"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

Person-centred care [PCC]: is it really happening? c/o National Voices

individual

|

INTERPERSONAL : SCIENCES

humanistic --------------------------------------- mechanistic

SOCIOLOGY : POLITICAL

|

group

PCC = what’s important to the individual, is co-ordinated around their needs and involves them in decisions. "To be person-centred, that care needs to work together to wrap around all the needs of the individual in a holistic way. Sadly, our report found that neither the NHS nor adult social care can demonstrate co-ordination of care, despite ‘integrated care’ being a key goal of all national and local leaders over the past five to 10 years. The way health and care services work must change to reflect the needs of the population. It would be a start to recognise that co-ordination of care is an important factor, and that we need to be measuring whether it is happening."	(many) Definitions = 5 key indicators of pcc:  good information, good communication, involvement in decisions,  care co-ordination  and care planning. Service user reported data from 19 nat. surveys NHS:  in primary care, only 39% of patients said their GP was ‘very good’ at involving them in decisions. What’s more, personalised care planning doesn’t really happen. Only 3% of GP patients with one or more long-term conditions reported having a written care plan, suggesting that opportunities to deliver personalised care in the NHS are being missed.
"Personalisation of care is more advanced in adult social care than in the NHS, with 89% of adult social care users reporting that the care and support they received helped them to have control over their daily life. Similarly, 63% of people using a social care personal budget said that this had improved their ability to make everyday decisions. Participation and control of decisions is well-established in adult social care, with just over 90% of those using community adult social care saying they were involved in decisions about their care and support needs." (See original post - report for important additions)	20+ years policy  England Care Act 2014 National Voices coalition of health and care charities  report ‘Person-centred care in 2017' No National data on this... "It is clear from our report that a strategic overhaul of how care is measured is needed. Rather than single-service, single-setting, activity measures, more credence needs to be given to the experiences of the people who rely on services. Only then can we help local systems succeed in offering personalised, integrated and holistic care. Whilst there have been some advances in the delivery of person-centred care, there is still a long way to go before the policy rhetoric matches the reality experienced by people."

[100th post] Care Programme Approach & Drupal NW England 10 Oct 7-9 pm Preston

With 29 posts in 2006 (from April) + 70 posts this year makes this the 100th post. Is there another 100....?

CARE PROGRAMME APPROACH [CPA] - MENTAL HEALTH
Working in mental health - policy, practice, professionalism are never far from problems. Problems that in the most extreme form can result in suicide and homicide. The costs associated with inquiries recently made the (Health Service Journal) news here in the UK; despite the financial input (£80M) subsequent change is apparently very slow in mental health services if it happens at all.

Through autumn:spring in a couple of posts I'll reflect on CPA with reference to Hodges' model and informatics. The magic wands will be found elsewhere; possibly when the results of a CPA review and consultation are published in November...?

I notice the CPA Association website is powered by Drupal....
(now the Care Coordination Association)

DRUPAL NW England user group
The 1st Drupal User Group NW England meeting will take place:

Date: Wednesday 10th October 2007
Time: 7pm to 9.30pm
Location: MOKA Cafe Bar (probably upstairs), Preston

Every: 2nd Wednesday of the month.

The details are on the DRUPAL UK website.