Mental Health and Physical Activity

You know you're on the right (running) track when there is a journal that seeks to address the fundamentals of parity of esteem that is mental and physical health:

Robertson, R., Robertson, A., Jepson, R., and Maxwell, M. (2012) Walking for depression or depressive symptoms: A systematic review and meta-analysis, Mental Health and Physical Activity, 5, 1, 66-75. ISSN 1755-2966 https://doi.org/10.1016/j.mhpa.2012.03.002.

Sometimes, geography matters too in terms of intervention choices and the population of a study:

Moran, R., Sperandei, S., Peel, N., Gray, T., and Reis, A. (2024) The long-term effect of surf therapy on posttraumatic stress, depression, and anxiety symptomology among current and former Australian defence force members - A nonrandomised controlled longitudinal study in a community setting. Mental Health and Physical Activity, 27, 100629, ISSN 1755-2966. https://doi.org/10.1016/j.mhpa.2024.100629.

While researchers seek an holistic view -

Ciaccioni, S. et al. (2026) Modifiable determinants of adolescents’ physical activity and sedentary behaviour in school, home and mixed settings: A DE-PASS systematic review and meta-analysis of self-reported data with a holistic analysis. Mental Health and Physical Activity, 31. 100803,
ISSN 1755-2966, https://doi.org/10.1016/j.mhpa.2026.100803.

- and the above journal 'Supports open access', I do not believe my individual circumstances would qualify for differential treatment of fees:

'Article Publishing Charge (APC): USD 3,190 (excluding taxes). Actual APCs may differ based on individual author circumstances.'

This is a pity, as surprisingly thus far, the journal does not appear to have explicitly referred to 'parity of esteem'? Clearly a soapbox for me, there is plenty of room for others to join in the debate. To acknowledge, however, severe mental illness is well represented.

Given the holistic scope of Hodges' model the lack of inclusion in such literature is a shame. 

Acutely so, as Hodges' model begs (demands!?) consideration of holistic bandwidth. The matter of exercise and activity as a therapeutic option in mental health care quickly gets intense and heated (even if the interlocutors are recumbent). Social prescribing seems well established. On social media ['X' still for me] voicing the benefits of exercise does not always go down well. 

Fabiano N, Puder D, Stubbs B. Could not prescribing exercise for depression be psychiatric malpractice?

British Journal of Sports Medicine 2025;59:1388-1389.

Ironically given the limitations of the bio-psycho-social model, the 'barricades' don't go up they are a permanent feature. As soon as we need to consider the political dimensions of health care, legal and professional accountability, policy, funding, accessibility, the minutiae of human rights (individual instances). Plus, in the UK the welfare benefits bill, the struggles of young adults not in employment, education or training; then division and oppositions are all that is. And, what can be individual and collective opportunities are missed.

My source:  https://x.com/NTFabiano/status/2103876655366521278?s=20

Laws, Rules, Promises & Campaigns

They are not all represented on W2tQ, but many have been posted over the years. Campaigns launched in the aftermath of avoidable deaths within NHS delivered care. The initiatives seek to translate grief into positive affirmative action by making a difference to patient safety, the quality of professional care, policy and funding in some instances. At least drawing attention to the latter.

It is staggering that staff need to be 'reminded' of what should be professional, practice-based, and philosophical (personal - team, ethics and ethos, and values integral to nursing, and healthcare interaction that should be integral and ingrained. 

I thought "What's my motivation?" was a theatrical cliché?

Poppy's Promise is a commitment to making every healthcare experience more compassionate, respectful and person-centred. It supports staff to work in partnership with patients, families and carers, ensuring every voice is heard and every person feels valued.

Oliver's Campaign: The Oliver McGowan Mandatory Training on Learning Disability and Autism is named after Oliver McGowan, whose death shone a light on the need for health and social care staff to have better training. The Health and Care Act 2022 introduced a statutory requirement that CQC-registered providers must ensure their staff receive learning disability and autism training appropriate to their role.  

Jess’s Rule makes sure GPs take a ‘fresh eyes’ approach with patients, making them think again to diagnose and catch serious illnesses earlier. Jess’s Rule – Three Strikes and we Rethink - was launched in England on the 23rd September 2025 by Department of Health and NHS England and in The Isle of Man on the 31st March 2026 by Manx Care. It is endorsed by the Royal College of General Practitioners.

Martha’s Rule helps us notice early signs that someone may be deteriorating and gives you the right to request a rapid review if you’re worried that your or your loved one’s condition is getting worse. This may include a review by the Critical Care Team. Sometimes small changes happen before they show in tests. These can be early warning signs. Martha’s Rule makes sure we listen to concerns and act on them.

Nobody should be separated from the people they love and who care for them. John's Campaign works for the right of people with dementia (and other disabilities or individual needs) to be supported by their family carers — in hospitals, in care homes, and wherever care happens.

