‘Prevention Demonstrator’ - GM Live Well

England’s First Prevention Demonstrator: Opportunities for Greater Manchester and its VCFSE sector

Greater Manchester has been chosen as England’s first Prevention Demonstrator, an initiative announced in the Government’s 10-Year Health Plan earlier this year. It marks a step toward transforming public services with a more ‘preventative’ approach.

The Greater Manchester Combined Authority (GMCA) was named as the first prevention demonstrator in the UK Government’s 10 Year Plan for Health in July. It will take a community-led preventative approach to the provision of public services which means fixing the foundations of a person’s life – such as housing, and access to education and employment opportunities – as a means of preventing ill health from social and economic detriment and improving lives, as well as reducing pressure on acute and crisis services.

The Prevention Demonstrator will be building on the Live Well Model of service delivery, which brings together services such as health, employment support and debt advice at a neighbourhood level working with the voluntary, community, faith and social enterprise (VCFSE) sector, providing a blueprint for the rest of the country.

Warren Heppolette has been appointed to lead this work, seconded from NHS Greater Manchester where he was Chief Officer for Strategy, Innovation and Population Health. Warren has been closely involved in the GMVCFSE Leadership Group’s Commissioning and Investment sub-group which aims to improving standards and practices for the benefit of the VCFSE sector.

Continued ...

Lucy North, Communications and Policy Officer. Published: December 5, 2025

⍚

'Sustainability' and 'sufficiency' (as per the previous post) are words of the moment. Policymakers want change to have a permanent quality, which ironically means individuals within a population benefitting from initiatives like this have a mindset that makes them flexible to future changes and challenges.

As Camilla Cavendish notes in 'Andy Burnham will need to play a new card now', Manchester's prevention demonstrator has echoes of David Cameron's Big Society and the Troubled Families project. There are two other words that can work for individuals and populations: impetus and momentum. Within this through Hodges' model we can equip people and communities for lifelong learning. We can also highlight, as Prof. Kevin Fong did at RCN Congress 2026 in his marvellous keynote - that resilience is found between people, not within individuals.
 

See also: Presentation - Prevention, Health and Good Growth: Realising Our Prevention Ambitions

Philip Britteon, Alfariany Fatimah, Stephanie Gillibrand, Yiu-Shing Lau, Laura Anselmi, Paul Wilson, Matt Sutton, Alex J. Turner, (2024) The impact of devolution on local health systems: Evidence from Greater Manchester, England, Social Science & Medicine, Volume 348, 116801,
ISSN 0277-9536, https://doi.org/10.1016/j.socscimed.2024.116801.

My source: Camilla Cavendish, Opinion: Andy Burnham will need to play a new card now, FTWeekend, 20-21 June, 2024. p.12.

Previously: 'prevention' : 'big society' : 'troubled families' : 'social prescribing'

(ii) What sort of field is 'nursing'?

Mathematics without Apologies:
Portrait of a Problematic Vocation

Harris quickly differentiates between pure and applied - practical mathematics. Nursing can claim mathematical tenure in being a constant. A constantly problematic vocation for governments worldwide. Temporarily recognised for its criticality, in terms of the population's dependence on nursing by the COVID pandemic. The global nursing workforce while often a political football in its host country, is in intensive care amid demographic change and policy imperatives. 

Neither maths/mathematics, numeracy, nor arithmetic are indexed in:

Curriculum Development In Nursing Education (4th. Edition).

If present, such detail might suggest a concept-based curricula approach, but the dichotomies of qualitative-quantitative and subjective-objective work to good effect; performing as per the axes of Hodges' model. Perhaps, there are nonetheless, more similarities between mathematics and nursing than an axial first-glance might suggest?

I've noted (if not lamented) the fall in prominence of nursing theory, models of care in nurse education and practice. Within the corpus of books the phrases are still common in terms of usage:

It seems that 'models of care' are not the sole preserve of nursing and health disciplines. These models are also defined by management consultancies*, care commissioners, economists, philosophers and policy makers. Hodges' model itself can be used to argue this is a legitimate activity, desirable and to be expected. 

An admittedly small sample, but here in NW England student nurses I encounter struggle to recall 'a' model, or theory that has caught their attention. With discussion, they realise they have been to this abstract place before. The attention on models and theory does not appear to match the focus afforded in North America. The political background of national health systems provision, the state of development of health services and systems and education make a huge difference between nursing academia globally, even as we strive to be one-family. 

Harris writes of the quest narrative in mathematics. There are problems solvers and the theory builders in mathematics. Tenured mathematicians seek the 'golden goose'. Hodges' model is the quest here: a golden goose in cognitive form that all can possess with requisite basic literacy and explanation. While as noted in (i) mathematics is a relaxed field (Preface, p.xi), it seems nursing theory is a (largely) deserted field. Ironically, seeking person-centredness, this is where Hodges' model begins - a necessarily conceptually deserted field that offers only structure but with the prospect of unconditional positive regard.

