Compliance [権利擁護]
Compliance
大辞泉
１ 要求や命令への服従。
法令遵守。特に、企業がルールに従って公正・公平に業務を遂行すること。
服薬遵守。処方された薬を指示どおりに服用すること。
２ 外力が加えられたときの物質の弾力性やたわみ強度。
とある
だが、日本文化はComplianceを「自主規制」と解釈しがち
だから硬直化する
http://twitter.com/#!/search/%23Compliance
大辞泉
１ 要求や命令への服従。
法令遵守。特に、企業がルールに従って公正・公平に業務を遂行すること。
服薬遵守。処方された薬を指示どおりに服用すること。
２ 外力が加えられたときの物質の弾力性やたわみ強度。
とある
だが、日本文化はComplianceを「自主規制」と解釈しがち
だから硬直化する
http://twitter.com/#!/search/%23Compliance
Ministry of Health and Welfare: A Nursing Home's Perspective [権利擁護]
Ministry of Health and Welfare: A Nursing Home's Perspective
By Takahashi Ken-ichi, Director of the Cattleya Public Nursing Home
A complete audit of nursing home residents?
In September 1992, I wrote an article for a specialty publication criticizing the Ministry of Health and Welfare's paper entitled "Guiding and Auditing Welfare Facilities for the Elderly. The ministry document included a heading called "Policy Formulation for Individual Entitlements," to become mandatory for all residents of public nursing homes. In my article I pointed out that it is dangerous if the government records, evaluates, and plans the lives of individuals.
The article included the following passage: "It is possible to audit the flow of money by collating various ledgers and receipts. Auditing people's lives with documents, however, is not a practical idea. [What they are planning] is to apply the concept of balance sheets (policy on individual entitlements, minutes of entitlement evaluation meetings) onto dossiers of people's lives (i.e., case records), in order to audit whether results show a profit or loss (in terms of the effectiveness of rehabilitation, effectiveness of ADL, intelligence evaluation scales)."
Now I must revise this statement. It is NOT possible to determine the crucial flow of money under audits carried out according to Ministry of Health and Welfare guidelines. And I would like to add that those in most need of "Policy Formulation for Individual Entitlements" are none other than the civil servants themselves.
A royal inspection, complete with courtier
In 1993, when the critique was published, the public nursing home at which I am employed was, by "coincidence," subjected to an audit by the Ministry of Health and Welfare (under normal circumstances, the prefectural authorities come for an audit every year). You do not know how worrying it can be to have every corner of your ledgers examined unless you've experienced it. Unlike a certain welfare group currently in trouble for collusion with ministry officials, there was nothing to fear at the home I work at, but even a slight mistake in office procedures would have led to disaster.
In any event, the ministerial audit went without a hitch. But my attention was on something other than the audit itself.
During the two-day audits, an official from the prefectural government accompanied the ministry auditor. An official car provided by the prefectural government is used for transportation. What I found strange is that throughout the audit, from morning till evening, the prefectural official spent the entire day waiting in the car (buses and taxis are available in the vicinity of the home). Meanwhile, I have to make do with a constrained budget and stretch my personnel resources to the limit. On the ground we are "busy enough to wish the cat could help" (as the saying goes), bathing our residents, taking care of their toilet, and feeding everyone. All that time, the prefectural official in charge of driving does nothing all day except wait for the official from the Ministry of Health and Welfare. Prefectural taxes are being used just for waiting. It's not as if a foreign dignitary is visiting -- is a civil servant from the national government that much a VIP?
I think this sort of thing, like wining and dining, amounts to a gift of complimentary services between government officials. I cannot help but think that an extension of this attitude results in the use of food budgets for paid entertainment. How frustrating it was to be instructed on the correct use of taxes (the budget for the nursing home) by people for whom such practices are the norm.
