Hodges' Model: Welcome to the QUAD: accountability

Hodges' model is a conceptual framework to support reflection and critical thinking. Situated, the model can help integrate all disciplines (academic and professional). Amid news items, are posts that illustrate the scope and application of the model. A bibliography and A4 template are provided in the sidebar. Welcome to the QUAD ...

Showing posts with label accountability. Show all posts
Showing posts with label accountability. Show all posts

Tuesday, May 19, 2026

RCN Congress: Ebola, privacy and 'care bundles'

The first discussion at RCN Congress #RCN26 on Nursing as a STEM profession, or STEAM, with the arts added, became a resolution:

https://www.rcn.org.uk/congress/congress-events/nursing-as-a-stem-profession-2026

This was marvellous as it touched so many aspects that Hodges' model readily encompasses.

There is scope for the addition of emergency items:

https://www.rcn.org.uk/congress/Submit-an-emergency-agenda-item

Yesterday I wondered about the latest ebola outbreak, national and international aid^. Plus, privacy, having noticed a stream on twitter regards the NHS and a contract with Palantir. Yes, 'X' as a source is a problem, but concerns about access to confidential clinical information is found in the quality press. What does the Information Commissioner's Office say? Well, it seems there is a history:

https://icosearch.ico.org.uk/s/search.html?collection=ico%7Esp-search&query=PALANTIR&profile=_default

While searching for 'care bundles' I came across this:

 'The scope and force of medical privacy is further supported by a secondary layer of protections based in sectoral and other forms of regulation. Anti-discrimination laws, disability rights, and employment law, for example, all recognize and operate to preserve medical privacy by restrictions of use of medical information outside of the medical setting. 

 These intersecting normative strands of medical privacy, derived from different sources, together form a set of norms designed to protect a bundle of interests that is essential to the maintenance of an effective healthcare system that encourages and protects appropriate care-seeking and treatment. Whether and how technological changes in the collection, storage, and processing of data affect the construct of medical privacy is a pressing question. Just as a bell cannot be unrung, erosion of the sphere of medical privacy is unlikely to be restored.' p.330.

I realised over the past twenty years or so I've paid less attention to the fact that sections of a population, those often most in need of healthcare will not engage, be care-seeking - if they have no faith and trust in how their information is managed and protected. Minority groups, the digitally excluded (whether by choice, or literacy, economics) the influence of media are all vulnerable. Protection of data and the integrity of health services and systems is surely a matter of professional import both clinically and informaticians? As a registrant, I've always put it to student nurses that they should be aware of what happens to the data they as a registered nurse, enter in the electronic health record.

Pierce, R. (2018). Medical Privacy: Where Deontology and Consequentialism Meet. In B. van der Sloot & A. de Groot (Eds.), The Handbook of Privacy Studies: An Interdisciplinary Introduction (pp. 327–332). Amsterdam University Press. https://doi.org/10.2307/j.ctvcmxpmp.17
 
^What, only one sentence? Yes, but I'm still worried; geography - distance now matters little. While, on the other-hand: care-seeking...?
 
Previous posts: 'ebola' : #RCN26

Wednesday, April 29, 2026

100,000 signatures to win a parliamentary debate about the ownership of the water industry

INDIVIDUAL
|
     INTERPERSONAL    :     SCIENCES               
HUMANISTIC --------------------------------------  MECHANISTIC      
SOCIOLOGY  :   POLITICAL 
|
GROUP


'I feel thirsty!'

'It's really hot, let's have a swim!'



... Water ...

Public services

Public health




My source: 
https://x.com/Feargal_Sharkey

Previously: 'water' : 'pollution'

Tuesday, March 17, 2026

Be careful - the laws you wish for ...

INDIVIDUAL
|
    INTERPERSONAL    :     SCIENCES               
HUMANISTIC --------------------------------------  MECHANISTIC      
SOCIOLOGY  :   POLITICAL 
|
GROUP


LETHAL AUTONOMOUS 
WEAPON SYSTEMS




laws


Reminder: The FT View, Iran and the rising perils of AI in warfare, FTWeekend, 14-15 March, 2026, p.10.

Thursday, January 22, 2026

NANDA-I Newsletter - theme of clinical reasoning


'This month at NANDA-I, we have been exploring the theme of clinical reasoning.


