Chairs and Beds: The Theatre of the Absurd [balance!]

Hodges' model: Stages of Care/Despair

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Group

Beds needed for 'treatment' mental illness and physical, preparedness for public health events. Reduced beds for 'modern medicine', sustainable health care, reflecting health education, preventive approaches and improved health literacy (. . .?).

NHS hospital beds data analysis We look at NHS bed data in England compared to other countries, bed stocks over time, the impact of COVID-19, safety breaches and intensive care capacity.

"The Theatre of the Absurd, on the other hand, tends toward a radical devaluation of language, toward a poetry that is to emerge from the concrete and objectified images of the stage itself. The element of language still plays an important part in this conception, but what happens on the stage transcends, and often contradicts, the words spoken by the characters. In Ionesco's The Chairs, for example, the poetic content of a powerfully poetic play doe not lie in the banal words that are uttered but in the fact that they are spoken to an ever-growing number of empty chairs." p.26.

Bed Availability and Occupancy – KH03 "Bums on seats" (Lecture theatres)

Esslin, Martin. The theatre of the absurd. London: Pelican, 1982. (3rd Ed.).

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/

States of mind and policy [I]: 25% of hospital beds...

The repeated things that some people say, what does that denote?

The repeated things that other people say, what does that demonstrate?

INTERPERSONAL : SCIENCES

SOCIOLOGY : POLITICAL

In which care domain does the Person living with dementia reside?	1 : 4 - 25% of occupied beds [ diagnosis? ]
... and what of their carers... with their expertise?	there is a strategy - yet more hospital champions are needed and training.

My source:
BBC Radio 4 & RCN Students mail list

In political hands person-centred care is a quantum phenomena (entanglement)

individual
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Acute mental health needs RISK Self-harm Local care? Empowering the individual? Accessibility Cognitive distance Let therapy commence Continuity (dist-ress) Remote policy touch Organisational (distance) dementia? threshold   ↘	RISK  Self-neglect personal hygiene domestic environment local-regional-national?  metrics: Km or Miles or time? Gallons or Litres? Cost? Illusory savings? threshold ↓
RISK   Harm to others to integrated care  multidisciplinary care      threshold →	Beds

Lintern, S. (2014) Mental health patients sent hundreds of miles for a bed, HSJ, 14 August.

Beds shortage = Gathered Sobs
Mental Health = Lethal Anthem?
Mental health = Lean Halt Them

Bed image:
By kieran jones (http://www.clker.com/clipart-bed-icon.html) [Public domain], via Wikimedia Commons

Coronavirus: Under a conceptual Macroscope

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group - population

Cognitive access info clarity in communications Motivation Anxiety Isolation Impact upon mental health Psychological Trauma Staff Wellbeing during COVID19 Information Mis-Information Stay HOME [unless: homeLESS?]* Self-isolation Self-exile  Long COVID (My education?) Long COVID (My mental health?) My health literacy: touching my own face 'distance' hand washing  +++ watch the road as a pedestrian too SELF-CARE

Coronavirus transmission Epidemiological Modelling Statistics Triage Duration of Self-Isolation ICU beds Ventilators - INNOVATION Industrial production Excel & NEC [UK] extra beds Recovery - Rehabilitation Physical access info Logistics (transmission) Testing kits Anti-body test PPE Evidence: Face coverings Personal Protection Equipment Vaccine Research Development PHYSICAL DISTANCING 2 metres Long COVID (My physical health?)

SOCIAL DISTANCING DISTANT SOCIALISING^ Staying connected family, friends, community - using social media to reduce - Social Isolation Social Media - Public Protection Role? Community Response Social Care - 'Enforced' PJParalysis? Volunteers Protect Our NHS 'Social' rehearsal? Future preparedness? Public understanding of Science

WHO: Pandemic REPORTING National :: International Consistency - Standards Lockdown Reversing Lockdown: Government Communications: (Mis-)use of media National reporting Emphasis upon economic impact? Response of Businesses Transparency of contracts, 'deals' Definition of 'Key workers' NHS England Law - Policing Policy (distancing#)

*General Population Health Status, Health systems, Healthcare systems, Politics of Health, Socio-Economics - austerity, Inequality, Inequity, Preparedness .. the Collective ...

^#Political lack of coherence in policy: Poor integration.

