Readers’ letters in the 28 August issue

Letters include: Gay discrimination, Doctors shun advocates, Price squeeze hits homecare, Challenging dementia document


Why the Hackney model is doomed (Letter of the week)

Donald Forrester’s response (Letters, 14 August) to my letter about the Hackney experiment is based on a misunderstanding of an edited version (“Hackney’s efforts should be backed”,

I don’t argue that the Hackney model is about “simply a nice title and extra pay”. Based on my experience training and working in inner London for 20 years and a review of the research evidence, the only reasonable conclusion is that this model has been tried and failed.

It was also unwise for Donald to cite the medical consultant as an exemplar for Hackney’s consultant social workers. Most nurses and junior doctors would disagree with his belief that the consultants they encounter “work with and know the people she is responsible for”. I imagine a lot of social work team managers resent the implication that they don’t or that the use of evidence-based approaches is rare in social work.

The new Hackney teams are not multidisciplinary they rely on unqualified staff and risk placing dangerous levels of responsibility on the shoulders of poorly supported consultant social workers.

I am not criticising Hackney’s attempt at improving the quality of social work for its citizens.

I just don’t share Donald’s naive optimism or wishful thinking and am cynical about the media spin used to attract social workers into a practice model that has failed for the same ­reasons: lack of funding, inadequate ­management, no co-ordination with other agencies and being misled by disingenuous local politicians.
Steven Walker, senior social work lecturer, Anglia Ruskin University

Posters exclude gay men and lesbians

We are pleased that the Family Planning Association has chosen to focus its sexual health week on the issue of people with learning difficulties (“Professionals tell fpa of barriers to sex for learning disabled”,

But we are sad that gay and lesbian people with learning difficulties have not been shown on the posters. We think this is an oversight.

The barriers that people with learning difficulties encounter when we try to exercise our right to have relationships are even bigger if we are gay, lesbian or bisexual.

Leaving same-sex relationships out of the poster series continues to avoid the issues and misses a chance to speak up about our right to sexual orientation. The Brook poster series “Young disabled people can” some years ago was a good example of inclusivity.
Newham People First, London

Advocates victims of doctors’ arrogance

Why are some doctors reticent in relation to independent advocates (“Doctors’ ignorance is bar to advocacy for people who lack capacity”,

Surely the majority of their non-mental health/learning disabled patients will not have in-depth medical knowledge and yet “there are some examples of doctors who think a discussion with a non-medically qualified person is a waste of their time”.

Aren’t those doctors simply showing how ignorant they are at best and arrogant at worst?

I am concerned that such doctors may be trying to “control” a patient with a learning disability/mental health problem on the grounds that “doctor knows best” when some don’t know best and may be hiding behind their professional status.

I have experienced medical personnel trying to make a unilateral negative decision about whether a severely disabled patient was to be resuscitated without speaking to family. They had decided that this particular patients’ quality of life was such that, in effect, he was not entitled to his basic human right to life. Advocacy intervention played a large part in stopping this being the accepted rule for that patient.
Name and address withheld, Independent advocate, South Wales

Price squeeze on homecare providers

We are encouraged that the Association of Directors of Adult Social Services has acknowledged that councils must reflect inflationary pressures in next year’s round of fee increases to homecare providers (“High fuel costs may lead care providers to refuse contracts”,

However, inflationary pressures are hitting providers, their workforce and service users now.

We can expect many councils to award below-inflation price increases in April, pleading poverty and an unfavourable government settlement. But they need to recognise the value of homecare and the effect that their price squeeze has on recruitment and retention of care workers.

Putting off a solution until April will be too late for many.
Colin Angel, Head of policy and communication, UK Homecare Association

Issues missing from dementia document

Having just responded in detail to the government’s consultation, Transforming the Quality of Dementia Care, we were amazed to read the interview with Ivan Lewis (“Ivan Lewis challenges adult care sector to deliver”, He appears already to have moved on since writing the foreword to the document. Yet the deadline for responses is not until 11 September.

We make four points. First, the threat made to local authorities on commissioning. What is his alternative – a privatised system?

Second, the determination for publicly funded users to have personal budgets, even though they are not universally suitable.

Third, the concept of a two-tier system with those in work being funded at the expense of “people who have entered the care system later in life contributing themselves”! Where does this leave the principle of the NHS (free at the point of need)?

Finally, his appeasement of those who could pay more tax. With the growing differential in earnings, the effect of government policy to protect higher earners is to transfer the burden of health care needs on to those least able to afford such costs.

None of these points arose in the consultation document so we were unable in our response to challenge the complacency of the minister and his government.
Sidney Martin, Director, Medway Older People Communication Network

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