Recently in Adult care Category

by Hackney GP Michael Fitzpatrick

The old medical adage "prevention is better than cure" has been extended from infectious diseases to diverse social problems, such as obesity, teenage pregnancy, substance abuse and antisocial behaviour, all supposedly raging at epidemic proportions.

Although the conviction that early intervention yields better outcomes has a common sense appeal, it is only true if the diagnosis is correct and the preventive measures used produce the desired effects (without producing adverse consequences).

But consider obesity and teenage pregnancy. It is by no means clear that the scale of these problems is as great or the consequences as serious as the scaremongers and moralisers who have taken up crusades around these issues seem to believe. Panics about alcohol and drugs, crime and delinquency have come and gone over the years, whether or not there has been a significant recent increase in these problems. The causes are complex and simple solutions are in short supply.

Early intervention is driven by the power of wishful thinking. The notion that there is a window of opportunity before the age of three within which adults can decisively influence infantile development is an old dogma of psychoanalysis now dubiously reinforced by speculative neuroscience. Massive research into Sure Start has confirmed that the evidence for its efficacy is very weak - yet it is stronger than that for any other form of early intervention.
The downside of early intervention is that it pathologises whole communities, inevitably communities that already suffer poverty and neglect.

By replacing family and social links with therapeutic relationships between targeted individuals and professionals, early intervention further undermines personal resilience. Rather than strengthening individuals and communities, it renders them more atomised and more dependent on state support.

by Dr Mike Fitzpatrick

The history of medicine reveals that doctors resort to recommending diets when they have no effective treatments - a state of affairs that prevailed from antiquity until the 1930s. Dietary protocols for numerous conditions, from insulin-dependent diabetes to pernicious anaemia, have disappeared with the development of new drugs or other forms of therapy.

The food issue: why food is at the heart of social care

Two apparently unrelated stories struck me when I read last week's Community Care (29 April 2010). Both left me with strong feelings. Both deserve further comment.  First there was the tribute, following his premature death, to David Morris, longstanding senior policy adviser on disability to the London Mayor.

by Richard Humphries

Many hope that White Paper 'Building the National Care Service' published last week will become a key staging post towards a reformed social care system.   
If I had to choose a Beatles' song to describe the journey so far, it would be 'The Long and Winding Road' - and the destination still seems a long way in the distance.

by Michael Fitzpatrick

I often think it is strange that parents ask me - as a GP - for advice on matters of child-rearing.
It is understandable that parents should seek medical advice about their children's coughs and fevers, even about teething and nappy rashes. But why turn to a doctor for help with sleeping and feeding problems, toilet-training, tantrums and bad behaviour?

by Geoff Ettridge

Over many years as a local authority manager I often saw examples of savings proposals put forward by other directorates or agencies that had financial consequences for social care. Whether intentional or not, these decisions seldom delivered savings for the public purse because those made in one service often caused pressures in others.

by Simon Stevens

Last week I had my first proper outcome-based "review" now that I have reached my "maximum rehab potential" since the start of my Guillain Barré syndrome in January. I have always been nervous of reviews and I imagaine social workers can also be nervous when they have to work with a well known, empowered and rather vocal service user. With 17 years' experience behind me, I feel that the balance of power has started to shift in my favour.

A major reform is needed in the relationship between those who provide care and those who rely on it for ageing with dignity, writes Denise Platt

by Peter Beresford

The prime minister's party conference commitment to introduce free home care for people with the highest needs has made a further mockery of the government's green paper consultation. This wasn't even on the menu. The government wanted the green paper to foster a big public debate. It seems only to be increasing controversy.

By Kaarina Elisabeth

Personalisation, I am in no doubt, would transform the lives of mental health service users and lead to better outcomes. Before I'd even heard of self-directed-support, I was lobbying for it. Why, I wondered, does nobody listen to my own assessment of my needs? There is one reason that appears to preoccupy the minds of everyone I've met involved in commissioning services: that of risk.