- learn about the conceptual framework Hodges' model. A tool that can help integrate HEALTH and SOCIAL CARE, INFORMATICS and EDUCATION. The model is situated, facilitates person-centredness, integrated - holistic care and reflective practice. A new site using Drupal is an ongoing aim - the creation of a reflective workbench. Email: h2cmng @ yahoo.co.uk Welcome

Sunday, July 31, 2011

Department of Health tackles shortfall of Personal Assistants

Source: Department of Health, 27 July 2011

Plans to make it easier for people with disabilities to employ Personal Assistants to help them to live as full a life as possible were revealed today by Care Services Minister Paul Burstow.

A Framework for Personal Assistants helps offer universal support for people with care needs as well as the PAs they employ. It maintains the flexibility of the role, which makes them so vital in helping people with disabilities to live their lives and aims to increase the number of PAs available.

Research shows that those receiving payments can be nervous about becoming an employer and the lack of a clear, universal job description can be a barrier to those considering joining the profession.

The publication is part of the personalisation agenda at the heart of the Government's Vision for Adult Social Care to deliver services chosen by people to meet their individual needs. By 2013, everyone eligible should be offered a personal budget to spend on the best care package for them. It is estimated that by 2025 this could create nearly 1.2 million Personal Assistant jobs - there are currently less than 200,000 people working as Personal Assistants in England.

Care Services Minister Paul Burstow said:

"Many company executives would describe their PA as a life-saver, but for those who employ a personal assistant for their social care needs, they really do give them back their life. Being able to set the job description spelling out exactly what support you need and when, can be liberating. It's much better than trying to fit your life around Local Authority-commissioned services.

"I've seen today in Essex what can be achieved when social services work together with people who need personal assistants to make sure both they and their PA are fully supported. The difference it has made to these peoples' lives is a clear reminder of why personalisation is so important and is at the heart of our plans for social care."
The new framework will:
  • Provide employers with an up to date toolkit to make the practical side of employment easier to understand including job descriptions and interviewing;
  • Develop an induction framework so all PAs have the same basic introduction to the role based on the Common Induction Standards developed by Skills for Care;
  • Create a clear, national toolkit including templates for contracts and other legal aspects of employment. This will be regularly reviewed and updated;
Use Local Authorities to assist in background and reference checking where requested; and Work with Job Centre Plus to make all staff aware of PAs as a career option for job seekers. In some areas employers and PAs already receive all this support and more - but it isn't the norm. This Framework will also look to help share best practice so everyone has access to the same information and support.

Paul Burstow, this morning, visited ecdp (formerly Essex Coalition of Disabled People), a disabled person's user-led organisation which offers a high level of support to people employing Personal Assistants including a full payroll service and access to training and development opportunities for Personal Assistants. They currently support nearly 4,000 people to employ personal assistants.

Anyone looking for information or support on hiring or becoming a Personal Assistant should visit the link below.

The Personal Assistants Framework ...

The Vision for Adult Social Care ...

My source:
The Choice Forum - the Foundation for People with Learning Disabilities http://www.learningdisabilities.org.uk

PJ: Personal Assistants will also benefit from a conceptual framework around which to ground their lifelong learning. I do hope another conference will be organised that might provide an opportunity to highlight the relevance of Hodges' model to Personal Assistants in social care, Asst. Practitioners and Support Workers.

Wednesday, July 27, 2011

my notes (1) Public 2.0 Culture, Creativity and Audience in an Era of Information Openness

This one-day conference at University of Westminster last Thursday was well worthwhile. On the Wednesday afternoon I visited the Saatchi Gallery. On the way there on the King's Road I could not walk past the Peter Jones store. I have not added a link: competition! ;-)

At Public 2.0 there was just over 50 people from a mix of backgrounds.

To begin there were introductions by Tom Corby (conference convener, artist, academic and writer working at the University of Westminster), David Gauntlett (writes and teaches on how digital media gives people new opportunities to create and connect) and Ian Forrester (Senior Producer at BBC R&D and emergent technology expert). In my notes I have scribbled mutualization in mainstream media, datasets and the consumption of the same which I believe David raised.

Ian shared some personal experiences of his engagement with health services that prompted his reflections on the volume of data that hospitals must process. He made the key point that data drives informatics. At the end of the day it is about data not informatics and moving from data to paths and trends.

Ian's presentation made me feel instantly part of the mix. He raised the ongoing conundrum for would-be e-health services of public vs. private data and how some things are kept private.

