Another Czech article about how professionals working in a hospice managed stress; unfortunately for the researcher, they didn’t consider their work to be stressful. But any good researcher can cope with this: she moves on to look at the claim that work involving a lot of contact with death and dying is stressful. This is a common reaction by people who do not have this experience, but is not usually borne out in reality.

So asking about the claim that working with death is stressful is, to me, the right question. It is a myth that repeated involvement with death and dying is particularly stressful – no more so than, say, dealing with dangerous mentally disordered offenders, or child protection, or helping frail older people think about moving into care homes or into the care system. There are many positive aspects to working in palliative care compared with most other forms of social work: generally you get good feedback and a feeling of satisfaction from helping people achieve a good death; this balances any stress.

So, what is experienced as stressful, and why?

Looking at the literature some years ago for my chapter on staff stress in palliative care, I found a division in thinking. Most people managed their stress in various ways and did not feel that it was involvement with death that was stressful.

However, people who found their work stressful were often reacting to particular aspects of the work, rather than a repeated involvement with death and dying. For example, nurses found conflict in the families of their patients difficult to handle. I suspect that social workers, whose experience means that that take it for granted that families are the most likely cause of conflict and difficulty in people’s lives, might be more relaxed about that.

Another thing is that research shows that stress comes from loads of things in life, among which your work is usually a minor factor. The important thing is how you personally organise yourself to deal with work stress, and to some extent whether your team support that.

The Czech article that stimulated these thoughts: Sumberova, M. (2911) Postoj pomahajicich… (I haven’t given you the whole thing: English translation:  The approach to death of helping professionals in a chosen hospice and their ways to manage the stress caused by their frequent encounter with death.) Socialni Prace/Socialna Praca (Czech and Slovak Journal of Social Work) 11(3): 99-111.

The Journal website here: http://www.socialniprace.cz/english.php (abstracts and some articles are in English).

My chapter: Payne, M. (2008) Staff support in Lloyd-Williams, M. (ed.) Psycho-social Issues in Palliative Care (2nd edn) Oxford University Press, 231-52.

An article on volunteering in Czech hospices, which is not strong, suggests that this is because there is no historical tradition of volunteering; consequently there is no social prestige attached to volunteering. They authors also argue that how death is seen in society is an important factor: when this is seen as a loss rather than as a natural part of life, people will not want to volunteer to help dying people. Finally, preparation by the hospice is important because people require a level of maturity to be comfortable with their own death, in order to work with others who are dying.

One of the issues is about the transferability of the hospice model between countries is whether the British and American assumption of a volunteer contribution does work in other societies. You would have thought that the wish to be part of the death of family members might then extend, as it does at least at St Christopher’s, to wanting to ‘give something back’ to the place that helped the family member, or to a realisation that it is possible to make a contribution, and that you want to. But if there is no general social tradition of volunteering in a country, organising to promote and support a volunteer contribution is an important thing to do in a social agency. Even in the UK, it is a truism of the volunteering world that you have to put resources into supporting and organising volunteering; it doesn’t just happen. The more so where there is no social tradition.

But an important point is that volunteering gives you an increased range of people to be involved in and offer diverse experiences to people who are dying. If you don’t have volunteers, you’re limited to the professionals, the doctors, nurses and others that are employed. And nice though they usually are, they often do not come from the same locality or social experience as their patients, so engaging local people in volunteering makes social connections that the professionals can’t achieve.

I’ve been reading this is the Czech and Slovak Journal of Social Work: http://www.socialniprace.cz/english.php or a comment from me:  http://intsw.blogspot.com/2012/02/czechslovak-social-work-journal.html

The article: Vavrona, S. and Polepilova, R. (2011) Dobrovolnictvi v hospicisch (Volunteering in Hospices) Socialni Prace/Socialna Praca, 11(4): 79-91. (there’s a full English abstract).