Dáithí's Law: Dáithí Mac Gabhann was born in October 2016 with a condition called Hypoplastic Left Heart Syndrome, which basically means that Dáithí was born with half a working heart with the left side not forming correctly in the womb. More information on HLHS can be found here. Dáithí has now been waiting for the gift of a new heart for over 7 years.

Activism is not restricted to patients, parents or guardians but key campaigns have followed through staff efforts:

A message from Kate about the campaign…
“Hello, my name is Dr Kate Granger MBE and I’m the wife of Chris and the co-founder of the #hellomynameis campaign”

⃟ 

The initial website for Hodges' model 1998-2015 and now archived, featured four pages of links to resources associated with the domain they represented. The SOCIOLOGY links included:

Patients, Carers & Self-Care

individual

|
INTERPERSONAL : SCIENCES             

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

SOCIOLOGY : POLITICAL   

|

group

Patient - Nurse ...	Patient - Nurse ...
Guardian - Parent Family Carer	Government Funding Policy makers

In Hodges' model, if neglect, accidents, untoward - serious - never incidents, what is complex, complicated, preventable signify anything; it is the collapse of a situation to the individual-group axis.

For the people involved they will simultaneously hear and feel a catastrophe.

Armed with Hodges' model, plus early insights into informatics, the oscillation between the person on your caseload, and not just beyond the spouse, partner and family but out to the political-zone of aggregation that is your caseload, the local and national population and statistical reports has always been fascinating.

Viewed theoretically, or practically the vertical axis of Hodges' model appears simple, and yet holds great power. A gift of abstraction and dramatic effect - for actor and audience alike. As an 'actor' we can see  our practice and its character humanistic - mechanistic played-out literally through the horizontal axis. Before we act, we can reflect upon the quality and humanity of our care. The audience, peers, families, managers, community, commissioners can also follow the 'narrative', (or lack of it!). Is there a paradox here in these virtual-digital times that the what is really material in care and caring is missing? We must hope the coroner does not need to attend [the play], being able to concentrate on other matters.

Previously: 'compassion' : 'communication' : 'safety' : 'listen' : 'motivation'

Brief introduction to Hodges' model

Hodges’ model is a conceptual framework of universal value in theoretical work, practice, policy and care management. While this model is a product of the health-education sector, it is global in scope, taking in the current situation, history and future as complicated by scientific, socio-political, technology and climate change. Practice-based, Hodges’ model is a tool simple in form and yet powerful in terms of how it can help users frame the problems and opportunities of the 21st century. The model was originally taught in studies for the post-registration certificate of care of the mentally ill in the community and other courses. Student assessment included the completion of a case study (vignette), demonstrating competence in application of the model and its embedded (implicit) values.

Access to education, especially early years, is emphasised as foundational for personal and community growth and development. For individuals this can set the course for lifelong learning and an ability to contribute to society and the economy. Given this primary challenge, global institutions and policy makers point to the need for curricula that are relevant. In turn employers and industry leaders need a (global) workforce who are: 

• reflective practitioners;
• critical thinkers;
• able to see the ‘big-picture’; and focus on detail and priorities when needed (risk and triage);
• decompose a problem, but also integrate (care);
• work as team-members;
• and extend across several literacies.

These challenges are ongoing for education (being health literate, so as to address personal, social, health and economic education, and the sustainable development goals), and increasingly climate impacts.

'Curiosity': child safety and safeguarding c/o BBC News

'Teacher who killed his adopted son given whole life prison sentence

14:30 18 June

That concludes our live coverage of the sentencing hearing.

To recap what happened at Preston Crown Court earlier: A teacher who sexually abused and murdered the 13-month-old baby boy he adopted with his partner has been told he will spend the rest of his life in prison.

Preston Davey died in July 2023 at the hands of Jamie Varley, 37, who subjected the child to physical, sexual and emotional abuse during the final four months of his life.

Varley, from Blackpool, told police Preston had accidentally drowned in a bath, but a post-mortem examination discovered the child had suffered 40 injuries.'

Continued ...

◇

individual

|
INTERPERSONAL : SCIENCES             

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

SOCIOLOGY : POLITICAL   

|

group

curiosity
	PROFESSIONAL CURIOSITY

Source (Various): BBC Live News https://www.bbc.co.uk/news/live/c4gyrewq8xkt

 Previously: 'curiosity' : 'risk'

iii Book: 'Complexity in Health Care - A Paradigm Shift for Clinical Practice'

In reading this book and others on W2tQ, I must make the following points:

  * my need to remember the purely USA context (I have never worked there);
  * my healthcare, nursing, informatics experience is NHS-based;
  * this review (and others) is motivated by the project here - Hodges' model;
  * as a result, I will be quoting heavily, there is much to bring to your attention.

