|
Explain: section 47 assessment
This refers to section 47 of the NHS & Community Care Act 1990, which requires local authorities to carry out needs assessments on anyone who might need community care services. In the case of clients who are blind, deaf, dumb, or substantially and permanently handicapped by illness, injury or congenital disability, there is a formal requirement that the authority respond to a request for assessment. Such clients are entitled to be involved (Disabled Persons (Services Consultation & Representation) Act 1986) and receive a written explanation. Section 47 is a right to be needs assessed, not necessarily needs-met. However, there is a duty to provide services that are necessary to meet the clients' needs (Chronically Sick & Disabled Persons Act 1970 section 2). Also, if the assessment identifies needs which the authority does not meet, it needs to show it did not act unreasonably or irrationally, otherwise it may be open to judicial review. If a carer is involved then they can request that their ability be assessed and take that into account when assessing needs (Carers (Recognition & Services) Act 1995, Carers & Disabled Children Act 2000).
The Coughlan case in 1999 concerned a car accident survivor left tetraplegic and in a nursing home, with double incontinence, partial respiratory tract paralysis, and headaches. The courts tried to define the line between health and local authority provision, and nursing care, by reference to the relationship between two other statutes, the National Assistance Act 1948 and the NHS Act 1977. Since then the Health & Social Care Act 2001 has defined nursing care as any services provided by a registered nurse and involving either provision of care or planning, supervision or delegation of provision of care, except for services which do not require a registered nurse due to their nature and circumstances. This nursing care should be provided free of charge. (In 2005 the Sowden v Lodge case was also considering the 1948 and 1990 Acts.)
In 2003 the Health Service Ombudsman complained that the NHS and social services had little incentive to review eligibility criteria and seemed to be left to do the bare minimum. She therefore required compensation for individual clients with Alzheimer's, stroke and vascular dementia.
Note: For many social workers 'section 47' is more frequently used in reference to the Children Act 1989, where it refers to the local authority's duty to investigate suspected child abuse.
Note: In Scotland community care provision is contained in the Social Work (Scotland) Act 1968, the Children (Scotland) Act 1995 and the Community Care & Health (Scotland) Act 2002. Scotland has free personal and nursing care, whether provided by a registered nurse or not. Wales has the same primary legislation as England but the Assembly issues its own policies.
Explain: Joint instruction
CPR 35.7
Where two or more parties wish to submit expert evidence on a particular issue, the court may direct that the evidence on that issue is to be given by one expert only…Where the instructing parties cannot agree who should be the expert, the court may select the expert from a list prepared or identified by the instructing parties, or direct that the expert be selected in such other manner as the court may direct.
Pre-Action Protocol 2.14
The protocol encourages joint selection of, and access to, experts. The report produced in not a joint report for the purposes of CPR Part 35. Most frequently this will apply to the medical expert, but on occasions also to liability experts, e.g. engineers. The protocol promotes the practice of the claimant obtaining a medical report, disclosing it to the defendant who then asks questions and/or agrees it and does not obtain his own report. The protocol provides for nomination of the expert by the claimant in personal injury claims because of the early stage of the proceedings and the particular nature of such claims. If proceedings have to be issued, a medical report must be attached to these proceedings. However, if necessary after proceedings have commenced and with the permission of the court, the parties may obtain further expert reports. It would be for the court to decide whether the costs of more than one expert's report should be recoverable.
Bill Braithwaite QC (Brain and Spine Injuries: The Fight For Justice, 2001) notes that experts by habit tend to produce apparently one sided reports, which can be counter-productive. One side effect of lawyers instructing one expert jointly may be that these reports become more neutral. Brain and spine injury is one area in which he feels there are many consultants who are well placed to be single independent experts.
John Sheath (Clinical Negligence Claims (8.35) in Goldrein, de Haas & Frenkel: Personal Injury Major Claims Handling: Cost Effective Case Management, 2000) notes that provided liability and causation have already been resolved, or else dealt with by different independent experts, joint instruction of a single expert is 'the modern common sense approach'. But he cautions in cerebral palsy (CP) cases, while money can be saved by joint instruction in relation to the therapists, there is still a need for independent paediatric neurologist's report because of life expectancy / multiplier considerations.