Another day, another court case, now from the UK Supreme Court, and this time about a patient, Melanie Rabone, who committed suicide, the resultant personal agony of the parents which was very strikingly acknowledged by Lady Hale in her judgement and  the ‘operational duty’ on a healthcare organisation to do all it can to prevent suicide. This is relevant to palliative care services because many palliative care patients actively consider suicide and of course some seek assisted suicide. As part of this case, there was passing mention of what a health service should do if someone announces their intention to go to Switzerland to be helped to commit suicide. What is the balance of freedom to decide and duty to protect?

The NHS Trust in this case was negligent, and paid compensation to the patient’s estate. But had they also breached the European Charter of Human Rights, Article 2 ‘Everyone’s right to life shall be protected by law’? There is a very full, but rather dry, detailed judgement by Lord Dyson, but I have excerpted below Lady Hale’s points, missing out the legal discussion of precedents, drawing attention to the points of interest to palliative care serviecs in my own comments.

You can see the Press Release summarising the case on the web here: http://www.supremecourt.gov.uk/decided-cases/docs/UKSC_2010_0140_PressSummary.pdf

You can see the full report of the judgements here: http://www.supremecourt.gov.uk/decided-cases/docs/UKSC_2010_0140_Judgment.pdf

First of all, Lady Hale gives a powerful summary of the case and its importance.

91. A hospital trust, in breach of its duty of care towards its patient, allowed a young woman, who was suffering from a severe depressive episode with psychotic symptoms and had been admitted a week earlier after a serious suicide attempt, to go home on leave for two days. The only support plan was the care of her parents who were not in favour of her being allowed  home. The following day she hanged herself from a tree in a well-known local beauty spot, at last succeeding in the suicide which she had previously attempted and seriously threatened even more often. The hospital trust has admitted liability to her and paid a sum in compensation to her estate. So why, some might ask, are we here?

She follows this by demonstrating an equally impressive grasp of what it means to lose your child.

92. We are here because the ordinary law of tort does not recognise or compensate the anguish suffered by parents who are deprived of the life of their adult child. In this day and age we all expect our children to outlive us. Losing a child prematurely is agony. No-one who reads the hospital’s notes of the series of telephone calls made by this patient’s father to the hospital on the night in question can be in any doubt of that; or that the agony may be made worse by knowing that the loss both could and should have been prevented. It is not surprising, therefore, that parents are among the recognised victims when the right to life of their child, protected under article 2 of the European Convention for the Protection of Human Rights and Fundamental Freedoms, is violated.

Then on to the legal points. The crucial thing for any healthcare organisation is the ‘operational duty’ to protect life. Melanie Rabone was a psychiatric patient, and the operational duty was particularly an issue because her psychiatrist had made clear to the hospital management the risk of her committing suicide. Because many palliative care patients consider suicide, and are assessed, a palliative care service might well have a rather similar ‘operational duty’ to protect their patients’ lives under Article 2. As Lady Hale says: In the health care context, this also entails having effective administrative and regulatory systems in place, designed to protect patients from professional incompetence resulting in death…[I]n certain circumstances, the state’s positive obligation to protect life goes further than that. It entails an obligation to take positive steps to prevent a real and immediate risk to the life of a particular individual from materialising…’

93. Article 2 begins “Everyone’s right to life shall be protected by law”. As Lord Dyson has explained, it is now clear that this simple sentence imposes three distinct obligations upon the state. The first, which does not arise here, is a negative obligation, not itself to take life except in the limited cases provided for in article 2(2). The second, which also does not arise here, is a positive obligation to conduct a proper investigation into any death for which the State might bear some degree of responsibility. And the third, with which this case is concerned, is a positive obligation to protect life. As a general rule, that positive obligation is fulfilled by having in place laws and a legal system which deter threats to life from any quarter and punishes the perpetrators or compensates the victims if deterrence fails. In the health care context, this also entails having effective administrative and regulatory systems in place, designed to protect patients from professional incompetence resulting in death. But it is not suggested that English law and the English legal system are defective in this respect.