Harris, M. (2015) Mathematics without Apologies: Portrait of a Problematic Vocation. Princeton University Press.

*Reimagining the nursing workload: Finding time to close the workforce gap. https://mck.co/43tMB7v
via @McKinsey [A post may follow.]

See also: 'commissioning'

'nursing theory'

"healthcare finance" - September 2022

 INDIVIDUAL

|

 INTERPERSONAL    :     SCIENCES               

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

SOCIOLOGY  :   POLITICAL 

|

GROUP

	NHS Supply Chains - (Procurement, Logistics, Sustainability...) Virtual Reality - Virtual Wards Patient-level cost data Standardised finance systems
	Healthcare Finance - September 2022

Whole Theory - The Bigger Picture - Holistic Approach?

Together health and social care professionals orchestrate* person-centred, integrated care with constant regard to patient and public safety and quality. We cannot do this without effective administrative, management and financial support and resources.	"The Bigger Picture"
	Contents: Patient-level cost data Standardised finance systems PFI liability revaluation Reclaiming VAT on welfare services Population Health Previously on W2tQ: Value, Values-Based Commissioning

*Khine, Myint & Saleh, Issa & Dillenbourg, Pierre & Jermann, Patrick. (2010). Technology for Classroom Orchestration. New Science of Learning: Cognition, Computers and Collaboration in Education. 10.1007/978-1-4419-5716-0_26. 

Source: @HFMA_UK

Call for Papers: The Digital Movement in Nursing

Call for Papers: FOCUS The Digital Movement in Nursing

Focus Edition Guest Editor

Prof. Camille Cronin, Director of Research and Impact, School of Health and Social Care, University of Essex, UK

The Journal of Research in Nursing (JRN) is a leading peer-reviewed journal that underpins good research with current policy and aims to publish papers that will influence nursing practice and health- and social-care policy.

Over the last two years we have seen an unparalleled digital-technological response to the COVID-19 pandemic that has re-shaped the way health- and social-care functions, for better or worse. This change has been fast and relatively unevaluated, with little time or opportunity made available for the involvement of nurses, critical discussions or reflections. What did this do to the nursing world? JRN is commissioning this focussed edition to find out more.

We are seeking papers that showcase, describe, and highlight the impact of new digital technology and innovation on digital health related to nursing. These might include:

• showing how nurses are leading the development of such technologies or digital solutions; or
• how service users were involved in developing a digital resource using participatory practices; or
• the impact these innovations have had on nurses, and patients and their families – e.g. on accessing health care, on delivering and evaluating care; or
• what do we expect for the future and how do we enable the future health-care workforce to keep pace with such change?

Papers can be built around different research designs, case-studies, evaluations, or service improvement initiatives and may address any of these issues in relation to digital health:

• improving the quality of health-care and health, access, and safety through digital health;
• using digital health data to improve health- and social-care services;
• improving recruitment, deployment and retention of health- or social-care workers using digital technology;
• developing innovative technology and digital health strategies to improve care;
• developing or using technology;
• demonstrating initiatives that use technology to promote health and/or wellbeing; and
• what, if any, are the consequences of the rapid insurgence of digital health technology?

As JRN’s mission is to contribute knowledge to nursing practice, research and local, national and international health and social policy, the contribution of the paper to, or implications for, both nursing practice and health and social-care policy must be made explicit.

Authors interested in contributing to this edition of JRN should submit by 1 JANUARY 2023.

More details ...

The Cass Review Interim Report ... reflections ...

 ... that may stand for themselves?

[ with my emphasis ]

Independent review of gender identity services for children and young people: 

Interim report

February 2022

Introduction from the Chair

"... the aim of the Review is to ensure that children and young people who are experiencing gender incongruence or gender-related distress receive a high standard of NHS care that meets their needs and is safe, holistic and effective." p.11.

 

"As with autism, the framework for assessment needs to become formalised so there are clearer criteria for diagnosis and treatment pathways which are shared more widely. These should incorporate not just whether the child or young person meets DSM-5 criteria for gender dysphoria, but how a broader psychosocial assessment should be conducted and evaluated, and what other factors need to be considered to gain a holistic understanding of the child or young person’s experience. Professional judgement and experience will still be important, but if the frameworks and criteria for assessment and diagnosis were more consistent and reproducible, there would be a greater likelihood that two different people seeing the same child or young person would come to the same conclusion." p.60.

"Assessment and management: All children and young people who are referred to specialist services should have a competent local multi-disciplinary assessment and should remain under active holistic local management until they are seen at a specialist centre." p.92.

[ and from: https://www.england.nhs.uk/commissioning/spec-services/npc-crg/gender-dysphoria-clinical-programme/implementing-advice-from-the-cass-review/ ]

"Dr Cass has now sent further advice on the core components of this model. You can read the advice in full here.

In summary, she has said:

  ...

