Social work and end-of-life care

Social work is important in end-of-life care

Changes in liberty safeguards:kidding yourself you’re not locking someone in

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The Deprivation of Liberty safeguards are part of the Mental Capacity Act 2005 which require care agencies to get authorisation before restraining people, for example refusing to let them leave hospital or confine them in their room. An interesting result of the changes to the NHS is that local authorities are taking over as supervising bodies for hospitals, because the Primary Care Trusts are being abolished (the local authorities have been given money to do this; another example of the costs of the reorganisation which I bet the Department of Health didn’t think about).

Link to Department of Health document.

This is interesting, because there is a widespread view that hospitals don’t bother all that much with the safeguards. Neither do a lot of care homes, but at least the local authorities that are supervising them are not usually also the managers. It will be interesting to see whether this change makes much of a difference.

A related slice of information comes out of the recent CQC report on care services (see p 103).

There were a significant number of concerns about the use of seclusion to manage challenging  behaviours. Safeguards were not always implemented and, in particular, poor recording did not give a clear picture of the use of seclusion and longer-term segregation.

A range of different terms were used to describe circumstances in which people might effectively be detained in seclusion: “Nursed in his room”, “Placed in the low-stimulus area for a sustained period” or “Chose to be in the safe-care suite”.

It seems that nurses and managers may be kidding themselves that they are not locking people up, when they are doing the equivalent and calling it caring. Nurses and social and care workers (and their managers) need to be a bit more self-critical about what they are really doing.

Link to the CQC report.

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Written by Malcolm Payne

9 December 2012 at 9:57 am

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