Well this is going to ruin my history of social work lectures. The Law Commission has published a consultation paper on reforming the law on adult social care (which goes back at least to the National Assistance Act 1948 and earlier for some cl;ient groups and is covered by loads of legislation and guidance. We need this. Comment later.

Look at the paper: http://www.lawcom.gov.uk/docs/cp192.pdf

Incidentally, I see from various presentations at this conference that there’s a new abbreviation around in social care: SU.

I had to think twice before I realised this meant ’service user’.

Was this the exciting new concept that would replace the oppressive and derogatory use of terms like ‘client’ or ‘patient’ to demean our SUs, and instead treat them with the respect and independence that was their due as sister human beings?

There was also a moving account from something called Pearl (it means ‘positively enriching and enhancing residents lives’. Yuk – they should not have bothered with the words; this is a hotel company that also does care homes and it calls its hotels pearl; they could have done without this). And notice that they don’t know about apostrophes, when I’m a crabbit old service user, I shall be demanding that my provider is able to spell and puctuate their glossy brochures, as evidence that they take trouble over what they do.

However, now I’ve had the grouse, I thought this was a very good, non-unipart, way of motivating their staff to learn and develop both the systems and the skills of good care for people with dementia. Note, you management consultants: systems, skills and people – all together, all at once. That’s holism for you.

And truly convincing.

There’s a website but it’s not very informative: http://www.fshc.co.uk/elderly-care/dementia-care

However, not to be totally cynical (you didn’t think that did you?), there was a fantastic presentation from Stockport ASC (Adult Social Care – this is the latest jargon for what most people still call the social services, but you didn’t need to be told that, did you?)

Look at the site:http://www.mycaremychoice.org.uk/how-can-we-help.aspx

It decided its old website was boring and impossible to find anything on (how many of us can say that?) and did a survey which told them, among other things that older people did not like to be thought of as people who had ‘needs’ and ‘care needs’. So they redesigned the website to enable people to answer simple questions through a series of positive questions like: ‘How do you get on with the day to day?’

Then you get a series of possibilities, not problems, so the site actively tells you what is possible. It ends up with a package of options and will soon allow people to calculate the costs.

This really would allow social workers to get on with the job of helping people make their own decisions. Rhey also have a guy who goes round in a van with the aids in response to the assessment, so that people can pick one that matches their decor and then the man fits it.

Why can we not have something like this for continuing care assessments, instead of claiming that some professional assessor needs to go through pages of papaerwork to find out the commonsense answer to what people want to be able to do in their lievs.

Big tick for Stockport.

Among the first-half drones at this conference was a duo talking about something called ‘connected care’. It turned out that someone in healthcare has found about about community audits (a technique widely used in community work for forty years or more): you train a few people to carry out and analyse a survey of their local community to find out what you already know, but the results have more credibility because they’ve found it out themselves by participating (ie doing what they’re told would be a good idea by the professionals – this is my new definition of participating in the NHS).

Someone on their film identified the main concern about people presented with another survey from the NHS, that they can’t be bothered to respond because they know nothing is going to happen as a result. This of course is why getting someone from the local community to do it is an ace, because it’s harder for people to say ‘no’ to an earnest neighbour, preferably young or old, so they’re harder to abuse.

Apparently, though, the latest management-speak for dealing with people who don’t believe you’re going to do anything is to tell respondents in advance that you cannot afford anything, and then they won’t be disappointed afterwards. This way of getting people more connected to the NHS was hailed as a new project development insight. I was always taught to see it as ‘not raising expectations’ – it’s been a standard social work technique for at least the forty years I’ve been using it; it’s always been vital in social work, because it’s really hard to get anything for anyone from a deprived community, so it’s best not to raise their hopes.

The survey apparently found out useful things: for example, local people would like more social activities, especially for older people. Unfortunately, the presentation did not go so far as to say anything that they’ve actually done as a result of their community audit; we were invited to accept that this ‘industry best practice case study’ is going to lead to wonderful things if we do the same, only they haven’t quite got there yet.

And probably won’t, if normal life and the economy is anything to go by.

The new pot of multicoloured pens on my desk betokens the fact that the Chief Executive has sent me to one of those sponsored conferences, the type where there are lots of people selling things that think giving you a pen, or (latest fad) a canvas climate-friendly bag, will get you to buy their wares. On this occasion the main sponsor was Unipart. You may think this is a vaguely familiar company name: no, not ‘Hitler has only got a Unipart’, but the car parts company that was spun off from the failing British Leyland in the 1980s. The guy from the company had a good line: ‘Rover is over’, with a missing letter in the doctored logo. Anyway, this lot have redefined themselves as a health and social care management consultancy: transferable knowledge for transplant surgery I suppose.

