Monthly Archives: January 2011

The Decision Maker

Over the week, I have a few posts planned about different aspects of the Mental Capacity Act 2005 – it’s partly because I’ve been asked questions specifically about it and partly because I, personally, find the area enormously interesting.

Working, as I do, primarily with older adults, means that I work with a lot of people with dementia of one form or another. Working with a lot of people with dementia means that the issue of capacity or lack of it is one that we deal with every day. While far from setting myself up as an ‘expert’, I thought it might be interesting – possibly helpful – if I shared some of the issues that have raised themselves in our own borough.

 
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When the Mental Capacity Act 2005 ‘went live’ we had a lot of training about capacity, capacity assessments and the roles of IMCAs (Independent Mental Capacity Advocates).

In a sense though, the Mental Capacity Act just firmed up a lot of practice that had been  happening within the sphere of ‘case law’ or ‘common law’.

One thing it does do though, is provide more protection and guidance for anyone who carries out an assessment of mental capacity – and make no mistake – anyone can carry out an assessment of mental capacity.

Today I want to look at the idea of ‘The Decision-Maker’ as it is one that still causes a great deal of angst in the office.

Who is the Decision-Maker?

The Decision-Maker is the person ‘on the ground’ so to speak if they suspect that the person lacks capacity and  are there (figuratively as well as physically)  when a decision needs to be made.

So the carer who goes in to someone’s house in the morning to someone who cannot make a decision about what is ‘weather appropriate’ clothing, might be the decision-maker in that case.

A husband might decide that it is best for his wife to have steak for dinner rather than chicken because steak was always her favourite. He is the decision maker.

These are the kind of snap decisions that might not immediately come across as being subject to an ‘assessment of capacity’ but many people – especially those involved in care – would take thousands of decisions in the ‘best interest’ every day.

Most commonly it will be family members or carers who make these decisions.

Sometimes, of course, it is the involved professional.

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Last week, I was sent a letter from a GP asking for an assessment of capacity for an individual for whom I am the care coordinator because she was refusing to take her medication. Could tell him if she had the capacity to refuse medication?

I responded that I could not because the GP is the decision-maker.

(Of course, while happy to advise and support -  the decision is not mine to make).

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Another nurse in the team discussed with me a conversation he had had with a social worker in one of the community teams who had asked him to ‘make a decision’ about the type of care a particular resident was having at a nursing home.

The social worker is the decision maker. Sure, she can ask advice, that’s no bad thing. But she cannot delegate the decision making to my colleague.

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A few months ago, we had a request from a social worker in another team to assess the capacity of someone who had dementia to make a will.  The referral came to the team meeting and was summarily dismissed with a ‘the solicitor has to do that’ remark. It seemed counterintuitive at the time but the Code of Practice is very clear about this. (MCA COP 4.38 – 4.43)

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The person making the assessment as to whether capacity exists has to be the person on the ground who is suggesting (or not) that action that is to be taken.

Those are some fairly straightforward examples. Sometimes it is a much more difficult place to be.

There is someone I’m working with at the moment who lives at home. There are proverbial risks hanging from every corner of the house. I can’t even begin to recount them! She has been agreed for residential care. She has  family who take an interest who find they are constantly worrying about her and want her to move to a residential care home nearer to them although, they tell me with slight reservation, she always said she would rather die at home than go to a residential care home.

I’d like to devolve the responsibility of my decision to someone else. Really I would. I sometimes see my caseloads play out on the imaginary front pages of the Daily Mail or the Sun.

After completing my capacity assessment (I’ll come to the details of that tomorrow), I surmise that no, she does not have the capacity to make a decision about her needs regarding her residence.

That doesn’t mean that I then ship her off to a residential home even though she doesn’t want to go though.

My decision takes into account the risks and the strength of feeling that she wants to be at home and her utter and complete distress at mentioning residential care.

She remains in the community with increased support and every time I see her my heart is in my mouth.

I wish someone else would make the ‘decision’ but while other people can inform and support me with it – just as I said to the GP – it is my responsibility.

