How not to do heroin harm reduction

There’s an argument that any references to heroin use in culture inevitably glamourises it. I recall there being a lot of debate about this around the time that Trainspotting was released in the cinemas.

My own view, and this might be coloured by my anti-censorship inclinations, is that while there may have been a bit of glamourisation, the film did also show the harrowing nature of heroin addiction. Overdoses, withdrawal symptoms, HIV transmission – they were all dealt with in gruesome detail. After watching Trainspotting, only a jaw-dropping imbecile would conclude that getting hooked on smack was in any way desirable.

Now let’s take a look at Vice – the magazine for jaw-dropping imbeciles.

We all know that pumping heroin into your veins turns you into a phenomenal artist. Basquiat? Cobain? Burroughs? Have you seen the shit they were putting out before they started using? Of course you have, because it was put on your high school syllabus to teach you that you’ll never be able to create real art without a smack habit. But one group of artists your school books might not have mentioned are the dealers who use their own graphics to beautify their heroin baggies. Kind of like acid tab art, I guess, only more sinister and likely to kill you.

Yes, this is indeed an article on “The Art of Heroin Bags”. No, I’m not kidding, I just wish I was.
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Not Working Together Any More In The Name of Less Bureaucracy

Regular readers of my efforts in NSBS may have discerned an emerging pattern, the theme that simple solutions to problems in social care will not work because reality is complicated and perverse. That certainly wasn’t my intention when starting out. I’ve merely been reacting to some of the major news items in child care social work, specifically the government’s proposed changes to the process of assessing adopters and foster carers. Banging on about the same thing is tiresome for me as a writer, let alone the poor reader.

But here I am again, putting fingertip to keyboard in response to Community Care’s exclusive that “ministers are planning to ‘slaughter’ key child safeguarding guidance as part of measures to tackle bureaucracy in children’s services.” Apparently on the instructions of Michael Gove, Working Together is to be reduced from 300 pages to 60 or even 10. In welcoming the Munro Report on child protection work, many of us wondered exactly how the recommendation that has been embraced most wholeheartedly by the government, a decrease in bureaucracy, would be put into practice whilst maintaining quality standards and the absolute necessity of keeping good records. Now we know – by dismantling wholesale an intricate but solid structure of multi-disciplinary procedures created in response to a failing system that left vulnerable children unprotected and replacing it with a few sides of A4. It’s an absurd response to the complexities of safeguarding, almost as baffling as the concept that I have regular readers.
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The Court of Appeal ruled yesterday on the scope for adult safeguarding

The Court of Appeal ruled yesterday (DL v A Local Authority & Ors [2012] EWCA Civ 253 (28 March 2012)) on the possible scope of adult safeguarding. An elderly couple had chosen not to take steps to protect themselves from their potentially violent and aggressive son. Could the local authority safeguard them?

Here is the ruling in a nutshell: local authorities can intervene to protect people who have mental capacity to decide for themselves and choose not to be safeguarded, but only if they lack capacity to decide for themselves in some other way.


In one sense the Court has said nothing new; but in another it has said something controversial.

Nothing new, because it upheld judgements made below (i.e. by the High Court) and therefore doesn’t change anything, even though the judgement is a welcome expansion and elucidation of the law in this area. Something controversial because as the President of the Family Division said at an earlier stage in this litigation,

I am of the view that the present case involves an extension of the inherent jurisdiction… [paragraph 20]

What’s it all about?

Can we intervene to protect an adult who chooses not to protect themselves from their grown up child, because they want to protect their relationship with their child?
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Paying for Care and Generating Blame

Sold - Day 67 of Project 365

I read Liz Kendall’s article on the Guardian website a couple of days ago and while I haven’t been able to respond fully until today, I did want to.

Kendall is the shadow minister for care and older people a particular remit (as far as having a specific spokesperson for older people) that doesn’t exist in government.

Generally, I’ve found her input to be helpful. There were a number of issues raised in this article though that concerned me.

Kendall is right to draw attention to the issues that present themselves in relation to care and quality of care in this country and focused on the inequity of payments in the care system which she is right to identify as a key area that needs to be reformed and hopefully will be shortly.

The current charging policies are all over the place and there is no consistency between local authorities however for me, I see the issue of quality of care and equity of provision of high and trustworthy standards of care to be, if anything, more of a crisis.
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Adult safeguarding – introducing the concept of insignificant harm

The proposal is that the threshold for adult safeguarding should be “significant harm”, rather than the lower “harm” threshold recommended by the Law Commission. Mithran Samuel at Community Care (@mithransamuel, @ComCareAdults) debates the wisdom of this (‘Will safeguarding threshold leave adults at risk?‘) with reference to arguments aired at their Adult Protection Conference, and I note reference to the Department of Health favouring the same threshold as for children.

Good for them! I hope it was more than a quest for neatness and simplicity. I venture to suggest a parallel with the children’s significant harm threshold is legally and morally right.

I fear being torn off my high horse whenever I write favouring less intervention. Many can understand that our human rights, forged in the aftermath of a long and bloody fight against totalitarianism, are largely rights to be left alone by the State. But I write from within a profession that epitomises State intervention in private life; and many are comfortable with that and uncomfortable with anything that might limit their right to intervene.
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It’s all about the training! CQC and Deprivation of Liberty Safeguards

Inveraray Jail

Today, as Community Care reports, the CQC has published its annual report into the operation of ‘Deprivation of Liberty’ safeguards for 2010/11.

Deprivation of Liberty safeguards are a particular part of the Mental Capacity Act which allows a legal process of authorisation where there is felt to be a ‘deprivation of liberty’ in a care home or hospital related to someone who lacks the capacity to make a decision about whether they remain there or not. The process of decision-making relating to whether a Deprivation of Liberty is authorised revolves around the managing authority (the organisation which is potentially depriving the person of their liberty) and the supervisory body (the local authority or PCT (or whatever they are called now) where the person is or who is responsible for the care of that person (if, for example, they have been placed out of the local area the responsibility remains with the placing authority).  The decision is made on the basis of a number of assessments (six actually) which are undertaken by at least two people, one of whom must be a doctor and one of whom must be a ‘Best Interests Assessor’ (who can be a social worker, nurse, occupational therapist or psychologist).  The Best Interests Assessor, unsurprisingly, makes a recommendation not only on whether the deprivation is in the person’s best interest,  but whether the framework and care plan constitutes a deprivation of liberty at all.

So that’s DoLs in a nutshell. What have the CQC got to do with it? Well, amongst other things, monitoring these Deprivation of Liberty authorisations is another part of their work.
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NHS #RiskRegister Leaked

So, the much-debated Risk Register for the NHS reforms has been leaked onto the Internet.

Personally, I’m still trying to interpret and digest its contents, and therefore my immediate thoughts aren’t more cogent than, “Wow, that’s a lot of stuff marked red!”

Some areas marked as red (i.e likely to happen, and would have a high impact) include, to take a couple of random examples:

By dismantling the current management structures and
controls, more failures, including financial, eg GP consortia
go bust or have to cut services, and credibility of the system
declines as a result.


Risk that transition is managed by people who are
themselves at risk, eg in organisations such as SHAs, PCTS,
may not be effectively managed, with risk of delays,
performance dips and key staff lost as a consequence.


There is a lack of clarity during the transition in terms of
accountability e.g. between board, PCTs, and Consortia
during the transition years and the first year of the new
system. This leads to delays and increased costs and poor
BAU performance.

Okay, I know that the point of this risk register is to identify such risks and therefore work to eliminate them, but there really do seem to be a lot of them.