Clinical reasoning is at the heart of nursing; it’s how nurses make sense of complex patient information and choose the best path forward. While many nurses think of diagnosis as the centerpiece, it’s really the thinking that leads up to it, gathering cues, interpreting what matters most, and then safely determining goals and actions, that makes all the difference in outcomes. Strong reasoning helps nurses notice subtle changes and act with confidence.


As healthcare grows more complex, understanding how nurses think, not just what tools they use, helps elevate care for every patient. We’ll be sharing insights throughout the year to help you stay connected to nursing knowledge and its impact on care delivery and education.'

 

Teaching Tip: Clinical Reasoning in Practice

Start With Assessment to Improve Reasoning

When nurses work with standardized languages and clinical judgment tools, it’s tempting to dive right into diagnosis. But the most accurate and useful nursing judgments always come from strong, systematic assessment first. Quality assessment supports better interpretation of patient needs and more precise identification of nursing responses.


Quick Tip: Use a flexible assessment framework, whether it’s a conceptual model or a tool like functional health patterns, to make sure you’re capturing the data that matters most first. When you build a solid foundation with assessment, everything that follows (including diagnostic thinking) becomes clearer and more grounded.  

 

My source: 'Friends of NANDA®-I Newsletter' subscription (with my emphasis).

See also:
https://nanda.org/2025/12/nanda-360-for-educators-and-researchers-strengthening-nursing-knowledge-through-diagnosis-centered-reasoning/

Assessment, plus planning, implementation - action, evaluation (plus, formulation).

Functional and cognitive [Health, Illness, Climate, Poverty, Political, Security, Prevention, Self-care, ...] patterns.

'... make sure you’re capturing the data that matters most first' - Situated, Context, Salience.

For a competent practitioner an assessment can also be 'therapeutic' for the patient.

Previously: 'classification' : 'diagnosis' : 'NANDA' : 'ICD'

Tuesday, November 04, 2025

Descartes - alive and well ...

... within the Incident Reporting System

'Policy guidance on recording patient safety events and levels of harm 
This guidance is for users of the new Learn from Patient Safety Events (LFPSE) service, to provide context and guidance on selection of appropriate categories when recording incidents. It focuses on which Event Type is appropriate for different circumstances, and how to select the most appropriate options for the Levels of Harm categorisation required within Patient Safety Incidents.'

Previous harm grades

No harm
Low harm
Moderate harm
Severe harm
Death


individual
|
INTERPERSONAL : SCIENCES
humanistic -------------------------------------------  mechanistic
SOCIOLOGY : POLITICAL
|
group-population
New psychological harm grades

No psychological harm
Low psychological harm
 Moderate psychological harm
Severe psychological harm
n/a

New physical harm grades

No physical harm
Low physical harm
Moderate physical harm
Severe physical harm
Fatal







Q. 'n/a'. Discuss.

CPD reading.                      

Monday, September 15, 2025

The sands of time are running out ...

... ironic, when the place you most
need blue-sky and long-term thinking,
innovation and action is becoming a desert ...

Individual
|
      INTERPERSONAL    :     SCIENCES               
HUMANISTIC  --------------------------------------  MECHANISTIC      
 SOCIOLOGY  :    POLITICAL 
|
Group






Image(s) © Harry Haysom

With thanks to HARRY HAYSOM - DESIGN & ILLUSTRATION -
and for being able to edit and apply this work to Hodges' model.

Visiting bookshops regularly, following the media and https://harryhaysom.co.uk/

 - I realise I'm more aware of Harry's brilliant work than I thought.

https://www.instagram.com/harryhaysom

My source: FT Magazine, January 4/5 2025. p.10.

Thursday, August 28, 2025

Lessons NOT learned: Bhopal, Brumadinho, Fundão, Kafue River ...?

Individual
|
      INTERPERSONAL    :     SCIENCES               
HUMANISTIC  --------------------------------------  MECHANISTIC      
 SOCIOLOGY  :    POLITICAL 
|
Group



Kafue River -
( clearly - not a 'person', nor the Rio Doce )

Signs of Life
Signs of Government, Law & Accountability



Friday, August 08, 2025

'White Coats Vs The White House' c/o BBC World Service

Individual
|
     INTERPERSONAL    :     SCIENCES               
HUMANISTIC  --------------------------------------  MECHANISTIC      
 SOCIOLOGY  :    POLITICAL 
|
Group


WHITE COATS



WHITE HOUSE



White Coats Vs The White House
The Documentary - 21 August 2025

'What is going on with US science? Science Journalist Roland Pease asks whether the rounds of cuts, reorganisations and political strong-arming can be weathered, and how they will likely affect us all.