As noted in post (i) there is much to whet the appetite, a paradigm shift, 'comprehensive, collaborative, and integrated care' (p.11) certainly have become popular topics in the medical literature. Not only that but 'interpersonal and intersubjective treatment models' too (p.12).

The role of 'Case Managers' is highlighted, plus the Case Management Society of America, which is committed to:

•  Improved Consumer Health Outcomes
•  Professional Diversity, Equity, and Inclusion
•  Cultural Competency and Humility
•  Advocacy for the Health Consumer
•  Integrity and Ethical Principles
•  Promoting Health Equity
•  Educating Case Managers Across the Care Continuum
•  Evidence-based Quality Care
•  Holistic, Compassionate Care
•  Fostering Communication and Collaboration
•  Advancing Research, Innovation, and Use of Technology
•  Fiscal Accountability [ https://cmsa.org/about/ ]

Whether the USA influences global trends in the structure and form of healthcare is another post, but there is a UK Case Management Society too: https://www.cmsuk.org. I can see a fit here [UK] with the development in recent decades on social prescribing. A different role, of course but part of a complex jig-saw.

As expected definitions are provided: 

'Roger Kathol has eloquently defined "health complexity" as "the interference with the achievement of expected or desired health and cost outcomes, due to the interaction of biological, psychological, social and health systems factors when patients are exposed to standard care delivered by their doctors" [1].' p.10. 

Roger G. Kathol, Rachel L. Andrew, Michelle Squire, Peter J. Dehnel (2018) The Integrated Case Management Manual: Value-Based Assistance to Complex Medical and Behavioral Health Patients. 2nd ed. Basel: Springer.

I can see where this definition comes from, but for me, it does not sit right. The problem when there is 'interference' is the assignment of responsibility and consequence that blame can follow. We've seen this, and in mental health too), with the recover model^. Some of the terms here may be completely innocuous politically speaking (which is the author's intent of course), but they can also be 'weighted'. Hence they can become concrete terms of judgement. Think about it: achievement, expected, desired, cost (and) outcomes, standard care, delivered (by doctors)? Or, am I over-thinking again.

In the margin I pencilled/drew:

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group

Standard -	care
Other -	factors

As ever, the individual patient is our focus. The individual is supported (literally) by the social and political (infra-)structures that act as a scaffold, safety-net for most.

Time flies, I can't believe it was 2007 I posted 

Plush HQ foyer, shame about the mannequins!

I had this notion of life-size cardboard cutouts representing the average people who use a given health service provider (local, or not so local these days?). The data will be there in statistical annual reports. I'd noticed the displays - analogue and digital that greeted visitors at a local NHS Trust HQ. This would be the book's 'routine patients' who receive standard care. 

Chapter 3 introduces 'variables' which again is brief, but imporant as variables recur throughout the book. The 'Clinical Field' is first outlined, as in:

• Sources of clinically relevant factors;
• Dynamic factors;
• and: Variables representing contributions from practitioner(s).

Abstract variables are differentiated from those that are concrete. It's reassuring to read there is no true simplicity within the clinical field, and the author's goal is to 'unpack complexity so it remains as true to life as possible, not just manageable conceptually.' p.18.

Frankel et al. are primed to go beyond this. Maths, as in statistical procedures are one tool. Chapter 4 adds to this with a theoretical model to guide clinical understanding of patients with biopsychosocial complexities, the foundations of our paradigm shift. p.23.

If you have an understanding of Hodges' model you can picture my response to this. But, staying grounded, the whole book and paradigm shift represents a form of scientific "emergence". It is frustrating that literature searches fail to pick out Hodges' model. 

Frustrating too as reading of "awe", also on page 23, I have experienced this many times (over say 1977 - 2019 ...). So, I held on to my dummy (pacifier!?) and read on ...  

Chapter 4 Technical Considerations is one the longest and contributes all of Part III. Here you can read about science, measurement, statistics, empirical, operational definitions, intelligence, reliability. I often see a chapter, book section as a useful primer for students and the same applies here; with inter-judge realiability, validity, control, null hypothesis, statistical methods and much more. Reference to mathematics (axiomatic too) had me hoping for more. I picked out Structural Equation Modelling:

 'We would also like to suggest that following the steps involved in "structural equation modeling" (path analysis) is a good way of conceptualizing and reasoning about complex clinical variables altogether. For example, constructing a clinical model informally (intuitively, loosely from data) and thinking about (diagramming) how the variables involved may moderate and mediate each other can be a useful activity for clarifying the nature and requirements of a complicated clinica1 situation. 
 

