Book review: Values-Based Commissioning of Health and Social Care

This book was a welcome change from the last review, being quite brief in comparison at 155 pages including the index. This isn't a criticism, it just helps in clearing the decks for other reading and distance learning.

The text is no lightweight, however; and should be mandatory reading for all health and social care personnel. Well maybe not all; but that is part of the problem. The clinical and social care workforce are trained to care. Commissioning (and clinical coding) is something done in another location, by other personnel.

If there is a recurring criticism of public services it is that they are cossetted, protected, removed from many of the financial realities of the world. The book, published in 2012, was written anticipating the structural and financial change brought in by the Coalition government and the need for austerity. Therefore, the public sector and clinical staff are not  immune from the vagaries of finance as might be assumed. For the past couple of years I've witnessed the regular shakes of the sieve and heard of the same within local authorities.

Christopher Heginbotham's book provides the background and tensions of commissioning and delivers much needed insight on several fronts by conjoining what so often seems remote. The lesson of the book for me is how distinct finance and commissioning are. I can sum this up as: if person-centred clinicians are concerned with sense-making for and with patients and their families, then commissioning is the sense-making of the available finance. Viewed this way you see the importance of commissioning.  Clinicians are concerned with evidence-based care, ethics, the health reforms, outcomes, quality, and of course values. Add to this patient involvement and public engagement and you have a read that opens a field that many clinicians dash by (in the public sector?*) as they manage various clinical priorities.

Chapter 1 and 2 set the scene of values-based commissioning, definitions, the fact-value distinction; and the post-Labour NHS. The health reforms (chapter 3) are central to the text, but despite the date of publication which the author acknowledges there is little loss of significance. The health and social care commissioning landscape is still taking shape, outcomes based commissioning (chapter 9) can make the news as implementation is delayed (Williams, 2013). Chapter 4 describes the seven fat years followed by seven lean years; an excellent overview with the major influences at work, The Wanless Reports and Marmot Review for example. It is salutary in these times to see NPfIT as a footnote, with IT benefits still to be accrued (p.32). The need to respond to the public health challenges are noted (chapter 6), as with the potential mental health impact of climate change.

The book's figures and tables are a great asset, very useful to educate student nurses about commissioning, value and values. There are a couple of references to colour (p.72) in what are black and white - grey illustrations. 'Reading' the diagrams you can follow them. The author's background comes across, as with location and mental health experience. The book is I believe relevant to readers across all sectors. Heginbotham also indicates that the book is one of a series by CUP, and points to Fulford et al. as a sibling. There are a couple of repeated words but otherwise the production is excellent.  I was a little surprised to find a catastrophe in the text - catastrophe theory (p.51). It is well deployed in explaining complexity and values. When I say surprised perhaps I would really like to see more on this theme of complexity and emergence, but Mr Heginbotham stays clearly on track.

My bias - Hodges' model - found the following standout points:

The number of sentences and figures that describe the individual, group, community and population (the structure of Hodges' model). The way that values can act as a counterpoint and essential adjunct to evidence (subjective - objective; qualitative - quantitative).

Some situations are more biological than others - in certain sorts of surgery, for example - and some have a much larger values base - such as in psychiatry (p.40).

 Reference to (Cronje and Fullan, 2003):

The medical literature demonstrates an equivocal attitude which suggests a 'collective need to better integrate scientific quantitative data . . . and the art of human judgement . . . into a common definition of "rational" medical practice (p.40).

Figure 7.8 Filtering the evidence through a values-based matrix (values across four care domains?).

The use of models to test the real world and reference to a values space.

I posted previously about the nhm - new holistic model (p.80).
(back to the review..!)

Technical aspects (a law and index) and ethical issues that beset commissioning are introduced (space is limited), and recur helping to integrate the book as a whole. Chapter 5 deals with public involvement and engagement and how it can be enacted. Chapter 7 on integrative commissioning invariably raises patient and service user care pathways.

Is this the Rorschach test for patient, care professional and commissioner: please draw your care pathway? 

The book admirably deals with the ideal and realised in the space available. As such even when there is a linear care pathway it is how it is experienced that counts (values and outcomes...). (It is sadly the person-affirming life-story pathway that is so often lost.) 

Perhaps, this is what I have in mind above in referring to emergence. Despite the existence of care pathways in practice the route in-through health and social care is probably found in a rather chaotic way (sudden care transitions); with delays, placement changes, ward movement(s)-stasis, choices to be taken into account, lack of attendance, missed appointments. ... This is why trying to define pathways may certainly assist, but it is the granularity of those definitions and their experience that snags at our clothes along the way. As Heginbotham advises - care pathways are not something to use in a slavish way. This excellent and well referenced book should provoke and establish interest in this very important health and social care activity. An activity and process that must be informed by the values of the public and those of patients and be more than a process, but realised in shared purposes and practise.

*When we stop and reflect we also recognise ourselves as tax-payers and so seek value-for money, and the other e's of efficiency, effectiveness, efficacy...

Many thanks to CUP for the copy.

Williams, D. Trust forces delay in outcomes based commissioning plan, Health Service Journal, 6 December 2013. p. 4-5.

Heginbotham, C. (2012) Values-Based Commissioning of Health and Social Care. Cambridge, Cambridge University Press.

