In the absence of much about anything on the Department of Health website (only bits of which are re-appreaing from the archive as someone vets them as suitable for the new ConDem regime – why are they doing this for basic professional and legal guidance, one asks?), I’ve been enjoying one of the documents that is still going on, the consultation about making sure health care workers cooperate with each other; this seems to be mainly about safeguarding, which since vetting and barring seems to be in question, other forms of cooperation might be too. In this document, is a paragraph on social work:

2.8 We have been made aware that in mental health and learning disability health care settings, multi-disciplinary teams may include social workers, who are employed by local authorities and seconded to NHS trusts. We believe that
social workers in these multi-disciplinary teams sometimes provide care which could fall within the above definition of ‘health care’. In such cases, it is our view that these groups of social workers who are connected to the provision of health care will be “health care workers” under these regulations (as they will provide services to a designated body for purposes connected with the provision of health care) and that designated bodies will be subject to the duties of co-operation in respect of them. However, we do not consider that social workers generally will be “health care workers”.

It goes on to ask if social workers provide health care and if so where, sort of implying ‘don’t make it difficult for us’. Well, I am second to nobody in being absolutely clear that social work is not healthcare, but I’ve never seen any sign of understanding about this from the DH before, so I suppose you could see this as progress.

BUT…

You mean they had to be ‘made aware’ up there in the Department of Health that there were some social workers employed by NHS bodies working on mental health and learning disability (and palliative care). Is there really any point in a separate duty to cooperate (since most of it’s about safeguarding anyway) that does not fit across the Board. Have they got their minds in gear about the real world up there in the DH? I’m aware, of course, that there are legal implications of how you define health care workers, and that inevitably will involve a lot of waffle, but the whole Act on which this is based is a health and social care act.

The question to ask is not among those that this consultation is asking, but whether there is any point to this jargon-filled gargleflim at all.

You can decide for yourself at: http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_113577.pdf

To Bratislava for a lecture at the Comenius University (the geographically challenged may need to know that Bratislava is the capital of Slovakia, which seceded from the Czech republic in the 1990s, after the economic transition of Balkan.eastern European countries). I discovered that Ryanair is calling Bratislava Vienna, which is obviously charging too much for the masochists’ airline to go there; Vienna is three quarters of an hour on the motorway from Bratislava. And since my last visit in 1993, I find Bratislava has created a lovely restoration of its beautiful central European town centre on the Danube. Really worth a visit, if it weren’t for the British stag parties, who even excited the ire of the students.

Th Comenius University has one of the oldest social work courses set up in the region, post-Communism, with a lively group of students (see photo) and committed group of staff (see other photo). There was a lot of interest in bereavement, although many of the younger students could not imagine spending their lives working with dying people. I spent some time with students working with homeless people. In view of the feeling that services and support was really poor that felt pretty soul-destroying too.

The real satisfaction of palliative care social work, I always think, is the good feedback and the feeling that someone really appreciates what you’ve done and is able to move on because of it – not common in a lot of social work.

Meeting some Comenius students in Bratislava

And while I’m at it, have you looked at Datagov? This website gives you access to government datasets available on the internet. If you look at ‘data’, you can search for whatever you might be looking for or click on one of the items from the data cloud; lots of interesting stuff on older people for example. ‘Applications’ links you to search sites. I found myself often ending up on the Data4NR site, which has loads of stuff on local communities and social information.

The datagov home page: http://data.gov.uk/

The data4nr home page:http://www.data4nr.net/introduction/

You might find the Homecare website useful; it has listings of home care providers, mainly nursing and private care agencies, but also all local authorities, with their websites a click away if you want to look at an unfamiliar LA website.

The website: http://www.homecare.co.uk/index.cfm

Understandably, the media comment on on the Condem re-write of the NHS Operating Statement (the government’s instructions to the NHS about what to do) has focused on the removal of the waiting times requirements – your GP no longer gets a kick if (s)he makes you wait longer than 48 hours for an appointment and your A&E can keep you on a trolley longer than 4 hours (but they’re told the removal of the target does not mean that they should not try harder; I’ll wait to see, but I think these targets have been useful).

However, there is stuff on better cooperation between health and social care, particularly on re-ablement (that is, getting everybody back to work and not claiming government social security payments) and a commissioning document.on end of life care is still expected later this year; so that is where we should look for the improvements they’ll be going for, and the incentives that they’ll be offering to Pcts and others to do their bidding.

The operating statement:http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@ps/documents/digitalasset/dh_116860.pdf

When you go to hear politicians, the announcements are often bland and sketchy; you go to hear the subsonics about how they’re thinking about what should happen. Here’s a classic from Lord Freud, now the Minister for Welfare Reform; he’s the guy that’s advised both Labour and now the LibComs on cutting budgets. With a name like that, you’ve just got to look at the subconscious.

Obviously he’s got the lordship and the ministerial role to achieve quick results (for results read cuts). He made this speech to organisations interested in getting people off social security benefits. There’s a new bit of jargon for you ‘off-flows’ – the flow of people off benefits and into work that doesn’t cost the government so much.