Picking up on his health emphasis at questions I asked for his thoughts on the demise of Google Health. His response noted how Google seeks to 'disrupt' market sectors to initiate change. Obviously health is something that really is very personal. (Health is clearly complex and cussed even for global enterprises too.)

Ian spoke of how public data has strange effects - with over-sharing:


Another question had Ian identify the need for a personalised engagement tool. Something that is labelled "my data" and facilitates data portability. The personalised aspect to this once again shows the health links. This issue recognised generally is also about empowerment, data ownership and the ability to disengage should people so choose.

I've missed a trick just learning of Quantified Self (busy trying to quantify other people - qualify too). Must look into this.

Ian also pointed us to a forthcoming BarCamp in Manchester hosted by the BBC.

Friday, July 22, 2011

Nurses & Social Media - mise en scène

... health on the thrust stage

From: Wordsmith.org
1. The setting of a scene in a play, movie, etc.
2. The setting or background of an event.

From French mise en scène, literally "put on stage".
The health care domains model provides a 2 x 2 stage.

It may be a conceptual stage, but it is nonetheless demanding. It demands we perform the translation from theory to practice and check constantly exactly where we are AND where we need to be.

Should we become so ill that hospital treatment is needed the dependency and the sense of vulnerability this provokes often makes us feel that we are 'performing'. Not only that but as a  patient we find our selves on a thrust stage. When illness strikes it seems we are surrounded by this audience of clinicians who can potentially see us from all angles and be privy to very personal information about us.

The demands cut both ways though. Modern health care IS collaborative. Stagecraft here then means there should be minimal furniture and scenery to hide behind. Strange then that in terms of personalised care background details really do matter.

So, everyone matters. Teamwork counts. We try to keep patients off the stage. Patients and carers as expert carewrights may already know their lines - they can teach us. Suddenly everyone is an actor. Suddenly all the players must pass by way of the vomitory and the responsibilities that passage demands. On this stage care also needs to be exercised as per the direction of the NMC.

Original image source:

Tuesday, July 19, 2011

Nursing, history and (future) travels

From: Stu Young c/o Facebook, Royal College of Nursing Students, 3:28pm Jul 19

Dear All,

Please look up the "Mary Seacole Memorial Statue Appeal" page on facebook it has moved to a new page, please support this cause for a nurse often forgotten by history.

Mary Seacole Memorial Statue Appeal

Mary Seacole born in Jamaica in 1805, died in London 14th May 1881: Jamaican / Scottish nurse, doctres.


PJ: The other week I took my mother and aunt to Tywyn, Wales to trace family history and meet some friends. On the way back we stopped in Bala. I had heard of another nurse and a bookshop reminded me: Elizabeth Cadwaladr - with a movement for another memorial.

The lady in the shop explained the way to Betsy Cadwaladyr's home. That's a walk for the next trip.

UK Centre for the History of Nursing and Midwifery (disbanded 2018)

RCN: History of Nursing Society community

Monday, July 18, 2011

c/o BBC Radio 4: Emergency Foods - the very youngest-vulnerable and eldest

Food is the commodity after water that so many of us are able to take for granted. At the moment in the Horn of Africa a famine is raging. BBC Radio 4's Food Programme this week deals with Emergency Food. This provides great insight into the infrastructures, communications, technologies and developments that are being brought to respond to such crises. This programme takes us beyond the images of sacks being dropped by air, supplies being delivered by truck; chaotic situations that also demand crowd control to the actual foods, their form and content.

For nurses nutrition is a key element on the curriculum, a routine part of ward / community assessment and care delivery. Sadly meeting the nutritional needs of patients is a key nursing care activity that is the subject of marked criticism. How do you draw nurse's attention to nutrition beyond stating the obvious? How do you motivate students and assure competency is signed-off in that final year? Learning is a very personal thing what with self-directed study, lectures and blended learning ...  but it seems the emphasis on basic nursing care that includes nutrition can be lacking.

I know we can argue there is no comparison: the scale.
A few patients on a ward.
A country on the brink of famine - Somalia (BBC).

You know the real images that count: from rust coloured lands, the youngest skins and ravaged lands parched through to those infant's eyes that can still just wonder while so many others are closed.

I wonder if listening to this programme and reflecting on the very youngest-vulnerable might also help engage attention on the older-vulnerable - indeed all our patients?

Isn't increased awareness of nutrition AND global health what 21st century nursing should be about?

