I visit a patient with the lead doctor. It’s a family I’ve been working with for some time and I know they are anxious, so I try to make the visit as informal and relaxed as possible. It gets off to a poor start when the doctor hollers at the patient as if she is deaf. I see the patient’s family recoil and it goes downhill from there. No matter how much we try to claim the team works across disciplines, it is very clear that the medical part of the equation still dominates. I try to salvage the meeting as best I can, but the patient’s son contacts me later to put in a formal complaint. He points out the doctor’s appalling bedside manner and I find it hard not to disagree.
A student social worker is on placement with the team. He is young but very keen and I invite him to join me on a placement review. In this case the residential home is state of the art, feels homely and crucially, doesn’t smell. We are both overwhelmed and impressed. We check the care plans, speak to the patient and enjoy a cup of tea in the lounge area. Later I warn him that most residential homes aren’t like this one. I make a note to invite him on a different review.
I’m on duty so I plough through the pile of pending cases. Most involve chasing the referrer (mainly GPs) for further information and clarification. It turns into an afternoon of emailing and talking to answerphones.
I spend the afternoon with a woman who is a carer, and we talk through her needs. I complete a carer’s assessment under the Care Act. The new form is more in-depth, and more person-centred than previously and takes a lot longer than before. We spend almost two hours going through the form together. It’s useful, however, and raises some concerns about her wellbeing which I try to address. She’s clearly desperate for some respite but is unsure about strangers providing care to her husband. Her family don’t live locally and she’s not used to asking for help. We discuss some short-term solutions, like a sitting service or day centre, which she agrees to think about. Just as I am leaving she hands me a wedge of old council tax bills and asks if I can decipher them as she can’t work out what she owes.
I go to see a woman to talk about her finances. She is suspicious, understandably, and I try to explain my concerns about a large amount of her money that has gone missing. She is hostile and defensive but muddled about how she pays for things and who looks after her money. I suggest that I talk to her again with her community psychiatric nurse. The CPN has known her much longer than I have and she reluctantly agrees to a meeting. I eventually manage to locate her named CPN, introduce myself and ask to be kept informed about the patient.
We receive a referral about a potential safeguarding incident so I make some calls and try to reach our safeguarding co-ordinator to get her advice. I complete a domestic violence risk assessment which makes me feel even more alarmed, so I discuss the case with my manager. Luckily there are several protective factors and there is no immediate risk but I spend the rest of the day trying to speak to the co-ordinator.
It’s raining and our kitchen window won’t close properly so there is a flurry of activity during one particularly heavy storm, as we try to stop the kitchen flooding. It’s not a new problem, and it’s been reported but nothing seems to have been done. Someone pops out to buy cake and we enjoy a slice as we listen to the rain.