Actually the Unipart management consultant was the best speaker among the drones in the first half. Although I do wonder about a management technique that tells you that staff engagement is so important, but that managers need to ‘drive through’ change (although perhaps this analogy was a leftover from his car industry past). I’m afraid I’m a Toyota staff member: my accelerator’s bust. Another example of businessification: why is it assumed that some failed car company spinoff (I know Unipart was thought to be the unipart that was successful about British Leyland) has management skills in health and social care? Personally, I’d have a lot more confidence in less industry experience and more health and social care experience.

Temple in Tokyo

We are accustomed to seeing Eastern countries as places where spirituality has an important role, unlike our ungodly country. Part of this is exoticism, of course, the peace and beauty of this Tokyo temple has many resonances with the peace and beauty of many Christian churches and Islamic mosques. However, the conference we attended in Japan was markedly professional and health and social care oriented.

I wish we could learn more about different cultural arenas of thought and debate. But then, perhaps we do not really know enough about how Christianity and Western cultures see death and dying in the 21st century. How far is spiritual care from social and psychological care? They are clearly all related, but if we say (the simplification we often use) that spirituality is about meaning, what about social meaning and psychological meaning – equally important concepts in those areas of study.

Mother and child, Tokyo

One of the important holisms we discussed in Japan, because my colleague Dr Debra Swann focused on it, is what it means to be providing palliative care in a general hospital. There are pluses and minuses of course, but one of the striking things, talking to a hospital social worker recently, is the anxiety of some acute medicine colleagues not to want to recognise when someone is dying because of their commitment to doing all they can to provide treatment.  Of course, we see this in hospices, in the patient who arrives at the last moment, or who has not really had the chance in hospital or out-patient treatment to work through what their increasingly advanced illness means for their survival and their family.

All the fuss about assisted dying has not helped this; some doctors are beginning to fear that getting people to think about death means that they are going to be accused of trying to kill them. The assisted dying lobby has not yet got the point that most people want the very opposite of assisted dying; they want all possible forms of assistance to live.

Mount Fuji at sunrise – we’re still in Japan.

The conference in Japan was – their choice of subject – on holism; I was never very sure why this was an issue for them; however, it is a current interest of mine.

I think the view of palliative care holism that it is about total pain and bringing together physical, psychosocial and spiritual issues is an outdated concept. I ask myself: what does it mean to be whole, in health and social care services? It is not just holistic medicine either, that is just looking beyond the immediate symptoms you are dealing with.

What it is about is the conjunction between health and social care; the Department of Health ‘healthandsocial’ which we have all been taught to say as a slogan of togetherness, but nobody really does anything about, especially in healthcare because they think that only healthcare matters, and that everything else ought to contribute to it, particularly social care..

Anyone who’s actually worked in social care knows, though, that it is part of a whole gamut of public services: housing, social security, justice, transport, leisure, education etc etc. Many things we do as part of social care for a frail older person involves many of these: adequate housing, adequate and correct social security, feeling safe, being able to get around in spite of frailty, being able to live some aspects of life that you enjoy, being able to develop yourself. Healthcare is just the instrument of being able to live all these social aspects of life. When you have an illness, you want to be cured so that you can get on with your life.

So the question you have to ask when thinking about holism is: what does it mean to be a human being, a whole person. And that certainly means being healthy, but it also means all those other aspects of social well-being, without which being healthy doesn’t matter much. That is one of the reasons why people are saying they would rather be helped to die than kept alive but with no quality of life. What does being healthy mean as part of being a whole human being? Being maintained alive but without human opportunity is being questioned, so we need to think about and try to achieve being wholly human up to the end of life. While that means more than healthcare, we haven’t yet done enough to say what our services need to do to achieve being wholly human. Slogans like ‘dignity’ and ‘respect’ do not achieve this, because again they are simply about being treated as human within health and social care, not being human in our whole lives.

Just back from a palliative care conference in Japan at the Peace House Hospice; a committed and thoughtful multiprofessional crowd with a good number of social workers:

You may be intrigued by the surgical masks; no, we were not carrying dread diseases and the pollution is not bad, this is a Japanese health preventive practice; perhaps with no good evidence to support it, so we were told.