94. However, in certain circumstances, the state’s positive obligation to protect life goes further than that. It entails an obligation to take positive steps to prevent a real and immediate risk to the life of a particular individual from materialising…

Here is the point that there is no general duty to prevent people from committing suicide, and the Switzerland example is given. But it is different if there was a ‘real and immediate risk’ that the patient might lose their life.

100. We are not here concerned with that broader question, but with the more precise question of when the state has a duty to protect an individual from taking his own life. It does seem fairly clear that there is no general obligation on the State to prevent a person committing suicide, even if the authorities know or ought to know of a real and immediate risk that she will do so…Autonomous individuals have a right to take their own lives if that is what they truly want. If a person announces her intention of travelling to Switzerland to be assisted to commit suicide there, this is not, by itself, sufficient to impose an obligation under article 2 to take steps to prevent her…

And in the following paragraph, Lady Hale does express clearly what duty a healthcare organisation has in its ‘operational duty’: The State does have a positive obligation to protect children and vulnerable adults from the real and immediate risk of serious abuse or threats to their lives of which the authorities are or ought to be aware and which it is within their power to prevent.

104…The court has more than once found a violation of the prohibition of inhuman and degrading treatment in article 3 when the authorities have failed to use their powers to take action to protect children from the risk of serious abuse or ill-treatment about which the authorities knew or ought to have known…[T]he operational duties under both article 2 and article 3 are similar if not identical. The State does have a positive obligation to protect children and vulnerable adults from the real and immediate risk of serious abuse or threats to their lives of which the authorities are or ought to be aware and which it is within their power to prevent. Whether they are in breach of this obligation will depend upon the nature and degree of the risk and what, in the light of the many relevant considerations, the authorities might reasonably have been expected to do to prevent it. This is not only a question of not expecting too much of hard-pressed authorities with many other demands upon their resources. It is also a question of proportionality and respecting the rights of others, including the rights of those who require to be protected…

105. In the light of all this, there can be little doubt that the operational duty under article 2 is engaged in the case of a patient such as Miss Rabone. She was admitted to hospital precisely because of the risk that she would take her own life. The purpose of the admission was both to prevent that happening and to bring about an improvement in her mental health such that she no longer posed a risk to herself. The experts were agreed that for patients such as Miss Rabone, one of the most risky periods for further suicide attempts is within a week or so of beginning to recover. Her mental disorder meant that she might well lack the capacity to make an autonomous decision to take her own life. Although she was an informal patient, the hospital could at any time have prevented her leaving…

So what should the healthcare service have done? Again, Lady Hale is clear: There is a difficult balance to be struck between the right of the individual patient to freedom and self-determination and her right to be prevented from taking her own life… But The State does have a positive obligation to protect children and vulnerable adults from the real and immediate risk of serious abuse or threats to their lives of which the authorities are or ought to be aware and which it is within their power to prevent. …There is every indication that had she remained in hospital she would not have succeeded in killing herself. The question was whether she should have been allowed to go home for a whole weekend. Having regard to the nature and degree of the risk to her life, and the comparative ease of protecting her from it, I agree that her right to life was violated.

107. However, it does not follow that because the operational duty was engaged in this case, it has necessarily been broken. There is first the question of whether the risk was sufficiently real and immediate to require consideration of what might be done to prevent it. I agree, for the reasons given by Lord Dyson, that it was. Although the doctors gave different assessments of the degree of risk, they were agreed that it was real and ever-present…There is next the question whether the hospital should have done more to prevent it. There is a difficult balance to be struck between the right of the individual patient to freedom and self-determination and her right to be prevented from taking her own life. She wanted to go home and her doctor thought that it would be good for her to begin to take responsibility for herself. He was obviously wrong about that, but was he so wrong that the hospital is to be held in breach of her human rights for failing to protect her? It may not always be enough simply to say that the experts were agreed that the decision to give her home leave was one which no reasonable psychiatrist would have taken. But The State does have a positive obligation to protect children and vulnerable adults from the real and immediate risk of serious abuse or threats to their lives of which the authorities are or ought to be aware and which it is within their power to prevent. …There is every indication that had she remained in hospital she would not have succeeded in killing herself. The question was whether she should have been allowed to go home for a whole weekend. Having regard to the nature and degree of the risk to her life, and the comparative ease of protecting her from it, I agree that her right to life was violated.

