'Advice, not orders’? The evolving legal status of clinical guidelines

Healthcare professionals are expected to deliver care that is consistent with clinical guidelines. In this article, we show that the English courts are increasingly willing to be persuaded by written guidelines when determining the standard of care in cases of alleged clinical negligence. This reflects a wider shift in the approach taken by courts in a number of common law jurisdictions around the world. However, we argue that written guidelines are still only one element that courts should consider when determining the standard of care. It is possible to deliver perfect care that deviates from professional guidelines and even to deliver negligent care by uncritically following a guideline that is flawed. We further argue that written guidelines are relevant beyond defining the accepted standard of care. This is because the decision to deviate from a guideline suggests the existence of multiple approaches that should be discussed with patients as part of ensuring informed consent. It is therefore likely that written guidelines will become an even more prominent feature of the medicolegal landscape in future years

How should individual older people represent their interests to government?

SIGLEGBUnited Kingdo

A stronger voice for older people

SIGLEAvailable from British Library Document Supply Centre-DSC:1087.117(5th) / BLDSC - British Library Document Supply CentreGBUnited Kingdo

Carers' Perspectives on their Needs and Local Authority Occupational Therapy Practice

Unpaid family carers are the main providers of care for older people in the community. Local authority occupational therapists are required by law to assess the needs of such carers in their work, targeting their interventions to support carers' roles. This small qualitative study identified the perceived needs of nine family carers of adults with physical disabilities in one English county, exploring the extent to which these needs were met by local authority occupational therapists. Data were collected from semi-structured qualitative interviews with nine family carers. These interviews were transcribed verbatim and analysed using elements of grounded theory methodology. Six varied categories of carers' needs emerged. Occupational therapists met the participants' needs for practical assistance and information, but not for respite or financial assistance. Regarding support network issues, the participants reported poorly integrated community services and little initial awareness of occupational therapy. Once seen by an occupational therapist, however, they wished to remain 'on file' to gain instant access to a valued source of support. The recommendations made include the generation of family carer targeted occupational therapy information resources, ongoing therapist liaison to raise general practitioners' familiarity with local service provision and additional research.</p