80 years after Vannevar Bush proposed what became the pact between government and universities that led to decades of global scientific dominance, is the edifice being toppled?

Bush’s report “Science, The Endless Frontier” led to the unwritten pact between university scientists and government funding that underpinned US leadership until now. “Trust us with the money, we’ll give you the global scientific advantage”.'

continued: 

https://www.bbc.co.uk/programmes/w3ct81nr

Friday, June 13, 2025

IP? No! Not 'intellectual property' the other one . . .

'Interested Persons'

- also vested in data, information, knowledge, 
who knew how, what, why, when, where ...

individual
|
INTERPERSONAL : SCIENCES
humanistic ------------------------------- mechanistic
SOCIOLOGY : POLITICAL
|
group
identity - witness - involvement
recall - memory

Knowledge - Answers

The (sudden) power of situation, circumstances,
 time and place.

Events

Society
Team - Teamwork

Social Justice

Interested Persons

Coroner's Court



My source:

Marriage, M. In Search Of Lost Time, FT Magazine. FT Weekend, 22 February 2025, pp.21-27.

Sunday, May 25, 2025

RCN Congress iii 2025 - Accountability for patients in ambulances

The resolution (with a reading list) on Accountability for patients in ambulances

- drew attention to language once again (yes, well there's a truism: what do you expect!). This time highlighting how corridor care is now variegated. In addition, politically you can circumvent addressing an issue, by referring to 'never events', and 'zero tolerance' as we read:

'This agenda item addresses the urgent issue of accountability, for both registered nurses and the organisations they work for, when patients are cared for in ambulances waiting to access emergency departments.

The resolution comes at a time when, across all four countries, there are unprecedented ambulance handover delays with patients left in vehicles which are neither appropriately staffed nor resourced outside overwhelmed emergency departments. Despite the prolific nature of this practice, there is no clear guidance on accountability. Who is responsible for the care and safety of those patients - the ambulance service, the hospital, the emergency department, or the individual registered nurse providing care?

These delays accessing care and the lack of guidance on who is accountable for the waiting patients, compromises the ability of health care staff to provide good quality care and risks patient safety. It also exposes registered nurses and other health care professionals to professionally, ethically and legally ambiguous situations. It could also contribute to the crisis in nursing wellbeing, raising issues such as moral distress and professional, emotional and physical burnout. It may, therefore, also impact the already perilous recruitment and retention.'

Student nurses, paramedics ... please take note: There is a paper to be written on Hodges' model and the gaps we encounter in health and social care. For Brian Hodges this started with the theory-practice gap; one of four original stimuli for the creation of the model. 

As the idealised standards, quality and safety of care being delivered are surrendered; this gap stands out as the virtual keystone.

individual
|
INTERPERSONAL : SCIENCES
humanistic ------------------------------- mechanistic
SOCIOLOGY : POLITICAL
|
group
individual - PURPOSES
patient safety - distress
nurse wellbeing
emotional burnout
moral distress
personal ethics
individual responsibilities

procedure
delivered care - observation
mattress, trolley .. ambulance design
instrumentation, noise
time - duration
logistics - PROCESSES - handover
physical resources - beds

communities of PRACTICE
team working - coherence
team experience - students
THE DAMAGE - that is 'BOOK-PASSING'
The public's - carer's experience
(wither friends and family)

law - guidance - ambiguity
POLICY
professional accountability
risk management
organisational responsibility
workforce
recruitment & retention



Previously: 'RCN' : 'gap' : 'accountability' : 4Ps

Wednesday, February 12, 2025

Book review #3: Handbook on the Ethics of AI

I've started several 'gap' lists, including a draft post or two. Seeking to help bridge the theory-practice gap is an original purpose for Hodges' model.

Friedman's chapter 5 Responding to the (techno) Responsibility Gap(s). It is almost as if Friedman's title is parameterised. We could insert the domains of Hodges' model (plus, spiritual - safeguarding!) in there. Then there is the magic of languages, for responsibility substitute accountability and do a deep-dive applying Hodges' model in a specific domain. Friedman notes it is not entirely accurate to talk of a single "responsibility gap". Can this provide evidence for the situated potentiality of Hodges' model's and role in fostering situational awareness? Although there is an ongoing roll-back of CSR - corporate social responsibility, I scribbled in the margin:

