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,

    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

    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

    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

    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

    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

    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

    Heather Bland

    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
    London Heads of Registration and Inspection

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