DEC: http://www.dec.org.uk/

Wednesday, July 13, 2011

Healthcare USA* - Finance and the need for peripheral vision!

I came across this item on twitter c/o Gregg Masters - many thanks Gregg.

2011 Benchmarks in Accountable Care Organizations: Metrics from Early ACO Adopter

A key part of this is the chart below - which is copied below:

New Chart: Top 5 Challenges of ACO Creation
SUMMARY: Accountable care organizations (ACOs) create integrated delivery systems that encourage teams of physicians, hospitals and other providers to collaboratively coordinate care for ACO members. We wanted to see the biggest challenges organizations face in creating an ACO.

I keep coming up against and apologising for the fact of geography that puts me on the UK side of the Atlantic (it's the place I call 'home'), the NHS 'market' and the different ways health care is debated and framed with respect to finance. Basically 'P'rivate medicine and 'S'ocial medicine.

My perspective is limited, but the same applies to many people whether East, West, Private or Social and of course in reality things are never that cut and dried.

The reason I've picked this up though is three-fold:

Firstly, this post was found in the summary above and is wrapped up in the three words - integrated, collaboratively and coordinated - icc. Looks like we've got an ACO alright.

It is A Complex Organization.

The clue to the publication and survey is clearly vested in 'accountable', but in terms if icc where and with whom does accountability rest? No doubt accountability can - and must - be defined financially. What about the 'C'? When we think about 'care' - integration, collaboration and coordination there is a need to acknowledge and for me - reach out across the [h2cm's] humanistic axis.

Secondly, the graph 'speaks' volumes, but I wonder what I'm missing in not having the full copy? I wonder where the real human *care* factors are in this? If my colour vision is correct it would be worth checking the exact make-up of the 18% 'Other'.

Thirdly, I have a problem I admit. Residing in the UK working in the cocoon (and not so cosy at the moment) that is social medicine I see the US health care sector as a Matrix-like green ;-) haze of falling and tripping dollar signs - $$$ $$$. I know that's unfair as the N & S American continents are of course also fueled by those positives that charge and motivate health care workers the world over. In the chart though even when 'staff' are mentioned it's in terms of 'buy-in'. Yes it may be a cheap shot, but I'm versed in some dialects of consultancy speak...

There could be an account of the individual, nursing care, the therapeutic relationship, the quality of outcomes ... in the evidence-based care contribution 8%, but these days the search for evidence is fiscal too.

I just wonder here what might be lost in achieving integrated, collaborative and coordinated care if the people - the extended team - are lost amid the finance? Sometimes to see we need to rely on peripheral vision too. In fact it's a bit like looking down a telescope to 'see' you have to look off-center. If financial accountability is what colours your health care world, don't forget to avert your vision and take in the black and the white.

With no prospect of a 'study tour' (a scratch of the surface) there is much I need to learn of the organizational systems, commissioning and finance of health - not just in the USA, but here in the UK.

*These issues apply globally.

Saturday, July 09, 2011

Learning to pee and poo (again!)

I did not have to learn to pee and poo - you could say it came naturally.

My apologies: I know this is not the way to engage people, but believe me there is an issue in this waste-land.

Loving parents, guardians, and baby sitters the world over come to the rescue of hygiene, skin care and the quality of environmental aroma tending to the nappy / diaper changing when we are babies. Family pride counts too in place of the yet to be gained person-al sense of dignity.

We all (well the vast majority of us) have the potty training tee-shirt - even if at the time we were illiterate (an amazing woman this Mother Nature). I've also experienced potty training - the ups, downs and spills with my three children. It really is magic seeing them gain that control and independence.

When I was a student nurse hygiene, skin care, privacy and dignity were constantly stressed. These were a measure of the standard and quality of nursing care. It was the one thing around which continuity of care was built. We don't usually think of care continuity in these basic terms, but there it is. While there is so much that can divide ward / care shifts, day and night staff here was something that indicated performance, or the lack of it. Obviously enough, it was closely associated with continence and toileting.

Over the past decade and more we have all noticed the many changes in nursing, social care and with it the use of continence pads. Not just as a stand-by, but a routine continence management device that saves staff time and pressure on the call alarms. If you are catheterized then plainly there is no need for the commode, or bed-pan.

Now it seems with i-pads (no pun intended) the same applies,
now the nurses say "use your pad"!

Amid the clamour for dignity and respect, personalised care, high quality nursing care the location and bounds of the political care domain are found. Nursing has changed with social care. Nursing duties have been contracted out of the profession, freeing nurses to nurse.