INDIVIDUAL
|
      INTERPERSONAL    :     SCIENCES               
HUMANISTIC  --------------------------------------  MECHANISTIC      
 SOCIOLOGY  :    POLITICAL 
|
GROUP
user
user
user
corporate

Of course, 'user' still applies in the political domain, as we are all citizens; users of the State (note also the socio-technical utility of keeping the 'user' in sight). There is also personal ethics, and the legal duty of care - as a nurse (in my case) and for a member of the public. Discussion on notions of responsibility, in light of AI, especially self-driving vehicles, and autonomous machines (weapons) is much needed. Regulatory gaps are recognised; amid current news of debate on the degree of regulation of national and international financial systems. Nyholm's four-fold formulation on responsibility is invaluable as examples are provided. There is a reference to nine notions of responsibility, and the link to accountability and retribution.  I like Friedman's  discussion of responses to responsibility gaps as; optimists - technological approach; human-centred and hybrid approaches; plus pessimists (4.3). The latter includes debate and campaigns to 'stop the killer robots'. Did this chapter, have a positive effect in extending thoughts about events in the middle east? There are two points here I will return to in the final post.

For students, Schwarz's chapter 6 takes readers back to a literally pivotal development in ethical thought and debate: Trolleyology, with the addition of algorithms and killer robots. What Searle's Chinese Room (noted p.276 here) argument is to AI; so trolley-based dilemmas are to ethics. A point made by Schwarz, referring to the development of subsequent variations. (Following on from #2, Brian Magee's interviews with John Searle on philosophy of language and Wittgenstein are also well worth a listen.) Schwarz's chapter (and the whole book) could be read in preparation for an undergraduate course: computing, law, policy, philosophy, and ethics, for example. The challenge of determining responsibility and accountability "the problem of many hands" (p.71), is not limited to AI. This is a global issue in achieving justice for many previously healthy, competent, quite 'ordinary' people.

The question posed above, applies "equally"(!) here too: 3. mathematical morality for war. Ever since reading of argumentation through the Open University and other sources, I'm sure this is applicable to Hodges' model (with its 'own' algebra)? I'm no mathematician but the book provoked excitement rather than anxiety as I read: 'Principle of Permissible Harm (PPH) and probabilistic reasoning - with formulae (pp.88-89). There are some important (imho) 'take-away' messages here, but I don't want to spoil things. Nurses need mathematical skills, in drug calculations and are assessed on the same. Statistics are used in research, of course but maths is hardly the primary motivation for entry into the care professions: 
'Designing technologies in a way that takes into account broader human-centric values is an important and laudable approach to responding to new and emerging technologies in any arena. It cannot, however, serve as a substitute for moral deliberation and the act of taking moral responsibility for harmful acts, especially when lives are at stake. Reducing this to a mathematical problem ignores everything that cannot be captured in discrete numerical terms or as data points. And in situations where people and their lives become nothing more than data points, non-computational aspects, such as relational or embodied dimensions of human life, are marginalized if not entirely obscured. The real world is not reducible to binary logic, it is rife with contested, contradictory, and clashing values that might all be equally relevant It is complex in ways that cannot always be neatly captured or mathematically modeled. In other words, ethics cannot be "solved."' p.91.
More to follow ...

Handbook on the Ethics of Artificial Intelligence. David J. Gunkel (ed.). Cheltenham, UK: Edward Elgar Publishing Ltd. ISBN: 978 1 80392 671 1245

https://www.e-elgar.com/shop/gbp/handbook-on-the-ethics-of-artificial-intelligence-9781803926711.html


Related previous posts: 'general + AI'

Tuesday, December 10, 2024

Webinar: 11 December - Universal Health Coverage (UHC) Day 2024

"The UHC Compass and Social Participation:
empowering patient organisations to hold governments
 accountable for universal health coverage"

Register for the UHC Compass launch!

To mark Universal Health Coverage (UHC) Day 2024, IAPO will officially launch the UHC Compass at an exciting webinar titled "The UHC Compass and Social Participation: empowering patient organisations to hold governments accountable for universal health coverage" on 11 December 2024, from 11:30 to 13:00 GMT via Zoom.

The webinar will be conducted in English with simultaneous interpretation into Spanish.

