Signatures: Patient* and professional get engaged

These days signatures are a prime time issue.

For personal, professional, business, political and electronic accountability the dotted line in one shape or form still rules. In health and social care there's another signature that contributes to security and certainty: the relapse signature. Whether you see this as stark pessimism or realism there's no doubting its ... erm ... significance.

Relapse is an unfortunate prospect across the care spectrum, but especially for people with severe and enduring mental health problems and those with long-term medical conditions [LTMC]. For these people and their families the risk of relapse is a fact of life. As new health and employment policy encourages people to return to work, employers are affected too.

Health economists and commissioners of care recognise how in the UK of about 17 million people living with LTMC, just 2% of them account for 30% of unplanned hospital admissions. [Carlisle, D. (2006) Predicting the Future, HSJ, 2 Nov. p.24-26] Add to a LTMC a mental health problem (very likely!) and you have a mega care 'transaction' with multiple signatories involved.

If you listen carefully you'll hear the arrows whiz by towards the financial targets that follow.

Hodges' model can help target those arrows and assist with in-flight corrections across the care spectrum, especially when staying-well needs to be emphasised and enhanced. This does not mean you pull a flip chart or laptop from your pocket and commence a presentation on the model. If engagement at this point is rather like paddling up-river, then h2cm can help you navigate and locate the best channel for communication. If family and carers are also on-board that is great. Together, you can map the physical, emotional, social and service aspects of a previous crisis. Alternately, you can anticipate future difficulties in each of the care domains, identify and agree courses of actions and solutions were possible.

Nurses have a penchant for injections and - increasingly - prescribing. There is also the matter of how best to deliver and reinforce social and information prescriptions? So inject some realism by having the participants use their imagination. Given events last year are x and y really likely at 02:30 AM? There are several benefits in using Hodges' model:

• Using the model can help both internalise and externalise problems and solutions -

patient: "This is my fault!"
carer: "I can cope with this myself."

• Formal arrangements, documents and agreements can follow this global yet gentle introduction.
• The model can capture physical signs and symptoms, side-effects, interpersonal and behavioural changes.
• Strengths & Weaknesses: Pros & Cons, Warning Signs.
  
• Outline plans, actions for X,Y,Z ...
• Share expectations.
• Service coverage 24 hours?, alternatives. Respite provision.
  
• This is not about you the professional (or volunteer!) displaying your knowledge, the patient and family are the experts.
• Even though you set boundaries on the session (time, objectives, 'taboo topics - for another time & place' ...), you may be surprised by what the four+ care domains help reveal for future reference and benefit. (This also extends to palliative care, where relatives and carers needs are further emphasised.)
  
• If the patient and family struggle to understand h2cm, don't forget you can still use the model as a guide, an aide mémoire.
• And OK flip chart paper would help! ...
  

Now, if you can please sign here ............................... confirming this message received:
it's over to you - and make that care count!

*And carers too of course.