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Other decisions I might have made have been with the input and support of an advocate (Independent Mental Capacity Act Advocate has a formal role – which again, I’ll come to later in the week) but they don’t make a decision for me. I am not bound by their advice (although I’ve never gone against it!) but at the end it is advice to help me make a decision – not make a decision for me.

To make a decision there has to be a reasonable belief that a person lacks capacity. There are some indicators about what form and what steps should be taken during this process but as a professional being asked to make decisions, the most important thing that has been drilled into me is to ensure that I record clearly the reasoning behind my assessment and my decision.

We have some very good forms (I don’t say that very often!) that we use when we are carrying out these Capacity Assessments which really take us through the process and the legal requirements on a step by step basis and form their own record and reasoning.

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But I’ll come back to the process tomorrow.

In the meantime it is important to remember that the Mental Capacity Act is a document that protects the service user/patient/all of us.

Someone doesn’t lack capacity just because they don’t agree with the professional decisions made around and about them just as they don’t suddenly have capacity just because they agree to do what they are told.

Making decisions about other people’s live – especially very significant decisions – isn’t always a comfortable place to be – but the mantra of best interests needs to be playing in the background of our heads along with the very basic tenet of ‘what would this person want if they didn’t lack capacity?’.

The answer isn’t the same as ‘what would I want if I lacked capacity’ or ‘what would their family want for them?’  Sometimes it is but that isn’t necessarily the default position. Yes, of course family and friends must be consulted. As good a picture as possible must be created of that person’s life, aspirations and hopes. Often it is the same as the people around them who love them most.

It must though always be a very transparent decision that, if challenged, can be defended. To the Court of Protection if necessary although lets hope it never is!

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It’s a lot of responsibility at times but legally it can’t be shirked.

Weekend Links 3

Another list of social work-related links that I’ve come across over the last week and have caused me pause for thought.

1.  Whose side are you on?  Mel at Mel’s Skim Cap asks herself. It’s certainly emphasises some of the reflection that comes from asking where we place ourselves between users/clients/patients and professionals.

2. Anti-social Social Worker updates us on his progress.

3. Malcolm Payne at St Christopher’s Hospice argues that Adult Social Care need stronger focus on teaching about death, loss and bereavement.

4. Nechakogel writes about the utilitarian principle and whether maximising happiness is incongruent with maximising social justice. And what ‘happiness’ for a society actually is.

5. Social Worker to Be (who is not a ‘to be’ anymore!) writes about barriers to work which are being increased by the current government for people who are or have had disabilities. Fantastic post.

6.  At Virtual Connections, Nancy writes of 10 reasons for Social Workers to be Web 2.0 literate – and some great comments as well (not just the one from me Winking smile).

7. How Not to Do Social Work (I don’t believe that title for a second!) has a great post about Risk and some of the nature of Risk Averse services and professionals.

8. JaeRan Kim poses an ethical dilemma.

9. Therapydoc at Everyone Needs Therapy treats us to a fantastic stream of consciousness post (I must try that sometime!) and I learn a little bit more than I ever knew I didn’t know about life in Chicago and American Football.

10.  And SocialJerk treats us to a slice of New York life on a Snow Day and lessons about life that she has learnt from children.

Next weekend, I’ll be in Scotland so I’m not sure I’ll have time to put links up  but as I wrote yesterday, I’m hoping to post throughout the week!

Have a good Sunday everyone and thanks for visiting!

Mini post – (AKA random weekend musing + plug)

I haven’t put together my social work links for the weekend yet because I was busying myself putting together this weeks

This Week in Mentalists’ on the ever excellent ‘Mental Nurse’.  Anyone who doesn’t follow that site – do. It’s long been an inspiration to me..

I hope to pump some more specific social work links over the weekend.

I’m also working on a few posts relating specifically to Capacity, the Mental Capacity Act and DoLs so if you have any questions – or want to prompt me in a particular direction – do ask – I can’t promise I’ll deliver though!

It may very well be a theme for next week though.

Thanks all!