108. I also agree that her parents have not ceased to be victims of this violation simply because the hospital has paid compensation to her estate. They are victims in their own right and remain so whether or not she died intestate so that, as it happens, her estate would be shared between them….It is also important that fundamental human rights be vindicated, and never more so than when the most fundamental right of all, the right to life, is at stake.

I have been reading the judgement in an interesting court case, which will affect anyone who prepares independent reports for courts and any social or healthcare organisation that investigates complaints and has records that contain sensitive personal data, as all health and social care records do.

What happened was this. A couple went through a divorce and there was a dispute about the children. The independent social worker (who checks out the arrangements for the children on behalf of the court) asked for a psychiatric report on the father. After this, he did not get the care of the children. He complained to the NHS Trust that about the psychiatric report. They replied that they could not get permission from the mother to look at her records, and so they could not investigate the complaint. There was a series of court cases, and eventually the Court of Appeal (Civil Division) made a judgement. You can see it on the internet here: http://www.bailii.org/ew/cases/EWCA/Civ/2011/1529.html I must say it is an admirably clear bit of writing on behalf of the court that any normal person can understand. Good for them.

There are two things of interest here.

The first point is: should the Trust have agreed to investigate the complaint at all? This question arises because the psychiatrist who prepared the report did so as an independent contractor for an officer of the court (the independent social worker). He wasn’t doing it on behalf of the NHS Trust, and so they should not fall for responsibility for it. However, they decided to take on the complaint so that he could have the satisfaction of a response. The judge said they didn’t need to do that, but good for them, I say. Much better to respond to a dissatisfied member of the public, rather than reply ‘not us, guv’, which is so annoying to people.

The second point is of great interest to those of us dealing with patients’ records. The husband claimed that the duty to respond to a complaint meant that there was an implied permission to have access to the records. But the court said ‘no’: medical records are ‘so sensitive and confidential’ that disclosure should be specifically required by legislation or regulations; it should never be taken to be implied by the provisions of other legislation. Here is the relevant passage:

Mr Ley [the advocate for the husband] says that in those circumstances bearing in mind that the Trust is placed under a statutory duty to investigate the complaint, it must have implied power to enable it to carry out its duties and that that implied power can be regarded as satisfying the saving in section 35(1) of the Data Protection Act to the effect that personal data are exempt from the non disclosure provisions where the disclosure is required under any enactment.

I cannot accept that argument. I agree with Ms Butler who has appeared for the respondent NHS Trust that if any such power is to be found, particularly a power in respect of records so sensitive and confidential as medical records, then such a power would be required to be express. It is simply impossible to spell out of the duties cast upon a responsible body under the 2009 Regulations an implied statutory right to call for the disclosure to it of medical records in relation to which the relevant patient has not given consent to disclosure.

There you are: the Court of Appeal saying clearly that you should never take it as implied that data in medical (and probably also social) care records should be disclosed if it is required for some other official purpose (possibly an officially convenient purpose). Parliament or regulations based on Parliament’s legislation, should always have made it explicit that confidential information may be disclosed, in whatever circumstance.

A final point is also of interest. By this stage of the game, the husband was trying a judicial review of the grounds on which the NHS Trust refused to deal with the complaint because it could not get access to the records. We all have experience of complainants who try numerous avenues at once to pursue their case. The comments of the third judge are instructive, because they point out that you should always try to have your complaint dealt with by the most appropriate authority, not all of the possible ones together. This comment g

oes on from the point that…

judicial review is a discretionary remedy. I should unhesitatingly refuse it in any event. Firstly, because the issue which it seeks to raise is in effect a collateral attack on proceedings which are either concluded or still continuing in another court where the whole of the evidence can properly be investigated by those who are charged with that duty. Secondly, because if (I say only if), there were to be a prima facie case of any kind of professional misconduct, the right body to complain to is the appropriate professional body and not the Foundation Trust.

