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It’s been another good week for yours truly, if not quite so eventful as the week before. Typically enough, the day after I was moaning on these very pages about my cold and how it had triggered thoughts I would rather not have had, the cold completely evaporated. So it’s not hard to imagine how chuffed I felt that I hadn’t succumbed to temptation.
Aside from all that, I again managed to get to the gym three times, attended the MILE programme twice, attended our recovery support group on Tuesday evening (where we welcomed a brand new member) and Matt S and I had another jam session on Friday afternoon (where we were also joined by a new recruit).
At this rate pretty soon I’ll have to think of a title for the project and perhaps even a name for the act. All positive stuff!
I also made a start on a close reading of the Welsh Assembly consultation paper on Integrated Care Pathways – which was somewhat less positive. To say that it’s dry reading would be an enormous understatement, and it’s only because I have some experience of reading and digesting official documents, that someone with my background has managed to hack my way through it so far.
However, of far greater concern than the likelihood of its being opaque to those who will be directly affected by the changes detailed in its pages, are its tone and the assumptions it is based upon. I found its tone highly patronising. It describes service users in terms of extreme passivity – service users are people to whom things are done to and done for, not people who are to any extent in charge of their own destinies and/or (dare I say it?) recoveries.
That the available evidence may demonstrate this to be true is surely the result of a self-fulfilling prophecy. An individual in treatment is told repeatedly that they have no control over the ways they are treated by the agencies they come into contact with and, lo and behold, they surrender that control without complaint.
Almost as worrying for me is the prospect of ‘information sharing’ between agencies, which is almost exclusively regarded by the paper as a ‘good’ in itself. Fortunately I am not currently in the position that I have to pass any of my personal details or history to any of these agencies. But if I were I would be objecting in the strongest possible terms to that information being shared with another (possibly unspecified) agency without my express permission being sought in each instance.
It seems from the tone of the document that a client would be required to sign a blank cheque for their information to be shared with whomsoever the professional in charge of their case saw fit to include – which further reinforces the objectification and dis-empowerment of the service user.
Rant over…
Oh dear, oh dear. The old UK not doing to well on the publishing papers front is it?
Philadelphia 10 UK 0
I am there with you. Dry paper purusal a speciality!
And on the poor record of publishing papers, I’m afraid I’m about to blog on another. Gotta hold these guys to account!
Glad you’ve got over the cold and had a positive week.
On the stuff about service users I am with you 100%. They try to take away your ability to act on your own initiative but the bemoan that you are to passive. Self-fulfilling prophecy is right my friend.
I sometimes feel that I take things too personally but we do need to speak out on issues such as these. Figures for people who enter and maintain recovery after being “treated” by a tier 3 prescribing service are very poor and the lack of empowerment must play a big part in this.
Far from a rant, you make some very salient points
Matt
Interesting stuff Gareth. Just in terms of information sharing, all agencies are governed by the Data Protection Act. Getting clients to sign a ‘blank cheque’ (i.e. an open ended info share consent) is a breach of the Act. It can get a bit hazy with criminal justice interventions but the same basic principles apply. A consent form should state clearly what information will be passed on and in what circumstances and which specific agencies will receive it. This consent form should be reviewed and a new one generated if any circumstances change (i.e. necessity for somebody else to receive information) – always with the express (signed) permission of the client. If no circumstance change then the form should be reviewed at each care planning review meeting and these should take place at least every 3 months if not every month. Any information that is passed on that is not covered in the consent form (and not covered under exceptions around harm to self and others etc) is liable to be a data protection breach. I fear such breaches are a regular occurrence. This needs to be addressed.
As does the mind-set that see clients as people ‘to do things to’. I’m afraid this is a result of a ‘needs based’ assessment culture which focuses pretty much in it’s entirety on problems, issues, gaps and deficiencies etc. A document on Integrated Care Pathways (and people have been producing these (often elaborate) documents for years now) is essentially reinforcing the ‘professionalism’ and ‘power’ of the agencies concerned at the inevitable expense of the ‘client’ and the community.
What we need to see are assessment systems that recognise the Recovery/Social capital of individuals and the communities in which they live. Systems that enable individuals and communities to generate their own integrated support pathways and develop their assets. Check out John McKnight. Going to be hearing a lot about him I think in days to come.
Take care.
Why is it so important to them that patients should be in a state of learned helplessness? I cannot see how fostering dependency can be regarded as any sort of good since it leads to higher case-loads and diminished efficiency. Of the 6 keyworkers I have encountered over the last couple of years I rate only one as outstandingly good, one as good, whilst the other four are dire.
As you say Alistair, breaches of the Data Protection Act are a regular occurrence. However, what I fear will be the end-result after the Welsh Assembly have put their proposals to their legal team, is that the consent form will list a number of specific agencies which may or may not be concerned in a particular client’s care – thus circumventing the requirements of the Act – and still a blank cheque in my humble opinion.
To Geph’s point, “fostering dependency” may not do any good to anyone but it does serve to reinforce power inequalities between professional and client – further entrenching the status quo.
Pucker blog and comments to all, anyone aware of the NHS CARE RECORDS SERVICE being implemented?
If so? look at writing and implications! the “WHOLE” country has legal acces to your history both past and present! Within the NHS.
Just thought I would add this! personally for myself – I have nothing to hide, 484 pages of my own medical history I recieved the other week.