Thwarting visits from officials on the ground
1993. In this year, local governments across the nation were formulating and announcing regional welfare plans for the elderly, tailored to local characteristics, and based on the Gold Plan, said to have been promoted by Administrative Vice Minister Okamitsu Nobuharu, who was arrested on suspicion of having taken bribes. The new welfare plans were better compared to the earlier plans, because they included detailed targets and deadlines, such as nursing homes and day-care centers to be built by 1999, or the number of staff to be hired. "The Ministry is serious this time." This was the impression, and people on the ground worked with heightened intensity.
At the time, I was assigned as associate editor of a publication specializing in welfare for the elderly. Together with staff from public nursing homes, I devised a feature along the lines of "working staff -- not some prominent person -- visiting and discussing their vision with ministry officials, who work so hard to improve welfare for us citizens." The publication's management negotiated with the ministry, and everything was ready. Pages were reserved, staff chosen for the visit, and even the schedule was finalized. Yet immediately prior to the interview, the ministry canceled.
Apparently, when the issue reached the higher echelons of the ministry, it was shelved out of "a danger of causing misunderstandings." I can only think that the Ministry of Health and Welfare wants to exist on a higher plane than mere mortals. They come to audit, clad in the armor of authority, but they don't even allow visits by staff on the ground.
Authoritarianism instills helplessness in citizens
I admit that this episode is a personal and trivial matter. But for me, an official of a nursing home, it was a significant event. And that is, in fact, the crux of the issue. Citizens accumulate numerous experiences of such small incidents, and start to believe they are powerless -- and consequently become convinced that they will suffer if they give their straight opinion. In the end they give up even trying. I submit that herein lie the origins of the breeding ground for momentous crimes such as the tainted blood products scandal. It is because those in authority are aware of the imposing power of their authority that they do such things as hiding evidence the way they did, treating, in effect, patients and citizens with contempt.
Guilt by association
It should be said that this culture of snubbing citizens is not limited to bureaucrats of the Ministry of Health and Welfare. A public nursing home is run on public funds (taxes). My salary comes from those funds. Ministry officials and the staff of a public nursing home can thus be said to be, from a citizen's standpoint, in the same position.
I sometimes think that the staff of public nursing homes, myself included, have a similarly contemptuous attitude toward residents. In other words, clad in the armor of the closed nature of residential homes and a false idea of perfection, we force our good intentions on the residents and do not criticize ourselves. I do, of course, try to be as self-recriminating as possible.
It would seem, however, from the permeation of such an attitude to the very ends of the tendrils of the welfare apparatus that it could well be because each and every worker in the welfare industry is tightly tied down by the absolute authority of the ministry. In reality, under the current system, the principle job of the regional governments is to constantly gauge the ministry's disposition. To be quite honest, as someone who daily struggles to make ends meet under a tight budget, I sometimes let my fancy envisage a thick connection with the ministry. If the official on the other end (a ministry official) had been so inclined, I myself could have ended up a perpetrator.
Empowerment for citizens
Ever since the recent corruption scandal in the Ministry of Health and Welfare became public, there have been calls for stricter moral standards among civil servants. But it is just too ridiculous if those calls come from politicians, who are cut from the same cloth. I can't help but think that, no matter how much you call for stricter ethics, all that happens is that straight arrows become even more rigid than heretofore and premeditated criminals just become more wily.
In conclusion, I believe empowerment of citizens is essential in changing the current situation of welfare administration. There have been calls for public disclosure of information. For example, even when determining bids for individual nursing contracts, it is necessary to have the right to know what processes determined the decision and with whom the responsibility lies, i.e., who made the decision according to what criteria. And each and every citizen must be guaranteed the right to voice objections. The true value of disclosure lies in whether or not citizens can exert external pressure on the administration. Whether it be the national government or a worker dispatched by a public nursing home, each and every citizen must be able to protest deplorable occurrences that affect him or her, to express what he or she wants to have happen, and to investigate the outcome. Collectively, all this will lead to changes in welfare, as well as society.
Moreover, only when the transparency of the approval process is guaranteed can I live free of the fear of being told, "We trash requests from a facility run by someone who writes stuff like this."