RESOURCES ON CASE MANAGEMENT
Publications
C.A. Glass: Spinal Cord Injury: Impact and Coping
(British Psychological Society, 1999) ISBN 1 85433 301 1 pbk 167pp.
Aimed at recently qualified staff from all disciplines. Although using terminology of 'keyworker'/'named nurse', what it describes is case management, albeit not much community based given its acute bias.
Julia Twigg: Bathing - the Body and Community Care
(Routledge London 2000 230pp ISBN 0 415 20420 8 hbk 0 415 20421 6 pbk) £15-99 pbk
The book draws on the body, the cultures of bathing, management of personal care, spatial and temporal ordering of care, medical and social boundaries and rationalisation, employment of careworkers, bodywork, emotional labour and power dynamics.
Though bolstered by impeccable sociological and cultural research, Twigg never lets her book get bogged down in statistics, anecdote or jargon. She succeeds in cutting a clear path and a touching message - stop, think, and do as you would be done by. This should be compulsory reading for anyone who invades someone's space for a living, and for anyone who employs them.
A.R. Crossman & D. Neary: Neuroanatomy
(Churchill Livingstone 2nd edn 2000) ISBN 0443 06216 1 (pbk 189pp £19-95)
By a mile the biggest, cheapest, most colourful, up-to-date and gory tour through your central nervous system, and many a medical student's best friend. This tells you what it is, where it is, what it looks like in and out of your head and what clinical consequences its absence has.
Laura Middleton: The Art of Assessment - practitioner's guide
(Venture Press, Birmingham 1997 pbk 76pp ISBN 1 873878 87 7)
Middleton is Head of Social Work at UCL Preston. She deals with (1) What is assessment? (2) The dynamics of need, demand, special need (3) Organisational agendas (4) Interagency work (5) Good and bad assessment (6) Professional and management issues
Jacki Pritchard (Ed.): Good Practice with Vulnerable Adults
(Jessica Langley 2001) ISBN 1-85302-982-3 pbk 318pp. £22-50
Aimed at social care workers, relentlessly practical from real-life situations dealing with abuse. Steve Kirkpatrick's tips on interviewing (or not) from a police perspective are particularly useful. The Good Practice series also includes violence, counselling, risk management, supervision and child protection.
BSRM & RCP: Rehabilitation following acquired brain injury - national clinical guidelines
The NICE guidelines in June 2003 dealt with the first 48 hours after head injury. The BSRM and RCP guidelines (published December 2003) set out standards in post-acute rehabilitation and long term care.
Available from RCP Publications Department tel. 020 7935 1174 ext 358 at £16 inc p&p UK or £18 overseas. 84 pages. ISBN 1 86016 164 4
www.rcplondon.ac.uk
CBIT
Following 2003's publication of High & Dry - living with ABI in Northern Ireland, the Children's Brain Injury Trust (CBIT) has published Scotland's Invisible Children - acquired brain injury revealed. Also downloadable since their launch at the Plymouth conference in July 2004 are Learning From The Experts, four leaflets by young people: (1) Intro (2) Fatigue (3) Memory - at home (4) Memory - at school.
www.cbituk.org
Assessment of Mental Capacity
The BMA and Law Society 'little blue book' has had a second edition, including the MB tests for medical treatment and the Masterman-Lister guidelines for finances. Also chapters on litigation, contracts, voting, family and sexual relationships, and research. An indispensable guide, equally helpful for case managers.
BMJ Books London £12-95 ISBN 0 7279 1671 8
My Dad's Had A Brain Injury
Headway has published a second edition of Katie Field's work, edited by Debbie Clarke and revised by Holywell School Loughborough.