Panellists include:
  • Dani Mothci – International Alliance of Patients’ Organizations (IAPO) 
  • Dr Pamela Cipriano – UHC2030 & International Council of Nurses
  • Lara Brearley – Special Programme on Primary Health Care Universal Health Coverage - Life Course, World Health Organization
  • Dumiso Gatsha – Success Capital NGO & Civil Society Engagement Mechanism for UHC2030 (CSEM)
  • Nicola Bedlington – Global Patient Think Tank & Millwater Partners
  • Smitha Sadasivan – Global Patient Think Tank, Inclusive Health Policy, Disability Rights India Foundation & CSEM 
  • Paul Mendoza – Psoriasis Philippines and Psoriasis Asia Pacific & IAPO
The UHC Compass is a dynamic tool created by patients for patients, empowering local leaders and communities to advance universal health coverage (UHC). In the context of the World Health Assembly resolution on social participation and UHC Day 2024, this session will explore how the Compass can serve as a tool to hold governments accountable for investing in UHC.

Co-created by the Global Patient Think Tank (GPTT), a diverse group amplifying the patient voice in the UHC movement, the Compass is proudly hosted by IAPO. Our mission is to ensure this resource reaches and benefits our global network of patient organisations.

Join us to discover how the UHC Compass can help make UHC a reality for everyone!

Learn more & register [https://www.iapo.org.uk/node/15686] Share https://iapo.cmail19.com/t/d-fb-sfiudt-iuqjytrli-o/ Tweet https://iapo.cmail19.com/t/d-tw-sfiudt-iuqjytrli-b/ Share [https://iapo.cmail19.com/t/d-li-sfiudt-iuqjytrli-h/]

[http://www.iapo.org.uk]

The International Alliance of Patients’ Organizations is registered in England and Wales as charity no.1155577 and company limited by guarantee no.08495711.

Registered office: Hounslow House, 7 Bath Road, Hounslow TW3 3EB, UK.

It is also the IAPO's 25th Anniversary.
More details at:

https://www.iapo.org.uk/node/15687

I will post again in the New Year.

My source: HIFA

Previously: compass : UHC : patients

Thursday, December 05, 2024

iii 'Our Housing Disaster'

'Our Housing Disaster'
Image: Goodreads

Here on W2tQ many posts have referred to 'common sense' over the years. Apparently, there is no such thing - which may be another blog post).

https://www.psychologytoday.com/gb/blog/too-many-goals/202005/theres-no-such-thing-common-sense

In 'Our Housing Disaster' Julian Richer is simultaneously analytic in identifying problems and potential solutions, logical and to me commonsensical. There is a need for debate and decisions at a political level. Residents, must also be involved, have a say. Chapter 10 lists shorter-term actions and longer-term. 

The history of this disaster is tackled in chapter 3. Chapter 4 links very well explaining the rise of renting. If there was ever to be another edition - which the book and issue well-deserve; it would be good to a nod to evidence-based housing policy? This is suggested, as is integrating the many threads of housing; work, transport, infrastructure, shops, water and services. I've posted here about the number of All-Party Parliamentary Groups and talk of joined-up government. Housing is anything but joined-up. You could argue all MPs and Lords should read this book. 

Overall, the book is well produced, the text very readable, large size and well laid out. The 'references' for each chapter are in the form of links. Needless to say, I have only tried a few. The book seems smaller - narrower than a standard paperback, so may have fewer words / line. For posts i & ii, I extracted text from photos, which is a challenge without stressing the book's spine (as I've written before no doubt, I'm squeamish when it comes to books).

In the UK, the Right to Buy and Help to Buy, have long been a feature of housing policy. Of Help To Buy, it has 'cost taxpayers £29 billion in cash terms by 2023' (p.45) and has additional consequences. Milton Keynes is the 'right-to-buy-to-let' capital of England (2017, p.48). Surely, it is time to move on -  and quickly. The history of how we got here is fascinating, like a slow car-crash with critical events that accelerated the inevitable. Taxpayers and citizens all: we have missed out. There is mention of preventing corruption (but yes, more effort on money-laundering and tax evasion please!). The need for buildings inspection, standards of construction and materials and responding to the climate crisis and high energy costs are also stressed.

Richer's stance is tempered, and sets an effective tone. He is not preaching, even as he points to land owned by the Church of England. I remember the NHS selling estate, and yet there is more. While the book is not long, an index would help. I like the final summarising and concluding sentences for each chapter. Physically, they are bound to be there obviously, but there's a welcome sensible thread to these imho. With an index, perhaps I could check back to look up 'productivity, reduced', a problem that has plagued the UK economy. To what extent does housing contribute to this now; since the 1960s? The King's Fund and many other organisations and commentators advocate daily for social care. While it is acknowledged, social care is not one of the government's 5 key 'missions', and now (5th Dec.) there are milestones. Richer refers to the problem of bed-blocking in the NHS, and the need for suitable future housing so older adults can continue to 'live' in their homes.