Cuts – a personal tale

A couple of weeks ago, I had one of those deeply depressing moments that will generally punctuate a career in social care.

I had to go and tell a woman, who cares for her mother with enormous patience and dignity, that we could not increase their personal budget although her mother’s care needs had grown.

I suppose I went to my manager in a relaxed almost casual way and explained how the needs of the older woman had changed and to ensure her well-being, she needed additional time.

I was told, with a degree of equal sadness and regret that there would be no increase. If we were to provide what I felt was a necessary increase in care, the time had to be taken from the the hours already allocated.

She did, to her credit, try to have a discussion about this with her own manager but there was no budging on budgets. Despite the change in various situations, there would be no extra money. In fact, she added, the plan really needed to be cut.

It had been my first personal budget implemented. The council, in an attempt to encourage and prod us to implement these personal budgets had promised us and by extension, the service users and carers we work with, that no-one would be disadvantaged by moving to a personal budget so even if the RAS (resource allocation system – the way that figures are attached to needs through the personal budgets  system) did not ‘deliver’ enough money to provide an equivalent package of care that had been delivered under the ‘old’ system – it would not be reduced (and here’s the key) at least, not initially.

Now this particular service user and her daughter had what was a high package of care. It had costed much  more than the ‘RAS’ had spat out.

After making the promises, after the move to personal budgets is no longer an optional roll out of volunteers – the cuts are coming.  There is no longer the carrot to offer of ‘equivalent packages of care’ because we now offer everyone as a matter of course a personal budget and those who were not receiving them are being transferred over to the new system regardless – they don’t have to be self-managed, of course, but they have to exist.

So I visited the family and we looked at ways of shifting around hours.

The hours that were cut were the respite hours.

I suppose it was inevitable.

Family carers are invisible. The work they do is not costed. Of course the daughter was sacrificing her own needs for a few hours respite to her mother’s needs for additional personal care.

This is what the cuts mean to one family.

I had to tell them and negotiate with them about what to cut from their own package of care.

Not the Prime Minister. Not the Millionaires in the cabinet. Not any elected politician or Council Chief Executive. No councillor had to sit in that room with me and look the service user and carer in the face and ask them what they would prefer to give up from their package of care.

I’ve known this family for many years. I have a good understanding what is at stake for them and how much these cuts are hurting. I also know they won’t complain or grumble or shout from the rooftops.

They are not going to be going on any rallies or demonstrations against the cuts – not least because the respite hours have been cut.

We who can, have to demonstrate and shout and scream on their behalf.

And you know, as I know and I say this with a heavy heart – they’ll be much more of this to come.

Death

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It was a fairly standard visit as they go. I knew the block of flats. It was one of those seemingly ubiquitous 1950s  high rise blocks that had been built in the shadow of the wartime bombings.

I knew that particular block though. You get this, when you’ve been working in an area for a fair amount of times – particular estates or blocks that will bring back a range of memories about the people you know who live behind the doors.

There had been a family there, in this block, with whom I’d worked for a couple of years until I was moved to a different patch and handed over with a fair bit of reluctance on both parts, to a colleague.

Now, the boundaries have been redrawn again and I found myself in exactly the same building – in the flat directly underneath the one in which I had spent so much time.

On my way in, I tried for the life of me to recall the name of the family that I’d been working with previously. It worried me that I had spent so long in the life of a family and I couldn’t remember their surnames (I remembered the first names fine, of course). I pondered about the nature of my job, flitting in and out of lives but the lives continue and have to deal with such anguish of illness and tragedy. I can walk away from it.

As I went towards the lift on my way out of the flat I had been visiting (I was on the 11th floor at this point, and while not adverse to staircases, I sometimes have limits), I saw the woman who I had visited so many times a few years previously, coming down the stairs.

I immediately remembered her surname. Thankfully. Maybe I just needed to connect the face with the name.

She did an almost double-take when she saw me and she greeted me warmly. She told me the rest of the story that I knew, partially, from my colleagues’ visits of her husband’s death.