• ‘The services should have an appropriate multi-professional workforce to enable them to provide an integrated model of care that manages the holistic needs of this population’.

• ‘Staff should maintain a broad clinical perspective to embed the care of children and young people with gender uncertainty within a broader child and adolescent health context’."

 

LMIC: Opportunity to get involved with the National Institute for Health and Care Research, UK

Hello,

We have an exciting opportunity for people with lived experience based in low and middle income countries to get involved with the National Institute for Health and Care Research (NIHR) as funding committee members and reviewers, and we’d very much appreciate your help.

The NIHR is funded by the UK government and is a major funder of high quality global health research. Our next research programme is the Research and Innovation for Global Health Transformation (RIGHT) Call 5 , which is focused on strengthening health service delivery and resilience in low and middle income countries (LMICs) in the context of extreme weather events.

Would you be interested in joining us and giving your recommendations on which research proposals to fund? We are looking for people with lived experience of extreme weather events. Your insights and ideas can help shape research that is important to people living in LMICs, and improve healthcare services for some of the most vulnerable and marginalised communities.

The role of public committee member or reviewer involves reading funding proposals and providing a written summary of reflections. We pay a fee for involvement as a way of thanking you for your support. 

Please complete the Expression of Interest Form and submit this to us by Monday 16 May 2022.

If you have any questions or would like to discuss this in more detail, please get in touch with Razina Hussain at ccfcei AT nihr.ac.uk. 

Thank you and best wishes,

Razina

Razina Hussain

Programme Manager, Community Engagement and Involvement | PPI and Engagement | NIHR Central Commissioning Facility (CCF)

e. razina.hussain AT nihr.ac.uk

Central Commissioning Facility

Grange House

15 Church Street

Twickenham

TW1 3NL

My source: HIFA

High Intensity Networks - serenity integrated mentoring SIM model of care

individual
| 

 INTERPERSONAL : SCIENCES 

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

SOCIOLOGY : POLITICAL

| 

 group

'Serenity' a humanising term? TRAUMA informed? Expressing distress Poor coping skills Suicidal ideation, Plans, Intent Self-harm Personal Responsibility -  Serenity Practitioner values? Therapeutic modality Access to Therapy - DBT ...? Active research in this field - Parity? Chaotic presentation [Define] High Intensity: Needs highly personalised care 'person-centred care' 'This' is why I became a MH Nurse: Values

High Intensity Network# and “serenity integrated mentoring” (SIM) model of “care” Nursing theory: 'patiency' Integrated Recovery Programme - IRP [Define] High Intensity: Attempted suicide, Frequency, Nos. of services, Nos. of A&E attendances, Dual, n-diagnosis, Data Evidence-base Independent review Mare Serenitatis: Peace on the Moon? Resource allocation: Framing the problem* 'Clinically'

Language & Terminology 'High Intensity' Education of students: 'committed' - 'completed'? Care in the Community (Social) Serenity Social Justice Community - MH Nursing - of Practice Therapeutic relationships Historical artefact: The therapeutic alliance

Policing, Law & Enforcement “high intensity users” (HIUs) of emergency services Mental Health [Police officers] Teams Criminalisation Decriminalisation of Suicide 1961 (Organisational) Serenity? High Intensity (Service-centred) Cost, Time, Personnel, Services involved Commissioning, Policy Outcomes - Cost Savings? NMC MH Nursing Standards MH Nursing Curricula

^#Website not provided: "Service Temporarily Unavailable" 

*There is a 'problem' here. Is the main symptom and sign however, evidence of an ongoing lack of parity of esteem?

My source: Twitter - various

 

HSJ: Human centred systems - the case for [disintegrated] integration

individual
|

 INTERPERSONAL : SCIENCES 

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

SOCIOLOGY : POLITICAL 

|

group

Listening, communication slip ups YOU! are a - “bed blocker” “frequent flyer” My purpose Valuable or Vulnerable person? “PROTECT the Person”	Services, Teams, Silos Repeated doubling up, duplication Threshold raising simplify the steps 1940s style factory production line model ? 5-year cycle, interventions, (budget) ? Place-based
Neighbourhoods Anthropology of Communities PUBLIC - 'shared purpose' lived experience - develop a more flexible multidisciplinary workforce coproduction :: purchaser provider led model of commissioning social scaffolding in neighbourhoods -	initiatives Organisation 'INTEGRATE' Sovereignty, governance structures, pooled budgets “PROTECT the NHS” Public Service reform:  local government, dept of work and pensions,  police, housing and community and voluntary organisations.  - joint investment models

 

Human centred systems - the case for integration, By Donna Hall, 15 February 2021. HSJ. https://www.hsj.co.uk/service-design/human-centred-systems-the-case-for-integration/7029472.article 

 