So often in health we are taught, and learn to assess, plan, intervene, and evaluate a person-centred set of needs, a patient's needs, and a carer's needs. It is welcome to see a collective - population-based focus on needs. The book delivers on the title. So there are no details of nations (or cities) that have a  much better housing system and controls. Over the years it's been interesting and encouraging to read about Vienna in the FT. Below I have mapped/associated selected concepts to the care / knowledge domains of Hodges' model:

INDIVIDUAL
|
INTERPERSONAL : SCIENCES              
humanistic ------------------------------- mechanistic
SOCIOLOGY : POLITICAL   
|
GROUP
psychological security
mental health
'my' home, my space
identity
peace of mind when costs met
facilitate well-being
memories
LAND - the 'hope' value
sense of continuity / permanence
children being safe making friends
access to 'GREEN' spaces
my life course - personal history
Cognitive assurance: my area -
family & friends / pets /school / work -
attachment

LAND - UK geography
physical shelter
physical health (NO damp, mould, noise...)
House building targets/programmes
my space/room
having an address - identity
displacement
public/environment health
eviction
house building - infrastructure
land - costs
transport links
bed-blocking in hospitals
Climate Change

place to make a home
raise a family
belonging
sense of community
friends & neighbours
 anti-social behaviour by tenants
social care - older adults
social care disabled
access to work, schools
resources to service a community
lack of spare capacity to support people & families in need/crisis

the economy: interest/mortgage rates
indebtedness - poverty
housing POLICY :: COSTS
national housing & land assets
inspection and building standards
forms of tenure: private, rented, housing assoc.
LAW - housing & land legislation
housing rights
migration, refugees
independent advocacy / NGOs
compulsory purchase



Thank you Mr Richer for an excellent read and synopsis. I do hope the government listens! My daughter's partner works in estate agency, so I know where my copy is heading: a new home!


Wednesday, December 04, 2024

'Our Housing Disaster' ii

'Our Housing Disaster'
Image: Goodreads

Late to reading about economics, apart from the 'quality press' and an 'O' level in social history (which has actually been really useful in my nursing career), this book can ground and crystallize 'housing' as heard and viewed in the news.

I've a love for hi-fi that I share with Julian Richer, but my wealth lies elsewhere and is decidedly non-monetary. Reading his column in The Sunday Times, I'm impressed with Mr Richer's insight and the extent of his philanthropy. The book notes several initiatives and collaborations, e.g. TaxWatch -https://www.taxwatchuk.org/

On the news you hear of 'intervention' in the market - usually equity or bonds. You - the government - can intervene, or let the market, a market by implication, look after itself. Markets find their own equilibrium, shift to stability ultimately; and this despite economic crises, billion-busting scandals and political parties totally screwing-up.

So, it appears governments have allowed the housing market, to make its own moves.

It's back to the future, the 18th century of laissez-faire: the market has spoken, and its a utter mess.

The book's contents are well structured and delivered in full.
Introduction
1 Disaster? What Housing Disaster?
2 A Housing Crisis That Harms
3 Where Did Housing Go Wrong?
4 The Rise of Renting
5 The Shrinking of Social Housing
6 Underregulated and Oversubscribed
7 Land and Planning: The Price of Permission
8 Making Better Use of Buildings and Land
9 Building a Solution
10 Time for Action - My Housing Manifesto
Conclusion

OHD covers the population as a whole, but 'health' is very well represented in terms of personnel and the impacts of lack of housing and poor quality, unregulated housing: 

'Inability to afford housing is one of the grievances feeding into strikes by public sector workers - even better-paid ones. A survey by the British Medical Association (BMA) in December 2022 found that nearly half (45.3%) of junior doctors had struggled to afford their rent or mortgage in the past year. To earn more, some were taking on extra shifts and the BMA said this added to its concerns around junior doctor exhaustion and burnout. 

The consequences reach out to the public at large, as housing problems hit staff recruitment in health services, education and so on. The NHS visibly cant cope: basic structures are crumbling.' p.25.
We can imagine the anxiety and depression this might provoke. Even for people you might think (assume) would be ordinarily resilient. These are clearly extraordinary times. An email - RCN Magazine - today supports the same conclusion:


The relationship between health and housing is not limited to chapter 2. In chapter 2 though damp and mould (yes a specific case), unsanitary conditions the loss of environment health officers and skilled personnel, reminded me of decades ago an article in HSJ, or in that 'quality press' about the community health councils - CHCs having their teeth extracted. Public (MENTAL) health has taken a stunning fall and desperately needs to be put back together.