She told me and I listened. We had, by this point, moved downstairs into a more sheltered area. She interspersed the story with tears. I listened more. We walked a little way together.

‘People tell me’ , she said ‘that I should be glad to have got my life back’.

She had been a devoted carer for her husband who had needed an incredible amount of care at home.

‘And that’s not how I feel’.

I nodded, and listened some more.

I gently reminded her how  much she had done but mostly, I listened.

Throughout the conversation, there were tears running down her face.  I offered her a tissue but she did not wipe away the tears. She just continued to talk.

As I was heading into a different direction, she touched my arm lightly and thanked me.

‘I can’t talk to anyone really about his death’, she said. I nodded. ‘I mean about the details – about what happened’.

‘I don’t want to upset my children, you see’, she said.

I nodded and explained that I felt glad that she had been able to share this with me.

As I headed up to the bus stop back to the office, I pondered the nature of random encounters and the importance of knowing and being attached to a particular community.

I was also pondering the way that we think and discuss death. I have worked for almost 10 years in older adults services. Death happens. It happens in many ways but it never stops being something of a shock.  It never stops being the crucial key in the life of the family around that person.

When my student was on placement, two of the people who were allocated to her died. We reflected a lot about the nature of the job we have and what we do when that work comes to an end through a death.  Sometimes it is difficult to have a discussion with family members after a death has taken place. It might feel awkward or intrusive. It depends a lot on the length of time you have known a family and the nature of the involvement – whether it has been welcomed or not.

Generally, I think back to my own experiences of my parents’ and grandparents’ deaths and try and pick up on the need to connect and acknowledge the life of someone rather than trying to brush what may be difficult conversations under the carpet.

Death is still a taboo. Especially to those who do not have personal experience of it.  For me, I count my childhood and adulthood through the deaths of those whom I have been close to. That sounds dramatic but it builds a unique perspective. I spent much of my adolescence trying to think through issues surrounding death. Through the anger, the blame, the fear of ‘being left’, the confusion – what do you do WITHOUT that person who was the rock, however unwell, however much disease ravaged the body,  the unresolved pieces that need to be fit together.

One thing that I have learnt, through personal experience and through professional experience is that it’s good to talk and conversely, it’s good to listen quietly and let the stories be told.

Sometimes when you face a bereavement some people, friends, family, for their own reasons (often fear), don’t want to listen – they express sympathy but they display discomfort. Sometimes people don’t want to hear about death.

Listening without comment, to the commentary about a person’s last moments isn’t always easy but it is undoubtedly important.

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Yesterday Community Care had an article on their website talking about the need for social workers to have training around talking about death.

It struck me as a coincidence. As I talked about death. In a corner of a lobby of a high rise block of flats in central London. And I think it helped. I hope it did.

Johann Hari’s manifesto for change in care homes

A week or so ago, Johann Hari, a journalist and columnist for the Independent, wrote an article about his grandmother and the poor to verging on abusive care pathway that she experienced through devastatingly shoddy system that was and is not fit for purpose.

Today he writes again for the Independent proposing a series of changes across the sector which would improve the quality of service delivery.

I have a massive amount of respect for Hari and he writes very eloquently and passionately. I desperately hope more people listen to him than have listened to us, within and engaged with the sector who have been shouting, Cassandra-like, for so long.

His proposals are quite straightforward.

- Support elderly people to stay in their own homes wherever possible

This concurs with the evidence produced yesterday by the Alzheimer’s Society in a report published yesterday ‘Support.Stay.Save’ which concludes that while care in the home (rather than premature residential home placement) is a favoured outcome – the quality and training of staff is a serious issue – however if this were challenged, promoted and improved, there would be an eventual saving in the costs of placement in residential care.