My source: https://twitter.com/antlerboy/status/1392547724201971716?s=20

The humanistic and mechanistic in patient transport & safety

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group - population

Person - Identity 'Suspended personhood' ? Dissociation -> Alienation ? MENTAL - physical health Clinical assessment Mental Illness Mental Health Crisis Orientation - Mental capacity Anxiety - Distress - Stress 'Lived experience' Risk to Self / Self neglect Can person's needs be met? Trauma Individual sense-making "If I am in a cage ..." SUBJECTIVE - objective QUALITY - quantity Aesthetic (psychological) impact of conveyance

PHYSICAL - mental health Open - Closed Wards/Units Locked - Secure Clinical assessment Risk to Self / Self neglect Physical MECHANICAL restraint: Handcuffs Vehicle: Cage vans - confined space Logistics: Patient transport 'Transfer' local <---><-> remote Location of Specialist Units Number of places Data gathering Records OBJECTIVE - subjective QUANTITY - quality

Risk to Others Ability to cooperate Families - contact / visiting Shared lived experience: Treatment, Care Vs. Punishment Patient-Public Involvement Discourse Collective sense-making Perpetuation of stigma Blunted / Polarised dialogue:  Anti- Critical Psychiatry Barriers to dialogue: 'Service-users' - Services

Police & Policing Law Mental Health Act Mental Capacity Act Liberty Protection Safeguards Duty of Care Accountability - Liability Staff involved in transfers Policy Policy Instruments Data - Reporting: Commissioned Research? Employee safety Mental Health Services Commissioning: Private Sector - Public Sector Transport Services Standards Psychiatric Intensive Care Unit

I'm sure the vast majority of transport service providers - public and private, are of a high-standard, seek to assure safety of all involved and professional, but exceptions must be addressed.

See also:

Carli Brosseau and Alex Lang

Read more here: https://www.newsobserver.com/news/local/article230255979.html#storylink=cpy

‘How many have to die?’ SC mental health patients endure nightmare transport conditions.

https://www.newsobserver.com/news/local/article230255979.html

If I come across further information (esp. UK centred) I will add here.

h2cmng AT yahoo.co.uk

Read more here: https://www.newsobserver.com/news/local/article230255979.html#storylink=cpy

My source:

Cage vans are used routinely in the UK for patient transport between hospitals. There is currently no record of how frequently used. There is no requirement to demonstrate that this degree of imprisonment is proportionate, or that less restrictive transport is impossible https://t.co/jvVL2atSVe

— Alex Thomson (@AlexBThomson) July 25, 2020

Social Care: in the round and square c/o King's Fund

Simon Bottery's Long Read -

What’s your problem, social care? The eight key areas for reform

- and listed below, have been mapped to Hodges' model. The full article and comments are well worth reading and may help readers discern the relationships between the key areas identified.

1. Means testing: it’s not like the NHS 
2. Catastrophic costs: selling homes to pay for care 
3. Unmet need: people going without the care and support they need 
4. Quality of care: 15-minute care visits and neglect 
5. Workforce pay and conditions: underpaid, overworked staff 
6. Market fragility: care home companies going out of business 
7. Disjointed care: delayed transfers of care and lack of integration with health 
8. The postcode lottery: unwarranted variation in access and performance

I have associated each with the respective knowledge (care) domain in which they are placed:

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group - population

1. Parity of Esteem in Means Testing 2. (Catastrophic) Cost to me, anxiety, depression, stress 3. Unmet need (mental health, counselling ...) 4. Quality of Care (Mental Health, Well-Being..) 5. Workforce (values, person-centred, self-esteem, job-well-done, BE the Difference?) 6. Market fragility (attractiveness as career pathway, having a leader) 7. Disjointed care (number of carers, lived experience...) 8. Postcode (I thought this had been addressed?) (postcode? - a remote 'thing' outside through the window and (summer) garden]

1. Parity of Esteem in Means Testing 2. (Catastrophic) Cost to NHS - innovation, change, prevention, transformation 3. Unmet need (physical, access ...) 4. Quality of Care (Time, Logistics) 5. Workforce (tasks, scheduling, physically reasonable?) 6. Market fragility (scale, bed occupancy, local demographics...) 7. Disjointed care (geography, transfers, A&E admissions...) 8. Postcode ('literally') North, West, East, South, Regions, London, Urban, Rural ...

1. What is your Parity across 2. (Catastrophic) Cost to my family. 3. Unmet need (socialising, access, carer ..) 4. Quality of Care (Relationships, Belonging, Communication, Family Groups..) 5. Workforce (job satisfaction, status, social worth ..) 6. Market fragility (Public perception, marketing, negativity bias - local news, time for outreach, intergenerational engagement...) 7. Disjointed care (input of family, local provisions, self-funding - budgets...) 8. Postcode (pre-social care, pre-lottery?)

