Social work and end-of-life care

Social work is important in end-of-life care

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Complexities that lead to risk – useful practice ideas

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In a very thoughtful short article on risk and complexity (something  any social worker would be interested in), this specialist risk consultant says there are three things that connect risk and complexity :
– if there are lots of parts and interconnections
– if there are uncertainties, so there are changes and disruptions, and
– if it is time constrained,  so you don’t have time to think and plan.
Link to article on risk

Written by Malcolm Payne

13 January 2015 at 11:48 am

Posted in social work

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A social worker and a grandparent – an important contribution to society

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Jean StogdonAn inspiring life history of a social worker’s contribution to society. And an example of what you can achieve as a grandparent and in your later life.

Written by Malcolm Payne

7 January 2015 at 4:05 pm

Advice – what to do to respond to historic abuse allegations

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20140920 historic abuseClaims of historic abuse get a lot of press coverage. How do you handle getting involved in a scandal? Many social workers and local government officials get mixed up in their local authority’s reaction, but increasingly social workers work for a private sector organisation, or a small organisation like a hospice that may not have the legal backing or the experience to react well to getting into such a situation.

Legal advice from an experienced law firm (link to the advice) suggests six things you should do, and I’ve added a bit of my own advice from experience, too:

  • as soon as you hear about the possibility of something coming up, get together as much information about what happened as you can find, so that you’re not on the tv news giving the impression you don’t know what’s what.
  • check your insurance; also my advice would be to  and check in with any potential supporters, such as committee members, trade unions, professional associations and personal friends who may be knowledgeable and experienced in such situations
  • make sure you have a consistent message, think about the damage to your reputation and be ready to say more than ‘no comment’; also my advice would be to have a message that is more than saying how good you try to be – say what you’ve actually done and achieved
  • information  requests about something in the past are often advance warning that something is about to hit you; be alive to that – make sure you know what you’re required to say (and not to say – confidentiality, but don’t invoke data protection unless you’re really sure it’s relevant, often it isn’t) and what you want to say; my advice again: use the opportunity of an early request for information to research things and plan any responses in advance, so you’re ready
  • information requests about deceased persons are still affected by confidentiality requirements – my advice: check the law and the information commissioner’s guidance on access to health and social care records before saying anything; another reason for being well-prepared
  • notify the relevant authorities of anything you should and keep a record of the notification – I always used to do it in writing and keep a note of what I said when people rang me up; I also used to grade my reports in levels of horrendousness, so that they couldn’t say that I hadn’t made it clear it was serious if it was, and so that I could not be accused of exaggerating something.

Written by Malcolm Payne

1 October 2014 at 11:31 am

Values is more than a collection of words

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140502 global values mapNoel Timms, the eminent social work professor researching values of the previous social work generation used to refer to ‘values talk’ (meaning saying how important your values are as a professional without actually working hard connecting this with the extensive [philosophical analysis). I came across an example of this.

Below is a link to a ‘Global Values Project’, which is quite a naive bit of collecting up random views about human values, based on a vaguely spiritual conception that we all have basic values as part of our human makeup. This is a dubious conception: I think that most people acquire their values from their personal and professional culture; claims that some values are natural, or basic to human life mistakes the importance of history, culture and indeed blind prejudice in creating our values. It is designed to sell you consultancy with an ‘accredited values professional ‘, whatever one of those is and whoever accredits them, to work on your values using some fairly basic pencil and paper exercises.140502 20 selected values

However, the graphic is quite a nice presentation of a lot of words concerned with values, and there is a version (right) that shows selected twenty values words, chosen as the most important by people involved in the project. These might allow you to apply your mind (or your team’s mind) to thinking about your values. Remembering that thoughtful use of values in working, perhaps especially on spiritual issues, means a lot more than just using words.

Link to the Global Values Project.

Written by Malcolm Payne

5 May 2014 at 1:55 pm

Deprivation of Liberty Safeguards: review the constraints and get external reviews

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More on the recent Supreme Court decisions on Deprivation of Liberties Safeguards; this legal commentary provides helpful guidance to local authorities, care home providers, hospices, hospitals and the like on how they should review their practice and decisions.

The helpful point is: ‘focus on the constraints’, not on the overall circumstances that a patient is in. And get independent external reviews done of long-standing arrangements; it is easy to get seduced by continuing with arrangements that seem to be working well.

Deprivation of liberty safeguards: “A gilded cage is still a cage” | Kennedys.

Information governance report covers social care, deceased people

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20140227 Infogov reviewStimulated by all the discussion about whether we should agree to GPs sending our medical records to a central source to be sold to insurance companies and the like, I’ve been looking at last year’s Information Governance Review.

