Guardian service follows social work’s staffing crisis

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