Looking Back – A Professional View

There are a few general themes that have preoccupied me over the last year.

Probably most significantly, has been the change in the Mental Health Act.  Although there aren’t actually many of the substantial changes that were initially planned, there were some vital differences that have made significant changes to the implementation of the Act and, as will become increasingly apparent over the coming year, it’s interplay with the Mental Capacity Act..

As a Social Worker, the switch to the professional designation from Approved Social Worker to Approved Mental Health Professional is something that has caused consternation all round. Personally, it hasn’t really made any significant difference at the moment. Certainly not yet and not for as long as I’m working for a Trust that is still only sending Social Workers on the training in any case while they thrash out details regarding pay.

I have no doubt that change will come in this respect,  but it will be more slow stream.

Equally important, over the long term has been the removal of the  need for a doctor to be a Responsible Clinician (previously Responsible Medical Officer). Again, nothing has changed yet apart from the letter of the law. In the Trust I’m based in, there isn’t any great rush or wish to train anyone except doctors to do this and as for me, there is nothing in the world I’d less want to do (well, ok there are a few things I’d probably want to do less but I can extremely wholeheartedly state that it’s something I never intend to do).

The implementation of the Mental Capacity Act is something that has become more apparent. This was implemented last year but now more case law is developing. Working in a team that primarily works with older people, capacity is something we have to confront frequently. Actually, I am quite a fan of the legislation. It is more protective than the previous ‘common law’ solutions and I am much more frequently presented with wards asking me about whether they are depriving people of their liberty. It has become more of a ‘buzz word’ but it’s all good, in my view.

The rolling out of the Best Interests Assessments will further strengthen the right of the individual and it will be an interesting theme for the early part of the year and one I expect I will cover significantly – I have my training booked for February and the assessments will click into place from April.

Another theme I have returned to frequently relates to residential and long term care, specifically for the elderly.  I have to say, as has probably been guessed that this is a bugbear of mine. I have tried not to come across as overly negative because I have come across some wonderful and extremely caring settings. I worked in residential care for about 6 years and it is the path that led me to social work in the first place. The contact and the effect that some of the lowest paid workers, namely the hands on care staff, can have on someone’s life and quality of life is unbelieveable.

It’s easy to fall into a ‘public – good, private – bad’ view of long term care settings and of course things are never that easy but the move towards profit making and cost efficiency at the price of everything makes me personally uncomfortable.

This comment, on the Active Care thread sums up pretty much my thoughts, and my thanks to Sharon for sharing it with me.

Sharon Edens, on December 28th, 2008 at 8:28 am Said: Edit Comment

Southern Cross have indeed made more money by putting up the fees… nothing wrong with that, but what is not reported is the fact that they have also removed all capital expenditure from the hands of the Managers and regional managers and every piece of equipment which is needed now has to be agreed by the managing director even for basics like pressure releiving mattresses.
Southern Cross is a poor employer, I am aware of at least 10 Managers, within the midlands area who are actively seeking other jobs, they get no support, they are critisied all the time and they feel completely demoralised.
Southern Cross needs to wake up and get back to reality of ‘caring’ for those in its care and employ instead of watching the balance sheet all the time – remove some of the senior management whose salaries could be used to buy required equipment – remove people who do not value their employees work but rather will take a dislike to someone and do everything to get rid of them just based on that.
There are some really good homes, people working in the homes, but senior management are blind to their efforts……. senior management nursing morality seems to have disappeared!!!!!

Southern Cross seems to be indicative of the need to put profit before quality care. It’s ironic that although it is one of the largest care providers in the country, I have never had any personal experience of working with them. But I know  many like them.

My hope for the Best Interests Assessments when we have to assess people who are in residential and nursing care who do not have the capacity to make a decision as to their living environments, is that we are able to allay conditions to their placements that are able to be presented to the residential care homes and improve the conditions therein – by mandating that Mr X needs to have access to go to the local shops or Mrs Y has to be presented with choices of food. Little things. But it’s a hope I have.

But that’s more for next year.. all in all, I doubt the main issues will change much but I’ll explore them a little more over the week..


Healthy Eating (and drinking)

Good news for Christmas Eve. According to The Telegraph, eating chocolate and drinking wine and tea improve your memory.

Researchers discovered that wine has the most pronounced effect in boosting people’s memory, followed by chocolate and tea.

And those who regularly consume all three in modest amounts were found to perform best when asked to carry out a series of brain tests.

The article goes on to explain that

Those who regularly drank moderate quantities of wine scored better in all six tests than those who abstain.