 In simplest terms, an independent variable is the causal or influential variable that impacts and effects the dependent variable. A moderating variable is a dichotomy, and refers to two comparison groups (e.g., male/female; passed/fail; religious/nonreligious; tall/short; high versus low socioeconomic status) that display significantly different degrees of magnitude on a correlated relationship. For example, the relationship between a specific treatment for a medical disorder and treatment outcomes may be moderated by socioeconomic differences. The treatment outcome relationship may be stronger and more positive for individuals with elevated socioeconomic standing who therefore have better support systems and access to medical professionals, and fewer economic stressors.' p.36.

I think from this the authors might be sympathetic to giving 'life' to the POLITICAL domain and Hodges' model; after all it lives in people's daily experience - acknowledged or not. The book's structure works thus far: Chapter 5 Nature-Nurture (n.b. no escape!)  and the Epigenome. The structure - flow - works, as at just over four pages, it begs further reading (beyond the listed references). I still have my copy of:

Fritjof Capra and Pier Luigi Luisi (2014) The Systems View of Life - A Unifying Vision. Cambridge: Cambridge University Press.

 

With the epigenome being added to the 'patient complexity equation' in chapter 5, I wondered whether this was predictable, a promise, or a tease?

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group

nature?	NATURE?
NURTURE?	nurture?

 

Previously: 'complex' : 'nature' : 'mental health' : 'person(-centred)'

More to follow ...

^Jones P. (2014) Using a conceptual framework to explore the dimensions of recovery and their relationship to service user choice and self-determination. International Journal of Person Centered Medicine. Vol 3, No 4, (2013) pp.305-311. 

Steven A. Frankel, Steven D. Thurber, James A. Bourgeois (2023) Complexity in Health Care: A Paradigm Shift for Clinical Practice. Cham. Switzerland: Springer. ISBN: 978303114948.

ii Book: 'Complexity in Health Care - A Paradigm Shift for Clinical Practice'

I didn't have time to finish reading Frankel et al. before WCCS26. This book has an index which was very useful, to efficiently check certain points. It is amazing the number of books without an index.

Chapter 1 is 'Guiding Principles' and links really well with the index. At two pages it is brief and yet also constitutes Part 1. 

Part II The Clinical Situation, continues an introductory thread. Chapter 2 The “Clinical Situation”: An Introduction to Its Structure and Complexity is what attracted me to the book. At five pages, there was more in this vein. I looked ahead and found that the chapters all seemed short. Checking the book's web page, 50 chapters in 270 pages, so just over 5 pages and well referenced too.

Initially, you might feel short-changed, of course, I didn't with a review copy. But don't worry. You are in patient- person-centred hands here. Sometimes content matters. The three authors work and are researchers in psychiatry. For me, the guiding principles and part II provide a handshake with the index. The person here then, is given a literary hug. Immediately, there is a link between the variables of care and the structure of a case (or caseness). 

'But importantly that "structure" is dynamic changing over time. We classify variables as "clinical" as they are brought into play for the purpose of treatment, i.e., the goal of healing.

The clinician is not just challenged to unravel this complicated situation but also to represent the patient accurately, including his or her "human" elements as represented by temperament and personal attitudes. What are the patient's essential needs. tolerances, preferences? Yet, there is even more to know about each patient. Does she have children? What is her financial status, her ethnicity? What are her attitudes about medical professionals. Does she believe in medicine, or even in science?

Beware! None of these factors are dispensable when trying to understand a patient. Just try to leave out a few and you are left with a gutted rendering of that person, not a living human being.' p.7. 

(and continued in fragmented form below ...)

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group

'The result even when this level of detail, is available may still be an anemic version of the patient.    Traditionally a medical patient is subjected to an extensive workup that includes a mental status examination, in addition to a detailed past and present history, ...	... and an extensive "review of (organ) systems.
Now add the multiplicity of problems, psychiatric and systemic medical, from which the patient suffers. ...	Multiplicity may include systemic medical, psychiatric, social, financial, and lack of access to health providers.' p.7.

'From this description it seems logical that complex patients presenting with mixed medical-psychiatric disorders be managed with an ongoing collaborative approach delivered by a multispecialty team. Included may be a primary care physician, psychiatrist, and/or psychotherapists. One or more of the collaborating professionals may be a nurse practitioner and/or a physician's assistant.' p.7

I will return to the 'logical' in the final quoted paragraph above. The author's declare their intent from the outset, and by the literature-to-date they achieve this (may I please add? 'in spades!').

 

Over the years and as raised on W2tQ, several colleagues and contacts have asked "Where is the book on Hodges' model?" Not to sound weird, but this book asks that same question through some challenges to the usual 'medical' text. There are several lessons to take away here, even if only to keep a dream alive. While the physical size of a textbook, its practical appeal and stance makes it appear as something to pop in your top shirt/jacket pocket. A pocket guide: quite an impression just 10-20 pages in, and in this digital age.

