Gaps and Legacy Issues in Health and Education

 ... and across the Professions and Disciplines

I've just revised what may be table 1 of an exploratory paper. The table's role is to inform the motivation, scope and overall purpose within the introduction. The aim is to outline the gaps and legacies in health and education. Is this the combined inheritance of life chances, health and work career: gaps?

1. Theory-Practice gap

   A. Research in Practice – Translational Research;
    B. Education/Training: University – Apprenticeship (see 4.B);

2. There is no research-based conceptual framework taught and applied across health and social care systems and services.

3. Individual – Collective (Population) Health

4. Legacies of:
     A. Integrated care (global: funding / philosophy / location / disciplines / academic …);
     B. Parity of Esteem
          i   Mind - Body – Cartesian dualism;
          ii  Funding of Health Services [mental health - general];
          iii Research funding; Policy & Education);

C. Person-Centred Care – Service-Centred Care;

D. NHS - Social care;

5. (Ill-Health-Disease, see 4.B.ii) Treatment versus Prevention first 

6. Long-term policy Vs Short-termism

7. Personal, Local, Global: Developed – Developing Health Systems & Services 

8. Determinants of Health (Schrecker and Bambra, 2025)
   
   

Any thoughts, key sources ... are most welcome, e.g. should there be a place for sustainability, self-care, the literacies and the basis of funding public, private, or charitable (mixed)? h2cmng AT yahoo.co.uk
 

Schrecker, T., Bambra, C. (2025). ‘Lethal But Legal’: The Corporate Connections (Commercial Determinants of Health). In: How Politics Makes Us Sick. Palgrave Macmillan, London. 
https://doi.org/10.1057/978-1-349-96127-6_7

Well-being of Future Generations (Wales) Act 2015

I do remember reading about the Well-being of Future Generations (Wales) Act 2015 in Resurgence & Ecology, Russell Warfield, Acting for the future. Issue 322. 2020. pp.20-24 [with another gem to follow]. Belatedly, here it is:

The Well-being of Future Generations Act

There are 7 connected well-being goals for Wales. They are:

• A prosperous Wales
• A resilient Wales
• A healthier Wales
• A more equal Wales
• A Wales of more cohesive communities
• A Wales of vibrant culture and thriving Welsh language
• A globally responsible Wales

 ...

This is about ensuring that future generations have at least the same quality of life as we do now. The act provides for better decision-making by ensuring that public bodies:

• take account of the long term
• help to prevent problems occurring or getting worse
• take an integrated approach
• take a collaborative approach, and
• consider and involve people of all ages and diversity.

Text source, video below with a 10th Anniversary video also:
 https://www.gov.wales/well-being-of-future-generations-wales

 

I wonder what tools they use to help the integration?

IFS Report: 'From fiscal rules to fiscal traffic lights: rethinking the UK fiscal framework'

'In other words, the current framework means that macroeconomic volatility is mainlined into policy volatility, which adds unnecessarily to economic uncertainty and makes good policymaking less likely. There is also a problem of asymmetry: when the forecast improves, any additional ‘headroom’ is typically treated as free money and happily spent. Yet when the forecast worsens, the rules tend to get changed or ‘gamed’: Chancellors of all political stripes have proved adept at promising future tax rises or spending cuts which are unlikely to be delivered, but which allow them to meet the letter of their rolling fiscal targets. 

All this is to say, the current framework is not delivering good outcomes. It is not achieving sustainable public finances, it has limited credibility with financial markets, and it is not creating the conditions for good policymaking or for a high-quality public debate about the important issues at play. It seems likely that any framework, left in place for long enough, will start to create problems in practice, as unhelpful norms emerge and actors find ways to game the system. Just as the tendency of HM Treasury to fudge its forecasts in the 2000s was one reason for the creation of the OBR as a corrective mechanism, the dysfunction around the current framework necessitates a change in thinking and approach.'

INDIVIDUAL

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    INTERPERSONAL    :     SCIENCES               

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

SOCIOLOGY  :   POLITICAL 

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GROUP

'Fixation upon - lived [ equilibrium ] experience 'RAG' assessment of patients in mental health services - caseload management	fiscal headroom' GOOD - BAD PASS - FAIL Equilibrium Outcomes
Public Policy   Interviews   sustainable public finances   good policymaking (here) high-quality public debate Cost of Living	Report: IFS Policy Office for Budget Responsibility

My source: Valentina Romei, IFS urges end to fixation on fiscal 'headroom', Financial Times, 19 February, 2026, p.3.

