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.