 

As you would expect from mental health practitioners - psychiatrists - psychotherapists, interpersonal, subjective-objective and intersubjective factors are integral to how complexity is defined and measured. In Chapter 2, pp.11-12 there is mention and reference to the Value-Based Integrated Case Management Complexity Assessment Grid:

Specker, S., Andrew, R., Drexler, E., Koithan, E., Thurber, S., & Frankel, S. (2026). Development of the Self-Administered Health Complexity Screening Instrument. Professional case management, 31(2), 81–89. https://doi.org/10.1097/NCM.0000000000000845

I will check this instrument as I complete this review. As noted on April 9th this book was published in 2023, so I remain grateful to Daniela and colleagues at SpringerNature for the review copy (which also enjoyed WCCS!).

Previously: 'complex' : 'holistic bandwidth' : 'mental health' : 'person(-centred)'

More to follow ...

Steven A. Frankel, Steven D. Thurber, James A. Bourgeois (2023) Complexity in Health Care: A Paradigm Shift for Clinical Practice. Cham. Switzerland: Springer. ISBN: 978303114948.

National Centre for Creative Health

Creative health is increasingly recognised as a driver of better care and better value in health and care systems. Integrating creative health into prevention, public and population health strategies, management of long-term conditions, treatment and recovery pathways contributes to:

• Reduced incidence of preventable illness
• Improved wellbeing of patients and service users
• Reduced demand on services

Many Integrated Care Systems and providers already incorporate creative health in physical and mental healthcare, social care, and public health, delivering measurable social and economic value.

Find out more about implementing creative health in your service, organisation or system from [our resources the resources ... 

NCCH has worked in partnership with NHS England to develop a Creative Health Toolkit. The Toolkit support systems to work with the assets in their communities and to develop their own approach.

NCCH publishes a monthly creative health newsletter created for professionals working across health and care.

Source: Email and National Centre for Creative Health 

Joining the digital dots across primary care and integrated care

My partner and I both received a letter today from our respective GPs. An invitation for a 'FREE LUNG HEALTH CHECK'.

Overleaf is an information sheet in landscape about the health check, plus three more sides of A4, similarly formatted - inviting trifold presentation.

After the 'Re. ......' an opening sentence asks: 'Have you ever been a smoker?'

Suddenly, I was dragged backwards through his-tory (some things don't change); not one history, but several:

INDIVIDUAL

|

    INTERPERSONAL    :     SCIENCES               

HUMANISTIC --------------------------------------  MECHANISTIC      

SOCIOLOGY  :   POLITICAL 

|

GROUP

My personal and life experience  and not just since my teens . . .

The letter states: **If you have never smoked, you are not eligible for this service**

My mother and father  smoked when I was a child and my siblings.    They got the message early 1980s.    'Society' smoked back then!     Once old enough, I refused to go to the corner shop.   Into the 1990s, patients, smoking (some chain-smoking) on admission, long-stay and other clinical areas. As a community mental health nurse, I learned diplomatic and health promoting skills when in the car, giving a patient a lift to hospital. And, when visiting their home where I was, of course, usually, a guest.

I wondered what has happened to the GP's records? To the primary care clinical record ? The custodians of my health record, that they should need to ask that question?    Or, does confidentiality tie some bureaucratic knots?   Where is 'integrated care' and its driver 'clinical informatics'?  The letter included the NHS Number.    Don't get me wrong, I/we appreciate the obvious effort here, even if the chronology is confusing, or,  speaks of afterthought? The letters are dated 19/06/2025. I must admit I haven't accessed my GP record, checking it for accuracy.   If anything, this is a prompt to do so. And seek a general medical.

Previously: 'smoking' : 'winwick'

Bio-Psycho-Social model: The L-shaped room

Qualification, induction, together with continuing professional development and mandatory training should see all health professionals having due regard for the 'political' in their respective roles. The 'Law and the Nurse' session, used to be, and remains a welcome reminder; also appropriately scary for this time of year. While at work the meaning of 'political' is nuanced with so many aspects and dimensions, e.g.

Public Service

Safety - Statistics - Quality

Zero tolerance - Never events

Leadership

Operating Procedures

Audit - Reports

churn of policy cranked by governments / parliaments

cost - savings - budgets - the plan

pay negotiation - Unions, Professional Organisations

Litigation

Administration Human Resources

Recruitment & Retention 

Disciplinary processes

Planning

Estates - Procurement - Supplies

The organisational tree - communications

structures - providers, commissioners, integrated

News: NHS, private sector, Social Care, Gov. 'Papers'

organisational (footprint) footprint

sustainability, green initiatives

signage - national - local

combined local policy initiatives and national emphasis e.g.

equality, equity, inclusion, 

management of violence abuse in the workplace, bullying, 

managing complaints, confidentiality
changes in reporting incidents, data returns,

information systems, governance and records management)

Is it me, or do the medical model, bio-medical model and the bio-psycho-social model somehow seem lacking?^

Individual

|

      INTERPERSONAL    :     SCIENCES               

HUMANISTIC =========================  MECHANISTIC      

 SOCIOLOGY  :    POLITICAL 

|

Group

psycho	bio
social	?