This past week in England the BBC reported: Ex-ballerina Elaine McDonald care ruling 'shameful'
Elaine McDonald, 68, took Kensington and Chelsea Council to court over its decision not to provide her with a night carer to help her use a commode.

The court ruled the council had acted lawfully in reviewing her care plan.
It seems many people are having to learn to pee and (perish the thought) poo again.
  • What is that like when you are not* 'on the toilet' and are fully oriented, have mental capacity?
  • What is it like when there are people around?
  • What is that like when you are on your own at 0100 hours and the carer's due at 0830-0900?
We know social care is an acknowledged mess. Dilnot has arrived.

For Elaine McDonald and others in her situation this is a special type of problem. It is a logistical, temporal, care-logic nightmare. Committing someone for a whole night for the sole purpose of toileting is hard to justify, but are there no compromises, no alternatives? Is there no pattern to discern? Does the Big Society - social enterprise not see an opportunity here? Care in the community never is the cheaper option. Are we discounting the value of mental health and the sense of well-being that will be an inevitable ('soul') casualty?

I must locate some resources on nursing reviews of continence - there must be several - reports, theses, guidelines, standards? The contexts in which this matters are legion. If you know of any please let me know (see right for contact details). At some future date I'll explore the dimensions of continence across the health care domains.

Attitudes to toileting are already impacting on nursing's status. Too posh too wash...

We know this speaks volumes and reflects upon what we describe as nursing and how we define nursing. 

But it goes much deeper than that -
not only does it represent how nursing is practised 
it reflects the very values that nursing must then take as its own -
that is nursing the profession.

*in a space suit - STS 135 space walk 12 July 2011 > 6 hours.

Image and story source:
BBC http://www.bbc.co.uk/news/uk-england-london-14042078

Friday, July 08, 2011

c/o HIFA2015 Press Release: BMJ Editorial calls on funding agencies to commit to Healthcare Information For All

Dear HIFA2015 colleagues,

Please find the Press Release below. The subject of the press release is an Editorial in the BMJ, calling for major funding agencies to commit to Healthcare Information For All by 2015.

The Editorial is freely available at: http://bit.ly/hifa2015-10

Please be sure to read the Editorial online and submit *your* comment to the BMJ (click on Rapid Response on the left side of the page). Your Rapid Response will be displayed on the BMJ website (after approval by the editors) and may be selected for publication in the print version of the BMJ. Thank you for your support.

We are informed that the Editorial itself will be in the print BMJ within the next few weeks.

Please distribute this message/press release widely to your contacts and networks!

Many thanks,
Neil Pakenham-Walsh
Coordinator, HIFA2015


BMJ Editorial calls on major funding agencies to commit to 'Healthcare Information For All by 2015'

London, UK, 5 July 2011 - Every day, tens of thousands of people die needlessly, particularly in low and middle income countries, often for the simple reason that the parent, carer or health worker lacks the information and knowledge they need to save them. An Editorial in the British Medical Journal by Richard Smith [1] and Tracey Pérez Koehlmoos [2,3] asks why a major funding agency has not yet come forward to support Healthcare Information For All by 2015 (HIFA2015) [4].

HIFA2015 ( www.hifa2015.org) is a global campaign and discussion forum. Its members range from senior executives at the World Health Organization in Geneva to community health workers in rural Uganda. Together they are working for the HIFA2015 goal: 'By 2015 every person worldwide will have access to an informed healthcare provider - lack of relevant, reliable healthcare information will no longer be a major contributor to avoidable death and suffering.' [5]. But progress has been constrained by lack of funding.

The Editorial states: "Funders are much keener to put money into drugs, vaccines, and bed nets than they are into something as nebulous as information access. Yet information and the capacity to act on that information is the first building block of an effective health system".

The Editorial concludes, "the best way forward would be for a major funder to recognise that improved health information is fundamental to global health improvement and development and offer substantial support, not just funds, to HIFA2015.".

HIFA2015 Coordinator, Dr Neil Pakenham-Walsh, welcomes the editorial saying "When we launched HIFA2015 in 2006, we knew our goal was ambitious, but we also knew it could be achieved if all stakeholders work together. All stakeholder groups are now working together and our work is expanding rapidly - what is needed now is financial support from a major funding agency. We repeat the call to the Gates Foundation and others made by international health leaders in The Lancet in 2006: "The challenge is to ensure that everyone in the world can have access to clean, clear, knowledge - a basic human right, and a public health need as important as access to clean, clear, water, and much more easily achievable."[6].

