Social work and end-of-life care

Social work is important in end-of-life care

Archive for February 2013

Scottish legislation on Self Directed Support

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Self-directed support is what is sometimes called ‘personalisation’ in which social care is managed to some degree by the person receiving it. The new Scottish legislation, the Social Care (Self-directed Support) (Scotland) Act 2013, comes into force in 2014, and then will be rolled out over the following five years. It offers people five choices:

  • Option 1 –  Direct payment – local authority make payment direct to the individual who then employs a carer.
  • Option 2 –  Person selects the support and local authority arranges it.
  • Option 3 –  Local authority selects support and arrange for its provision.
  • Option 4 –  A mix of the above.

A link to a legal comment: Self Directed Support – The Right Direction.


Written by Malcolm Payne

17 February 2013 at 4:22 pm

In end of life care, good life and good death is the aim, not ‘saving’ people

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130131 Reduction in life caseI have come across a law report on an end-of-life care issue that concerns many people: the doctor misdiagnosed a skin cancer, and was sued for a breach in her duty of care. This was the nature of the case (quoted from the judgement):

It is common ground that if the Defendant had referred the Claimant to a specialist with a suspected malignant melanoma in March 2006, as she should have done, he would have been seen within two weeks and the tumour would have been excised. The Claimant’s case as originally put in the Particulars of Claim was that “excision and treatment at this time would have carried a likelihood of cure and survival”. A fallback case, not spelt out until Professor James wrote a supplementary report very shortly before the trial, is that excision and treatment in March 2006 would at least have given the Claimant a longer period of disease-free survival.

My interest in this case is that the fallback case succeeded, not the original case. The successful case claimed for loss of a longer period of disease-free survival rather than a likelihood of cure. I often complain about press reports that people were ‘saved’ from death by medical interventions, or statistics are quoted saying that so many thousand people would be ‘saved’ from death if this or the other service improvement were made.

The point is that people are never saved from death, because we all die; what may happen is that their death is delayed and they have, as in this case, the potential for a ‘longer period of disease-free survival’. The concern in end-of-life care is about how long we can help people to have a good life before a good death. It is not about ‘saving’ people.

Link to the law report.

Written by Malcolm Payne

1 February 2013 at 11:07 am