Paper: "Defining Health in the Era of Value-based Care ..." mapped to Hodges' model

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group

Q. What is value? Demand (Individual) freedom to lead lives they have reason to value [Why we need a global generic conceptual framework:  Self care =  transformation of Demand into Supply] Patient Reported Outcome Measures (PROMs) 'benefit' across Hodges' model? 'harm done' across Hodges' model? Shared Decision Making -  patient centred care,  choice, autonomy,  Right Care, Right Time, Right Place?*

A's.  Value = outcomes achieved – money spent (Porter) 1.Allocative value – how to allocate resources equitably in such a way that maximum value for the whole population is obtained 2.Technical value – increased value associated with improvements in quality and safety of healthcare 3.Personalised value – individual patient values, in combination with best evidence and assessments of the person’s condition. (Gray) Supply - Outcomes PROMS: hip replacement, knee replacement, groin hernia and varicose veins Right Care, Right Time, Right Place Chronic disease Improving medical technology

Demand Social determinants of health "Unlimited healthcare intervention provision may lead to increased harm." Friends and Family Test Person- and community-centred approaches, such as peer support, self-management education, health coaching, group activities and asset-based approaches. Local - Community - National Porter recommends classification of outcomes in three tiers [16]. Tier one is ‘Health status achieved or retained’, including measures such as survival at one or five years, or for those with life-limiting conditions, the degree of health or recovery achieved or maintained. Tier two, ‘Process of recovery’, includes the time taken to return to normal activities and disutility of care, such as errors and adverse events in care, incorrect diagnosis, and discomfort. Tier three is ‘Sustainability of health’ and includes recurrence and long-term consequences of treatment.

"The definition proposed by Gray ... defines value in healthcare as ‘the net benefit, that is the difference between the benefit and the harm done by a service, taking into account the amount of resources invested’" Supply - Outcomes Health Economics limited healthcare budgets Governments - Industries Relationships demand - drug costs Moving FROM: cost-effectiveness and pay for performance TO: Value-based pricing Healthcare-associated harm Value-based healthcare has the potential to be used in local and national priority setting and policy development.

*This brief paper provides a very good outline of value-based care. 'Mental' in this paper is mentioned early on in a definition of health, thereafter you will find 'mental' in funda-mental, environ-mental plus incre-mental. 'Mental health' and values-based care will no doubt be discussed elsewhere. This brief paper suggests however, that we really do need a generic conceptual framework for health and social care. To be fully-realised value-based care must also reach, encompass and incorporate mental health and public mental health.


Gentry S, Badrinath P (March 06, 2017) Defining Health in the Era of Value-based Care: Lessons from England of Relevance to Other Health Systems. Cureus 9(3): e1079. DOI 10.7759/cureus.1079

Book review: iv Critical Mental Health Nursing: observations from the inside

Following on from Part i, Part ii and Part iii.

I'll try and condense things in this review-post.

The book has a global reach and is Antipodean in chapter 4 with Darren Mill's ethnographic dialogue of a MH Crisis Team in New Zealand. The account, while fictional is based on authentic events and is still quite 'socially visceral'. This is achieved by interspersing the text with statistics on demographics, ethnicity, culture, suicide rates and government policy. Additionally the author provides reflective thoughts on the telephone dialogue FROM: the office; TO: standing at a front door (and wading in water).

Resort to the police and use of the Mental Health Act (MHA), made me reflect about westernised MH services and the export of this model to developing nations; while acknowledging that New Zealand is 'developed' of course. Despite this, as Mills shows, there are profound health care and education concerns for indigenous peoples in Oceania. As Universal Health Care and the SDGs become key drivers (added to general economic improvements, rising middle-classes...) it appears many developing (Commonwealth) nations prefer the institutional care that Westernised medicine is still trying to disassemble, change, or distil into the community (see p.779 in Persaud, et al. (2018)).

While we quite rightly (crucially) talk about the choices for patients - the public; we might ask what choices are there for services? In instances of challenging behaviour within an institution (hospital - residential, nursing home...) we seek to (alter the environment) quieten, distract, divert, de-escalate, comfort... Perhaps, the avenues, the choices that mh services have - is a measure of their person-centredness, integration, modernity? These choices then have a direct bearing on individual practitioners values (p.89 as quite nicely follows...).

Critical Mental Health Nursing

Values are key in Felton and Stacey, The Doctor-Nurse Game in acute mental health care. Addressing values, commonalities and how they are defined, held, shared should better reflect the ideals and pragmatics that 'progressive mental health nursing (and policy) demands. This would obviously reduce the contention (violence, injustice, coercion...) and very need for this book. While gut bacteria have been implicated in mental illnesses and may number in the many millions, no amount of them will account for the contested state of mental health. Not until the issues in this book are more effectively reconciled and resolved then as Felton and Stacey state mh nursing work will remain a form of 'dirty work' (p.99). Felton and Stacey provide a practitioner focus on values-based practice. Value and values permeate the literature as I have noticed over several years. The distance that Felton and Stacey identify for academia from the 'dirty work' (p.103) is an experienced reality for community nurses. Many, including myself, are aware of  a wish to 'step back' as 'your' patient becomes an in-patient. Recognising the need to maintain a therapeutic relationship you don't want to be seen as an 'agent' of this particular change (not all thresholds are conceptual). I have negotiated this on many occasions and not always successfully which I wholly respect.

Chapter 6 Gary Sidley sets a critical stall - stance in 'Colluding with prejudice? MHN and the MH Act'. A brief history is provided; Sidley discusses the MHA as being legalised discrimination, Community Treatment Orders, Advance decisions and socio-political considerations in two dubious contructs: 'mental disorder' and the 'estimation of risk' (pp.111-113). He seeks alternatives to the MHA, questions the silence of CMHNs (p.115) and offers four explanations (pp.116-117). Another factor, and not an excuse, may be the loss of beds over the past 20 years and the distance between community services and their in-patient centers.

On page 117 and explanation four regards low self-esteem and high burnout among psychiatric nurses I wrote in the margin "DATA on teams. Meetings for MHA not about". Here in the NW England there used to be (late 1980s - 1990s) evening meetings for Community Mental Psychiatric Nurses. There is less local professional cohesion these days, if any? Admittedly, it takes leadership to drive such groups. While there is data for the MHA 2017-2018; individual practitioners and teams as a whole (often?) lack the information to manage individual caseloads in a statistical manner, or as a team (and adopt a default research stance).