Link to Information Governance Review Report

This is a follow-up to the Caldicott Review of 1997, which you can get on the Internet from the Government Archives; they are now archiving important web documents…

Link to the Caldicott Review (1997)

This is one of those amazing government documents that led to something happening, and for some years, I was a Caldicott Guardian, charged with representing patients team in the management of the hospice I worked for as part of ensuring the confidentiality of their records.

Link to the Caldicott Guardians website.

The Review Report from last year went back to the whole process, and particularly in the light of the massive expansion in communication arising from the ubiquity of the internet. Also amazingly, Dame Fiona Caldicott was still around to chair it, and still had enough credibility to do so.

One new feature is that health and social care are covered, since although the term ‘social care’ was just coming into use back then. It is now more commonplace. But not really in anything to do with the Department of (very much only) Health. In the new report it is all ‘elfnsoshall’ with the basic assumption that you don’t need to think very much about what social work is all about – just talk about the NHS and everything is the same. Very few people involved directly with social care were on Dame Fiona’s committee.

There is a section on children and family records, and this covers some of the complexities of social care records in this field, but it still references the Royal College of General Practitioners and the BMA rather than agencies with social care expertise. It notes issues about children’s social care records: many children’s social care departments have family records, alongside individual children’s records, and this has always been complicated, although is better in some ways since computers permitted multiple postings to different records, if an entry covered several children or family members in one go.

However, the report also notes that the Health and Social Care Information Centre (of current GP records fame that has covered itself with pooh over its schemes for GP information) does not have the statutory right to collect children and families social care data. I’m comforted by this, in view of the government’s wish to sell as much health data as possible to private sector organisations for as much money as possible, which has only been stymied for a brief period of grace before it goes ahead again, due to widespread anxiety about confidentiality. We can do without this organisation getting its commercialised mitts on social care data as well.

There is also a brief section on deceased people, since NHS records are clearly available to appropriate people after death, while this is not possible in social care. The proposal is to think about people being able to give custody of the health and social care data in their Will: this would resolve some of the problems health care agencies have in giving access. Although perhaps not. When I worked in a hospice, fighting over the records was often a follow-on to fighting among family members about the estate, sometimes as a proxy for their role in the family

5.7 The deceased

There is a lack of consistency in the approach to the data of deceased people within the health and social care system. The common law duty of confidence is generally regarded as extending to the deceased but the Data Protection Act only relates to the living. Legal representatives or those with a claim on the estate of a deceased person are able to access the health records of the deceased person through the Access to Health Records Act 1990, but there is no equivalent legal route for access to social care records. Some ‘work-arounds’are used but these are increasingly untenable (p 58).

As people gain more control of their information, it should be possible for a person to give custodianship of their personal confidential data after their death to someone, or to a research data bank, so that future generations can use it to learn and improve the health and wellbeing of society.

The review panel concluded that the Law Commission, in their review of the legal aspects of data sharing should consider looking at how the law surrounding deceased persons might be better harmonised. In particular, the Panel would like the Law Commission to consider ensuring there are no legal impediments to giving custodianship of their health and social care data within their last will and testament (p59).

But it does contain a useful pile of information about information – well worth taking a look at and following up.

Written by Malcolm Payne

10 March 2014 at 11:28 am

Seeing beauty in people gives them dignity – a good principle for good practice

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140222 Nursing and public healthBecause I’m involved in international social work, I often receive publications from foreign lands, although equally often they are in foreign languages which I don’t understand, or in the English as written by people who don’t quite get it right. One editorial board I contribute to is for a journal published from Wrocław in Poland called Nursing and Public Health Quarterly (well actually Pielęgniartswo I Zdrowie Publiczne but I thought it would be unhelpful to provide a non-translated title). I originally got involved, because the School of Public Health in Wrocław is very involved in palliative care.

This quarter’s papers include a really interesting brief paper, with an English abstract, which argues that beauty is a mystery, but that seeing it in people accords them the greatest possible human dignity. The writer has a set of questions for his nursing/medical students: they have three minutes to answer each, so he gets an unconsidered response. They are:

  • What is good?
  • What is beauty?
  • What is freedom?
  • What is love?
  • What is dignity?

I think these are a good set of questions to ask beginning practitioners in health and social care, to get them to think about the objectives and values inherent in their work. In fact, we could all ask ourselves these questions regularly.

You can read the abstract here.

If you can read Polish you can go the the journal through this link; its articles are online – there are also occasional English articles.

Written by Malcolm Payne

24 February 2014 at 11:03 am