^Thank you @SelfCareWeekEU

21 Aug update: See also -

Sheridan Rains, L., Johnson, S., Barnett, P. et al. Early impacts of the COVID-19 pandemic on mental health care and on people with mental health conditions: framework synthesis of international experiences and responses. Soc Psychiatry Psychiatr Epidemiol (2020). https://doi.org/10.1007/s00127-020-01924-7

Image source:
By CDC/ Alissa Eckert, MS; Dan Higgins, MAM - This media comes from the Centers for Disease Control and Prevention's Public Health Image Library (PHIL), with identification number #23312.Note: Not all PHIL images are public domain; be sure to check copyright status and credit authors and content providers., Public Domain,
https://commons.wikimedia.org/w/index.php?curid=86444014

To revisit post pandemic? 

There is scope to improve the placement of concepts as per Hodges' model.

"... Two beds and a coffee machine ..."

poetry in lyrics ...

 

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"Wonder how I ever made it through And there are children to think of Baby's asleep in the back seat Wonder how they'll ever make it Through this living nightmare But the mind is an amazing thing Full of candy dreams and new toys ..."	"Another ditch in the road You keep moving Another stop sign You keep moving on And the years go by so fast ..."
	"Another bruise to try and hide Another alibi to write ...."

savage garden

Source: Musixmatch

Songwriters: Hayes Darren Stanley / Jones Daniel

Two Beds and a Coffee Machine lyrics © Rough Cut Music Pty Ltd.

 

RCN Congress iii 2025 - Accountability for patients in ambulances

The resolution (with a reading list) on Accountability for patients in ambulances

- drew attention to language once again (yes, well there's a truism: what do you expect!). This time highlighting how corridor care is now variegated. In addition, politically you can circumvent addressing an issue, by referring to 'never events', and 'zero tolerance' as we read:

'This agenda item addresses the urgent issue of accountability, for both registered nurses and the organisations they work for, when patients are cared for in ambulances waiting to access emergency departments.

The resolution comes at a time when, across all four countries, there are unprecedented ambulance handover delays with patients left in vehicles which are neither appropriately staffed nor resourced outside overwhelmed emergency departments. Despite the prolific nature of this practice, there is no clear guidance on accountability. Who is responsible for the care and safety of those patients - the ambulance service, the hospital, the emergency department, or the individual registered nurse providing care?

These delays accessing care and the lack of guidance on who is accountable for the waiting patients, compromises the ability of health care staff to provide good quality care and risks patient safety. It also exposes registered nurses and other health care professionals to professionally, ethically and legally ambiguous situations. It could also contribute to the crisis in nursing wellbeing, raising issues such as moral distress and professional, emotional and physical burnout. It may, therefore, also impact the already perilous recruitment and retention.'

Student nurses, paramedics ... please take note: There is a paper to be written on Hodges' model and the gaps we encounter in health and social care. For Brian Hodges this started with the theory-practice gap; one of four original stimuli for the creation of the model. 

As the idealised standards, quality and safety of care being delivered are surrendered; this gap stands out as the virtual keystone.

individual

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individual - PURPOSES patient safety - distress nurse wellbeing emotional burnout moral distress personal ethics individual responsibilities	procedure delivered care - observation mattress, trolley .. ambulance design instrumentation, noise time - duration logistics - PROCESSES - handover physical resources - beds
communities of PRACTICE team working - coherence team experience - students THE DAMAGE - that is 'BOOK-PASSING' The public's - carer's experience (wither friends and family)	law - guidance - ambiguity POLICY professional accountability risk management organisational responsibility workforce recruitment & retention

Previously: 'RCN' : 'gap' : 'accountability' : 4Ps

New to nursing? after Jules (just scratchin the skin)

If you are new to nursing (social care, learning disability, forensic nursing... ) we have some amazing guests on this weeks show, appearing especially for you, because of you: because you care - on four stages .... [with apologies: Jules Holland, BBC 2]

Interpersonal : Sciences

Sociology : Political

Self Awareness orientation communication rapport, empathy anxiety values, beliefs mood, risk knowledge & skills aptitude and attitude	anatomy and physiology (The) Make the Beds  TPR [BP] hygiene birth...........................................death drugs journals, books nutrition assess, plan, actions, evaluate tech & equipment
community family relationships culture traditional medicine social networks public involvement	HUMAN RIGHTS Consent, Choice, Capacity health economics Law DoH, NLM, WHO health social care services professionalism policy

Tiles, gates, gems and beds

 

Hansje van Halem

'On a tile just by the head of my bed, I have placed a list of the ancient gates. It looks like a gold ring, with gems set into it, each a different kind of stone'.