Sidley is optimistic (p.119) citing a survey and report by the Mental Health Alliance (2017) and the conclusion that the MHA "is not fit for purpose". The optimism arises from political commentaries that suggest an impetus and opportunity that can bring change. Sidley asks the reader if mh nurses should become political activists. (In the late 1970s-1980s you wore a 'NUPE' or 'COHSE' badge, the RCN was not considered a 'Union' back then, and mental health hospitals were far more 'industrial relations focussed' than the Royal Infirmaries and General Hospitals.) Is there a place for conscientious objection in respect to the MHA, sending a powerful message and signal for an urgent need for reform (p.118)? Is there an irony in this (an inter - h2cm - domain), a twist on parity of esteem? On twitter I have noticed The Power, Threat, Meaning Framework provoking much debate (a future post?). This is another tool for change proposes Sidley. The chapters included here highlights again the importance of a book, and well referenced too; which I would encourage students, practitioners, managers and others to read.

Critical Values Based Practice Network

Persaud, A. et al. (2018) Geopolitical factors and mental health I. International Journal of Social Psychiatry, 64(8) 778–785. DOI: 10.1177/0020764018808548
https://journals.sagepub.com/doi/abs/10.1177/0020764018808548?journalCode=ispa&

"Values in Advanced Directives" mapped to Hodges' model

Hechter, et al. (1999) consider values in respect of advanced directives and medical treatment. The authors discuss an old debate in social science that still divides objectivists and subjectivists. Below, with my emphasis the four designated values are mapped to Hodge' model:

individual
|
INTERPERSONAL : SCIENCES
humanistic ---------------------------------------  mechanistic
SOCIOLOGY : POLITICAL
|
group

(ii) self-concept values involving feelings of dignity, self-control, and/or physical capacity (designated as function);	(i) hedonic values about pain, aversive physical states, chances for recovery to some minimally satisfactory level, and so forth (designated hereafter as pain);
(iii) allocentric values referring to concerns with creating an emotional burden for family and/or loved ones (designated as burden)	(iv) financial considerations (designated as cost) (p.409).

Since 1999 and considering the above I have added the following additions to reflect elements of change and a more generic view:

identity, self-expression (of needs), consistency in expressed wishes, intentionality, mood, alternative-adaptive forms of communication, time - active listening	distance, logistics (family, friends), what telecare might offer in terms of communication, evidence-based interventions, measures, assessment
independent advocacy, standards of social care, 'appropriate' placement for ongoing care, social - life history;	legislation - mental capacity, advocacy, evidence-based care - policy, pension, safeguarding;

While the focus of Hechter, et al. is specific these values also apply in a more generic sense. As students and lifelong learners engage with patients, carers and public they must learn to have due regard for the totality of values that might be encountered.

Hechter, M., Ranger-Moore, J., Jasso, G., & Horne, C. (1999). Do Values Matter? An Analysis of Advance Directives for Medical Treatment. European Sociological Review, 15(4), 405-430. 
 

Rose Report: "Create a short NHS handbook/ passport/ map summarising in short and/or visual form the NHS core values..."

Department of Health 16 July 2015:

Better leadership for tomorrow NHS Leadership Review 

Lord Rose June 2015, p.49.

The second prerequisite condition is cultural. The NHS needs to create a values-based culture. A large and complex organisation can be made more effective if all of its people behave in ways that are ethically consistent, and in ways that show they share the same values and base what they do on those values. There is already the ground work for this: the NHS Constitution includes a Staff Handbook, and Trusts communicate the NHS values contained within it in a variety of ways. But there needs to be a consistency in approach. Values must be easily and quickly understood across the NHS. Great leadership must be understood and fostered in staff at every level; the three military services are good examples of how this can be achieved across an organisation. A new and more visual format will promote this. 

R2: Create a short NHS handbook/ passport/ map summarising in short and/ or visual form the NHS core values to be published, broadcast and implemented throughout the NHS.

Papers in process, book reviews and volcanoes

There are three papers currently in process. There is some good and bad news; plus some similarity with volcanoes. This is in the sense of active, dormant and extinct.

The papers are - with no prizes for guessing the common feature:

1. The Scope of Nursing and Hodges' model
2. Case Formulation (Conceptualization), Diagrams and Hodges' model
3. Recovery and Hodges' model

Two papers are active, that's Case Formulation and Recovery. On the stove is Recovery and it's cookin. I've two co-authors providing invaluable input.

I've just read Terry Marks-Tarlow's Clinical Intuition in Psychotherapy The Neurobiology of Embodied Response and a review will follow my recommending this book right now.

There's a review copy of another book in the post that I believe can inform the recovery paper:

Values-Based Commissioning of Health and Social Care (thanks CUP)

I'm sure the concept of values-based commissioning is a gift to Hodges' model and the recovery paper. A theme to return to on W2tQ. The paper includes the Recovery STAR and relates this to Hodges' model.

The case formulation effort is with my co-author, and after a meeting in Manchester one early evening may incorporate risk formulation too.

The good news is none of these projects are extinct. The first nursing scope paper was rejected. The nursing scope paper is dormant, but is stirring following the symposium on person centredness in nursing early in May 2013.

There are two other books to get to grips with and a project that is in danger of extinction. The sight of Vesuvius next month may help: shift matters.

c/o HIFA - Publications re. primary health care & community health

Dear [HIFA] friends and colleagues with an interest in primary health care and community health:

Since my last communication with you more than 6 months ago, the entire field of global health has continued to be upended by our US government, with unconscionable effects on millions of people around the world, on advancements in global health research and its ethical foundations, and on the careers of thousands and thousands of people working around the world in the field of global health. As I said before, and I repeat now the obvious, it will take decades to build back what has been destroyed and to regain respect from the rest of the world for the United States and the values that most of us hold dear.