(Headway 2nd edn 2004 £4 ISBN 1 873889 44 5)
www.headway.org.uk
Hugh Marriott: The Selfish Pig's Guide to Caring
(Polperro Heritage Press Clifton-upon-Teme Worcs 2nd edn 2004) 352pp pbk £9-95 ISBN 09544233-1-3
Unreservedly recommended guide for reluctant carers by reluctant carer, with chapters including Burnout, Afterwards, Give Me A Break, and Pushing Them Down The Stairs. There are also extremely critical real-life responses to all those books (for pros) on lifting and handling, and (for significant others) on stress - and respite. It'll even advise carers on how to deal with you - so you might want to read it first.
CASE MANAGEMENT PRACTICE
World
The Case Management Society of America (CMSA) hosts an annual conference and annual CM awards (Case Manager of the Year, Award of Service Excellence). Its view is 'Case management is not a profession in itself, but an area of practice within one's profession.' Its overseas division, CMS International, has affiliates in Africa, Australia, Hong Kong and Spain, as well as the UK.
www.cmsa.org
The American Case Management Association (ACMA) and National Institute for Case Management (NICM) Inc. have a joint annual conference and meeting. Both focus on clinical case management (CCM) based in hospital and health systems. Previous years' topics have included: workplace violence; taking care of yourself; hiring the right people; legal issues in CM; CM and documentation integrity; managing difficult patient provider relationships; denial management; and measuring outcomes from a patient's perspective.
www.acmaweb.org
www.nicminc.net
The Case Management Society of Australia (CMSA) also has an annual conference and publishes the Australian Journal of Case Management, again largely health-based. Previous subjects has included: case managers and case load; supporting innovation in CM; conflict resolution; reviewing national standards of practice for case managers.
www.cmsa.org.au
Also in the US Catherine Mullahy and Deborah Jensen have published a third edition of The Case Manager's Handbook (ISBN 0763731889) Jones & Bartlett 3rd edn 2004 751pp cloth $65.95 plus CD-ROM with 40 forms (ISBN 0763732451) $21.95
UK
Tom McMillan & Mike Oddy (Service provision for social disability and handicap after acquired brain injury. In Wood & McMillan (Eds): Neurobehavioural Disability and Social Handicap Following Traumatic Brain Injury (Psychology Press 2001 ISBN 0 86377 889 5 hbk 315pp £39-95)) note in the UK brain injury case managers began to appear late 1980s with a role (wrongly) likened to social workers or key workers. In general terms the Griffiths Report (1988) recommended case management as a co-ordinating tool for community services. Whereas there is evidence in improving service provision and reducing costs of care and time off work, there have been few studies in brain injury. Greenwood.(1994) reported a controlled study of case management versus routine services in severe head injured patients followed up for up to two years. The case-managed group received more services, but outcome was not improved. The authors conclude that brain injury case management is not recommended as a routine NHS service, but that independent case management of specific individuals with severe and complex disablements is likely to be helpful.
The British Society of Rehabilitation Medicine (Rehabilitation After Traumatic Brain Injury, 1998, no ISBN) also noted the Greenwood study and observed that effectiveness of case management probably could not be proved because there were too few community services available to make any significant impact on the patients referred to the case manager.
The National Traumatic Brain Injury Study (Warwick University 1998, no ISBN) noted that case management was first 'hailed as the way forward' by Dixon (Case management issues and practices in head injury rehabilitation. Rehabilitation Counselling Bulletin 31: 325-343, 1988) and McMillan (An introduction to the concept of head injury case management with respect to the need for service provision. Clinical Rehabilitation2: 319-322, 1988), but then 'denigrated' by Greenwood (Effects of case management after severe head injury. British Medical Journal308: 1199-1205, 1994) which found early case management ineffective in quality of rehabilitation, family burden, client independence and return to work. However, it commented that the patients were unmatched and the case managed group were more severely injured than the control group, who achieved slightly better outcomes. Further, the study did not evaluated long term outcomes, thirty-one case managed clients being followed up for two years and twenty-five for less time. The NTBIS found it was precisely in the longer term, when other disciplines have discharged the client, that the monitoring a case manager provides becomes especially valuable.
|