12/30/96
By Takahashi Ken-ichi, Director of the Cattleya Public Nursing Home
A complete audit of nursing home residents?
In September 1992, I wrote an article for a specialty publication criticizing the Ministry of Health and Welfare's paper entitled "Guiding and Auditing Welfare Facilities for the Elderly. The ministry document included a heading called "Policy Formulation for Individual Entitlements," to become mandatory for all residents of public nursing homes. In my article I pointed out that it is dangerous if the government records, evaluates, and plans the lives of individuals.
The article included the following passage: "It is possible to audit the flow of money by collating various ledgers and receipts. Auditing people's lives with documents, however, is not a practical idea. [What they are planning] is to apply the concept of balance sheets (policy on individual entitlements, minutes of entitlement evaluation meetings) onto dossiers of people's lives (i.e., case records), in order to audit whether results show a profit or loss (in terms of the effectiveness of rehabilitation, effectiveness of ADL, intelligence evaluation scales)."
Now I must revise this statement. It is NOT possible to determine the crucial flow of money under audits carried out according to Ministry of Health and Welfare guidelines. And I would like to add that those in most need of "Policy Formulation for Individual Entitlements" are none other than the civil servants themselves.
A royal inspection, complete with courtier
In 1993, when the critique was published, the public nursing home at which I am employed was, by "coincidence," subjected to an audit by the Ministry of Health and Welfare (under normal circumstances, the prefectural authorities come for an audit every year). You do not know how worrying it can be to have every corner of your ledgers examined unless you've experienced it. Unlike a certain welfare group currently in trouble for collusion with ministry officials, there was nothing to fear at the home I work at, but even a slight mistake in office procedures would have led to disaster.
In any event, the ministerial audit went without a hitch. But my attention was on something other than the audit itself.
During the two-day audits, an official from the prefectural government accompanied the ministry auditor. An official car provided by the prefectural government is used for transportation. What I found strange is that throughout the audit, from morning till evening, the prefectural official spent the entire day waiting in the car (buses and taxis are available in the vicinity of the home). Meanwhile, I have to make do with a constrained budget and stretch my personnel resources to the limit. On the ground we are "busy enough to wish the cat could help" (as the saying goes), bathing our residents, taking care of their toilet, and feeding everyone. All that time, the prefectural official in charge of driving does nothing all day except wait for the official from the Ministry of Health and Welfare. Prefectural taxes are being used just for waiting. It's not as if a foreign dignitary is visiting -- is a civil servant from the national government that much a VIP?
I think this sort of thing, like wining and dining, amounts to a gift of complimentary services between government officials. I cannot help but think that an extension of this attitude results in the use of food budgets for paid entertainment. How frustrating it was to be instructed on the correct use of taxes (the budget for the nursing home) by people for whom such practices are the norm.
Thwarting visits from officials on the ground
1993. In this year, local governments across the nation were formulating and announcing regional welfare plans for the elderly, tailored to local characteristics, and based on the Gold Plan, said to have been promoted by Administrative Vice Minister Okamitsu Nobuharu, who was arrested on suspicion of having taken bribes. The new welfare plans were better compared to the earlier plans, because they included detailed targets and deadlines, such as nursing homes and day-care centers to be built by 1999, or the number of staff to be hired. "The Ministry is serious this time." This was the impression, and people on the ground worked with heightened intensity.
At the time, I was assigned as associate editor of a publication specializing in welfare for the elderly. Together with staff from public nursing homes, I devised a feature along the lines of "working staff -- not some prominent person -- visiting and discussing their vision with ministry officials, who work so hard to improve welfare for us citizens." The publication's management negotiated with the ministry, and everything was ready. Pages were reserved, staff chosen for the visit, and even the schedule was finalized. Yet immediately prior to the interview, the ministry canceled.