William Foege, eminent global health leader and former Director of the Centers for Disease Control and Prevention wrote this biting editorial <https://www.statnews.com/2025/08/18/rfk-jr-public-health-threats-william-foege-smallpox/> in which he said, among other things, 

"We will live through this drought of values, principles and facts and again apply our talents to improving global health and happiness. Do not back down.”

Atul Gwande, now one of the foremost champions of primary health care and community health of our time (even though he is, like me, an erstwhile surgeon!) and former Director of the USAID Bureau of Global Health during the Biden administration, gave an eloquent presentation of his perspective on the aftermath of the destruction of USAID on 28 April 2025 at the Harvard School of Public Health.

You can watch this here:
<https://www.bing.com/videos/riverview/relatedvideo?q=Atul+Gwande+presentation+at+Harvard+School+of+Public+Health+April+28%2c+2025&mid=26DA144398CF1F613D0A26DA144398CF1F613D0A&FORM=VIRE>.

Here are a few items of possible interest:

The Fourth International Symposium on CHWs will be held virtually next week.

I was most fortunate to be able to attend the second International Conference on Primary Health Care was held in Addis Ababa, Ethiopia, from October 6-10. It was a glorious event, with 750 attendees, mostly from Africa but with strong representation from UNICEF, WHO, Africa CDC, and other international organizations. 

The conference was sponsored by the International Institute for Primary Health Care – Ethiopia. <https://iphce.org/> Directors of PHC from 45 different African countries were present along with at least 50 community health workers from across Africa. There was palpable enthusiasm for the growing momentum for PHC across Africa.

Abhay and Rani Bang are world-renowned champions of community-based primary health care through their work with SEARCH <https://www.searchforhealth.ngo/> (Society for Education, Action, and Research) in Gadchiroli, India, with tribal people. Their seminal publications on the effectiveness of community-based primary health care and community health workers as well as their contributions to India’s national program for reducing neonatal mortality through home-based neonatal care, among others, have gained for them global recognition. Attached is an English translation of an article about their life’s work that was published in April Der Spiegel in the leading German magazine, Der Spiegel.

Nicholas Kristof has continued to share with the world some of the heart wrenching effects of the collapse of the United States Agency for International Development. The New York Times opinion columnist wrote <https://www.nytimes.com/2025/09/20/opinion/trump-usaid-cuts.html> on 20 September 2025 on the human dimension of the shutdown of USAID, citing estimates that 690,000 will die in 2025 and 829,00 will die in 2026 as a result of cutbacks in USAID funding, and 3.1 million children will die during Trump’s second term from these cuts (a PDF is attached if the link doesn’t work for you [mod: HIFA does not carry attachments]).

Two recent publications on novel approaches to reducing child mortality have gained widespread attention.

One study <https://www.nber.org/system/files/working_papers/w34152/w34152.pdf> in Kenya provided a one-time transfer of $1,000 to poor families and observed a decline of nearly half in under-5 mortality as well as in infant mortality. Another study reported that wrapping

A recently reported study <https://pmc.ncbi.nlm.nih.gov/articles/PMC12462887/> from Uganda found that giving mothers fabric treated with permethrin, a long-acting insecticide to protect against mosquito-born illnesses, as a baby wrap dramatically reduced malaria infections in the infants carried in them. There were 66 percent fewer cases among those children compared with babies in the untreated wraps. By the end of the six-month study, only 16 percent of children in the treated wrap group had been sick with malaria, compared with 34 percent in the untreated wrap group, many of whom had multiple malaria episodes.

Now available for purchase on Amazon.com are several important publications related to community-based primary health care and community workers.

Feel free to share this email and these resources with anyone else or with any relevant listserve you may have access to.

You are receiving this email because of your interest in primary health care and community health.

If you know of anyone that you think would like to be included in the listserv, just send me the person’s name and email address.

Warm regards, Henry

Henry B. Perry, MD, PhD, MPH Senior Associate, Health Systems Program Department of International Health Johns Hopkins Bloomberg School of Public Health Baltimore, MD, USA 21205 Hperry2 AT jhu.edu

HIFA profile: Henry Perry is a Senior Scientist at the Johns Hopkins Bloomberg School of Public Health, USA. Professional interests: Community health and primary health care. hperry2 AT jhu.edu

First NHS Constitution Launched

FIRST NHS CONSTITUTION LAUNCHED

An historic signing ceremony to mark the launch of the NHS Constitution for England took place at Downing Street today. The Constitution, the first of its kind in the world, was signed by Prime Minister Gordon Brown, Health Secretary Alan Johnson and NHS Chief Executive David Nicholson.

The Constitution will give power to patients and the public by bringing their existing rights together in one place so they know what they are legally entitled to – and how they can exercise their rights as well as understanding their responsibilities. It also contains a range of pledges to patients, public and staff, which the NHS is committed to achieving. For NHS staff, the Constitution will mean an NHS-wide commitment to equipping them with the tools, training and support they need to deliver high quality care for patients.

Lord Darzi’s review of the NHS, High Quality Care for All concluded last summer that there was a case for an NHS Constitution to enshrine the principles and values of the NHS in England. The landmark document will put in one place what patients, staff and the public can expect of the health service. It is designed to safeguard the future of the NHS and renew its core values, making sure it continues to be relevant to the needs of patients, the public and staff in the 21st century.

Health Secretary, Alan Johnson said:

“This is a momentous point in the history of the NHS. Following on from Lord Darzi’s Next Stage Review, the launch of the NHS Constitution shows how its founding principles still endure today and have resonance for staff, patients and public alike. It will ensure that we protect the NHS for generations to come.

“The content of the Constitution is based on discussions with thousands of NHS staff and patients across the country and will form the basis of a new relationship between staff and patients – a relationship based on partnership, respect and shared commitment where everyone knows what they can expect from the NHS and what is expected from them.”

