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

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.

Incidentally, they should change their approved photo of Dave on the Conservative website; it makes him look a bit immature, when more recent pics show him as being a more haggard now. But I should talk: the Director of Nursing says my pic on this blog is a bit flattering. Well, if that’s a bit flattering, what must the reality be like? I’m not saying.

And in the same session another ‘what are the rules about consent to doing things that might look like assisted dying’ Lord Patten asks another:

Health: Sedation Question Asked by Lord Patten

To ask Her Majesty’s Government whether patients entering NHS care may specify in advance that they do not consent to be treated by continuous deep sedation; and, if so, how. [HL5495]

Baroness Thornton: Yes. A person aged 18 or over who has the capacity to make such a decision may make an advance decision to refuse any treatment and, unless it relates to life-sustaining treatment, may do so verbally or in writing. An advance decision to refuse life-sustaining treatment has to be in writing, be signed and witnessed, and contain clear statements that it applies even if life is at risk. Where a person has made no advance decision and lacks the capacity to consent to a particular form of treatment, healthcare professionals should make decisions based upon the patient’s best interests, where practical taking account of the views of those close to them.

See it on the web: http://www.publications.parliament.uk/pa/ld200809/ldhansrd/text/91020w0001.htm#column_WA60

A House of Lords question yesterday on hydration, which shows the continuing drip, drip of Parliamentarians keeping on about rights to be kept alive – many people, particularly Catholics and Muslims, feel quite strongly that keeping on giving liquids is an important signal that a healthcare provider is committed to maintaining life rather than prepared to assist with death. As the answer makes clear, the medical view is that this is not the issue; that hydration is a ‘treatment’ that doctors cannot ethically give if it is medically inappropriate. This is something that needs a lot of careful explanation, and social workers need to be able to answer people’s questions about it, as well as other people who are helping people in healthcare.
Health: Hydration Question
Asked by Lord Patten

To ask Her Majesty’s Government whether patients entering NHS hospitals can request that their hydration is not stopped by doctors, nurses or other healthcare professions; and, if so, how. [HL5496]

Baroness Thornton: Yes. They may make their request in any manner they wish. However, clinicians cannot be compelled to provide the particular treatment requested. In deciding upon such a request from a patient, healthcare professionals may need to make a distinction between requests for fluids to keep the patient comfortable and hydration for a purpose that they consider to be “clinically unnecessary, futile, or inappropriate”.1

Note:

1 Paragraph 9.5 of the Mental Capacity Act 2005: Code of Practice

See it on the internet: http://www.publications.parliament.uk/pa/ld200809/ldhansrd/text/91020w0001.htm#column_WA60

A nice voluntary sector website with a series of comments what I call voluntary sector mustspeak, jargon borrowed from business, which the cool volly must be able to parrot so that people know that you only think in slogans.

http://www.bmelinks.org/the-cafe/the-cafe/511823392

No you’re not supposed to be entranced, it’s a new way in.

Until the spring, I was printing pics of the rebuilding works at St C’s; this is still going on, but now some of the new St C’s is open. So I’m now going into a sequence of pics of the new format St C.

I start today from the approach: as you come along the road, you see a new entrance with a blue marker (soon to have a label) and an entrance in the middle of the building rather than at one end.

More as I go on:

You’ll have noticed that I haven’t been offering pics of St Christopher’s recently; I thought it got boring looking at a building site, and although some parts of the New St C are now operating, they’re still fitting out, so I can’t do a splash of exciting new developments.

But I couldn’t resist some of the preparations for this year’s summer funday (fete to you old fashioned types).

So here, without more ado is the new garden pavilion for elves (actually I think it’s a not quite de-erected marquee-type thing; note the shrinking balloons, or at least I hope they were shrinking – perhaps someone’s not got enough puff).

You may have noticed that I have not had a rant recently on policy-aspirational job titles. I have not reformed, however, but I have started looking at the jobs behind the titles. Here in the Guardian for 5th November is a PCT advertising for an Associate Director of Business Development. This person ‘will take the lead role in marketing and the development of business acumen and focus across the Directorate [of Provider Services] and maximise the Directorate’s opportunities in a highly competitive and dynamic market’. This Directorate covers general practices, dental surgeries, community pharmacies and optometry practices, not exactly at the forefront of innovation, you might think – just keep the show on the road.

GP, dentist, pharmacist and optician: all services I use. Frankly I do not want them developing business acumen and focus; I’d rather they just did the job. How do these jobs benefit from being in a ‘highly competitive and dynamic market’? Since we’re talking here about a rural area where there probably isn’t much competition, I’ve no doubt such a market is tough to develop, even for someone earning nearly £65k. I suspect this is a businessification of what used to be called (and paid for as) a development officer, whose job was to find the gaps in provision and get people to work together to fill them.

Pics of the St Christopher’s building works, in solidarity with colleagues who are working in difficult conditions, so that things can be better in the future.

A bust (things are a little out of place at the moment)

The Department of Health has published draft guidance on a variety of forms and record-keeping when hospitals, hospices and care homes deprive people of their liberty under the Mental Capacity Act 2005. This is for training purposes for the supervisory authorities (PCTs and local authorities). As a draft this hasn’t happened yet, but advance training and checking up on what they’re doing seems like a good idea; it might happen rarely, but when it does, it’ll be a big issue.

Here’s the website: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_089772

Pics of the St Christopher’s building works, in solidarity with colleagues who are working in difficult conditions, so that things can be better in the future.

Caged dining (the dining room is now cut off from normal life):