Well said.

A picture on the front the latest Hospice Information Bulletin of Andrew Lansley, our beloved Secretary of State at a conference looking like a criminal who’s just been caught red-handed.

See what you think, go to this site, scroll down to Hospice Information Bulletin, click on ‘latest edition, January 2012: http://www.helpthehospices.org.uk/our-services/publications/publications-catalogue/

A paper on the confidential inquiry being run into premature deaths of people with learning disabilities remphasises (and lists the previous reports that have shown) that the medical needs of people with learning disabilities are often neglected because of communication problems or because professionals concentrate so much on the disability that they don’t look at the medical needs. I remember how difficult it was getting a dentist to treat learning disabled people I was responsible for as a social worker, yet they have dental needs just like the rest of us. It seems simple, but you have to think to cover all these everyday healthcare preventive needs.

I also wonder what you would find if you just did a confidential inquiry into the preventive healthcare of people in poverty or, particularly at the moment, fuel poverty.

The inquiry is still going on (this paper is a report on what they’re doing), and I hope it will give an impetus to better care.

Heslop, P. and Marriott, A. (2011) The Confidential Inquiry into the deaths of people with learning disabilities – the story so far. Tizard Learning Disability Review 16(5): 18-25.

In the internet free until 24th February: http://www.emeraldinsight.com/journals.htm?issn=1359-5474&volume=16&issue=5&articleid=1958616&show=abstract

There’s also a commentary on the paper free on the internet briefly: http://www.emeraldinsight.com/journals.htm?issn=1359-5474&volume=16&issue=5&articleid=1958553&show=abstract

And while I’m talking about lawyers talking to lawyers, here a good summary of recent cases on Deprivation of Liberty safeguards cases: http://www.mills-reeve.com/files/Publication/4b03ad83-4ba1-495c-a169-bfa8c6dbb489/Presentation/PublicationAttachment/c69b1dc3-e4c4-4744-a1cd-ca669bb27826/DOLS_January12.pdf

You might want to look at what Department of Health lawyers say about some of the same cases:

Department of health summaries http://www.dh.gov.uk/en/SocialCare/Deliveringsocialcare/MentalCapacity/MentalCapacityActDeprivationofLibertySafeguards/DH_124891

It seems that it’s still the case that these things are difficult for non-lawyers to handle: some of the points about these cases are that restraining someone (for example, buckling them into their chair to stop them having falls) is not necessarily a deprivation of liberty, particularly if you do it to help them with a disability that would mean that they would be in an even worse state if you weren’t caring for them. But your objectives in buckling them into the chair are not relevant to the decision about whether you are depriving them of their liberty.

I don’t know if the lawyers are enjoying this, but I somehow feel that they are not making it simple for people to decide what to do in day-to-day care. Happy hunting grounds for lawyers, it seems to me. Surely we could work up some sensible rules that normal people can understand. Since there seems to be a general feeling that these safeguards are not protecting people well enough. perhpas that’s because nobody can understand how they’re supposed to work.

An interesting article on a legal practice training training website (Squire Saunders). It is about the problems that arise if a small-scale care home goes bottom-up. It makes the point that 80% of care homes are run by the five major chains, but that the remaining 20% are often a bit run down. However, most of the value of a care home business is tied up the the property. If running the care home is not making a profit and the owner needs to give up, the only way they can do this is to sell the property and the business as a going concern, or go into administration, of which there are various kinds.

We need to think carefully about a system that relies on property values to support care costs, because frequent property bubbles across the world suggest that property cannot always maintain value. Care quality should not have to rely on property values, at least in part because if the property market goes wrong, there will be no care.