In surgical terms, how is the political domain best realised within a model of health and social care: anastomosis or transplant?

^As seen by a certain lens.

Previously: 'models' : 'bio-psycho-social' : surgery

The creation of Hodges' model: "All aboard!" 200 years

28th May 1997

When I interviewed (Mr.) Brian Hodges in Manchester on 28th May 1997, I learned he had created the model in 1983, mainly while commuting to Manchester Polytechnical College by train from (Totley) Sheffield, and back. 

I wish I could have been sat by him, to strike up a conversation. Although (among other points) I'm not sure how much he relied upon, or was chasing down the visual side of the model, with some skethces and drawings. So would I have noticed him thinking, drawing, crossing-out, and labelling? This I would have noticed, not that I have a habit of 'spying' and being nosey. Although nowadays, with the repeated announcements on the trains: ‘See it. Say it. Sorted’; perhaps I should?

In 1983 I was a general student nurse (SRN), and still over a decade away from becoming a community psychiatric nurse in 1985, and being (well) taught by Brian and colleagues in 1987.

I also enjoy a (reliable!) train journey, and used to read a lot travelling from the NW England through the London underground (Euston-Waterloo) to Plymoth, and later to Portsmouth in the 1970s. Happy days, then and today; with the railways reasserting their relevance. A quality shared with a certain little-big model I know.

Individual

|

      INTERPERSONAL    :     SCIENCES               

HUMANISTIC =========================  MECHANISTIC      

 SOCIOLOGY  :    POLITICAL 

|

Group

	Rail 200
	Nationalised - Private Private - Nationalised Charity - CIC

'National Care Service' - Casey Commission

'Casey Commission tasked with producing plan for ‘national care service’ by 2026

Government remit also asks independent commission to consider services for older people and disabled adults separately and to ensure recommendations stick to government spending settlement

By Mithran Samuel on May 2, 2025 in Adults, Social work leaders

The Casey Commission has been tasked with producing a plan next year for delivering a “national care service” over the course of a decade.

The 2026 report will be followed by a further report, due by 2028, setting out longer-term recommendations for the sector, according to the Department of Health and Social Care’s (DHSC) terms of reference for the commission, published today.

The Independent Commission into Adult Social Care, headed by crossbench peer and renowned government troubleshooter Baroness (Louise) Casey, started its work this week.

The plan to set up the commission sparked criticism from social care organisations, after it was announced in January, due to its three-year timeframe being seen as far too long to develop a plan for a sector under under severe immediate pressures and facing significant future challenges.' 

continued...

https://www.communitycare.co.uk/2025/05/02/casey-commission-tasked-with-producing-plan-for-national-care-service-by-2026/

The Casey Commission

... so many people ...

Individual

|

      INTERPERSONAL    :     SCIENCES               

HUMANISTIC  --------------------------------------  MECHANISTIC      

 SOCIOLOGY  :    POLITICAL 

|

Group

... watching this space.

My prompt: Letters to the Editor, The Sunday Times. 12th January 20025. p.22.

https://www.thetimes.com/comment/letters-to-editor/article/sunday-times-letters-labours-national-care-service-proposal-ghx22kzt2

Politicians! Please leave it to the Public ...

Individual

|

      INTERPERSONAL    :     SCIENCES               

HUMANISTIC  --------------------------------------  MECHANISTIC      

 SOCIOLOGY  :    POLITICAL 

|

Group

'Kick' - a verb, more often it seems, a noun.	Health and Social Care?
Gent kicking a can Wall poster/photo Corfu Town	... to kick the can down the road!

"Integrated - care": What's in a word, or two?

This blog post was sat in 'drafts' since 28/01/2007 (yes, I know what that suggests). It concerns an issue, or more properly a theoretical and experiential aspiration in health AND social care that should in truth have provoked many papers for Hodges' model by now.

In the almost 18 years since, I wonder about the total number of papers devoted to this subject, the service's delivery, policy, outcomes, reviews and reports on integrated care? In nursing theory, philosophy and the start of many 'learned papers', it is customary to begin with a definition of terms. What happens when we divide 'integrated care' and first treat integrated and care separately? Does this aid our understanding? Do we divide and conquer? Is there a difference in results? Conceptual analysis would see us do both, and conduct a literature search.