Means (let's Test that.) here too?  2. (Catastrophic) Cost to the State? 3. Unmet need (my choices, informal carer ...)  4. Quality of Care (Value for £, Measures, Inspection, safety..) 5. Workforce (pay and conditions, minimum wage?, Unions, contracts, training, BREXIT ..) 6. Market fragility (FUNDING settlements, estate, investment, staff turnover, Qualified staff, commercial history, profit, governance..) 7. Disjointed care (commissioning, ...) 8. Postcode (local policy, funding, protocols ..)

NHS as an Anchor Institution (needs conceptual anchors?)

... and four harbours?

INDIVIDUAL

|

INTER-PERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

GROUP

CONCEPTUAL ANCHORS NHS - mindset: continuity consistency constancy future career development: Person - not in employment, education or training INDIVIDUAL level	size, scale, reach, solidity geography buildings - estate and places reduce carbon footprint working with local partners nano - SCALE - macro SYSTEMIC level
COLLECTIVE level COMMUNTIES for fleet of co-production and collaboration domestic, state, global - SOCIAL level NHS understanding - local demographics and residents NHS as an actor for social benefit Partner in a Place SOCIO-	NHS as ANCHOR INSTITUTION and [Good?] EMPLOYER Report: Building healthier communities  increase access to quality work procurement and commissioning purchasing locally policy -ECONOMICS

c/o The King's Fund: Making sense of integrated care systems, integrated care partnerships and accountable care organisations in the NHS in England

When I see a 'model' I ask myself; what does this mean in itself? What is its purpose? I also (invariably) ask how does it relate to, or how might it support the theory and application that might underpin h2cm?

In February 2018 The King's Fund posted this item on integrated care systems. It wasn't just the 2x2 figure that caught my eye, but the axes and the additional amber tab (figure 1). Pondering for a time I have transposed this to Hodges' model below figure 1. Beneath that, I've provided an explanation for the altered schematic; recognising that as with h2cm such models are idealised representations.

c/o The King's Fund

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group

Individual care management Care for patients presenting with illness or for those at high risk of requiring care services	Population Health (systems) Improving health outcomes across whole populations including the distribution of health outcomes [Improving population health outcomes requires multiple interventions across systems]
'Making every contact count' Active health promotion when individuals come into contact with health and care services	Integrated care models Co-ordination of care services for defined groups of people (eg. older people and those with complex needs)

INTRA- INTERPERSONAL:
Individual care management has been changed from care services and individuals to this domain, which conceptually preserves the original placement. In h2cm as can be seen the interpersonal domain combines the individual and humanistic. In the 4Ps this domain also includes 'purpose'. Whenever possible it here (individual motivation) that self-care and self-efficacy and staying as well as possible relies on the patient's awareness and education about their condition and level of health literacy. There is recognition now that children need some awareness of mental health issues and the law needs to protect what images and content youngsters are exposed to on social media. So, ultimately 'how I manage myself' has a major bearing on the 'whole care management enterprise.' The focus on 'high risk' also denotes a need for an assessment and one that is part of the move to parity of esteem in respect of physical and mental health.

SCIENCES:
I have shifted Population Health (systems)from population to this (physical) individual domain, on the basis that our research, as in, quantitative and qualitative, needs to be synthesized and then ultimately generalised - across populations. While complex systems cannot be taken apart it is from the sciences (including social sciences) that evidence-based practice flows. There should be a feedback loop here, research that also takes into account the multiple interventions across systems (the amber tab in figure 1) and the outcomes achieved.

POLITICAL:
The King's Fund's figure 1 stands as it is of course, but I have 'moved' Integrated care models most radically. If there is no organisation, rules, order, policy, procedures ... then things will NOT happen (as they should). Agreement is also needed on definitions for reasons of standards, measures and accountability. Such matters are political (even if ignored - kicked in the long-grass). For services that are evidence-based (as just mentioned in SCIENCES) we need when possible for health and social care policies to also be evidence-based (for reasons of efficiency, equity, effectiveness and equality). While we cannot 'break' complex systems we can break models; 'health care systems' need to break ("be broken whilst still in flight") in order to be transformed for the 21st century.

SOCIOLOGY:
Making every contact count I have placed in the h2cm's Sociology domain. To me this initiative remains with care services, but I have switched this from individual to group-population within h2cm. Health care education places constant emphasis (research, CPD, mandatory training) upon interpersonal - communication skills and this is where clinical and social care interactions and interactions ultimately count. It is here that trust, the 6Cs, unconditional positive regard ... are 'counted' in qualitative terms. If the psychological represents the theory of psych-social intervention, it is in the social outcomes and benefits were the practice is (truly) delivered. It is also here that partnerships are forged and social capital found.

In social care as an example, the integrated care model should politically permit - allow for a sufficiently skilled and remunerated work-force (socially valued?) with sufficient time to ensure that every contact really does count.

<>

Forty years in the NHS suggests that when ever 'integrated care' is being written and even spoken about, then the context should be indicated at the same time; so at least - integrated care^1-5 as above?