Chocolate eaters also had “significantly” better results in the tests than non-consumers, while tea drinkers achieved better scores in four of the tests.

OK, it does give the ‘in moderation’ proviso helpfully explaining

The researchers warned people not to use the research to binge drink in the hope of improving their memories.

So there you go, it does you good. Enjoy.

image Rob Qld at Flickr

and Merry Christmas!

The Art of Subtlety

I was at a ward round last week. I don’t go every week but sometimes when I have some information that needs to be disseminated or gathered, I will and as often as not, I may sit in on discussions relating to patients that I do not know personally.

I tend to find them useful for my general learning experience. I understand how the medical and ward side work a little better. So it was that the daughter of a woman on the ward presented herself. Her mother has dementia and so does her father – both are known to my team but I didn’t know of either.

When she was discussing her difficulties in managing at home, one of the attendees commented that although her mother and her father had similar presentations, the difference between them was, and I quote, ‘that your father is pleasant’.

I think my jaw dropped with the implication by comparison that her mother, who was on the ward after displaying some disturbed and aggressive behaviours, was not at all pleasant.

The younger woman said ‘But this isn’t how my mother was, she was always very helpful, couldn’t do enough for people, very gentle’. I tell you, I just felt for  that woman as she battled with the idea that professionals might have an opinion that somehow her mother was less than ‘pleasant’.

Of course, not knowing either of the people involved, I could barely jump in but the Consultant did – unsurprisingly – and mopped up the pieces by explaining the personality changes that can take place when someone a further progressed dementia and smoothing over some of the gaps with a stern glance to his left every now and then.

I think all was well. It was far from an intentional slight but sometimes language can be very judgemental and can lead to thoughts and assumptions that really are very far from helpful in already difficult situations.

Southern Cross and Hillingdon

Southern Cross is one of the largest, if not the largest provider of private residential and nursing care in the UK. They had one or two financial hiccoughs earlier in the year. There have been a few stumbles along the way,  but they have now appointed a new Chief Executive, Jamie Buchan, a ‘turnaround specialist’ .

In a statement, Southern Cross said that a “key remit” for Buchan and his team will be to “refocus attention on excellence of service delivery and to develop a clear strategy to rebuild shareholder value”.

Well, it looks like he has the right kind of language to fit right into the care sector.

That’s comforting.

Yesterday, however, the MP for Hayes and Harlington raised the issue of the quality of care at Southern Cross homes in Hillingdon, in the House of Commons. In fact, his Early Day Motion reads as follows

That this House notes with extreme concern the reports of the poor standards of care in the residential homes for the elderly owned by Southern Cross in the London Borough of Hillingdon largely resulting from insufficient numbers of staff, working long hours without adequate support, management or training; further notes that Hillingdon Council and Primary Care Trust have at last suspended the placement of elderly people within these homes; and calls upon the Secretary of State for Health to launch an immediate investigation into care standards in these homes, and the role of the local authority in safeguarding the elderly residents in these settings, to take urgent action to protect the residents of the homes and to improve standards of care, including the withdrawal of contracts from Southern Cross.

It’s quite a staggering story that I hadn’t been aware of. What’s equality amazing to me is that this story doesn’t appear to have been touched by the national press. It has even been relegated to a few lines pointing to a video clip on BBC London – where it was first brought to my attention yesterday.

Fortunately, I could turn to the Hillingdon Times to provide further information.

There are four care homes in Hillingdon that are run by Southern Cross.  Aston House, Ashwood Care Home, Cedar House and Blenheim Care Home.

Now, I don’t know much about Hillingdon apart from it being where Heathrow Airport is but I imagine having to suspend placements in four care homes is having a pretty massive impact on the ability to find local and appropriate placements in the local area.

Where I work, when we have suspensions on placements even in one home, it has a fairly dramatic impact on waiting lists and service provision.

So back to Mr Donnell, the MP involved. He states in the Hillingdon Times that he has had a number of complaints about care in these homes.

“Over the past couple of years, concerns about elderly residential homes in Hillingdon have been raised with me.

“About 18 months ago a group of relatives came to me about how elderly members of their family have been treated.

This is no flash in the pan reaction but a situation that has been brewing over a long period of time.

The spokesman for Southern Cross says, a little ominously

“All except one of the Southern Cross care homes in the Hillingdon area have now received a ‘good’ rating following the latest inspection reports and we are concentrating on delivering a high level of quality care for all our residents.”

