Brian E. Hodges (1942-2022) RIP Creator of Hodges' Health Career Model

The end of 2022 and start of 2023 brought loss, reflection and change in terms of family, friends and educational ties. My children said goodbye to their grandmothers in the space of two months. 

Brian E. Hodges c/o Family.

Then I was contacted by Brian Hodges’s daughter Sarah, with the news her father had died. November through to January saw me attend three consecutive funerals. I’m grateful I was able to visit Sheffield and say goodbye to Brian and meet his extended family.

Yes, it has taken a while to post this. For six months I have been sorting, clearing, rationalising books, papers with a house-sale now imminent, liaising with Brian's family too. 

It is fitting to share this sad news now and celebrate lives well-lived, cast in the promise of a new academic year. I think Brian would have liked this - the potential, and prospects for students in the semesters to follow, lecturers wrestling with how best to communicate and engage their students.

I first met Brian in 1987 when he was a Senior Lecturer at Manchester Polytechnic - which is now Manchester Metropolitan University. Brian taught on the ENB 911 Care of the Mentally Ill in the Community Certificate course. On the course Brian explained his eponymous model. This was more than a decade before Project 2000 made nursing an undergraduate programme. Brian created the model as a response to this. Brian’s qualification in Learning Disability Nursing is key to the inclusion of individual, group (carers) and the POLITICAL domain.

The model contributed to our assessment on the course, which required we complete a case study applying the model to a client/patient on a placement which was conducted with another service. Seconded from Chorley my placement experience was at Bolton. I still have my case study and a set of Brian’s original lecture notes.

Straight away I knew there was something special about Brian’s model. I suspect I’d been primed after watching Tony Buzan’s TV programmes in the 1970s, ‘Use Your Head’ and related books on mind-mapping. By the time I joined the Internet-age it was 1997. I’d written some microcomputer programs on the ZX81 and BBC Micro ‘B’: Nursing Process, Computer Aided Patient Assessment; HAEM; and Shades of Grey. Several were published by Open Software Library (no longer operating).

An ongoing interest developed in nursing theory and models of care, from reading about the nursing process. An early thought about creating a computer program about Hodges’ model crystallised in March 1997 when I came across the Nursing Development Site. This was hosted by the University of Alberta, Canada. Seeing that Hodges’ model was not listed, I contacted the site’s administrator. The response was: “Why don’t you create something and let us know.” Brian was very patient and offered his thoughts via email exchanges (saved, but in Turnpike format). In 1998 I finally got in touch with Alberta and they added a link.

The notes below are from the resulting website (1998-2015 now archived). The product of an interview with Brian at Manchester Polytechnic and my interpretation of model:

“Brian thought up HCM on the then British Rail train service, commuting between Sheffield and Manchester in 1983. He was stimulated by the need to impose structure on a curriculum for a BSc Nursing Studies course. Having defined the model in 1983 a scheduled teacher was unable to take a class, providing an opportunity for Brian to share the model and his thoughts with students. Despite this impromptu start, within a short time academic colleagues recognized the value of HCM in curriculum design and development, in addition to clinical practice.

 
A problem for practitioners has always been ensuring a comprehensive assessment has been made. The HCM facilitates that process, as an aide-mémoire, especially critical when faced with child care / abuse assessment and care evaluations. HCM was adopted as a tool for use by students on courses. Not surprisingly a key area of application is Health Visiting. Other nursing fields includes the use of case studies in post-basic education - Community Psychiatry Nursing Certificate; community and mental handicap - now learning disabilities.

 
Key phases in development

 
The main development work following initial conception, was up to 1987. Due to illness in 1990 Brian has been unable to engage in in-depth development work with the HCM. Hence Brian's bemused surprise at my contacting him. Despite this there are many educators, clinicians and no doubt health care managers who having been exposed to HCM carry it, like myself, as part of their mental toolkit. So if you have taught or used HCM in the past, or (even better) use it currently Brian and I would be delighted to hear from you. Given the duration of courses at Manchester then of course many colleagues in other parts of the north west of England have heard of HCM, used the HCM, or possess a college set of notes on HCM. Do you?” . . .

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Sarah and family have kindly forwarded the eulogy which includes:

“Dad was born on 30th January 1942 to Vera and Gilbert Hodges, he was the eldest of three with a sister, Rita and younger brother Philip. He grew up in Kingswood, a suburb of Bristol and attended the local Grammar school. He loved being a Scout and was a member of the YMCA.

When he left school, he went to work for Boots the Chemist, telling us often about his’ behind the counter’ days. However, a conversation with a colleague led him to rethink his career and he applied to train as a nurse at a hospital for patients with learning difficulties. Being a male nurse in the 1960’s was quite ground-breaking, and so typical of Dad who was always pushing boundaries and taking the ‘road less travelled’.

Dad realised that he enjoyed teaching the students and became determined to raise the profile of nursing those with learning difficulties. This led to him to taking a year’s teacher training at Bolton College and with his new qualification he was determined to make an impact on nursing. In 1972 this lead to the move to Sheffield to set up a nurse training course at Sheffield Polytechnic and Middlewood hospital. He loved this job and the impact he could have on training nurses, alongside this he embarked on an Open University Degree and also developed the Hodges Health career model for nursing, which facilitated integrated care, person centredness, reflective practice and helped to bridge the theory and practice gap. He was very proud of this work, and it remains in use. 

Alongside his work interests Dad decided that he would learn to sail, and not only how to sail, but also how to build a boat. The boat started life in the hallway of the house in Meadow Grove Road, and whilst it amused me and Sarah, there must have been a moment where Mum asked him to move it somewhere more suitable. He successfully built the boat and taught us all how to sail.

