David Cameron the Conservative opposition party leader, made a speech last week on the ‘Big society’, which put forward his thinking on poverty and social intervention generally. As always, they’re against the state doing it, and many people can accept that there is a considerable degree of state failure in social provision. The problem for the Conservatives is that there’s a high degree of market failure in social provision as well. Often everyone accepts that the market is not the place for social interventions, or they have to set up some convoluted quasi-market system that is not really a market, and institutionalises complex state controls over voluntary action.

Voluntary organisations may be wonderful, but to rely on voluntary organisations to deliver wide-scale state services is inappropriate; it twists voluntary action by making it involuntary.

You can see this in the hospice movement. Hospices in the UK are mainly in the voluntary sector because St Christopher’s was originally a demonstration of what was possible in care for the dying and their families at a time when not a lot was done. Now Conservatives routinely say how wonderful voluntary hospices are as an example of how lots of other services should be run. But proper care for dying people and their families is a responsibility of society where government should take a lead and make sure that a high standard of care is widely available. They should not be pleased that they can offload that responsibility because enough sentimental and well-off people will make donations to support it,

Cameron’s speech on the web: http://www.conservatives.com/News/Speeches/2009/10/David_Cameron_The_Big_Society.aspx

The Touchstone blog by Richard Exell has a useful discussion of the speech, with references to many of the past Conservative documents on the topic that many people will not be aware of and rehearses the arguments against it; however, be aware that Touchstone is a TUC (ie trade union) blog:

http://www.touchstoneblog.org.uk/2009/11/david-cameron%E2%80%99s-big-society-speech/

While I’ve been migrating, the Director of Public Prosecutions  has published his guidelines on how he is going to decide whether to prosecute people if they assist suicides. He was forced to do this by the Debbie Purdy case earlier in the year. You can find the consultation at his website:

CPS Consultation : Assisted Suicide.

It sets out a number of factors in favour of prosecution for assisting a suicide and then against a prosecution. These are not totted up: there are major and minor ones and also the CPS should look at the whole situation. It is important to know what the factors are, because people will increasingly ask about it, and practitioners should not rely on press reports.

To avoid prosecution basically someone over 18 has to make a spontaneous and consistently maintained decision that they want to commit suicide, and the assister has to be clearly motivated by compassion, have a close relationship with them and not have an interest. It is better if assisters tried to dissaude them and clearly did it unwillingly in the face of a determined person. This helps, because I have come across people who have been determined to commit suicide, and have pushed their relatives into helping even though they have been against it. Assisters can’t do it for them: that would be murder.

They have to have a terminal condition, a severe disability or a severe degenerative condition from wehich they have no possibility of recovery. They have to do the act in private (no committing suicide for a public cause – you may remember demonstrators setting fire to themselves in a political cause).

The palliative care lobby will note that assisters are less likely to be prosecuted if the victim has investigated and rejected suitable care options.

One of the interesting things for social workers or palliative care professionals is that the definition of assisting is ‘aids, abets, cousels or procures’, so giving advice is relevant as well as practical assistance. A specific factor is that if assisters are paid to care for the victim in a care setting, they’re more likely to be prosecuted. Also, the CPS is likely to be less sympathetic if they are not a close relative or friend or if they gave advice not really knowing them (eg through a website). This makes it very clear that assisting suicide is only to be done in close relationships. therefore, in giving advice, social workers should probably take the line that anyone who inherits obviously should not be an assister, but in reality the requirement that assisters should be close is likely to be in tension. What do you say to assisters whose ‘victim’ (the preferred CPS term) is likely to have to pay carehome costs? They certainly have a financial interest, because they will inherit more if the victim goes ahead with the suicide. As time goes on because this is likely to be a big issue for families of frail older people, and the CPS view is not clear to me.

The DPP is Keir Starmer; one of our nurses saw a photo and said: ‘he’s a bit of a hunk isn’t he?’ This is for me a new view of a Director of Public Prosecutions. See the pic on the Guardian website and tell me if you agree.

Keir Starmer: ‘I wouldn’t characterise myself as a bleeding heart liberal . . .’ | The Guardian

All the debate about the assisted dying case in the House of Lords, which has required the Director of Public Prosecutions to come up with guidelines about who he will prosecute if they help someone die, has led to a lot of public comment. This week the satirical magazine Private Eye joins the club with ‘Assisted Dying latest’. Its front-page bubble photo has Prime Minister Gordon Brown asking a smiling Lord Mandelson: ‘Why have you booked me a holiday in Switzerland?’

And inside, a cartoon shows a scruff on a street corner holding a shot gun, next to a notice saying: ‘Assisted dying – cheap’.

But since I can’t reproduce these, another pic of the new St Christopher’s: you’ve crossed the road, approached the front door via the new sebra crossing, now you come to the new glossy reception area, all curvy light wood. Beyond, you can see one of the main aims of all the rebuilding, the welcoming new Anniversary Project centre:

My book written with Margaret Reith has now been published in the UK, and a couple of months ago in the US. It is called Social Work in End-of-Life and Palliative Care. It tries to take a more sociological and less psychological view of palliative care social work than many other writings on this subject, and emphasises the importance of practitioners in all social work settings being competent to respond to end-of-life issues, transferring that knowledge from palliative care practitioners. In that way, it connects with UK government policy in the end-of-life care strategy, although we wrote it because this was a good viewpoint for social work, and best for the people who use our services. We’re pleased to be at one with the government.

Publisher’s websites:
Lyceum Books, CHicago: http://lyceumbooks.com/swEndofLifePalliativeC.htm

Policy Press, Bristol: https://www.policypress.org.uk/catalog/product_info.php?cPath=10099&products_id=1780