What he’s saying here is that they’re going to be looking for organisations to help people off benefits: what sort of organisations will they be and how should they work? Listening to this, can the same principles be applied across government to other voluntary sector charities, say in palliative care of social work?

Here’s a bit of what he said:

To keep up the pace of progress we envisage, we will need well-capitalised and well-resourced groups that are prepared to take up the challenge of competition in this area. Given the greater off-flows we expect to see through migration from Incapacity Benefit to ESA (Employment and Support Allowance) under the new Work Capability Assessment, we will need companies with the scale to make an impact. And in view of the difficulties that we are all familiar with in targeting support to some of the hardest to reach, we will also need groups that already have – or can co-opt into consortia – the skills and expertise needed to provide real change to people’s lives. Consortia formation, financing and management will, I am convinced, lie at the heart of the successful operation of the sector. So if you represent a medium or larger organisation, you might want to accelerate your thinking about how you can work with partners with resources in other areas or locations. Many of you, I know, have already elaborated strategies in this area.

In other words, if you are a voluntary sector organisation wanting to get resources to do things on behalf of government, get big. Small local organisations, local contacts, representation may be truly lovely, but they want results, so big means easier to cope with for the government and more likely to bring widespace results. If you’re small and local with existing local connections this is gives feel-good, but get in a consortium with others so that you can get big.

Hospice managements: now apply this to yourselves. How are you going to get big and help with the government’s off-flows?

Want to see more of the speech: http://www.dwp.gov.uk/newsroom/ministers-speeches/2010/02-06-10.shtml

The absence of anything much being done in health and social care by the government at the moment leads me into the byways of healthcare, and I have comne across a research review for the Forestry Commission on the health benefits of forests, which was obviously an attempt to get some money predicated on health inequalities for a largely irrelevant agency. This example of tree-hugging policy development is about how walking in the woods is good for you and it concludes:

In reviewing the evidence from research undertaken to date we suggest that an urban forestry approach to targeting health and inequalities could focus on the:

• Restorative benefits of urban forests particularly those in immediate residential surroundings including street trees
• Social contact encouraged and facilitated by urban forest use.

Two groups that could especially benefit from a focus on urban forestry and health are children and poor communities.

I yield to nobody in my enthusiasm for social contact in the woods, but if we’re going to be cutting some healthcare expernditure, studies like this are my first prioirity. You have to say this was a pointless waste of time.

But if you want to know, here is the website: http://www.forestry.gov.uk/pdf/urban_health_and_forestry_review_2010.pdf/$FILE/urban_health_and_forestry_review_2010.pdf

Not to be St C’s-focused about it, there are two other honours that mention palliative care, MBEs, in the Queen’s birthday honours list:

Dr Constance Ada Mary LLEWELLYN-MORGAN

Chair of Trustees, Ty Bryngwyn Hospice,
Llanelli. For services to Palliative Care in
Carmarthenshire.

Professor Edwin John PUGH

Consultant in Palliative Medicine, North
Tees and Hartlepool NHS Foundation Trust.
For services to Medicine.

Who gets honours then and is it appropriate? Leaving aside the remnants of empire in the British system, all countries honour people who make a particular contribution Legion d’Honneur in France and congressional medals in the US, presumably following their own cultural criteria. For the UK, here is of course a committee that advises about who should get one, and anyone can put someone up for an honour, but my ercxperience of the voluntary sector suggests that many organisations plan this rather carefully to assure their recognition. Some people reject one or ask not to be put up of course. Senior civil servants also get a good whack, more or less routinely: you can tell who blotted their copybook or did a specially acceptable job by looking at the levelof what they got.

Even so, should it be quite so bound up in political and policy considerations? The head teacher who became a dame would have been less likely before Labour decided a while ago to honour contributions to teaching at the grassroots. Should it be entwined with political decision-making?  And, looking at a field such as palliative care, or social work, one wonders who keeps an overview. Since charitable activity is an important part of a field such as palliative care, people seem to receive honours for chartiable activity which in a way is a bit of a extra to their professional role: does that mean that palliative care gets a higher proportion than other health and social care specialties? If so, it might be because charities think about these things mroe carefully as a strategy in the fund-raising, reputational game.

Of course, one asks the same question abot royal patrons; again this is a routine part of the British charitable system, and other countries have their equivalents. but have we really looked at how far we want royalty entwined with charity?

I was full of excitement last week with the Queen’s birthday honours. Those revealing pictures of Catherine Zeta Jones, said by The Guardian to be ‘leading’ the honours, left me all a-flutter.

Down the list, we find that Barbara Monroe, the CEO of St Christopher’s, also got one (and a zizzier one than CZJ – Barbara’s now a Dame). The photos just do not offer quite the same thrill, though. But never mind; soon, presumably, we’re going to get new pics in the hat for the Palace ceremony. Or will it be a fascinator? We’re all agog to know and I shall reveal it as soon as a photo is extant.

In the meantime, congrats Dame Barbara; that’s recognition for the recent renewal of St C’s under her leadership, for child bereavement services where she has played a big role, and end-of-life care in general. And for social work – we can claim one of our own.