Faith in the inspection system isn’t particularly high at the moment and having a ‘good’ rating seems to be possible without necessarily providing a good standard of care.

It surely can’t be a coincidence that Southern Cross keep getting themselves into these situations as they relate to poor care provision.

One of the statements made by Mr Donnell in his statement to the House of Commons was that he didn’t want there to be a ‘Granny P’. All I can say is that there already have been many many older people who have been subjected to situations that are abusive and for which there have been no campaigns, no marches down Whitehall, no hand-wringing about the quality and delivery of adult social care and particularly of residential care.

It says enough that even this story is not more than a couple of lines on a local website anymore and it doesn’t seem to have interested the national press in the slightest.

Of course, you can’t make people be more interested than they are, but I think, were there the publicity behind these incidents, we, the general public, would be equally appalled.

Instead, the private companies cutting costs and poorly managing resources which are meant to be caring services can get away with providing a barely, if at all, acceptable standard of care.

I would love for there to be an investigation in the ways these contracts were handed out by local authorities who contracted out all their locally run residential and nursing homes to private companies. I think a few commissioners could be brought to the table – or at least brought to the homes to see what kind of services they are paying for.

We, social workers who are making placements, have been left with little choice in provision. If all the care homes in a borough are provided by the same company through block contracts worth hundreds of thousands of pounds that have been tied up for decades at a time, how are we in a position to complain to the commissioners about the services they are paying for when they are watching their own backs and in bed with the private care providers.

Just moving back to a personal experience I had a year or so ago. I had concerns about the treatment of someone I was working with in a residential home. I felt that his needs were not being managed. I complained to just about everyone – up to one of the commissioners. The commissioner in question took the word of the service provider over mine. He  had made the decision to award the contract to this care home and therefore felt, I expect, some loyalty to them. That is not how public services should interact with private companies.

edit  – For those with a personal interest in these matters there is an organisation that I have become aware of through the comments on this post which is the Relatives and Residents Association – Go take a look – we can all be more active in applying pressure relating to these matters.

Christmas Cheer

I have been in my new team for over a month now. I moved from a small office with two others (one of whom was part-time and not often around), into a large open plan office with 7 others.

Positive thing is that there’s usually someone around to chat to. Negative things is.. well, the same!

I have a nice little spot by the window with a lovely view over a park. I was worried that being the ‘last man in’ I might have been relegated to a ‘door view’ desk.  But no, I have a great view. Even the ‘guy from IT’ who has been installing some new database system on all the PCs in the Trust said he thought it was the most pleasant office he had seen – and he’s been to a fair few. I put it down to the ‘view of the park’ factor.

There have, though,  been a few ‘demarcation’ issues with the person sitting next to me when files wander over into her ‘space’ and get pushed back. Usual office stuff. No cross words yet though.

Last week, when I popped into the local Alzheimer’s Society branch to chat with one of the people who work there, they had a tiny little stall selling Christmas decorations and cards so, having some cash on me and being a bit of a soft touch, I bought some big glittery stars, some tinsel, ribbons, cards and some crackers.

image gailf548 at Flickr

On getting back to the office, I decided to decorate the room and gave everyone a cracker.

As each person arrived they told me how nice it was to have the office decorated and that they had never done that before! I was quite surprised. It might not be a terribly serious thing to do but it seems like a small thing to cheer people up a wee bit.

Gift ideas for Social Workers

Last week, Community Care printed an article which provided some gift ideas for the Social Worker in your Life.

A good article with some interesting ideas. But I thought I’d add one or two ideas of my own – of course, it might be too late for Christmas this year but you know, you can never receive.. I mean give.. too many presents!

image miszpinay at flickr

How about a nice button badge? Fried Social Worker Store has some interesting designs – I love Social Work – that says it loud and clear. Or a nice bag with the slogan ‘Social Workers sow seeds of healing in the lives of others’. I wonder if that would go down well if I take it with me to work or even use it in my leisure time..

And for the child in your life – how about a t-shirt with the loving slogan ‘My Mommy is a Social Worker’ I  hate to be cynical – but would you let your child go to school wearing that? I mean, it’s not that I’m not proud but I can’t imagine it would necessarily go down well.. (there is a daddy version too, of course).

But you know, what I’m getting for the man in my life – oh no, I just saw that it is unavailable in the UK – darn, the US really does get all the best things.

A Burger King body spray with

“the scent of seduction with a hint of flame-broiled meat”.

Maybe I’ll try and source some for next year – life just isn’t fair.