The Constitution is the result of extensive consultation with staff and patients, which was led by strategic health authorities and overseen by independent experts on the Constitutional Advisory Forum (CAF). In response to the consultation and report published by the CAF, the final Constitution includes:

• A right to makes choices about your care and to information to help exercise that choice;
• A new legal right to receive the vaccinations that the Joint Committee on Vaccination and Immunisation recommends that you should receive under an NHS-provided national immunisation programme;
• A right making explicit your entitlement to drugs and treatments that have been recommended by NICE for use in the NHS, if your doctor says they are clinically appropriate for you;
• A right to expect local decisions on funding of other drugs and treatments to be made rationally following a proper consideration of the evidence;
• Clear and comprehensive rights to complaint and redress.

David Nicholson, NHS Chief Executive said:

“Ara Darzi asked me in his interim report to lead a work programme exploring the merits of a Constitution for the NHS. This has been a fantastic opportunity to listen to what matters most to our patients, public and staff and to use this to set out clearly the values and purpose of the NHS system.

“It also pulls together in one place what the patients who use the NHS, the public who fund it and the staff who provide it, can expect to receive from the NHS, and the contribution they can make themselves.

“I’m proud to sign off the Constitution today and am sure that it will be a powerful driver of change in the system, and help us to deliver care fit for the 21st century.”

Professor Steve Field, Chairman of the Royal College of [General] Practitioners, said:

"By stating that patients have a responsibility to register with a GP practice, the NHS Constitution reinforces the central role of the GP and the importance of continuity of care in the NHS today and in the future.

"We become GPs because we want to help people improve the quality of their lives through better healthcare. GPs want to provide the solutions and lead improvements and innovations. Having the Constitution in place will help us improve standards and care for all our patients, whoever and wherever they are.

"The new NHS Constitution is something which all GPs, their practice teams and NHS staff can commit to and have confidence in. I'm convinced that it will be an important, defining point in the development of our NHS."

Sally Brearley, Chair of the Patients Forum said:

“The NHS Constitution is a very valuable re-affirmation of the principles and values of the NHS. I was delighted to be involved in the process of drawing it up. It demonstrates the commitment of Government to the NHS, and of the NHS to its patients. We know that the public supports the NHS. The Constitution provides an important opportunity for patients, public and NHS staff to focus on giving our best to the NHS, and getting the best out of it.”

Also published today are the Handbook to the NHS Constitution; a Statement of NHS Accountability; regulations, directions and guidance to support the new rights around choice, vaccines and the funding of drugs and treatments; and our response to the consultation and the CAF’s recommendations.

The Health Bill, published last week, will underpin the new Constitution by creating new legislation to ensure that the Constitution will be reviewed every 10 years and a duty on NHS bodies, as well as independent sector and third sector providers of NHS services, to have regard to the Constitution.

ENDS

My source: COI’s News Distribution Service is the public sector leader in the electronic delivery of news releases and information direct from Whitehall departments, and more than 100 agencies and non-departmental public bodies, to the national, regional and specialist media. COI’s News Distribution Service is the public sector leader in the electronic delivery of news releases and information direct from Whitehall departments, and more than 100 agencies and non-departmental public bodies, to the national, regional and specialist media.

Narketpally syndrome: A different approach to medical education and research

From: Marc Jamoulle
MD (UCL 1974), PhD (ULg 2017)
Family physician, Belgium (INAMI 15324119004)
marc.jamoulle AT uliege.be
Associate researcher at HEC-Liège, BAS-SCM, University of Liège, University of Rouen, D2IM & CAMG-UCL, Brussels

hi friends,

in an unknown syndrome, another way to deal with the patient, to learn from the patient, to develop a partnership with the patient, caring while waiting for the cure,

Jamoulle, M., & Soylu, S. (2025). Phenotyping Long COVID in Children in Primary Care: A Case-Based Study Using the Human Phenotype Ontology. ORBi-University of Liège. https://orbi.uliege.be/handle/2268/334447

From: Rakesh Biswas
rakesh7biswas AT gmail.com

This paper illustrates a global patient-centered learning ecosystem, anchored in Narketpally, that adopts a syndromic approach to medical education and research. Rooted in the etymological origins of 'syndrome' ("together we flow"), this approach reframes medical research as a collective, contextual response to individual patient needs.

https://pubmed.ncbi.nlm.nih.gov/40674544/

Methods: The structure of the paper is intentionally modeled as a team-based learning exercise, grounded in our prior Web 2.0-based cognitive tools: CBBLE (Case-Based Blended Learning Ecosystem) https://pmc.ncbi.nlm.nih.gov/articles/PMC6163835/ and PaJR (Patient Journey Record) https://pajr.in/. These are framed against the conceptual scaffolding provided by three key publications: a framework by Sturmberg et al. and two contrasting commentaries by Greenhalgh and Ioannidis.

Results: Through our ongoing CBBLE-PaJR workflow, thematic learning outcomes emerged in response to these frameworks. Sturmberg's stratified realism helped us recognize how individual patient connections, recorded in our daily practice and online learning portfolios, can drive both contextual learning and meaningful changes in patient outcomes. Greenhalgh's commentary inspired our conceptualization of a 'wildebeest river crossing value model,' contrasting population-based efficiency with individual-centered compassion. Ioannidis's critique of methodological rigor highlighted the potential for expanding low-resource, high-impact research through patient-centered designs, particularly in phases 1 and 4 of the clinical trial hierarchy.