Apparently, when the issue reached the higher echelons of the ministry, it was shelved out of "a danger of causing misunderstandings." I can only think that the Ministry of Health and Welfare wants to exist on a higher plane than mere mortals. They come to audit, clad in the armor of authority, but they don't even allow visits by staff on the ground.
Authoritarianism instills helplessness in citizens
I admit that this episode is a personal and trivial matter. But for me, an official of a nursing home, it was a significant event. And that is, in fact, the crux of the issue. Citizens accumulate numerous experiences of such small incidents, and start to believe they are powerless -- and consequently become convinced that they will suffer if they give their straight opinion. In the end they give up even trying. I submit that herein lie the origins of the breeding ground for momentous crimes such as the tainted blood products scandal. It is because those in authority are aware of the imposing power of their authority that they do such things as hiding evidence the way they did, treating, in effect, patients and citizens with contempt.
Guilt by association
It should be said that this culture of snubbing citizens is not limited to bureaucrats of the Ministry of Health and Welfare. A public nursing home is run on public funds (taxes). My salary comes from those funds. Ministry officials and the staff of a public nursing home can thus be said to be, from a citizen's standpoint, in the same position.
I sometimes think that the staff of public nursing homes, myself included, have a similarly contemptuous attitude toward residents. In other words, clad in the armor of the closed nature of residential homes and a false idea of perfection, we force our good intentions on the residents and do not criticize ourselves. I do, of course, try to be as self-recriminating as possible.
It would seem, however, from the permeation of such an attitude to the very ends of the tendrils of the welfare apparatus that it could well be because each and every worker in the welfare industry is tightly tied down by the absolute authority of the ministry. In reality, under the current system, the principle job of the regional governments is to constantly gauge the ministry's disposition. To be quite honest, as someone who daily struggles to make ends meet under a tight budget, I sometimes let my fancy envisage a thick connection with the ministry. If the official on the other end (a ministry official) had been so inclined, I myself could have ended up a perpetrator.
Empowerment for citizens
Ever since the recent corruption scandal in the Ministry of Health and Welfare became public, there have been calls for stricter moral standards among civil servants. But it is just too ridiculous if those calls come from politicians, who are cut from the same cloth. I can't help but think that, no matter how much you call for stricter ethics, all that happens is that straight arrows become even more rigid than heretofore and premeditated criminals just become more wily.
In conclusion, I believe empowerment of citizens is essential in changing the current situation of welfare administration. There have been calls for public disclosure of information. For example, even when determining bids for individual nursing contracts, it is necessary to have the right to know what processes determined the decision and with whom the responsibility lies, i.e., who made the decision according to what criteria. And each and every citizen must be guaranteed the right to voice objections. The true value of disclosure lies in whether or not citizens can exert external pressure on the administration. Whether it be the national government or a worker dispatched by a public nursing home, each and every citizen must be able to protest deplorable occurrences that affect him or her, to express what he or she wants to have happen, and to investigate the outcome. Collectively, all this will lead to changes in welfare, as well as society.
Moreover, only when the transparency of the approval process is guaranteed can I live free of the fear of being told, "We trash requests from a facility run by someone who writes stuff like this."