In practice, (and clinical - especially) we often use words in rather lackadaisical way. Not surprising really, after all we've got a job to do! When pronouncements are made regards health and social policy I hear it as good intentions. I also reach for my soap box. It is often hyperbole, rhetoric. The same applies to the related idea and ideal(?) of holistic care, and person-centredness. I'm biased, of course, but I believe that Hodges' model can help to scope, and define these idealised features of health and social care (and education). As noted, people don't have the luxury of time to stop and deliberate on the precise meaning of the language they routinely use. As noted, at the end of the day - if it gets the job done then that's sound.

In a poll of words that are both much used and the meaning taken for granted integrated must be near the top for several reasons:

• its seniority: it has been around for decades.
• its scope across sectors and day-to-day life.
• our dependence on its fulfillment.

N-Gram suggests some possible insights into integrated and related forms of care:

https://books.google.com/ngrams/graph?content=integrated+care,holistic+care,person-centered+care&year_start=1800&year_end=2022&corpus=en&smoothing=3 

[Trying to embed, results in 1/3 white space at the bottom?]

It seems that integrated care [IC] has been a standing agenda item in health and social care media, education, the workforce, conference, exhibition and policy for several decades. Perhaps, things have calmed somewhat? So either IC is either very important, complex, a hard thing in practice or maybe it's all of these and more besides? IC is a undeniably a compound concept. Is this a cop-out though? You declare something 'compound' then sit back - job-done? I've suggested the same of threshold concepts in health (and probably other contexts?). Time will tell. In the meantime I have reflected on 'integrated care' across the domains of Hodges' model:

self

|

INTERPERSONAL : SCIENCES              

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

SOCIOLOGY : POLITICAL   

|

other

INTEGRATION OF: PRACTITIONER; Team; service; org... Philosophy* assessments threshold for acceptance into service (referral criteria) patient experience & engagement health education / literacies programmes spiritual research involvement	INTEGRATION OF: health record (e- or paper) location - team base care disciplines geographical area referral sources assessments - tools/scales data and statistics research involvement
INTEGRATION OF: HEALTH & SOCIAL CARE public engagement hospital  carer (parent/guardian) experience community services social care - NHS family experience public engagement in research Patient / Public Community Advocacy Treat demand :: Support prevention	INTEGRATION OF: funding leadership / management accountability - complaints (not the same thing!) outcome measures ILLNESS - PREVENTION / education self-care <> planetary care -  Sustainability assisted dying! palliative care! Public - Private - Voluntary Sectors Provider :: Purchaser [Systems] All-Party Parliamentary Groups^

*ethics, values.

^One aspect of so-called 'joined-up government'.

Reablement, Rehabilitation, Recovery: Everyone’s business c/o BGS

In March 2023, we published Joining the dots: A blueprint for preventing and managing frailty in older people. This set out seven touchpoints of care that should be available to older people, as and when they need them and 12 recommendations to systems. One of the recommendations is specifically around the provision of rehabilitation and one of the touchpoints is ‘Integrated urgent community response, reablement, rehabilitation and intermediate care.’  

In this new document, we take a deep dive into this Blueprint recommendation, looking at the evidence behind the provision of rehabilitation for older people and highlighting examples of best practice from across the UK and internationally. We argue that rehabilitation should be a component of virtually all care for older people, across all care settings, and that there is no such thing as ‘no rehabilitation potential.’ 

This document has been led by Professor Anne Hendry, Honorary Professor at the University of the West of Scotland and Senior Associate at the International Foundation for Integrated Care and a group of BGS members from across the UK and across disciplines have contributed to drafting the document. We hope that BGS members, commissioners and system leaders will find it useful in planning rehabilitation services for older people in their communities. 

More information - full report.

'Other exhausted words' ... ?

"A writer I admire expresses in a few words his disdain for plausible but empty political language, beginning with one good example. "The word, Fascism," he writes, "has now no meaning insofar as it signifies 'something not desirable.'" He adds other exhausted words, including democracy, freedom and patriotic - convenient terms for establishing righteousness, easily melting into self-righteousness.

The writer is George Orwell, in his celebrated 1946 essay "Politics and the English Language." Orwell contended that language had become corrupt and debased in his time, but the survival of his examples into the present contradicts him, suggesting that not only the problem but the very examples may be timeless."

Plain, direct language remains rare, desirable - and risky in ways that authority, even more than the rest of us, tries to avoid." ...

... "Dilution of meaning is familiar in a way that can make us feel comfortable, or even worse, comfortably righteous."

Individual
   |

      INTERPERSONAL    :     SCIENCES               

HUMANISTIC  --------------------------------------  MECHANISTIC      

 SOCIOLOGY  :   POLITICAL 

|

Group

concept critical thinking parity	framework evidence-based transformation
holistic care integrated care person-centred	outcomes prevention sustainable health care

n.b. With some words more exhausted than others; while some have not, as yet, been fully exercised.