'integrated' as in -

• philosophy (ethics, morality, values)
• spiritual (values) (and part-whole of 1-5)
• political - policy, government funding
• economically - commissioning (models of care, sustainability)
• management
• care delivery
• team organisation
• community involvement
• patient involvement
• health literacy, health promoting

...?

Accessibility: apologies that there is no equivalent text to figure 1.

My source: https://twitter.com/TheKingsFund/status/1093556280248147969

After 41 years of listening - now it's your turn [ please ]...

If you are a researcher, author, lecturer or editor ... (you get the gist already...) and the project that currently has your undivided attention (well, almost) is a draft paper or literature review on any of the following:

metamodels of care / nursing / healthcare / global health
metacognition of care / nursing / healthcare / global health

holistic care / nursing
integrated care / nursing

models of care

models of nursing
theories of nursing

models of healthcare

conceptual frameworks in health, social care or education
(across - theory, practice, commissioning, funding)
history, current state, future of the above..

(I could add more)

- then please consider this request.

If there is no reference in the work to Hodges' model, as in:

The Health Career Model

Hodges' Health Career Model

Hodges' Health Career - Care Domains - Model

The Health Career - Life Chances - Model

- then I would humbly suggest to you that the work in front of you is incomplete.

Yes. I am variously disappointed, dispirited, desperate* since the terms of a well thought out, comprehensive search strategy should surely pick up a breadcrumb leading to Hodges' model? Fellow mentors and supervisors I need some help.

But, help with which one you may well ask?

Well, here's some background to account for the seeming lack of version control:

The Health Career Model

 &
Hodges' Health Career Model

These were the original titles for the model. The 'health career' has always referred to the idea and phenomena of 'life chances' (see bibliography in sidebar for Hughes).

Hodges' Health Career - Care Domains - Model

The original website from 1998 appeared to cause some confusion with visitors taking career to relate to work and professional opportunities. The 'care domains' addition sought to distract from that, to emphasize the care knowledge quality of the model.

The Health Career - Life Chances - Model

I have always tried to include Hodges' in the titles I have employed. More recently, it appears that using a name appears to accentuate the perception for others that the model was "Not invented here". Plus, there may be copyright and other proprietary provisions.

The reference to Hughes and life chances goes back to 1958, but seems even more relevant now given the importance of epigenetics, technology, sustainability, ecology, universal health care, access to information and healthcare knowledge and global health.

So, even if not germane to the main arguments of the paper or work at hand I would hope that the model might at least be referenced, as per:

Maffissoni, André & Vendruscolo, Carine & De Lima Trindade, Letícia & Zocche, Denise. (2018). Redes de atenção à saúde na formação em enfermagem: interpretações a partir da atenção primária à saúde. Revista Cuidarte. 9. 1-13. https://revistacuidarte.udes.edu.co/index.php/cuidarte/article/view/549

Many thanks!

Care with a Smile: For a Smile in Care Homes

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group

Self-esteem, self-image anxiety, worry, depression Able to express needs communication Ability to ask, remind, argue - self-advocate Challenging behaviours, agitation, aggression Irritability, poor sleep reduced attention and concentration Observation of staff - pain? Loss of dentures, memory

Changes in gums, gum disease, weight loss cleaning teeth, false dentures, fit, marking dentures, care plans Access to toothbrush, toothpaste, mouth wash, Oral hygiene Sugar – sweets (one of few pleasures?) Risk of thrush and other infections (cardiac?) Mobility of the resident Appearance and sense of well-being Pain of toothache, analgesia – tiredness Avoiding eating and drinking properly Access to dental surgery Changes with speech Equipment challenges of remote care, technology changes Mobile clinics

Responding to expressed distress - whether explicit or implicit (listening - caring) Confidence. Isolation Avoiding other people. Having friends and family to advocate for dental care Impatience with others, argumentative, shouting Family expectations

Guidelines Commissioning of dental care in the residential / nursing home sectors Local authorities, Health, CQC Asessment - Evaluation Referral process Staff  awareness and knowledge The nursing home make the referral? The family must make the referral? Payment National standards Domiciliary visits paid in advance. Dental service packs packs circulated to residential and nursing homes across a Region. Global access to Dental care?

Evidence for simplicity, genericity, openness and holistic competence

N-th mover to Integrated, Person-Centered and Holistic Care

walk the talk, sour grapes, or holistic humbug?