12/30/96
地域包括支援センターにおける権利擁護 [権利擁護]
2010年1月18日発行
NPO法人 湘南ふくしネットワークオンブズマン
「成年後見支援センターだより」
への寄稿文を掲載します
------------------------------------
特集「地域包括支援センターにおける権利擁護」
地域に必要な権利擁護とは何か
昨年（09年）の11月に、韓国の大学で開催された学術大会に招かれました。
テーマは、「高齢者長期療養保険制度のもとで高齢者福祉施設の実践的な問題と課題 〜高齢者福祉の現場の権利擁護を中心に〜」でした。
韓国は08年7月に、ドイツ、日本に次いで公的介護保険制度を導入しました。施行後1年を経過し、韓国の福祉分野の研究者や国家人権委員会の担当者も参加して今後の韓国福祉の権利擁護のありかたを探る学術大会でした。
湘南ふくしネットワーク（Sネット）理事長の高山さんの教え子でもある韓国の研究者がこの学術大会を開催準備をしたので、日本の福祉現場の実践者としてぼくを招いてくれたのでした。
その中でぼくは茅ヶ崎での実践例も報告しました。
茅ヶ崎市は2000年4月に日本の介護保険が導入された半年後に「茅ヶ崎市介護サービス相談員派遣事業」を全国でも先駆けて導入しました。この介護サービス相談員制度は介護保険導入の直前に、国会の委員会で「介護保険導入にはSネットのようなオンブズマンな相談活動が必要」だと審議され導入されたものです。ぼく自身も相談員派遣事業のスーパーバイザーを神奈川県に任命され厚木市を担当しているので、茅ヶ崎市や厚木市の現状を韓国で紹介しました。
また、茅ヶ崎市は「成年後見支援センター」も、08年から市とSネットの協同事業として市町村としては全国でも先駆けて発足させていることを紹介しました。
しかし、韓国の研究者は日本をよく研究していて、「社協の地域福祉権利擁護事業はどう機能していますか？」「地域包括支援センターにおける権利擁護は実際にはどのように役立っていますか？」と、報告後の質問の中で尋ねられました。正直、ぼくはドキリとしました。（通訳を通じてのやり取りなのでぼくの記憶に基づく内容を要約、補足しています）
社協の地域福祉権利擁護事業については、「実際にはお金の管理等が主に注目されており、本来の権利擁護のほんの一部分であること。」「判断能力が不十分な人に対してのサービスなのに、個人と社協との「契約」に最低限の契約能力が利用者に求められている点で矛盾をはらんでいて充分に活用されてるとは言えない」
また地域包括支援センターにおける権利擁護については、「地域包括の現場では、専門職たちは予防給付プランのルーティンワークに追われ社会福祉士としての専門性をなかなか発揮出来ないのが現状だ。」
「しかし、そんな中、茅ヶ崎市の主催で茅ヶ崎市成年後見支援ネットワーク連絡協議会が隔月で開催され、市の高齢と障害担当、保健福祉事務所、社協、包括、障害系の相談センター、弁護士・社会福祉士・司法書士・行政書士等々の会の代表らが一同に顔を合わせて成年後見支援に関する具体な事例を共有する機会を持っている。そこで地域に必要な権利擁護とは何かが少しずつだが見えてきて来ている。これはとても貴重な実践だ。また茅ヶ崎市では地域包括の社会福祉士の虐待事例検討会に成年後見支援センターの相談員が隔月で参加し具体な対応例を共有している。」
海外に出て自分達の活動を説明する事は、今私たちが何をしているのかが鏡のように見えてきます。
茅ヶ崎市においても地域包括支援センターのありかたが再検討されています。優秀な専門職たちが権利擁護の専門性を充分発揮できる環境を整えるのは行政と市民の責任です。日本の権利擁護を、そして茅ヶ崎の実践も韓国の研究者達は注目しています。
NPO法人 湘南ふくしネットワークオンブズマン 公式サイト
http://www.npo-snet.com/
2010年1月18日発行 NPO法人 湘南ふくしネットワークオンブズマン
「成年後見支援センターだより」
http://www.npo-snet.com/kouhou/Wish05.pdf
（会場となった、ソウルサイバー大学 国際会議室）
2009年11月6日から8日
韓国に行ってきました
韓国版の介護保険(高齢者長期療養保険制度)の施行１年目ということもあり
ソウルサイバー大学の招きで