Hari says’

There is a whole range of services that make this possible – from Meals on Wheels to home helps who are there to help an old man to shower in the morning and get into bed at night. We should be stepping them up, to keep anybody who possibly can free and independent. Instead, we are ruthlessly stripping them away.

and it is this that breaks my heart. We are tightening criteria, raising the bar to access support and increasing the cost of these services to those who may be responsible for their own costs. Hot meals on wheels delivery is not a default position anymore – they’ve been replaced by a fortnightly delivery of frozen food. This is a saving on paper to the local government but in the longer term denying this additional personal contact of a regular face delivering hot meals, is a much larger cost.

Councils have tendered out for the services at the lowest baseline cost. Care staff are provided on minimum wage, with little, if any, training and barely any dignity in their employment conditions so no wonder that corners are and have been cut. We need to provide the best possible rather than the cheapest possible.

They are better off with their families – so offer the care home funds to them first

Again, a seemingly obvious point. Hari states that residential care can cost upwards of £450 pw. Why isn’t that same amount of money offered in the home? It makes perfect sense. It makes perfect logical sense. Of course, some people will always need the 24 hour care. To be honest, we tend to fund increasingly higher packages of care in the home and it isn’t unknown for similar levels to be provided. I have one service user who has a package of virtually double that in her home (as a personal budget) but am frequently told that that is an unusual case and it’s only possible because a family member takes on a significant amount of care.

Local authorities do need to get over their aversion to funding overnight care in the home though. That would immediately make this more possible. Personal budgets theoretically should allow this point to be immediately actionable. In practice, it is not easy to squeeze the funds out of the interminable RAS (Resource Allocation Systems).

Make being a care worker a desirable profession

Hari says

Today, our elderly are looked after by people who are paid the same amount as street-sweepers, and have the same level of training..

This breaks my heart. I spent 7 years working as a care assistant in a residential home. I applaud this point. There were times when I met with friends from university and I was almost sneered at because of my job. Actually, scratch that ‘almost’.

‘When are you going to get a ‘proper’ job?’ I was asked. Eventually the pressure of that pushed me into social work. I am glad I did it but it is hard to understand where the sneering came from. Sure, money is an aspect of it but it’s wider than that. Sometimes the management seems to join in with this scornful and hierarchical approach to care workers – it’s important to remember that if a manager is not going to treat staff well and with respect you can be sure that residents will not be treated well either.

Increasing not only pay but conditions of service – decent holiday pay, sick pay and training – would make a difference. I’d like to see more of a line of career progression as well.

Retrospectively, I look back with a massive amount of fondness to those days. I was lucky to work in good homes where I was instilled with a good work ethic and values that supported resident’s rights. I know how easy it is as a worker to ‘go native’ within an organisation and agency if the work ethic and values are not good. It leads to spirals of dispirited behaviour.

I wish every social worker had had the experiences I had in hands-on care work. It was invaluable and it shapes a lot of my actions and values today. I doubt many do or will in the future. That’s more the shame.

Now, I am so proud that I was a care assistant in a residential care home. I wish I had been at the time.

Make every home publish its staff-to-residents ratio

Theoretically this should be possible. It should be easy to access. It makes a big difference. When relatives go to visit care homes I advise them to ask about this and perhaps ask the member of staff showing them round how long they’ve been there and what the staff turnover is.

Clarity would be a fantastic and simple indication of whether a care home runs on bare minimum or below minimum staffing ratios. Unfortunately the CQC doesn’t really help much here.

Hari says

Every parent knows how many pupils there are per teacher in their child’s school. Nobody knows how many carers there are per resident in their granny’s home. I asked at every home I considered: nobody would tell me. But this can make the difference between a good home and a terrible one.

I’m surprised that no home could tell him when directly asked. Maybe because sickness is not taken into account – some homes seem to constantly run below the CQC required level due to ‘unexpected sickness’. The CQC could monitor this with spot inspections. It doesn’t. Or only when things are literally falling apart. It makes me angry.

Impose minimum nutritional standards for the food

This makes sense again and a menu list can’t always indicate what the quality will be like. However, unlike Hari, I have seen homes that have delivered well on this front. I am sure I’ve been to many many more over the years though.

The ‘Scores on the Doors’ system of food hygiene ratings has been extended to residential and nursing homes so perhaps that is a start.