Back to his work life he was offered a job as a lecturer at Manchester University and later became Head of Nursing Studies there. He loved his job and invested a lot of time in encouraging his students with his indomitable wit and zest for life. Always wanting to learn more, he also studied for an MSc in Health Education, which meant he travelled to London and loved to tell us about his walks around Chelsea.

Life changed dramatically in 1990 when aged only 48 Dad had a severe stroke which led to a left side paralysis; and a medical assessment that he would not walk again. His sheer determination meant that he did in fact walk, although never regained use of his left arm, which made a lot of day to day tasks very difficult. He had no hesitation about asking strangers to help on his trips to London in his electric wheelchair.

Although Dad returned to work a year after the stroke, he found he could no longer do the job the way he wanted to and took early retirement. Being Dad, he did not stop working and continued to do some teaching, and travelled to other education centres as an external examiner. He also took up a number of volunteering activities which could make use of his skills. He became really involved in health care improvement through service user input and ultimately Chair of Shop Mobility in Sheffield.

One volunteering opportunity led to many and he took up a number of positions in both Sheffield and London. He loved to travel to London on his own on the train, where after his meetings, he would meet Sarah for dinner. He always said ‘focus on what you can do’ so that is what he did. After the stroke he learned to swim again and joined his grandchildren in the pool at Centre-parcs, and played badminton on one of his much loved family holidays.

He did not let the stroke stop him travelling at all and visited France, Florida, Barbados and even St Petersburg in his wheelchair. He also loved trips to Chatsworth for ice cream.

He loved listening to jazz music and rock, had learned to paint and draw. He loved the theatre and bird watching and was an avid reader. In fact, he was interested in everything, knew so much on any topic you could choose, and always more up to date than those around him, often much younger, on all the latest thinking or technology.

His philosophy of life meant that even after the catastrophic event of the stroke, it did not mean an end to living and he found other opportunities which he grasped enthusiastically.

So many people were amazed and inspired by Dad for what he achieved. He was one of life’s cheerleaders always encouraging and supporting others to fulfil their ambitions and this is what we will take with us. When we are not sure in our lives going forward we know we will think ‘What would Brian / Dad / Grandad say’. He had many sayings which we will remember and whenever anyone was facing difficulties or challenges, he would say ‘You will be alright’, and we will be alright because he has have taught us to be so.

Above all he will be remembered for his sense of humour, his huge sense of purpose and service to others and for the determination to live life to the full and never be stopped by anything or anyone. He was so proud of his family and all they have achieved. He was an inspiration and encouragement to everyone he met.

This is the final page of Dad’s life, but it is not the end. Everyone who’s life Dad touched, and all the people present here today carries a little bit of him with them, his humour, his smile, his sayings, his tenacity. So, he will live on with all of us, it is a fond farewell and not a goodbye.”

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Train ticket 28/05/97 (also from 1st website)

Since the Community Psychiatric Nursing (Cert.) course in the 1980s and our initial interview 28th May 1997, Brian and I met on about ten occasions. As noted above, Brian enjoyed rail travel and in the interview I had this image of a train with thought bubbles - Brian's reflections with the model taking shape.

Image from 1st archived site

Brian’s passing and his family's observations prompted recollection of a trip to London in 1996; to an IEE Colloquium on Thinking with Diagrams (Digest No: 1996/010).

https://ieeexplore.ieee.org/xpl/conhome/5214/proceeding

I’m sure Brian met me there, demonstrating his independence, motivation and enthusiasm. I need to check but I’m fairly sure, even imagining he said he was meeting Sarah afterwards? My father accompanied me, we stayed with an aunt who lived near London Bridge back then. Happy memories for me too.

Brian knew of several sites across the UK, that used or took an interest in Hodges’ model. When the website went live in 1998, I’d hoped people with notes, insights, examples of application, pros and cons would come forward. Sadly this did not happen except for a few instances.

I’m so pleased to have met Brian and being able to carry his model forward. Even semi-retired, I rejoice in the freedom I have as a practitioner. As I believe Brian came up against many academic barriers in trying to validate, publicise and disseminate the model. There was no expressed cynicism in this however, but political realism about how the world – academia works. A lesson I know very well in trying to publish work.

I keep fretting about not completing the ‘new’ website, but perhaps I’m following Brian’s advice after all: “focus on what you can do”. Despite its limitations the blog is helping to spread awareness of Hodges’ model; learning each year of new publications citing the model. Hodges’ model isn’t just another 2x2 matrix—business/management consultancy style thinking tool.

The key is the model’s full title:

Hodges' Health Career - Care Domains - Model

‘Health career’ refers to ‘life chances’ and this was central to Brian’s values of person-centredness, advocacy, and ‘seeing’ the political in health, social care and his own educational development and health career. 

The work remains to take Hodges’ model forward, to pass on this ‘+’ shaped baton. I will reflect further, especially as I was initially determined to ensure that Hodges' model was not just left on the shelf. For me, Brian’s legacy is the increasing relevance of his eponymous model since its creation. Consider since the late 1980s developments in human rights, consent, mental capacity, safeguarding, protection of liberty, mental health act, prison health. Brian's model readily encompasses the person and the State - nationally and globally, access and provision to health services, primary care, sustainable development goals, the determinants of health. How do we switch from illness-directed to preventive, health educational services?

In addition, Hodges' model can conceptually represent all these - across time as a series of frames. Brian's model remains a gift to his students and today's learners; including, patients, carers, mental health and general nurses, district nurses, learning disability and health visitors. As suggested here - Brian's effort and work has proved a great gift to me (as friends, family and many student nurses on placement, mentored, signed-off will attest). Brian's model is not a be all and end all, he knew this. It is one of many tools, models and theories, but it can and must also help future generations: from self care, health care, to global health and planetary care.

Thank you Brian. RIP.