More to follow...

Tuesday, December 03, 2024

'Our Housing Disaster'

Our Housing Disaster

I must finish the spring and summer's reading as pictured, with another two books in the wings. While the smallest text Our Housing Disaster is cheap to buy, an important read and insightful.

Politically, in the UK and many other nations, housing and its opposite -  homelessness, and the supply and cost of housing are ongoing issues.

Julian Richer's book is low cost £4.99 post free with a promo-code; even as I obtained a free copy, learning of the book in Business section of The Sunday Times. 


Our Housing Disaster gets off to a flying start:

'Falling or stagnant house prices are seen as national 'ill' that we must recover from but, in fact, fast-rising house prices and interest rates have proved to be the real ill, destroying the dream of a property-owning democracy that was supposed to benefit all.

Britain's housing policy, such as it is, has failed on its own terms.' p.9.

I remember when Grand Designs appeared on our TVs. Especially the episode with the wood-frame eco-house by Ben Law. This seemed sustainable and time-limited too. Julian Richer really nails the housing problem without delay. Unfortunately, the audience appeal of TV programmes like Grand Designs, Location, ... seem to me symptomatic of the issue Richer raises above. I used to think that the 'middle class' were shooting themselves in the foot; as house prices rose and rose. There was a collapse at one point with the trap of negative equity that my family almost got caught in (had we bought a new home). Richer corrects this view, with a national perspective across ten chapters and 180 pages.

 If the link between health and housing needs to amplified Richer ably achieves this, and quickly:

'Poor housing is harming the nation's health. The housing ombudsman, Richard Blakeway, whose office deals with complaints from social housing tenants about disrepair and mould and damp in their homes, problems recognised now to be a threat to health, has found the situation to be so bad that he has called for a Royal Commission to look at the links between housing, health, and welfare. Too often, the various agencies in housing, health and social care tend not to link up, or even know what the others are doing. which can end up making people's housing situation worse. Someone who has been homeless or who has mental health needs, for example, can require a lot of support once they are housed so that they can pay the rent and maintain the tenancy. If they just get housed and then left to cope on their own, they can struggle, lose the tenancy, become homeless and whole cycle starts again, with all that waste of money and damage to lives.' p.16.
'In addition to the 8m, there must be millions more who are not in crisis, but who have a blight on their future: typically, young, working people, perhaps with children, who are living in private rented accommodation, with a roof over their heads but always worrying they might be evicted. The insecurity and uncertainty that they experience is not good for them or their children. Just as job insecurity makes it hard for people to build a career, housing insecurity makes it hard for people to establish a life.' p.19.
The statistics flow thick and fast but as readable as they are focussed they weave an effective narrative referring to the history of just how we got to this point. The text make stark the dire crisis and need for action and an urgent government response. 

More to follow.

Saturday, August 24, 2024

"In HIFA - let's save a space to make sense of mountains of data"

Dear All, (HIFA mail list)

While rather expansive in scope not just reaching to the arts but also referencing nature and mountains, the following blog post may be of interest:

"Health & Care results in mountains of data: c/o Burke & Cao 2024"

https://hodges-model.blogspot.com/2024/08/nan-shepherd-.html

While the focus and purposes for HIFA are clear, in practice 'information' (data, facts, knowledge, wisdom) must always be contextualised, situated, and (potentially) justified.

In addition to relying on the sciences, medicine, nursing and healing practices are also characterised as arts.

See also, the digital humanities and more specifically - 'Intima: A Journal of Narrative Medicine' https://www.theintima.org/

There have been many posts about records recently, but of course it what goes into the record that is critical.

Salience, what we pay attention to is key.*

The record is critical if something goes wrong and a professional finds themselves in a Coroner's court, and/or disciplinary hearing. The previous posts also discuss the patient's access to their medical record.

I'm not sure if the point has been made but even before 'health literacy' is taken into account, given access a patient may identify many mistakes/errors within the record on many details including demographics and procedures, treatments, diagnoses applied. (There are studies confirming the same - a benefit of IT systems.)

In mental health service - England the care programme approach (CPA) has ended - been retired. Some argue this has been done 'quietly'.