Although, sadly (and all down to me) I stepped off the PhD programme with an MRes, the intention was not to bring my journey with Hodges' model to a close. The joke of course with this model is that you are always presented with a crossroads. As I've written previously (even in draft!) this model is a baton to pass on to others. If the workforce of the 1970s to date evaluates its contribution to health care change and progress, then while the achievements speak for themselves, the challenges^* that remain still shout out:

1. parity of esteem 
2. integrated - co-ordinated and collaborative care

This week I received an email, purely as a list member I must add:

NHS Innovation Accelerator 

Applications for the 2017 NHS Innovation Accelerator (NIA) are now open. For 2017, the NIA is seeking local, national and international innovations that address the following NHS priorities:

·         Mental Health
·         Urgent and Emergency Care
·         Primary Care

The above is now closed but I immediately thought about Hodges' model, given that from the information provided mental health is a priority and a top priority for citizens. Plus, the things that can make a difference to problems:

• Suicide and relapse prevention
• Access and availability with a focus on perinatal, children and young people, dementia and psychological therapies
• Early identification and intervention to minimise the impact on a person’s life, the likelihood of escalation and, in some cases, the chances of survival
• Care closer to home including self-care and access to services at home, in a primary or community setting
• Holistic care of both mental and physical health needs including prevention, screening and treatment for those at greatest risk of poor physical health   

"There are many innovations available to improve mental health services, however they are not always used..."

There are however a series of requirements, which present a stumbling block as high impact evidence is lacking.

The purpose of NHS Innovation Accelerator lies in the name. The target is established initiatives and projects that would benefit the NHS and others from a boost of further momentum and leadership support including funding and mentoring. Hodges' model is far from this, but the call is interesting nonetheless.

Reading the details I can argue, for example, that Hodges' model is immediately applicable across the life-span. The model is already designed, but in use the model could be said to meet the requirement of being co-designed with people (including carers, where appropriate). I have used the model with patients and carers (young and adult) who have lived experience of mental illness. With some consideration of the patient, carer, as I have stressed here before on W2tQ the model is accessible to a diverse population. Critically, the delivery of the most significant benefit in terms of outcomes and cost savings needs proof.

It seems that many of the world's problems could be ameliorated through education. This has been evidenced for decades and yet globally there are those who politicise their respective educational system, or even worse deny sections of a society access to education.

In healthcare how can we demonstrate the effectiveness of what is basically a back-of-an-envelope tool? While not a solution Hodges' model helps us to resolve the constituents of healthcare demand and supply, to critically analyse and synthesize - what is going on? I'm sure Hodges' model is just one of many local 'innovations' (in this case created in NW England) that are not evidenced and are therefore missed. Why is this? It may be that the model needs to be re-discovered since being invented somewhere else, by somebody else makes it a non-starter. Similarly, reading the information 'model of care' always grabs my attention:

Your innovation can be a device, digital app or platform, 

a service, process, pathway or model of care. 

But as is often the case, this is framed in service commissioning, funding, delivery and yes patient outcomes terms. Devices, apps, platforms and services can be specified to a high degree. This is essential to success in research (as is dissemination). Aims and objectives can then be clearly defined, outcomes can be recognised and measured. Processes and pathways are perhaps more fuzzy? These are all important tools, aspects and contexts in health care.

My frustration is that this and similar research formulations seem to exclude tools and resources that are by their nature intentionally simple, holistic, generic and cognitive-reflective. The "model of care" is broken. A whole systems approach^# is needed that incorporates education and with it prevention and staying well; plus caring for those affected by illness and disease. We have to honour the legacy problems that the political, education and health systems have 'delivered'. Even if not broken the model of care is missing its twin, the model of life-style choices'.

I still believe there is a model - a conceptual framework - that must precede the (politicised?) model of care, if health and social care are to be truly transformed. Without this, well yes the NHS can accelerate, staff have demonstrated this repeatedly while negotiating all sorts of obstacles. The line of travel will however be circular; circular, but without the discoveries and change gifted to the particle physicists.

individual

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INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

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group - population

education mental health cognitive access benefits - outcomes subjective	Evidence process primary care, accident and emergency physical access objective
qualitative home social care co-design public engagement	quantitative strategy 'model of care' education system citizens cost savings

My source: 
Irina Johnston
CHAIN Administrative Assistant

If you wish to publicise information on the CHAIN Network please email your request to: enquiries AT chain-network.org.uk

CHAIN - Contact, Help, Advice and Information Network – is an online international network for people working in health and social care. For more information on CHAIN and joining the network please visit website: www.chain-network.org.uk

^*

1. parity of esteem (a very broad interpretation - the comparison and contrasts between mental health and physical care on several levels - demand, supply, funding, research, integration, staffing, policy, outcomes, evidence-base, social determinants...)
2. integrated - co-ordinated and collaborative care (this is not one thing, but several. These terms are sometimes used interchangeably. Care that is truly integrated will also be co-ordinated and collaborative.

^# This is not recourse to jargon, Hodges' model implies several systems from the outset.

Place-based systems of care: The King's Fund

individual

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INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

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group

individual workers mindset Leadership placEmotion	'place': physical & virtual? estates, buildings technology, e-health? travel - efficiency
Local need - availability "Home" "Hospital" "Community" Social Care : Health Recovery, Rehabilitation, Reablement	King's Fund Place-based systems of care leadership, commissioning, organisations, budgets, integration, populations, strategic budgets,

My source:
Ham, C., & Alderwick, H. (2015) Take a place-based approach to care, Health Service Journal. 125:6469, 16-17.

