradition, therefore, of a lot of so-called research from organisations with a vested interest in slagging off professionals without carrying out coherent research to support what they are doing. It’s also not clear who these people are, because the website gives you no clue about who the trustees or staff were.

I agree there is a problem with getting at the views of users who have lost their trust in professionals, and going to relevant user organisations is an important way of gaining access to them. But because their job is to represent the interests and views of the users who’ve been wronged, it’s hard to feel that well-constructed, unbiased and effective research is going to emanate from them. After all, their role in life is to be on the side of the wronged user, not to consider fairly the issues. Apparently the GSCC also commissioned a university also to do a project drawing on professional sources, some of which this report uses to slag off the university research. You can’t help feeling that the GSCC would have done better to spend some real money on a proper research project, using Witness’s expertise (if it has any, it’s not clear), because they’re right to say this is an under-researched area.

So where does the good sense come from? By getting some genuine experience from users, of course; as they say, a few genuine quotations can tell you a lot (actually they say ‘quotes’, but I’m into improving people’s English). You can always learn something even from individual experiences, because an individual experience makes clear how it felt and what might be done better, there are always things you can generalise to improve practice. Also, some parts of the research seem to have been reasonably well-constructed (the methods are not entirely clear, particularly the selection of respondents – a constant bane of consumer research by interested organisations). It got people to discuss scenarios about what is acceptable and unacceptable boundary-crossing, even if some of the personal interviews seem mainly to have been about eliciting well-rehearsed complaints.

A big problem is that that social workers and their agencies don’t make clear who they are and what their job is. This is not exactly a surprise, in part because social workers are presented as evil busybodies by most of the press, so they’re often a bit cautious in spelling out who they are and also in part because what they do is complicated and hard to explain. In mental health, there is an element of checking up on things (risk management as some people might like to call it), and it can be hard to explain this without putting yourself in a negative light. Some well-considered information leaflets and a good introductory session are important resources that many services that include social workers do not seem to have got right yet.

Then, people worried about blabbing around the so-called multiprofessional team. Even if you say, as we do at St Christopher’s, that information is shared with the team, there is a matter of ‘need to know’; all the doctors and nurses do not need to know the full details of someone’s private life. And leaving your calling card openly in a multi-occupied block of flats, or shouting out who you are through the letter box will not endear you to people trying to survive the stigma of mental ill-health, a particular issue for these respondents.

It’s also important to make clear what control service users have in particular situations.

I did have a lot of sympathy with some of the responses to one of the scenarios: you were distressed in a meeting/in private, so your social worker gave you a hug. In public is perhaps ok, according to some of the views of people who had not been ill-used by social workers (but not by those who had). My birth family did not do social hugs and kisses, and I certainly find it disconcerting that a lot of women social workers seem to think a natural form of greeting and leavetaking is to give total strangers a hug and kiss. It isn’t in many people’s lives, and especially it isn’t if you’re a man. One of the very earliest things I was taught in residential child care is to be absolutely clear that you’re not touching clients; and if you are, make sure there are reliable witnesses about what you had to do and why. I’ve always been grateful for the feeling of safety provided by that guidance, and judging by many of the comments here, so have the people I’ve worked with over the years. You can be empathetic without being touchy-feely.

The report: Parker P. J. (2009) Professional Boundaries in Social Work: A Qualitative Study. London: Witness.

On the web at: http://www.gscc.org.uk/NR/rdonlyres/A6E02A21-9B89-4841-B243-F87AF3DFC6A7/0/Professional_Boundaries_in_Social_Work.pdf

Witness website: http://www.popan.org.uk/index.htm

The latest attempt to keep minority ethnic groups out of the country makes volunteering one of the ways in which you can demonstrate your suitability for the fast-track citizenship process. Expect a whole load of extra applications from people from minority ethnic groups for volunteering in your hospice. This would be nice and add to the range of people who are part of a hospice service, but hidden compulsion is a worry. Nobody wants their dying relative to be cared for by someone who feels pressured to be there. The government just does not seem to get the idea that ‘volunteering’ means you do it because you want to; it is not volunteering if some Act of Parliament or government procedure makes you feel forced.

Information on the web about concerns: http://www.thirdsector.co.uk/News/DailyBulletin/946193/New-concerns-fast-track-citizenship-plans/09FA067C4027ADF896FC1BC0981A902F/?DCMP=EMC-DailyBulletin

The EU has published a strategy for global health policy, with  focus on maternal and child care, responding to climate change and talking about support for issues such as malaria prevention. Obviously major problems of ill-health and health inequalities remain. Buit this is very much a policy about achieving the Millennium Development Goals, and ignores that element of health and social care which is about care, not just about widespread changes will prevent or treat diease, which tend to focsu on the young. Inequalities affecting older peopleand dying people because they are not our future are ageist and in the end uncaring.

