The truth about the truth

Peter Beresford (Column, 2 August) raises a crucial moral and
human issue in his article on lying. Does truth matter? St
Augustine of Hippo noted wryly in his “Confessions” that he had met
many people who wished to deceive, but none who wished to be
deceived – we begin to see the hollowness of pragmatic arguments
that deception is often justified.

Lack of truth screws up human relationships and it screws them
up badly. In close relationships it may prove terminal, but it
damages trust in many other contexts where trust is important. Of
course there is a moral distinction between lying to protect one’s
own interests and lying to protect someone else’s. But even lying
to give someone else a stronger case, for example, has complex
ramifications, especially when endemic.

At the institutional level, what should not occur are situations
where people feel it is their moral duty to lie in order to protect
the interests of their organisations, unit or cost centre and its
employees and users.

This occurs when finance is tied to performance targets such as
school attendance or immunisation figures. Not to lie deprives the
organisation of much-needed funds – but to lie invalidates the
system, undermines trust, and effectively penalises others who tell
the truth. The public sector should not operate in this way.

Lorraine Harding
Department of Sociology and Social Policy
University of Leeds

Whose side are we on?

I was intrigued to read Peter Beresford’s article (Column, 2
August) about social workers having to “duck and dive”, operating
skilfully and sometimes unconventionally in order to utilise the
small spaces that are available in agencies to support clients and
service users. This resonates with my own experience of some 25
years as a social worker, mainly with children and families.

It has increasingly become difficult to work in anti-oppressive
ways, not least because of the move to managerialism with its focus
on procedures and routines. As an example, one has only to witness
much of the practice in relation to child protection and youth
crime. And as a corrective to this, one must remember that radical
social workers have always based their work on such values as
social justice and equality. Even though social managerialism seems
to have triumphed, perhaps all is not lost.

As Beresford notes, being economical with the truth often means
that clients can receive the benefits and services they should
receive. One must remember the old sociological question “Whose
side are we on?” – and act accordingly.

Steve Rogowkski
Oldham

Guidance won’t end postcode lottery

I do not advocate (News, page 4, 26 July) that councils should
take a narrow resource-driven view of access to services. However,
I would point out that any attempt to remove inconsistencies
between authorities would founder because of the different levels
of resourcing. As authorities can continue to take resources into
account the suggestion that the new guidance will end the “post
code lottery” is unrealistic. It is important that we explain this
clearly to the public.

I welcome the publication of the draft policy guidance for
consultation on fair access to care, to be followed by practice
guidance. The guidance does recognise that differences between
authorities do and will continue to exist. It emphasises councils’
responsibility to be clear to service users about what they can
expect.

The Association of Directors of Social Services shares the
ambition of the guidance to have good preventive services
available. But directors of social services know that these have
been under threat in many areas. We would welcome reassurance that
resources will in due course allow us to make a reality of that
ambition.

Given that a survey earlier this year showed 85 per cent of
departments predicting an overspend, I expect that some authorities
will want to question the alleged “limited resource consequences”
of the new guidance. Even the best performing councils will find
assessments will take time and attention not available for other
developments.

Moira Gibb
President
Association of Directors of Social Services

Small print obscures nursing care debate

Your account of the small print revelations of the Department of
Health draft guidance on free nursing care (In Focus, 2 August)
suggests something of a selective interpretation of previous policy
announcements. The NHS Plan, published a year ago, stated
explicitly: “In the future, the NHS will meet the costs of
registered nurse time spent on providing, delegating or supervising
care in any setting.” To suggest that this refinement has emerged
only with the small print of the draft circular obscures the
debate.

The issues concerning the definition of nursing care are also
not new. They arose with the publication of the NHS Plan, and in
the debate that surrounded the passage of the Health and Social
Care Act 2001. Of course there are problems with any definition,
but even if a decision had been made to fully fund all personal
care, this issue would remain. Wait for similar controversy in
Scotland over what constitutes personal care, and what can be
termed as living costs and housing costs.

The registered nursing care contribution (RNCC) tool is not the
same thing as assessment. The draft version of the RNCC is in fact
on the Department of Health website. The RNCC will only come into
play following the completion of an assessment, and that assessment
will be the single assessment process already announced as a key
component of the national service framework for older people. The
consultation draft guidance on fair access to care (News, page 4,
26 July) also restates the general principles of assessment for
adult social care, and further guidance on the single assessment
process is imminent.

It is vitally important that there is debate about many of the
issues raised, and that the practicality of the RNCC can be
evaluated.

Melanie Henwood
Independent health and social care consultant
Towcester, Northamptonshire

Pensions for ex-services personnel

I joined the Royal Navy as a 15-year-old boy seaman and left at
40 (“Wounded soldiers”, 2 August) as a highly skilled and
experienced petty officer seaman (submariner).

I am now employed as a social worker. While a submariner I was
involved in submarine escape trials and training, requiring very
rapid changes of atmospheric pressure, resulting in avascular bone
necrosis of my left femoral head and acetabulum. I therefore have a
20 per cent “war” disability pension (you don’t have to have been
in a war to get a war pension).

Please can readers of Community Care who are in contact with
ex-services personnel with any disability attributable to their
service, or the widows, widowers or partners of ex-service
personnel whose death is attributable to their service, suggest
they contact the War Pensions Agency on 0800 169 2277, or e-mail:
warpensions@gtnet.gov.uk The website is at www.dss.gov.uk/wpa/
index.htm

Peter Clements
Saltash
Cornwall

Primary therapy

I was interested to read Melissa Benn’s article on the need to
recognise children’s emotional needs in the school setting
(Perspectives, 12 July). In the Clay Cross area of north east
Derbyshire we have been doing just this for the past four years
with our Positive Play scheme.

The scheme is based in Clay Cross infant school. It started
because the head teacher and I were aware that many of the children
were failing in school and the normal behavioural policies were not
effective. Clay Cross is an area of high deprivation. A substantial
proportion of children in the school had low self-esteem, came from
difficult family situations and were unable to cope with the
complexities of the school day.

The scheme is based around individual play sessions in school
with a special education care officer. These focus on allowing the
children to explore their emotional needs and also giving them the
skills to cope in school. It has spread to other schools in the
area, covering nursery to secondary level. It has prevented
exclusions, improved classroom behaviour, improved academic levels
and given a more positive experience of school to many
children.

It is a very cost effective scheme. The recent Ofsted inspection
gave it great praise. So the future is not all bleak. There are
many schools where something is being done to help the most
vulnerable children.

Irenie Zelickman
Primary care liaison worker
Chesterfield