The problem is that a purchaser has to be acceptable to the CQC as an operator: it they’re not already registered this will take three months or so to achieve. In the meantime, the bankrupt or keen-to-get-out owner has to keep running the thing; so does an insolvency practitioner (one of the accountancy firms who take over and dispose of the assets of a company in liquidation) run the care home? Since the property market is depressed and the home is running at a loss, will they be able to get out from under with an eventual profit from the sale of the property? If they don’t, insolvency practitioners will not be prepared to take it on. And if they do, will they be able to stand the public opprobrium of closing the place and moving all the residents on.

We all watched as Southern Cross last year went down (mainly because it had agreed to pay rents that were too high to be covered by fees in these straitened times). But they were one of the biggies. Their problems thus became the government and the local authorities’ problems. A small scale default may be insignificant on the national scale, but for the people involved and the locality, it is a serious issue.

Question then: is anyone going to be prepared to take on the running of a care home that is sliding out of business? It looks as though it will be incredibly difficult just to go bankrupt, let alone sort the thing out. Relying on the biggies to do something is unlikely at the moment, since they have troubles of their own, and won’t want to take on down-market care homes.

All of which raises the further question: how far have we really looked at the social consequences of having care homes in the private sector? What are the local authorities and the local health commissioners going to do as the economy puts further financial pressure on care homes. This disturbing practical advice for lawyers just draws attention to the fact that it will be difficult to cope with for everyone involved, property owners, care home proprietors, potential buyers, residents, staff, regulators, commissioners and the older people of an area affected. What about the rights of older people and their families to a reasonable care home service in their locality?

We have not thought enough about planning for care during a business failure when the business is a care business. Just working on improving quality, as in training staff to provide better end-of-life care will not be enough if homes start running down because they cannot be financed.

The article here: http://www.squiresanders.com/files/Publication/1d9d6ced-8eba-45df-8bd5-06b36afcc490/Presentation/PublicationAttachment/e116c0a1-ad61-424a-825d-0771e6a9d7d3/CRI_Dec_Sector.pdf#page=1

Over the Christmas period, I missed the government consultation on bereavement benefits, but you’ve got until 12^th March to reply. And there’s lots of useful info in the consultation document.

There are three bereavement benefits currently payable:

Bereavement Payment – a one-off tax-free payment of £2,000 payable to someone after their wife, husband or civil partner has died.

Bereavement Allowance – a taxable weekly benefit which can be paid to someone for up to 52 weeks from the date of death of their wife, husband or civil partner if they are over 45 and under State Pension age.

Widowed Parent’s Allowance – a taxable weekly benefit which may be payable to a parent whose husband, wife or civil partner has died if they have at least one child for whom they receive Child Benefit. It is payable until the claimant reaches State Pension age or upon cohabiting or remarriage/formation of civil partnership.

So that’s basically a cash sum to pay for the funeral and other expenses at the time, a weekly allowance for re-adjustment immediately after the death of a partner and then an extra payment if you are responsible for a child. The government’s position is that it’s too complicated and, playing their current relooping Mpeg (this is the new form of a cracked record – who has records any longer? Do young people know that they could get cracks?), it disconnects people from the employment market, so bereaved people are not incentivised to get back into work (which of course would be good for them and save the government money).

The first aim of their proposed reforms are that people should be supported by normal income support, rather than special measures for bereaved people, so they want to have a bigger up-front  bereavement payment for the transitional period. This of course will push all bereaved people sooner rather than later into the standard ‘get work or else’ approach of the present government. There is a whole paragraph about the ‘lack of conditionality’, which means there’s no requirement to seek employment as a condition of getting the benefit. I imagine people did not think about that back in the 20s when widows benefits were first thought of. I don’t know how I feel about it now: on the one hand I recognise that most women as well as men who are bereaved now do go out to work and want to do so, and tying them into help and encouragement to move forward into work is useful. On the other hand, making it a condition of a benefit has a harsh feeling about it that naïf old me sort of feels I don’t want to be part of our welfare state.