上記の学術大会で発表の機会をいただきました
NPO法人 湘南ふくしネットワークオンブズマン
「成年後見支援センターだより」
への寄稿文を掲載します
------------------------------------
特集「地域包括支援センターにおける権利擁護」
地域に必要な権利擁護とは何か
昨年（09年）の11月に、韓国の大学で開催された学術大会に招かれました。
テーマは、「高齢者長期療養保険制度のもとで高齢者福祉施設の実践的な問題と課題 〜高齢者福祉の現場の権利擁護を中心に〜」でした。
韓国は08年7月に、ドイツ、日本に次いで公的介護保険制度を導入しました。施行後1年を経過し、韓国の福祉分野の研究者や国家人権委員会の担当者も参加して今後の韓国福祉の権利擁護のありかたを探る学術大会でした。
湘南ふくしネットワーク（Sネット）理事長の高山さんの教え子でもある韓国の研究者がこの学術大会を開催準備をしたので、日本の福祉現場の実践者としてぼくを招いてくれたのでした。
その中でぼくは茅ヶ崎での実践例も報告しました。
茅ヶ崎市は2000年4月に日本の介護保険が導入された半年後に「茅ヶ崎市介護サービス相談員派遣事業」を全国でも先駆けて導入しました。この介護サービス相談員制度は介護保険導入の直前に、国会の委員会で「介護保険導入にはSネットのようなオンブズマンな相談活動が必要」だと審議され導入されたものです。ぼく自身も相談員派遣事業のスーパーバイザーを神奈川県に任命され厚木市を担当しているので、茅ヶ崎市や厚木市の現状を韓国で紹介しました。
また、茅ヶ崎市は「成年後見支援センター」も、08年から市とSネットの協同事業として市町村としては全国でも先駆けて発足させていることを紹介しました。
しかし、韓国の研究者は日本をよく研究していて、「社協の地域福祉権利擁護事業はどう機能していますか？」「地域包括支援センターにおける権利擁護は実際にはどのように役立っていますか？」と、報告後の質問の中で尋ねられました。正直、ぼくはドキリとしました。（通訳を通じてのやり取りなのでぼくの記憶に基づく内容を要約、補足しています）
社協の地域福祉権利擁護事業については、「実際にはお金の管理等が主に注目されており、本来の権利擁護のほんの一部分であること。」「判断能力が不十分な人に対してのサービスなのに、個人と社協との「契約」に最低限の契約能力が利用者に求められている点で矛盾をはらんでいて充分に活用されてるとは言えない」
また地域包括支援センターにおける権利擁護については、「地域包括の現場では、専門職たちは予防給付プランのルーティンワークに追われ社会福祉士としての専門性をなかなか発揮出来ないのが現状だ。」
「しかし、そんな中、茅ヶ崎市の主催で茅ヶ崎市成年後見支援ネットワーク連絡協議会が隔月で開催され、市の高齢と障害担当、保健福祉事務所、社協、包括、障害系の相談センター、弁護士・社会福祉士・司法書士・行政書士等々の会の代表らが一同に顔を合わせて成年後見支援に関する具体な事例を共有する機会を持っている。そこで地域に必要な権利擁護とは何かが少しずつだが見えてきて来ている。これはとても貴重な実践だ。また茅ヶ崎市では地域包括の社会福祉士の虐待事例検討会に成年後見支援センターの相談員が隔月で参加し具体な対応例を共有している。」
海外に出て自分達の活動を説明する事は、今私たちが何をしているのかが鏡のように見えてきます。
茅ヶ崎市においても地域包括支援センターのありかたが再検討されています。優秀な専門職たちが権利擁護の専門性を充分発揮できる環境を整えるのは行政と市民の責任です。日本の権利擁護を、そして茅ヶ崎の実践も韓国の研究者達は注目しています。
NPO法人 湘南ふくしネットワークオンブズマン 公式サイト
http://www.npo-snet.com/
2010年1月18日発行 NPO法人 湘南ふくしネットワークオンブズマン
「成年後見支援センターだより」
http://www.npo-snet.com/kouhou/Wish05.pdf
（会場となった、ソウルサイバー大学 国際会議室）
2009年11月6日から8日
韓国に行ってきました
韓国版の介護保険(高齢者長期療養保険制度)の施行１年目ということもあり
ソウルサイバー大学の招きで
上記の学術大会で発表の機会をいただきました