Images: IFS

'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

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      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

'International Nurse's Day' 2025 #2 - c/o ICN & WHO

State of the World’s Nursing Report 2025

State of the World’s Nursing

Report 2025

'As the world’s nurses celebrate International Nurses Day (IND), ICN issues a rallying cry to governments around the globe for urgent nursing support, following the launch of the second World Health Organization (WHO) State of the World’s Nursing (SOWN) report.

The SOWN report is a vital assessment of the global nursing workforce in the aftermath of the COVID-19 pandemic and underscores the urgent need for bold investments in nursing to address shortages, strengthen health systems, and promote global resilience and economic stability.

The SOWN report reflects ICN’s IND 2025 report, Caring for nurses strengthens economies, and related Survey of National Nurses' Association (NNA) Presidents, reinforcing the central role of nurses in achieving global health, including Universal Health Coverage (UHC), and calling for immediate action to address long-standing challenges. The SOWN data presents a mixed picture. It highlights progress in areas such as advanced practice and nursing leadership, but indicates gravely concerning continued workforce shortages, inadequate compensation and working conditions, poor mental health support, inequities in the distribution and employment of nurses, and failures to fully enable nurses as practitioners and health care leaders.'

Continued ...

Caring for nurses strengthens economies

Caring for nurses
strengthens economies

'As we face growing health care challenges, from ageing populations and rising chronic diseases to climate-related emergencies and deepening global inequalities, the need for a strong, sustainable nursing workforce has never been greater. We cannot meet these challenges without sufficient nurses who are themselves well-cared for and supported. ICN’s International Nurses Day report reveals the severity of our current nursing shortage and well-being crisis – and the path forward. ICN’s “Caring for Nurses Agenda” provides a comprehensive roadmap for creating environments where nurses, patients, and entire health care systems can flourish.'

Source: ICN

Dear Doctor, I have a list . . .

It seems reasonable to suggest that my trips to see the GP as a child:

"What's the problem Mrs Jones?"

"It's Peter, he's not eating!"

"Well, does he seem ill? ... Is he lying down all the time?"

"No, he's running around all day"

"Well he sounds OK but let's check" ... ... ...

"Say arr!"

 (That's to me - not you reader!)

"Argh!"

"Mmm.. ok, ok. ... What does he eat?"

"Tomato soup, chips, chicken, beans on toast, raw carrot, boiled egg."

"Oh! And jam butties!"

"Well he's of slim build, no doubt underweight, but he's fine. Keep the jam butties rolling, and I suspect he'll keep running around."

- were in the days pre-one-problem-per-visit to the surgery. Even now I wonder is this an urban (rural) myth. But then it rears itself with a comment by family, or overheard. The 1960s and 1970s were a different time, a different age. We always saw the same doctor. Continuity mattered then. Thankfully, I was not a regular 'visitor', or the more derogatory term frequent flyer.

individual

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INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group

Ever since starting in the NHS as a nursing assistant, you became aware of the anxiety provoked by many patients when it is their turn to see the doctor. Being asked to bring the patient and any relative(s) through. It often entailed a walk.

I remember one instance their being 12 professionals. Learners can soon increase numbers and restrictions were imposed. Voices were raised. Patients did see the doctor separately. Back in 1980s, I became a CMHN (CPN) in 1985, I used to encourage patient's to prepare, to make notes of points - questions they wanted to ask. I framed it as their time, their opportunity. A learning opportunity too. Of course, humour always needs to be used carefully, but on occasion we would joke about walking into the meeting with a list.*

In case of long-term mental illness families are also greatly involved. Sometimes a case review would take place in the patient's home. If it's care in the community, delivered by the community team then surely the administration can be organised in support?

At times, I would offer to assist and the team were always responsive. This role of advocacy has changed, transformed over the decades, but it is still there. As a nurse you listen for the voice: but have to be ready to 'pick this up' on another's behalf. Ready

*Lists: Long a tool for safety and situational awareness.