They want to remove the age criterion (civil servants are now so illiterate, they don’t know the singular of criteria, but I do) and comment that the combination of the age limit and different contribution requirements for the longer-term benefits means…

that around 80 per cent of Bereavement Allowance recipients and 46 per cent of Widowed Parent’s Allowance recipients do not receive the maximum payment.

As a result they suffer from greater uncertainty, which is bad when they are already suffering from the ‘loss of control’ in bereavement and emotional turmoil which means they don’t take in how the benefits are calculated. Alongside the ‘conditionality’ approach, I find this claimed concern with people’s feelings a bit hard to believe; it feels out of place in the generally callous style of the text. Perhaps they should give their consultations to social workers to vet for niceness, as well as the Plain English people for readability. Or perhaps they don’t feel social workers are nice enough nowadays to make a difference.

Then, as we know, there is a plan to have a universal benefit the same for everyone, to simplify the system, and the aim will be to have bereavement benefits alongside this. So most regular provision will be from the universal benefit, if you are eligible for it. However, they did research which shows that most people suffer a period of disruption in the immediate aftermath of bereavement and are proposing to target these benefits there.

There are two options they are consulting on:

1                    Pay an increased lump sum payment in the region of £6,000 for all claimants without dependent children and £10,000 for claimants with dependent children

2                    Pay a lump sum in the region of £3,000 and a monthly allowance of £250 for a period of 1 year for recipients without dependent children; and a lump sum in the region of £5,000 and a monthly allowance of £400 for a period of 1 year for recipients with dependent children.

Obviously option 1 would be quick and easy, while option two would maintain the security of a sense of support for a longer (but not too long) period. The sums proposed seem decent and realistic.

They are also consulting about whether to simplify the contribution requirements to whether the deceased partner contributed for the tax year before the death; the problem with this is that if they were palliative care patients they would have been ill, so they might well not have made those contributions so close to the date. Another option is to remove the remarriage disentitlement, on the grounds that they would not be paying the benefits for very long and it is unlikely that most people will be ready to partner up again, so they simplify the arrangements (and reduce civil servant time and the length of application forms) – always a good thing. This of course would generally be true, although I’m sure any palliative care social worker can tell you about the widows, or more often widowers, who have lined up the replacement partner well before the death. Perhaps even the DWP doesn’t have the life experience to be aware of that sort of thing.

Department of Work and Pensions (2011) Public consultation: Bereavement Benefit for the 21st Century. (Cm 8221) London: TSO.

The consultation document on the web: http://www.dwp.gov.uk/docs/bereavement-benefit.pdf

Staff working for a care provider in the Isle of Man lost an unencrypted memory stick (encryption means you have to put in a password before you can get at the information on the stick) with lots of client/patient information on it. Nobody knows where it went. They have had to sign an undertaking with the Isle of Man and UK regulator for information security.

Within the undertaking Praxis have agreed that all memory sticks, laptops and similar devices will be encrypted, all staff will be trained in the company’s policy for the storage, use and disposal of personal information, information which is no longer relevant will be disposed of in a secure manner, compliance with data protection policies will be regularly monitored and lastly the company will take steps to ensure personal data is secure.

In the iPad age, information is becoming more mobile, and people take it for granted that they can work on stuff on their mobile phones, Blackberries and iPads wherever they are. That means stuff is going to get lost. I wonder how many health and social care memory sticks have been lost from handbags or pockets over the past year or two. And how many were encrypted – difficult because you have to remember and input the password every time you use it. But it’s still personal information and often in a hospice or social care agency it will be highly personal stuff. Are we thinking carefully enough about this?

Another organisation got hammered for losing membership aplication forms on a train.

Details on the web here: http://www.ico.gov.uk/news/latest_news/2012/action-taken-after-care-provider-lost-unencrypted-memory-stick-18012012.aspx