Your anonymous letter writer states a view that is shared by many (Letters, 2 August). As a guardian ad litem with a not too distant memory of being a local authority social worker, I am well aware of the crisis that exists in social work, and the extent to which workers feel undervalued, ill-rewarded, and burdened by impossible expectations. Social workers have long been leaving the profession in their droves to seek more rewarding pastures, and the resulting high turnover of staff and unfilled vacancies are facts that guardians know only too well - if not first hand, then by seeing the consequences for the children they represent. But this is no reason to applaud the guardian service being brought to its current predicament. Indeed effective representation of children's interests is all the more needed.
It is not a question of whether this is about pay and conditions or about children, as the two are inevitably connected. If experienced guardians continue to leave the Children and Family Court Advisory and Support Service because other areas of work value and reward their skills and experience; if they cannot work for an organisation that will not support them in offering a quality service, then who can blame them? I am not currently seeking an alternative career - though in my area, more than two thirds of those who came into Cafcass are doing just that as Cafcass rushes headlong into self-destruction. As I watch colleague after colleague leave, I cannot see the stripping of the service of its most experienced workers, the inevitable waiting lists, the court delays, and undermining of the quality of decision-making about children at extreme risk, as anything other than a disaster for the children Cafcass has been set up to represent.
Ben Grey
Bishop's Waltham,
Hampshire
Pacifying older residents is 'lobotomy'
Finally there is official confirmation (News, page 5, 26 July) that many older residents of both hospitals and nursing homes are being prescribed anti-psychotic medication to keep them quiet. I have long believed that such is the case and I would like to add my voice to all those who are strongly against such unwarranted action. In my opinion, such drugs are akin to lobotomy.
Not only is such prescribing likely to be inappropriate, it is also likely to lack the fully informed consent of the elderly patient. Some general practitioners may prescribe such drugs as being "helpful" in cases of dementia, especially when disturbed behaviour and high anxiety are seen to be present. However, far simpler causes may explain changes in behaviour, many of which are of a physical and easily treatable nature but which have an unfortunate ability to mimic the confusions of Alzheimer's disease.
If a GP is called to a care facility by staff members to treat an apparently disturbed older resident, it is reasonable to assume that the GP will prescribe on those reported symptoms. In this sense the GP acts on a professional discourse with staff who work closely with the patient. Should the use of this medication be subsequently challenged by a relative, the official line will be that the resident "consented" to the treatment and that the relative had no right or authority to question the diagnosis or medication because of that consent.
Looking at this question of "informed consent" to treatment should be given the highest priority. It is particularly important when treatment involves medication that will substantially change the patient's behaviour, personality and ability to act independently.
It would be my contention that, if a person is considered to be in need of such high-level sedative drugs, their ability to give an informed consent for their use is likely to be reduced, perhaps even to the point of legal incapacity to give consent.
Diane Brent
Congleton,
Cheshire
Abuse cases cannot be oversimplified
It is all very well to want to help victims of abuse - who doesn't? - but how on earth does Pauline Flavin (Letters, 19 July) suppose that anyone, child or adult, can ever make an allegation "without fear of disbelief"?
The whole process of investigation is for the purpose of determining what, if anything, actually happened. This assumes at least the possibility that an allegation may turn out to be exaggerated or wholly untrue.
This is no less valid when the allegation relates to child abuse, whether "ritual" or not. Indeed, it arguably "goes double", since such an allegation, by its very nature, involves accusing someone of a particularly nasty kind of wrongdoing so that the principle of innocent till proved guilty must be all the more strictly adhered to.
Michael Stone
Peterborough
AA for non-alcoholics
I too have been affected by loving someone who is an alcoholic ("Double jeopardy", 28 June and Letters, 19 July).
I was fortunate to find Al Anon at a time when my despair was so great that I was ready to accept the support, understanding, acceptance and valuing care that I have since received from this unique organisation.
Al Anon is a "sister" organisation to Alcoholics Anonymous and seeks to help people in the position the writer describes: those who are affected by someone else's drinking. A local contact for Al Anon can be obtained from AA or The Samaritans: both numbers are in the telephone directory.
Name and address withheld
Social work's a real job not a stepping stone
I am concerned about the diarist who has just completed her Diploma in Social Work course (Diary, 2 August). While offering sincere congratulations, I am worried that she is already starting to talk about moving into the education field, albeit still within social care, when she has not even started practising as a social worker.
The DipSW is designed to equip people to be social workers. We need people to do the job for which they have been trained and to work with vulnerable people. We do not need people who see the DipSW simply as a stepping stone to a more lucrative career.
I do not see how two years practice will equip the writer to teach others how to do a job he or she has done for so short a time.
Heather Bland
Dorchester
New care standards are already in place
The countdown to the National Care Standards Commission next April ("Ready for take-off?" 2 August) is stimulating debate on the standards and costs of care and on the nature of regulation. The higher public profile brought about by the changes is to be greatly welcomed as greater public awareness is vital in raising standards and combating abuse and neglect of vulnerable people.
Your coverage is a welcome contribution to the debate. It is unfortunate, however, that in her article (Perspectives, same issue) Yasmin Alibhai-Brown seems unaware that homes have been registered and inspected by local and health authorities for many years and that her list of things "inspections could demand to know" has long been incorporated in government guidance and local standards. There are around 1,200 names on the national list of cancelled and refused registrations and these are only some of the people excluded from the care homes sector through regulation since the mid-1980s. Her reference to "inmates" (rather than residents, patients or service users) is worrying - perhaps influenced by the visit she recalls to a particularly nasty home (which I hope she duly reported to the registration authority!).
Current regulators accept and hope that the new legal framework and national bodies could improve on the current system of regulation and raise the standards of care. However, we strongly resent the forthcoming changes being presented with the implication that nothing (or nothing good) has preceded them. Ruth Winchester ("Ready for take-off?" 2 August) is right to stress that the way the standards are applied is as important as their content.
No doubt Community Care will keep a critical eye on developments. Don't forget the new Early Years Directorate, soon to take over from local authorities the regulation of children's day care and childminding. ("The bringing up baby blues", 14 June).
Many of us in the field have expressed serious concerns about the adequacy of the new national standards and doubts about the effectiveness of the new organisation and management. We hope to be proved wrong.
Jack Valero
Co-Chairperson,
London Heads of Registration and Inspection