Well, the best start is for the person responsible to think ‘would I want to eat this every day’. No-one should be serving food they would not want to eat themselves.

Change the attitude

This is a broad brush that Hari paints.  The example he gives is a regimented imposition of bed times and morning times. There is something of the way that care homes are organised that sometimes some of the personal touches and individuality can be lost. This does differ in different care homes and there are as many attitudes as there are people. The key though is to emphasise individuality in choices and not to impose on others.

For me, it’s a matter both of training and staffing levels. Treat every resident as you would want a close family member of yours to be treated. It’s a very simple tenet and an easy one to remember. The difficulty is that not enough people will practice that way and so staff as well as residents are in danger of becoming institutionalised.

Stop the mass prescription of anti-psychotics to rebelling residents

This is self-explanatory really and to be fair (as Hari notes) it is one point that progress is definitely being made on. It is far less common now than it has been in the past. Quite rightly. Anti-psychotics can be dangerous for people with dementia.

Restore proper inspections of care homes

For me, this is a massive key to the whole process. The CQC needs to take responsibility for the decline in the standards and to restore spot unannounced inspections, day and night, weekend and weekday to EVERY SINGLE residential and nursing home in the country.

It is wholly unacceptable that there is a reliance on cheaper ‘paper’ inspections or ‘desk-based’ inspections and it is wholly attributable to staff being laid off by the CQC.

I have my sources (actually a couple of very good friends of mine whom I worked alongside in those days when we were all care assistants in the same residential home!) who work within the CQC and they have been given much larger caseloads and have less time to do more inspections.

Inspections need to put the providers on the spot and really and truly inspect. They need to check that what homes write about staffing ratios is really what is happening on the ground. We rely on them. They do not deliver.

As Hari says

In 2005, there were 50,000 physical inspections of care homes. This year, there will be a quarter of that number. David Cameron has called for “light touch regulation” of this sector, so homes are increasingly being asked to engage in “self-assessment”. That means they will be asked to fill in a few forms.

This, more than anything, makes me furiously angry. Light touch regulation DOES NOT WORK. It leads to increased abuse. I can give so many personal examples that I have witnessed. I will try to keep shouting until the system changes.

I wrote about this last November and have no doubt I’ll be writing about it again. And again.  And I’ll mention again because I think there’s a relevance that the Chief Executive of CQC is Cynthia Bower who was Chief Executive of NHS West Midlands when Stafford Hospital was delivering contemptible and appalling care. Hardly a CV that instills much confidence.

Make sure care homes that are shut down stay shut down

This raises the issue that care homes can fail and then just re-register and open under a new name which should be wholly unacceptable.

Again, I wrote about this last November when Private Eye and Compassion in Care were trying to gain more information about care homes that were closed down.

As Hari says in his piece, this was brought up by File on Four and Compassion in Care a couple of months ago.

Impose serious criminal consequences for elder abuse

There is a new law of wilful abuse of those who lack mental capacity which was introduced in the Mental Capacity Act 2005 but I agree with Hari in that the legislative framework for adult safeguarding needs to be as strong as it is for safeguarding children. Our hands are tied and the punishments do not fit the crimes.

It’s an excellent piece by Hari and I wholeheartedly applaud it. I hope more people will listen but we have to keep shouting as loudly as we can to improve the quality and attention of care for those who lack capacity and for all people who rely on others for support.

We all need to shout. Not just those of us who are directly affected or who have parents or grandparents who  might be affected (as we all may be eventually) but anyone who cares about living in a civilised society as well.

Perhaps its endemic of a society that wants to push the uncomfortable realities of ageing ‘under the proverbial carpet’ that has led to institutional abuse but our humanity is lost if we don’t stand up against it.

This is not a party political issue as significant damage was done under the last government but this government can’t get away with it either.

And thanks to Hari for raising these issues among a wider readership. I wish so deeply within my heart that this piece shocked me. Unfortunately, after many  years working in the care sector, I’m sad to say it doesn’t.