On the web: http://ec.europa.eu/development/icenter/files/europa_only/EU_role_global_health_issue_paper_en.pdf

The British Humanist Association (BHA) newsletter is suggesting its members go to meetings to reclaim dying from the hands of the religious. This is what they say:

The BHA is a member of the ‘Dying Matters Coalition’ – set up by the National Council for Palliative Care. The Dying Matters Coalition is responsible for promoting public debate about death and dying and for assisting the implementation of the Department of Health’s End of Life Care strategy…[local and national meetings are being organised]

The BHA urges all BHA members, if invited or approached about these meetings, to attend them if they can to express humanist perspectives on death, dying and life and to reclaim death and dying from the monopoly of the religious.

As I’ve said before in this blog, humanists seem to think that they have some special philosophy to promote. although most people just find them anti-religious, sometimes rabidly so. I think having a personal and shared philosophy by which to live your life (and therefore also to live your dying) is a good thing for most people.

I’m not clear what a humanist view of dying might be; apparently any member of the BHA can enlighten us. But since humanism generally emphasises the human capacity to manage the world with the rational use of human knowledge and skills, we need to be clear what we can control and what we can’t. Since we all die, we can’t control that. What we can control is how we die, by thinking about and planning for the kind of care and support we might need from our sister and brother human beings in our dying process. Dying is a social thing that we do in relationships, and when we’re dying it’s often too late to build the relationships that will support us.

So building human relationships is a good way of preparing to live our dying., and we don;t build relationships by rejecting other humans’ beliefs quite so aggressively as some secularists seem to believe is appropriate.

The NHS Evidence Update on cancer rates has been published, and gives you an idea of the accumulated evidsence on what kinds of cancer differentially affect particular minority ethnic groups. It says:

Overall cancer incidence was found to be lower in South Asian, Chinese and mixed race groups than whites.  However, some important specific differences were also identified:

• Black males of all ages were more likely to have a diagnosis of prostate cancer than white males. (Age standardised Relative Risk (RR) between 1.26 and 2.48, based on different assumptions regarding patients with unknown ethnicity)

• Black males and black females had higher rates of cancers o f the stomach. (RR 1.14 – 1.74)
• Black males and black females had a higher rate of liver cancer than white males and females. (RR 1.47 – 2.67)
• Black males and black females had a higher rate of myeloma than white males and females. (RR 1.79 – 2.80)
• Black females aged 65 and over were at a higher risk of cervical cancer than white females of the same age. (RR 1.13 – 2.50)
• South Asian men and women had a higher rate of liver cancer than white males and females. (RR 1.47 – 2.43)
• South Asian females 65 and over had an increased risk of cancer of the mouth (RR 1.18 – 1.97), whereas South Asian men may have a lower risk of getting cancer of the mouth than white men.
• South Asian females aged 65 and over had a higher risk of cervical cancer than white females. (RR 1.15 – 2.29)

Worth a look at the whole thing and links to the evidence:

http://www.library.nhs.uk/ETHNICITY/ViewResource.aspx?resID=326764&tabID=290

The Standards Board for England has published guidance on what is confidential for local councillors and the like, which is clear and succinct; other people may find it useful. It says:

Information is confidential:

* if it is about something serious and not trivial
* if the nature of the information is sensitive or personal, for example it is a business secret
* if it is information that you would expect people would want to be private
* if it was divulged in a way which implied it should be kept confidential
* if disclosing the information would be detrimental to the person who wishes to keep it confidential.

The good thing about this formulation is the emphasis on thinking what the person (a normal reasonable person) would want, and thinking about what they implied rather than specifically stated. Not news, but it sets it out well.

The full guidance on the web: http://www.standardsforengland.gov.uk/Guidance/TheCodeofConduct/Guidance/Quickguides/DisclosingConfidentialInformation/

The Standards Board sets standards for how local councillors and other elected/quango people should behave and investigates complaints: on the web: http://www.standardsforengland.gov.uk/

Their links site gives links to the Boards for the other countries: http://www.standardsforengland.gov.uk/aboutus/Usefullinks/

New Guidance and a public info leaflet have been issued about changes to arrangements for direct payments (where local authorities give people the cash to arrange their own care rather than fixing up packages of care themselves). This has been extended to people without capacity, for example some people with mental illnesses and learning disabilities.

The DH website guidance: http://www.dh.gov.uk/en/SocialCare/Socialcarereform/Personalisation/Directpayments/DH_076522

The Lords was not the only part of Parliament concerning itself with release of prisoners on compassionate grounds; among such cases are people who are terminally ill. This time specific mentions were made of Ronnie Biggs and al-Megrahi as the House of Commons cantered round the topic in a Westminster Hall debate (the place where they discuss things that are not politically important, so it doesn’t matter what they say). Below, I give some of the information retailed in the debate, which might be useful to social workers dealing with a particular case; there is more, particularly in the Minister of State’s reply towards the end of the debate.

The point of this discussion was to say that victims’ views should be taken into account, particularly where the release might put them in danger; where the Parole Board makes a recommendation, there are victim participation hearings. One factor was that there was someone to care for the person being released and the value of being able to spend time with their families, presumably for the families’ benefit.

