I’ve been enjoying the latest edition of Eurohealth, the journal of the European Observatory on Health Systems etc based at the LSE. It has a whole load of papers on health inequalities. One paper makes the point that we should be looking at non-death health outcomes, instaead of simply worrying about how obesity or smoking leads to early death. This would open the door to trying to look at some social measures, not to mention ideas like happiness.

One of the papers looks at how welfare policies might contribute to reducing health inequalities. An interesting series of tables shows how countries vary on the generosity of family policies (the Nordics come out top of course, with the UK fairly low down). But the UK has very low child injuries although it is somewhat above the line child poverty and infant mortality. Perhaps I’m wrong the moan about rabid press coverage of child abuse scandals, because this might suggest that the UK level of anxiety about child deaths and injuries may make a difference to our children. Perhaps the Daily Mail needs to pay attention to the US and New Zealand, which are well above the line. Or perhaps it needs to focus on ill-treatemtn of older people, and it might have the desired effect.

See it on the web: http://www.euro.who.int/Document/Obs/Eurohealth15_3.pdf

The ‘Health Herald’, a nursing blog, tells us its favourite hospice/older person blogs, putting this blog bizarrely into its pain management category – if there’s one thing I don’t rant on about it’s pain management.

I now feel a duty to comply (you didn’t know that about me did you?) So: Except to say that good pain and symptom management is an essential part of pallaitiev care, but mainly so that people can continue to lead interesting lives that allow them to complete the social tasks they need to achieve in the life that remains to them.

The listing at: http://nursesassistant.org/2010/top-50-hospice-care-blogs/

The Land Registry sent me a pile of leaflets pointing out that older people who live away from their property (for example in a care home) run the risk of fraudsters taking over the title of their home without their knowledge and selling it on. You have to make sure the register is up-to-date and they know how to contact you if you live somewhere else. Otherwise, presumably, someone claiming to have taken over your house can simply pick up mail from the Land Registry and you would never know.

Contact them on: http://www.landregistry.gov.uk/ to get leaflets yourself; currently this issue is on their front page, but there’s loads of other property info there.

An article in Guardian Public says ‘transformation’ directors (or ‘strategic managers’) are being appointed ion the public sector, and the NHS, in order to make sure that programmes to save costs are implemented to target.

Silly me. I thought transformation meant introducing innovations effectively. However, the statements from public sector great and good take it for granted that it’s about saving money.

See the article at: http://www.guardianpublic.co.uk/

The question mark says it all. Phil No-hope (the minster for all things social care) said on 19^th January that the government, in response to the consultation on the review of the No Secrets guidance on adult safeguarding, would legislate. But it is only legislation to formalise a bureaucracy that is mostly there anyway: they want safeguarding adults panels, like safeguarding children panels, in every area. Most places have these, so it’s a bit pointless. He also said they would issue new and improved guidance. It’s 10 years now since the last major piece of guidance, so this is not surprising.

I imagine nothing will happen before the election and that the other lot, if they get in, will not be bothering. This is mainly because the media frenzy and the political wibble-wobbles don’t happen when older people are biffed, neglected or stolen from by their relatives or carers; only when it’s children.

See the announcement and connect with the documents on: http://www.dh.gov.uk/en/News/Recentstories/DH_111276

A further twist in the saga of NHS charities; the government is delaying a new accounting standard that means that the assets of NHS charities where an NHS body is the sole trustee have to be included in the assets of the NHS body. People fear this will mean that the assets of NHS bodies will be reduced because of their charitable assets, when the charities should not be supporting the public purse. This mainly affects the big old teaching hospitals that had charities which carried on after the NHS was founded (some of them are very rich), but there are other charities set up for various purposes. Phil No-hope, the care minister, claims this is all about transparency. The Charities Commission says, apparently ,that they would like to see such bodies appoint more independent trustees, but not just so that they can get round these new accounting rules.

I worry about these bodies. I can see that leftovers of the pre-NHS hospital charities needed to continue with a charitable existence, and, amazingly to me, some people apparently leave legacies to NHS hospitals. You have to ask why – these are public bodies. The problem is that these large extra funds support the aims of some already privileged NHS bodies to gain even more privilege, and ignore participative planning and consultation with the people using their services and their local communities. In particular, it encourages expenditure in already rich parts of the country, mainly on hospitals or in the interest of maintaining their NHS hegemony. Charitable monies should be redirected towards community services and not to the interests or already big rich hospitals.

You can see the news report on: http://www.thirdsector.co.uk/News/DailyBulletin/978963/Delay-sought-new-rules-NHS-accounts/60B8C11D571BD969193A7C2FF064BE1D/?DCMP=EMC-DailyBulletin

Now off to a centre for older people in Wroclaw. Actually this is a virtual centre, because there are only two people who organise services in local centres and run a telephone helpline. Most interesting: they have imaginative partnerships with local companies, and give out certificates to businesses if they are assessed as older people friendly. This is a great development on disabled friendly assessments; I have not seen the older people assessments elsewhere. I forgot to ask, but wouldn’t it be good if they had a team of older people to do the assessments?

Discussion about older people’s attitudes to local services. Some people prefer local community involvement, while others prefer the anonymity of a central information service. This emphasises how important choice in the style of provision is – not everyone wants to be community-involved.

Also, about the communist past and the engagement-focused present. A bit of a feeling that older people who spent most of their lives expecting that the state will provide, actually want services, and do not want to be engaged in participation and self-management activities. Makes you think about the personalisation and self-directed care agenda in the UK.

My view: people should be entitled to say: ‘Just give me what I’m entitled to, never mind all the participation rhetoric. I just want the services, not the self-direction’.

Sitting here gazing out at the snow, I am thinking back to being in Mauritius last month. Every district seemed to have a social welfare centre. Obviously this was mainly a community centre, but there seemed to be playgroups, mothers groups, unemployed people’s groups and so on. Why isn’t a government social welfare provision like this central to every local community in Britain. Are we just too well developed for it? I don’t think so. I think a lot of people would appreciate a place that they can go to work together to enhance their well-being locally. And lovely to see ’social’ provision called that, and not provision for health or children. This one had a lovely view of the bay at Mahebourg at the wide.

Apologies for the only occasional posts – this is partly because I’ve been away a lot, but also because we’ve had some technical difficulties, now sorted out. I am now going to post a series of items which have been waiting.

I’m doing one of my Polish visits and have the chance to see a Wroclaw hospice (I have not correctly rendered the non-English alphabet of this city – you pronounce it vrotslav.

In the grounds of a Catholic hospital in suburban Wroclaw, in a treed garden (but this week heavily covered in snow), it is a two-storey stand-alone building, which has just had a new addition, with 16 beds in two-bed rooms. A bit hospital-like, and in this way it reminds me of a rather similar place I saw in Estonia a couple of years ago. This organisation, a off-shoot of a Catholic order of monks, does not have a home care service, another part of the city does, but it is unconnected with the in-patient unit.

Talk of people wanting the fact that they are in a hospice and are considered to be dying concealed from relatives.

I am there with some staff from the local social work college, one of whose students did a placement at St Christopher’s and is now doing a placement trying to establish a volunteer programme in the Wroclaw hospice. It has a mainly medical-nursing focus, although the part-time psychologist mainly has a counselling role, and there are no social workers.