Justice : A Citizen’s Guide to the 21st Century – a review

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I’ve been spending a lot of time recently thinking about the effects of some of the actions I take, particularly placing some of my work within an ethical and philosophical framework.

Yesterday, I caught ‘Justice : A Citizen’s Guide to the 21st Century’ on BBC4.

It is an absolute joy of a programme and I’d say that it has helped me reframe some of the questions that come to me on a day to day basis.

Michael Sandal, a professor in political philosophy at Harvard University, presents some of the key tenets of some prominent philosophers, Bentham, Kant, Aristotle for example and puts some of the challenges that they presented in their writings but in a modern context.

Philosophy and ethics, as Sandal states at the beginning, does not take place in a lecture hall vacuum of reading dusty texts but it takes place every day with every decision we make.

These tenets of ethics and philosophy affect every decision I make both in a professional and personal basis. When I make decisions about how to spend my time and whether to spend longer at one visit to be later for another. To the decisions relating to compulsory admission to hospital and decisions about ‘best interests’ and where the line for capacity and individual freedoms are drawn – these are all decisions that come to me daily.

As Sandal takes us to different places to discuss some of the concepts that were expounded by these philosophers.

It led me to question myself (almost socratically!)

Do I make the right decisions? Are there right decisions?

Perhaps it is the system that needs to be changed?

How does the state serve the citizen, or perhaps it is the citizen that serves the state – and if so, is there any problem with that?

Does the state protect us? What do we offer to the state in response?

Has the nature of the ‘Social Contract’ Changed?

Mainly there is a question of individual and collective rights.

I love the ideas of creating a context to promote a better way of politics working that moves away from the individual but doesn’t dismiss the individual rights.

It is an excellent programme which I can’t recommend highly enough that left me massive room for reflection. It presents what can appear to be somewhat ethereal concepts as they have become and places them on a practical level. Not just on the nature of my work and my place as a ‘cog in the machine’  but the nature of modern politics and the ethical base and role of politicians.

We can’t rely on politicians to be the vanguard and determiners of what a society should be like but take a role as citizens in creating a world and society in which we want to live, taking action, if necessary to make changes.

I try not to lose the connection with my background as a philosophy graduate but this programme re-instilled and reinvigorated some of my love for debate about ethics (ethics was always one of my favourite courses).

It is part of a season on BBC 4 about ‘Justice’.  I didn’t catch the debate about Justice and the Big Society which was on over the weekend, but I hope to catch it on the iPlayer. There a lot of really interesting programmes coming up. As for this programme, I’d recommend it highly.

Weekend Links 2

A few social work related posts I came across over the last week that caught my attention

Life of a Social Worker writes about the stigma of being a male social worker

Going Public writes about the potential end of day care in the ‘new era’ of social care.

Malcolm Payne on St Christopher’s Blog has some fantastic posts about the Social Work slant on the Health and Social Care Bill and a look from the view of palliative care. Really, though, everything he writes is worth reading.

The Masked AMHP has a fantastic post (and story) about animals and Mental Health Act Assessments .

An interesting post on A Shameless Agitator’s Inner Dialogue about interdependence.

Social Jerk has a positive story.

Social (Over)Worker has another positive story about family reunification – It made me feel warm and fuzzy until I realised that stories like these will be really affected by the government’s cuts.  She also has a great summary of why adoptions can take so long.

Neurology Social Worker looks at some of the uses of technology for carers in the field.

On a similar theme, at Virtual Connections there’s a post about the  use of mobile devices in psychotherapy. Now, I don’t do psychotherapy personally but I am intrigued about some of the apps described. Personally, I find my android MMSE app the most useful for when I forget the paper version and want a rough idea when I’m out and about!

Classroom to Capitol had a great post on Martin Luther King Jr Day (or last Monday if you are in the UK).  It put the day in context for me.

How not to do Social Work talks about a difficult telephone call he took.

And to follow-up from last week, Social Worker-t0-be now has her CRB and is all ready to start work – good luck to her.

Do let me know in the comments if you came across any other great posts over the last week!

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