HSJ Mental health: A sign of the time(s)?

I'm a subscriber to HSJ and greatly enjoy reading it, even if this includes catching up.

The January 13th issue was headlined "2016: THE YEAR OF OPPORTUNITY?"

The editorial/leader A year of opportunities with many unanswered questions (pp. 3-4) spanned more than the usual single page and commented upon:

• funding efficiency
• services transformation
• technology
• commissioning
• health and social care integration
• primary care
• hospitals
• mental health
• workforce
• regulation
• and leadership

Mental health has been much in the news of late with the promise of funding. HSJ noted:

"For mental health, the question is a simple one. Will the sector see the increased funding long promised?" p.4.

Leadership, regulation, workforce, health and social care integration, commissioning ... can all be related to mental health, but with February's news I wonder if mental health can be revisited as a piece of horizon scanning as per the sub-heading? Otherwise, before February is out - is this a case of "job done"?

There are roughly 60 sentences in the piece as a whole. Some of the sentences are quite long in contrast to the above.

Mental health 1 : 4 and yet here equivalent to 2 minutes - less in reality?
The mental health question may be simple, but the way it influences all the many unanswered questions including public - mental - health is obviously complex.
As a nurse manager I recall it being difficult to please everyone all of the time. Editors are similarly challenged, but mental health IS worthy of integration and journalistic recognition.


McLellan, A. (2016) A year of opportunities with many unanswered questions, Health Service Journal. 13 January 2016. 125: 6472, pp.3-4.

Clock image c/o http://www.oliverboorman.biz/projects/tools/clocks.php

Robots, surgery, resources and policy

individual

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INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL
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group

	"A proliferation of centres offering robotic surgery should be avoided ...
	until a national policy can be developed." p.14.

da Vinci Surgery

Clinical Commissioning Policy: Robotic-Assisted Surgical Procedures for Prostate Cancer, Draft for Public Consultation: NHS England.

The Robot Report

Dunhill, L. (2015) Robot wars over specialist site, Health Service Journal, 8 July. 125: 6453, p.14.

Navigating health and models: c/o HSJ

individual

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

group

Geisinger's Proven Health Navigator communicate and share decision making  patient - person focus patient access to records birthday cards, follow up benefits, outcomes purposes of integration	population management data gathered and applied preventive medicine referral reduction to hospitals early intervention case management of complex and chronic diseases
a "medical neighbourhood" offering care in the most appropriate setting - community care health promotion culture change1	Geisinger Health Systems (not for profit) health insurance, budgets care commissioning values based reimbursement system accountable, leadership culture change2

My source:
Moore A. (2014) Show you can navigate integration, Health Service Journal, 28 November: 124, 6425, pp. 20-23.

"A wise person once explained to me that delivering integrated care successfully was 

"more sociological than technical"".

 Prof. Chris Ham, On 'bilingual' clinical leaders. p.22.

Architecture and Design: 4 beds in 4 domains

'Privileged' is definitely the wrong word. Perhaps it is the advantage of experience and the passing of almost four decades and more....

Times have changed since arriving at Winwick Hospital on a bike as a student nurse for an early shift at 0655. I would  leave my bike just down a small corridor to the right of the main entrance. I don't think I locked it. Then depending on the ward allocation I walked through the red carpeted front of the hospital to the increasingly rough and seemingly lost corridors beyond.

Hospitals have changed markedly. Winwick and other asylums have gone - thank goodness.

Cockroaches, leaking roofs, two-storey blocks where when necessary the patients would carry the meals up the stairs. A charge nurse set about ensuring that the patient's were provided with proper safety equipment if there were no lifts. The dormitories were large: 40+ bedded and more. There were lockers of some description I think, but personalised clothing was still to follow in 1977.

Despite the emphasis on community care, a project that in reality is still a work in process, the need for hospital beds remains. I have worked to keep people out of hospital, to help provide crisis support at home. When beds are needed the experience for members of the public and their families is radically different today. As taxpayers we recognise the need for efficiency in design, procurement, commissioning and managing new buildings. So it is within the NHS. Visiting new modern facilities, and this includes private nursing homes, you really appreciate the benefits good design can bring for patients-residents, staff, students and visitors.

individual
INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

group

My space Private space - observations permitting/negotiated Space to wander Space for wheelchairs Colour Personalisation Temperature Why is Joe staying in bed? Why is Mary not going in the lounge? ...?	4 Bed Multi Bed Bay c/o ProCure21+
Public space Quiet spaces (who says?) 'Community' Lounge Dining areas Activities room Noise levels Meeting rooms Interview rooms ...?	Public Engagement Staffing Volunteers Project Management Value for Money Savings Security Policies Safety Services ProCure21+ ...?

Image source: http://www.procure21plus.nhs.uk/standardshare/