While the emphasis on documentation since 1990s has been onerous for some practitioners in the need for a 'comprehensive' record, the principles of CPA are well-based in practice: Patients (families) are entitled to - 1. A care assessment 2. A care plan 3. A named care-coordinator - keyworker 4. A review 6 monthly; annually as a minimum

For more than a year 1995.., I worked full and p/t as CPA co-ordinator for Chorley and South Ribble Health Authority; and produced a report highlighting the potential benefits of information technology in data gathering and processing and information reporting. (A conference was also organised with 60+ delegates, and 10 software vendors demonstrating their wares.)

The news drove the development and introduction of CPA during the late 1980s, with often stigmatising headlines for many people affected with mental illness - including psychosis it must be added. Recent events are troubling for society and services now, and in terms of history repeating itself:

"On average over a hundred people in Britain a year are killed by someone with serious mental illness. On the day the NHS is Nottingham is found to have missed opportunities to stop Valdo Calocane killing 3 people we ask why lessons aren’t being learned." 'X' https://x.com/BeckyJohnsonSky/status/1823459379846271002

"Between May 2020 and February 2022, eight risk assessments were completed for Calocane by the trust, which the CQC said appear to have been carried out for each of his admissions to hospital and updated at other times during his care. The regulator said that while some risks were highlighted, other assessments “minimised or omitted key details”. https://careappointments.com/care-news/england/211213/cqc-review-of-nottingham-killers-care-finds-key-risk-details-minimised-or-omitted/

The state of mental health services in the UK is much debated and here too 'information' is critical, especially 'seeing' the person and the nuances of interpersonal communication skills. These are often encountered through non-verbal communication and 'clinical intuition' which must be related to professional experience.

So information must simultaneously be recognised as a mechanistic and humanistic melange of processes, purposes, practices and policies (4P's in Hodges' model).

As highlighted before we can also contrast HIFA's and practitioners efforts to combat the severe implications and risks of 'information disorder'. And yet, also recognise how the arts, innovation and creativity also contribute to interpersonal engagement, therapeutic goals, case formulation, health and other literacies using *metaphor* and *analogies* - as per Nan Shepherd's musings explored in the blog post by -

Burke, R., Cao, E. To Care for a Mountain - What medical practitioners can learn from Nan Shepherd. Oxford Review of Books, Summer 2024, Volume 8, Issue 2. p.14. In association with Stanford. (open access)

Patient, public and practitioner safety is always the aim & objective.

Further reading & notes: https://www.cqc.org.uk/publications/nottinghamshire-healthcare-nhsft-special-review-part2/risk-assessment

Whiting, D., Gulati, G., Geddes, J.R., Dean, K. and Fazel, S. (2024), Violence in schizophrenia: triangulating the evidence on perpetration risk. World Psychiatry, 23: 158-160. https://doi.org/10.1002/wps.21171

*I hope to contribute to a 'philosophy of attention' research project, my contribution will draw on clinical experience above and apply Hodges' model to explore and debate ... 'attention', starting in 2025 to c.2030.

Regards to all, Peter Jones

Monday, May 20, 2024

NHS Contaminated Blood Scandal UK

UK  - World

Why we need always to acknowledge 
the political in health and health in politics

Individual
|
      INTERPERSONAL    :     SCIENCES               
HUMANISTIC  --------------------------------------  MECHANISTIC      
 SOCIOLOGY  :    POLITICAL 
|
Group

"In an interim report, the inquiry chair, Sir Brian Langstaff, said 'wrongs were done at individual, collective and systemic levels'."

                                                                    (UP)
contaminated       blood                             
blood            donors     'dying for 

COVER
 UP


 
scandal            paid          justice'    
(screening?)







My source: Various - over several decades.

Photograph: Daily Express
https://www.express.co.uk/news/politics/1795449/rishi-sunak-infected-blood-inquiry-heckled-booed

Monday, May 06, 2024

Book: "The Unaccountability Machine: Why Big Systems Make Terrible Decisions - and How The World Lost its Mind"

Individual
|
      INTERPERSONAL    :     SCIENCES               
HUMANISTIC  --------------------------------------  MECHANISTIC      
 SOCIOLOGY  :    POLITICAL 
|
Group
mind . . .

- and there was I ...

I always thought heat rises?

'heat sinks'

minima - maxima

'accountability ...
... 
...
...
... sinks'





Felix Martin (2024) Computer says no, Life&Arts, FTWeekend, 6-7 April 2024, p.9.