Another concern was that recall should be available; the case of Ernest Saunders who made a miraculous recovery from Alzheimer’s as soon as he got out was mentioned. It;s a bit difficult to apply that in terminal illness cases, since if they don’t die when the 3 months is up, they are presumably going to be closer to it. So have they had their bit of compassion, and can be zipped back into prison then?

This led to discussion about whether prison was for retribution, rehabilitation and also with a little reconciliation with victims on the side. Some people thought that the decision should be political, some not. I’m always against politicians making these decisions, because they can be pressurised by the media, although clearly some of the politicians speaking thought these things were too important for ordinary mortals.

The relevant legislation is: The Scottish Justice Secretary has the power to make decisions on a compassionate basis because of section 3 of the Prisoners and Criminal Proceedings (Scotland) Act 1993 (HC 20 Oct 2009 : Col 208WH). For Engliand:

The Minister of State, Maria Eagle, talked about the English system: It should be possible for that person to be released early to be with his family and to receive the appropriate care at home or in a hospital or hospice during his final days. In practice, that often relates to removing the handcuffs and taking away the guards from the hospital room in which the individual is going through the final part of his life. That is what that kind of release often means. The statutory authority itself is broad and simply provides that the Secretary of State may, at any time, release a prisoner on licence if he is satisfied that exceptional circumstances exist that justify the prisoner’s release on compassionate grounds. However, for prisoners serving a determinate sentence, the power is contained in the Criminal Justice Act 1991 or in the Criminal Justice Act 2003, depending on the dates of their offences and which of those Acts govern their release. For prisoners serving life or other indeterminate sentences, the power is provided by section 30 of the Crime (Sentences) Act 1997.(HC: 20 Oct 2009 : Column 219WH).

Prison Service Order 6000 outlines the circumstances in which, in cases where the prisoner is terminally ill, bedridden or severely incapacitated, early release on compassionate grounds may be appropriate. In instances of terminal illness, there are no specified time scales but the PSO suggests that release may be appropriate where life expectancy is three months or less. It specifically states:

“Early release may be considered where a prisoner is suffering from a terminal illness and death is likely to occur soon. There are no set time limits, but three months may be considered to be an appropriate period. It is therefore essential to try to obtain a clear medical opinion on the likely life expectancy.” (HC 20 Oct 2009 : Column 215WH)

“The Secretary of State will also need to be satisfied that the risk of re-offending is past and that there are adequate arrangements for the prisoner’s care and treatment outside prison. Early release may also be considered where the prisoner is bedridden or severely incapacitated. This might include those confined to wheelchairs, paralysed or severe stroke victims. Applications may also be considered if further imprisonment would endanger the prisoner’s life or reduce his or her life expectancy. Conditions which are self-induced, for example following a hunger strike, would not normally qualify a prisoner for release.”

Further detailed criteria are given in the appendix to the PSO. Reference is made to various factors, including the prisoner’s health, the benefits or hardships to him and his family, the risk of reoffending, the length of the sentence remaining and any remarks made by the trial judge.(HC 20 Oct 2009 : Column 216WH)

Some interesting figures were given: Maria Eagle, the English minister, said: Some 28 per cent. of applications for compassionate release are granted in England and Wales.

Pete Wishart gave some information on the Scottish position: The Act requires that there be solid evidence that a compassionate release should be made. The grounds for compassionate release are given in the Scottish Prison Service guidance about how such releases should be made. I am sure that the situation is very much the same for UK Ministers in this House and that they must consider all the available evidence when they come to make releases on compassionate grounds.

Consideration has to be given to the recommendations from the prison governor and the Parole Board, and all the medical evidence that is provided to support any compassionate release has to be considered. In terms of the guidance in the UK but particularly in Scotland, there are no fixed time limits, but life expectancy of about three months may be considered an appropriate period. The guidance makes it clear that all prisoners, irrespective of sentence length, are eligible to be considered for compassionate release.

In all the cases in which there has been compassionate release, but particularly in the case of the most important prisoner release decision that we have had, all the necessary criteria for consideration of release were met. It is also important to say that very few appeals for compassionate release are turned down. Most are fulfilled. According to the figures that are available, since 1999-2000 all the applications for compassionate release in Scotland have been met (all at HC 20 Oct 2009 : Col 208WH).

Another speaker wasn’t sure how right these figures were: John Robertson: According to my figures, in Scotland there have been 31 applications since 2000, from which 24 prisoners have been released on medical grounds, with seven requests denied—only one of those involved a murder. In England and Wales, 48 people have been granted permanent early release in the past five years, but there are no figures for the number of applications rejected, so I shall have to accept my hon. Friend’s 28 per cent. Of those 48 people, 14 were serving life sentences,… (HC: 20 Oct 2009 : Column 210WH)

There’s been a gap while I’ve been giving lectures abroad and while the new format of this blog has been sorted out.

Now another pic of the new St C’s; it’s another view of the new Anniversary Centre (I’m now calling it Annicen) where patients and family members congregate before or after appointments or day centre, or to look for info. I have been known to say it’s really just like Starbucks, but the menu’s better.