Podder, V., Kulkarni, R., Samitinjay, A., Salam, A., Gade, S., Agrawal, M., Surendran, A. K., & Biswas, R. (2025). Narketpally Syndrome and the Embedding of Contextual Values in Real-Life Patient Pathways. Journal of evaluation in clinical practice, 31(5), e70186. https://doi.org/10.1111/jep.70186
[Citation added PJ].
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International Journal of User Driven Healthcare (IJUDH) CfP

Dear Mr. Jones

In view of your work in patient-centered care, I’d like to invite you and/or your colleagues to submit a paper to this Special Issue of the new journal described further below and via the web link provided. I think our global readers would be very interested in your thoughts (and projects) on innovative ways to get relevant healthcare information into the hands of ‘users’ (both patients and providers), within the user-driven EBM paradigm, per below.

Please also share this call for papers with your colleagues.

Thanks for your consideration,

Susan Ross, MD

International Journal of User Driven Healthcare (IJUDH) Call for Papers

Editor-in-Chief:
Rakesh Biswas,
Center for Scientific Research and Development (CSRD),
PCMS Campus, India

Published: Quarterly

Call for Papers - Special Issue:

Submission Due Date: July 1, 2010
Special Issue On User Driven Healthcare and Evidence-based Medicine

Guest Editors:
Susan Ross, MD, FRCPC

Introduction

User Driven Healthcare (UDH) is part consumer-driven healthcare, part narrative medicine, and part Health 2.0. It stems from a concept of participatory healthcare whereby all stakeholders, enabled by information, software, and cyber-community, focus on healthcare value. But where does Evidence-based Medicine (EBM) fit into this framework? It is sometimes forgotten that EBM is a three-legged stool, comprised of the triad of evidence +provider expertise + patient preferences. In this EBM framework, provider expertise is needed to bridge the inferential gap between population-based evidence and the individual patient. And each patient's values and preferences should narrow that inferential gap further. But since the introduction of EBM nearly two decades ago, the primary focus of EBM proponents has been on Evidence, at the expense of patient preferences and provider expertise. Perhaps this is why the promise of EBM to foster the most efficient and high quality healthcare has not yet been realized.

Objective of the Special Issue

This Special Issue will focus on the following questions: Is the recent emergence of User Driven Healthcare really a new, post-EBM paradigm for healthcare, or just an overdue consideration of the other two legs of the original EBM stool? How might this trend affect all stakeholders?

Recommended Topics

Topics to be discussed in this special issue include (but are not limited to) the following:

• Developing valid patient-level evidence using the Web
• Evidence generation—clinical research strategies using social media and mobile technologies
• Examples of UDH to a) help formulate the right questions to ask in EBM; b) develop answers to those questions; c) disseminate the answers to patients and providers with a need to know; and d) test the impact of UDH-generated Evidence on patient outcomes
• Helping online patients sift the ‘wheat’ from the ‘chaff’—information management for patients in an EBM world
• How to incorporate patient preferences and values into ambulatory care decision-making (i.e., into the 10 minute visit)
• Measuring the impact of UDH on patient outcomes
• Patient-level decisions vs. population-level evidence (bridging the inferential gap)
• Pharmaceutical communication strategies using social media—impact on healthcare quality and costs in an EBM framework
• Place of social media in EBM—patient and physician online communities
• Practice of UDH vs. EBM around the world
• Regulatory issues of evidence dissemination by industry using social media in healthcare Statistical and other evaluative methods to assess the validity and reliability of evidence developed using social media and mobile technologies
• Trends in N-of-1 studies, and their relevance to EBM and UDH
• Use of collective intelligence to solve healthcare problems for individuals and communities

Submission

...

All submissions and inquiries should be directed to the attention of:
Susan Ross, MD
Guest Editor

Call for papers - Rivista Italiana di Filosofia del Linguaggio - Rhetoric and Health

Call for papers - Rivista Italiana di Filosofia del Linguaggio www.rifl.unical.it

Vol. 15, N. 1/2021 Rhetoric and health

Edited by Maria Grazia Rossi

Deadline: 20.01.2021

Words can act as a pharmakon, becoming a remedy or a poison. Considering both theoretical tenets and empirical findings, we have convincing evidence on the power of language and words in changing minds and fostering behavioural change.

In the context of health, it has been underlined how the quality of communication affect (clinical) outcomes, at the individual level (on patients) and the collective or societal level (on citizens). During the current COVID-19 pandemic, it has become even more clear that such communication effect is indirect and mediated by factors such as understanding, motivation, social assistance, trust in the system, etc. Words that are well-spoken but also, obviously, well understood can have a strong impact on the quality of our lives, concerning the clinical, emotional and social spheres. This is why the proper and effective use of words should be considered as a common ethical responsibility: it is an ethical responsibility for healthcare providers that directly take care of patients, but it is also a responsibility of public and private institutions working to promote behaviours favouring the adoption of a healthier life and the building of healthier societies, respectful of other people and more environmentally friendly. What happened from a communicative point of view to justify the need to activate a state of emergency and maintain lockdown restrictions is exemplary in this respect, also to discuss the conflict between values that is pervasive in our complex and interconnected societies. Even beyond the pandemic, many examples can be mentioned to discuss the importance of both the effectiveness and quality of communication. Take as examples social campaigns and/or advertisements on health issues related to cases such as the public debate on vaccination or antibiotic resistance, the social campaigns to combat pollution or against smoking in public spaces.

However, it is not obvious to find a consensual framework to define what counts as communication of quality, even if rhetoricians investigated heavily on this issue. Not necessarily a successful communication is also desirable from an ethical perspective. Obtaining persuasion – to be able to change attitudes and/or behaviours, it is not necessarily equivalent to do it in an ethically way. For example, implicit persuasion strategies often (but not always) can be described in terms of manipulation tools attempting to manipulate people and to change their habits. Again, this applies at the individual level within the interactions between patients and healthcare providers, with therapeutic recommendations described as genuine persuasive acts. At the collective level, it also applies to public communication, including the communication made on social networks, where fake news and misinformation spread even more quickly.

