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..


7 thoughts on “Looking Back – A Professional View

  1. You mention that “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”. Well that is what the employ carers and nurses to do. The carers and Nurses are not going to watch the balance sheets, if no-one did, then the 10 managers you claim to know are actively looking for jobs would have to be a bit more active in looking for a job. Yes, the top management in Southern Cross “earn” a lot of money, but for instance when a carer in Middlesbrough causes the death of a patient (see my latest newsletter) it is not a home manager in Preston answering questions from Judges.

  2. Thanks for that Gavin. Whilst I have emphasised I have no knowledge of Southern Cross in particular apart from how people have reacted to it. I think there has to be more than watching balance sheets to management though. I do work in an area where carers are employed on minimum wage. I think that training and employment conditions are fundamental to providing good care and that is where I worry about some of the costs being cut – and these are false economies, as you have highlighted.

  3. I think you have struck on an interesting point re the BIA and DoLS. I don’t think many people living in care homes will qualify for DoLS because the threshold is going to be high and just not having capacity is nothing like acute enough.The tension will come when the BIA are recommending conditions to make the DOL more pleasant which include as you say going out etc. The home will then state they cannot meet the needs of the indivdual with the staffing numbers due to the fees that the LA pay them for placements. As the Supervisory Body agreeing or not agreeing your conditions are also the commisioners of the care it sets up an interesting tension especially in line with FACS, Contracts and Fairer Charging Schemes that seem to be on-going. I have heard one lawyer state that this alters Community Care Law as the LA’s right to choose the cheaper alternative has been eradicated. We shall see…

  4. TT – we were told by a lawyer (so it may or may not be reliable!) that a lot of care homes were considering just referring all their residents for assessments in block to avoid having to make decisions on an individual basis about whether to refer or not – and leave those decisions to the BIA or the council to decide.
    And I suspect you are completely right about the outcomes regarding costs and charging implications. Will be interesting to see where it goes.

  5. That is a danger I know. I expect there will be a triage system is place run by BIAs who will get the first calls to discuss whether a patient is or is not subject to DOL and then to make a decision to precede with the full blown assessment process. A decision at this stage is compliant with the code of practice (surprisingly readable). I think the enquiries etc will work along similiar lines to MHA assessments. I can’t imagine any care homes wanting to refer all their patients when they see the amount of paperwork and leg work they are going to have to complete which will be a disincentive

  6. I think that is going to have to be the way it works. So many things seem like a shot in the dark though – I wonder why!

  7. Pingback: Mental Nurse · This Week in Mentalists (61)

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