Pinsky, R. When language fails us and the moment. The New York Times International Edition. January 30, 2024, p.12.

Previously: 

The view from Wigan Pier* ...

"Maslow's hierarchy of needs hides housing horror" c/o Gary Backler in FTWeekend

"John Burn-Murdoch sets out graphically the intergenerational horror story of housing in Britain since 1980 (Opinion, January 13). ...

Abraham Maslow, the American psychologist, placed the need for "shelter" at the very bottom of his famous hierarchy of needs. 
We used to know this. I have a photo of my newly married parents' first rentbook for the council house into which they moved in 1953. It is clear on the cover that after the "accountant to the council", the next most responsible officer is the "medical officer of health". ...

Individual
   |

      INTERPERSONAL    :     SCIENCES               

HUMANISTIC  --------------------------------------  MECHANISTIC      

 SOCIOLOGY  :   POLITICAL 

|

Group

mental health emotional needs	physical health shelter/physical security
social needs - belonging social care society	Rentbook for council house in 1953 © Gary Backler

Backler, Gary, Maslow's hierarchy of needs hides housing horror, Letters. FT Weekend, 20-21 January 2024, p.8.
Ack. Financial Times. https://www.ft.com/content/3b8719f6-d8e9-4997-b9b5-7dd7ba96fc08

Previously: Maslow.

When 'containment' and 'protection' meet injury

INDIVIDUAL

|

     INTERPERSONAL    :     SCIENCES               

HUMANISTIC --------------------------------------  MECHANISTIC      

SOCIOLOGY  :   POLITICAL 

|

GROUP

"MANUEL SUFFERED two serious brain injuries as a child in Denver, Colorado." p.54.

The function of the skull is . . ? "Brain injuries affect about 8.5% of the general population but rates among prisoners are far higher. Kim Gorgens, a neuropsychologist at the University of Denver, reckons that between 50% and 80% of prisoners and those on parole in America have brain injuries. A review of research in America, Australia and Europe suggests that the average reported rate is around 46%. Research conducted in 2010 by Huw Williams of the University of Exeter put the rate among men in British prisons at 65%. A study published in 2017 found that nearly half of all prisoners in New Zealand had been hospitalised for a traumatic brain injury before committing their crime. Researchers suspect that the numbers may be even higher in poorer countries because road-traffic accidents and violence are generally more common." p.54.

"A report in 2016 by the Centre for Mental Health estimated that in Britain the cost of traumaic brain injury in a 15-year old who goes on to offend is around £345,000 ($475,000). The cost to those affected and society more widely - is incalcuable." p.55.

The function of prison is . . ? "They are more troublesome while in prison and more likely to reoffend on release. This is especially true for those, like Manuel, who are injured as children." p.54. "Acknowledging the link between brain injuries and criminal behaviour is not to excuse lawbreaking. Most people with such injuries are capable of taking responsibility for their actions. However, it is easier to curb crime if you understand the factors that make it more likely, of which neurodisabilities are an important and neglected one." p.13.

Banged up. International, The Economist, March 27th 2021. pp.54-55;
And: Leaders. Knocked out and locked up. 438:9238, p.13.

See also:

UK Prisons Strategy White Paper

Headway: Brain injury and the criminal justice system

c/o HSE.ie - Model of Care for People with Mental Disorder and Co-existing Substance Use Disorder (Dual Diagnosis)

"The definition of Dual Diagnosis for this Model of Care is: ‘the co-morbid disorders due to substance use and/or addictive behaviours along with the presence of mental disorder(s)’. The disorders of substance use include disorders of alcohol use." p.10.

Model of Care for People with Mental Disorder and
Co-existing Substance Use Disorder (Dual Diagnosis)

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

mental disorder addictive behaviour - inc. gambling and gaming disorder lived experience recovery (here?) [cognitive access: orientation, insight, literacy, communication ..] training patient and	Demographics: Adult Dual Diagnosis team cover population of 300,000 Adolescent Dual Diagnosis teams 10 to 17 years lived experience data gathering p a th w  a ys [ physical access: place, time] e-health, therapeutic modules reablement, recovery (here?)
public involvement Carers Social Inclusion Social capital lived experience Vulnerable women, communities, homeless, ethnic minorities, refugees, recovery (here?) rehabilitation	Dual Diagnosis Service funding [ planned - in-patient beds ] TRAINING Service users lived experience interdepartmental discussion re. service provision for prison population probation services asylum seekers, immigrants Key Performance Indicators recovery (here?)

FOR: Economic, Educational, Environmental, Social, Political DETERMINANTS . .

READ: Cognitive, Physical, Social and Political ACCESS

My source: https://twitter.com/h2cm/status/1661299925391384576?s=20