The links between rhetoric and health can be therefore analysed from two different points of view. From a linguistic point of view, the main problem is to figure out which communicative strategies are effective to persuade patients (and citizens) in changing a given behaviour and/or accepting the treatment more appropriate to a specific medical condition. From an ethical point of view, the main problem is to figure out which effective communicative strategies are legitimate, meaning they respect values defining both the patient (citizen) agenda and the doctor (political/health system) agenda. The discussions concerning the frameworks of value-based medicine and patient-centered medicine fit in this context, as well as fall in this debate the current attention given to the frameworks of narrative medicine and persuasive technology (applied to telemedicine, mobile apps, social networks, etc.).

Vol. 15, N. 1/2021 of RIFL expects to explore the links between rhetoric and health, accepting papers aim at considering the role of communication in the context of health, and papers considering persuasion from an ethical point of view – at the individual level (between patients and providers) and the collective/societal one (between institutions and citizens, between media and citizens).

Papers should be theoretical or empirical. All fields will be considered (Philosophy of Language, Classic studies, Literary studies, Linguistics, Psychology, etc.) if they are relevant to discuss the persuasive and/or the ethical dimension of communication in the context of health. Papers exploring the following areas are very welcome:

• Words and language as pharmakon
• Communicating science, communicating the COVID-19 pandemic
• Doctor-patient communication
• Persuasion, argumentation and manipulation in the context of health
• Ethic of the medical discourse and ethics for health
• Ethical relevance and effectiveness of narrative medicine
• Shared decision-making between patients and providers
• Social campaigns and advertisement for health
• Persuasive technology and health
• Social networks and seeking information on the web
• Value-based medicine
• Patient-based medicine
• Public opinion and health
• Visual persuasion and the role of images in the context of health
• Linguistic strategies developed for healthcare providers
• Emotions and interpersonal relations in the context of health
• Language and placebo effect

We call for articles in Italian, English and Portuguese. All manuscripts must be accompanied by an abstract (max 250 words), a title and 5 keywords in English.

The manuscript must be prepared using the journal template Download template. All submissions must be prepared by the author for anonymous evaluation. The name, affiliation to an institution and title of the contribution should be indicated in a file different from that which contains the text. The contribution must be sent in electronic format .doc or .rtf to segreteria.rifl AT gmail.com.

Instructions for authors:

Maximum contribution length:

40000 characters (including spaces) for articles (including bibliography and endnotes).

Deadline 20.01.2021

Publication: June 2021

CFP Full text: http://rifl.unical.it/index.php/rifl/announcement/view/23

My source:

Philos-L "The Liverpool List" is run by the Department of Philosophy, University of Liverpool https://www.liverpool.ac.uk/philosophy/philos-l/ Messages to the list are archived at http://listserv.liv.ac.uk/archives/philos-l.html. Recent posts can also be read in a Facebook group: https://www.facebook.com/PhilosL/ Follow the list on Twitter @PhilosL. Follow the Department of Philosophy @LiverpoolPhilos

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

Resistence is futile: give in to the obvious need for the 'nhm'

INTERPERSONAL : SCIENCES
humanistic ------------------------------------------- mechanistic
SOCIOLOGY : POLITICAL

individual

nhm	ohm + nhm
nhm	nhm (+ ohm!)

group - population

ohm: The ohm (symbol: Ω) is the SI derived unit of electrical resistance, named after German physicist Georg Simon Ohm. (Wikipedia)


nhm: The nhm (symbol: +).

However, the principles do not extend to problems posed by cognitive impairment as a result of the illness and the ever present danger of wandering, seeking old and familiar surroundings, or acting on memories from years gone by. Some patients become aggressive at times; the service must have mechanisms for managing patients effectively in ways that recognise their inherent worth and humanity. The stigma and abbreviated autonomy that is implied in managing people with dementia requires a new holistic method of managing their care that relates the care to the patients'/service users' values. p.80. [my emphasis]

Heginbotham, C. (2012) Values-Based Commissioning of Health and Social Care, Cambridge, CUP. (Review to follow).

Editorial: "Living dolls and nurses without empathy" mapped to Hodges' model

The example of Hodges' model displayed below is based upon selected concepts and themes taken from the following editorial:

Dean, S., Williams, C. and Balnaves, M. (2016), Living dolls and nurses without empathy. Journal of Advanced Nursing. doi: 10.1111/jan.12891

individual
|
INTERPERSONAL : SCIENCES
humanistic ---------------------------------------  mechanistic
SOCIOLOGY : POLITICAL
|
group

'nursing' empathy - individual ability/quality 'the patient' patient anxiety:  emotional - psychological state reflection interpersonal skills compassion - PURPOSE individual values hearing the person artificial intelligence	'nursing' PROCESS (nurse-based observation skills) simulation technology - 'living doll' 'the patient' in bed (simulated) physiological data cardiac event - crushing chest pain voice-over technology -TECHNICAL (machine) objectivity
'nursing' communication skills experience PRACTICE public perception SOCIO- subjectivity	'nursing' nursing programmes - education litigation cost of placements professional values safety POLICY

Some further questions:
Where would you place holistic care?
Where does atomism lie?
In the above model where is situational awareness and how do we recognise an integrated approach?

My source: Trisha Greenhalgh
@trishgreenhalgh

There is no endorsement intended with this post. 

'Holistic reform of education' in Jordan (an eastern dose of serendipity)

View from The Citadel, Amman 23 April 2013

Yesterday morning I arrived back from Amman in Jordan, via Istanbul through to Manchester and full of new experiences and learning. I say 'safe and sound' because travel to the region is clearly not a matter of routine given ongoing events. Checking governmental advice in the UK it becomes a question of personal evaluation as was the unexpected trip to Colombia in 2011. Once the non-trivial decision is out of the way ... Jordan's nursing and educational communities provide a truly remarkable welcome and experience. Not only that, but the kingdom of Jordan and the people have so much to offer in their culture, history, hospitality and engagement.