In keeping with the sentiments of the editorial, the BMJ has made this editorial freely available online. To access the full text simply visit


For further information or interview, please contact:

Neil Pakenham-Walsh, Coordinator HIFA2015, Co-director, Global Healthcare Information Network
neil.pakenham-walsh AT ghi-net.org

The authors of the Editorial have also kindly made themselves available for interview:

Richard Smith, Director, UnitedHealth Chronic Disease Initiative, UK
richardswsmith AT yahoo.co.uk

Tracey Koehlmoos, International Centre for Diarrhoeal Disease Research, Bangladesh
Tracey AT icddrb.org

Notes for Editors:

1. Richard Smith is the former editor of the British Medical Journal and is now director of the UnitedHealth Chronic Disease Initiative.
2. Tracey Koehlmoos is Head of the Health & Family Planning Systems Programme, ICDDR,B, Bangladesh & Adjunct Professor, Department of Health Administration and Policy, College of Health and Human Services, George Mason University, USA.
3. Further to discussion on the HIFA2015 forum, Richard Smith and Tracey Koehlmoos published an editorial in The Lancet (22 January 2011) which led to a reversal of Elsevier's decision to withdraw free access to medical journals in Bangladesh.
4. Healthcare Information for All by 2015 is the flagship project of Global Healthcare Information Network - a non-profit organisation based in the UK. HIFA2015 is a global campaign and discussion forum that brings together more than 5000 health professionals, information technologists, publishers, librarians, researchers and policymakers from over 2000 organisations in 158 countries worldwide. HIFA2015 is supported by organisations such as the British Medical Association, Royal College of Midwives and Royal College of Nursing.
5. To achieve its goal, HIFA2015 has developed a three pronged strategy based on communication (bringing together a critical mass of interested parties in five global e-mail forums), understanding (of information needs and how to meet them set out in a database of evidence), and advocacy (persuading governments, funding agencies, and others to invest in cost effective health information services). For further details, see http://www.hifa2015.org
6. Tikki Pang (WHO), Muir Gray (NHS, UK), and Tim Evans (WHO): A 15th grand challenge for global public health. The Lancet 2006; 367:284-286.

Friday, July 01, 2011

Public 2.0: Culture, Creativity and Audience in an Era of Information Openness, University of Westminster 21 July 2011

I have just registered for this event - see you there perhaps!

21 July 2011 10.30am - 6.00pm
Location: University of Westminster, Regent Campus, 309 Regent Street, London, W1B 2UW

FREE but register here: ...

In recent years significant changes in the technological, social and media landscapes have redrawn relationships between cultural producers of all stripes and the people previously called readers, audiences and users. In parallel with this, unprecedented amounts of information have entered the public domain as a result of both top-down policy pressures and ‘bottom-up’ social activism. This process in turn has given birth to new cultural movements, opportunities for creativity, forms of information visualisation, and modes of content production.

This free one-day conference brings together journalists, academics, developers, artists, activists and business people to reflect upon these phenomena, show work, exchange experiences and signpost future trends.

The conference will be followed by an exhibition opening of work produced as part of /Data Art/, an AHRC funded research project exploring how broadcast and news data can be reformatted, explored and navigated using information visualisations. The project is the result of collaboration between: the Centre for Research in Education Art and Media (CREAM), the University of Westminster; BBC Learning and BBC Future Media and Technology.

Invited speakers include:

Tom Corby, conference convener, artist, academic and writer working at the University of Westminster.
Simon Rogers, editor of the Guardian Datablog and Datastore.
Ian Forrester, Senior Producer at BBC R&D and emergent technology expert.
Roland Harwood, co-founder of 100%Open an innovation agency.
David Gauntlett, writes and teaches on how digital media gives people new opportunities to create and connect.
Rob Myers, artist, writer, hacker and Chief Technology Officer for Philter Phactory.
Drew Hemment, associate Director of ImaginationLancaster, Lancaster University, and Director of the FutureEverything Festival. (TBC)
Julian Tate, lead developer on the Manchester Open Data Cities project for FutureEverything.
Ruth Catlow, media artist and co-founder and co-director of Furtherfield.org media arts organization.
Santiago Ortiz, Co-founder and research director at Bestiario.

In addition a ‘show and tell’ session will feature art and design works by independent companies and developers including the Bestiario design company, Andy Littledale, Gavin Baily and Harry Robbins.