Returning on Thursday from a full day's trip to Petra - amazing! - I asked for an English language paper to read at the hotel before leaving for the airport. I was provided with a copy of The Jordan Times to accompany a cappuccino^*. On page nine Mona Smadi,^# Asst. Professor, Al Balqa Applied University) wrote an opinion piece on Holistic reform of education. The opening sentence enabled my brain to reconnect with my legs (although I would have gladly walked back through the valley):

A holistic perception of reality means having a vision of the context of the constituent fragments and thereby gaining a clearer perception of the reality in its totality.

Prof. Smadi's focus is children's education and curriculum reform. The overlap between children's education, the professor's concerns and nursing is not limited to how curricula are designed and who owns them. Is, for example, the curriculum centered on the student as an individual nurse, or child? If nurses are to be able to integrate their learning and effectively negotiate the emotional and ethical spaces they find themselves in then when is this deeper thinking to start?

Petra 25 April 2013

Not surprisingly there was a lot of talk about this at the JNC conference. The theory - practice gap is not just alive and kicking there is an echo off the seemingly disparate walls. Given too the debate in the UK about student nurses spending time as a health care assistant before starting their formal nurse education. The word applied in the title of Prof. Smadi's university's is interesting. We are accustomed to applied mathematics, ethics, energy and of course applied nursing research and many other examples?

What of applied nursing - does that make sense? Or is there a circularity of sorts in nursing applied? I will check my notes as this point was raised in conference regards to evidence based care and evidence based practice.

Prof. Smadi's referring to a 'clearer perception' can also be extended to recognition of patterns, contexts and situations that are 'hot' in how they relate to values.

(There are a couple of points to add here which I will get too).


There was another serving of serendipity to add to that at Le Meridien, soon after rejoining the land of the virtual I came across the UK Department of Education's Preparing for Adulthood initiative on twitter. If you read the brief article by Prof. Smadi you will see how the two are closely related. Do lifestyles and family life today for many compromise the ability of families to teach moral values to children? As noted in the text this then becomes a critical role for education. In westernized cultures is this one of the qualities referred to in the saying of 'spending quality time' with the family? An acknowledgement of a deficit?

Source: http://www.preparingforadulthood.org.uk/

Vital and complex work in two senses. On the one hand cultures try to understand themselves; and on the other, they seek to understand the other others out there: now not so far away. The patterns that are realised be they mosaic, prayers, celtic knot, tartan, languages, landscapes - rock cut architecture - sculpture; these patterns work, that is 'make a difference' by virtue of both the detail and the whole.

"Petra is half-built, half-carved into the rock ..." UNESCO.

^#If I have not used the proper name and title I will edit this accordingly asap upon advice.
 
^*Why not an Arabic coffee? Well I had one the day before. What can I say... It was different in the preparation, being an observation as in so many cultural patterns (tea). I would like to think I will have another one day. The key thing is I did not necessarily want to have the capability to run to the airport at 11pm, or back to Petra for that matter.

Reflections [V] Conceptual Spaces At Work: Zwarts

As per previous CS@W posts Joost Zwarts' Constructing Conceptual Spaces for Lexical Semantics provided one of several examples at the conference of data analysis derived from large datasets. The abstract included:

The similarity structure of a conceptual space can be determined using lexical data or pile sorting, but it can also be based on some sort of analysis of the values involved. Using the work of Geeraerts et al. (1994) on Dutch clothing terminology, Zwarts (2010) demonstrates how a space of “shirts” can be constructed (either using graph or MDS techniques) along such lines, with fruitful results.  

This talk outlined the way features can be identified and decomposed. Key to this are classifiers which Zwarts listed as:

1 Psychological classifiers (piles)
 From similarity judgments or sorted piles
2 Lexical classifiers   (words)
 From common lexical descriptions
3 Analytical classifiers  (features)

The presentation provided a small example based on containers, which for me was very helpful as data is a real issue for my study of Hodges' model. There are datasets out there - nursing, classification systems - and secondary data sources to consider. As mentioned above Zwarts took a dataset comprised of 38,000 possible items from the clothing domain and used 244 from the sub-domain of shirts. [Geeraerts, Grondelaers, Bakema (1994). The Structure of Lexical Variation. Berlin: Mouton de Gruyter. ]

I am probably simplifying things but discussion of Hamming distance recalled for me old Byte articles on bit-classifiers. Whether a sign of progress (maturation) or my focus, but in the 1980s there were many articles on data structures and algorithms, for some reason quad trees proved quite an attraction. There was an approach to clinical classification by Johnson (1987) that adopted a ZIP code format. As Zwarts related his presentation I wondered where a primary care problem might reside in Hodges' model: (1000, 0100, 0010, 0001)? Alternately where is the emerging problem that is nudging this individual towards possible relapse?

Graphviz was used and multidimensional scaling. The talk became more technical, understanding aided by graphical examples as classical categories were introduced: A category C is classical iff it can be defined by a particular set of feature values. The conclusion brought together the technical aspects of the data examined: convexity is too strong, connectedness somewhat too weak, but that there is a clear notion of coherence. There was much here to learn from.

Johnson, B. (1987) Health Code, The Guardian, 23 July, 16 (see also (1990) Journal of Health Care Computing).

The following page is out of date but cites Johnson:
http://www.p-jones.demon.co.uk/infselct.htm [no longer available]

(I don't want to upset searches on Google for 'conceptual spaces', so I've two more further posts this month on the conference concerning CSML and OntoSpaces.)

Here is the view from my B&B I enjoyed some lovely walks into Lund, plus using the bus. With a map that stayed in my laptop bag, I enjoyed getting lost on two occasions.

The view from Hobykrok B&B

"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