Part of: Memory Palace exhibition at V&A 

More to follow.

ImROC: Briefing Paper 24 - Recovering Adult Acute Psychiatric Inpatient Wards

"Explanation, compassion and a holistic understanding of the person’s situation are critical (Royal College of Psychiatrists, 2017)." p.39.

(my emphasis)

"It requires practitioners to critically reflect on their values, beliefs, and biases and actively work to reduce as far as is possible the oppressive systems and practices within inpatient wards." p.15.

What models / frameworks for/of care do practitioners use? 

What models invite - are primed for:

• critical reflection (individually, or as a group, p.56)?
• recognition of oppressive situations, phenomena, ethical dilemmas?
• citizenship - citizenry (p.18)?
• deciding whether it is a journey, or not?
• a possible role in burnout (p.54) mitigation?
• reflection, development, and restoration (p.56)?
• are all models situated?

Individual
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neurotypical neurodivergent/autistic [Yes.] Can what has been stressed for decades - compassion, listening, validating, empathy, rapport, the therapeutic alliance, seeing the person ... in mental health nurse education, theory and practice, be strengthened through review of skill-mix, and workforce? Whilst, in-turn, being sensitive to the pressures on mental health RNs, as cohorts of students, seek to assure their learning experiences; and as qualified nurses old and new seek to protect their professional identity, values, standards, and ethics - responsive to the demands of the 21st century.

close to home transport physical environment: noise, smells, space, decor, light.. While (originally?) aimed at elective in-patient care, the mantra of discharge planning begins upon admission (even before) has reached mental health services and community mental health teams. Even as the reduced number of beds (perversely) provides ideal conditions, this should (must) not mean the 'game' becomes 'pass the parcel', 'musical chairs' - the person lost in the many processes.

Hell is other people - as the saying goes ... When the therapeutic value and potential of relationships are recognised, the need for a tool to identify and critique what is relational is even more critical. Not just to realise what has long-been psycho-social, but the 'alt-def' of person-centred. This demands simultaneity in assurance. We contrast the humanistic with the mechanistic - service-centred. Let's not forget the need for integrated** care. See community/society as the safety net it can be. So DO NOT: raise a patient's / family's expectations (p.49) only to let them down.

least restrictive Let's not re-learn the lessons of history, but if you insist...?^ One mention of (social) 'determinants' (p.37)! Please take a look out of the [safety] window; and beyond the APPG Committee room...  Wither ambition, courage in policy - to discover what is evidence-based (the lesson since 5th July 1948)? In-patient care is too late.* For sustainable health services and systems we need to act sooner, educate, to try to address all the determinants. Please remember what 'you' (through policy..) have done to the patient as a concept: patiency. <- Recovery carries political heft.

Please remember what 'you' (through policy..) have done to the patient as a concept: patiency. Recovery carries political heft. No one wants to create, foster, instill dependency, but (emotional labour) care delivery demands space and time: being with, or at least available.

*If this was the guiding principle for all disciplines, stakeholders, policymakers, researchers could this:

• place emphasis (again) on prevention; staying well - relapse prevention;
• help generate alternate modalities for therapy / care;
• help concentrate services to deliver person-centred, recovery and trauma informed in-patient experiences - where therapeutic outcomes are  at least feasible/possible;
• begin from literacy-first stance: take up educational focus in schools - PSHE, work-place;
• health career - life chances?

**physical-mental, care context, philosophy of care - trauma - recovery - strengths, funding, disciplines, pastoral, health - social care - housing ...

^Dept. of Health. Caring for people: the CPA for people with a mental illness referred to specialist mental health services. London: 1990

Joint Health/Social Services Circular  C(90)23/LASSL(90)11

Rachel Perkins, Sharon Gibbard, Yasmin Blackwood, Simon Barnitt, Lowri Smith, Anna Cheetham, Poppy Repper, Anne Rackham, Ben Dorey, Jo Luck, Julie Repper. Recovering Adult Acute Psychiatric Inpatient Wards: Creating Recovery-Focused, Trauma-Informed and Neuro-Inclusive Culture, Relationships and Practice. ImROC. Briefing Paper 24. 2024.


See also:

ImROC (2023) Thinking about Recovery Together

ImROC (2023a) Team Recovery Implementation Plan for Acute Inpatient Wards

Wand, T. (2024), We have to cancel psychiatric nursing and forge a new way forward. Int J Mental Health Nurs. https://doi.org/10.1111/inm.13301

Warrender, D., Connell, C., Jones, E., Monteux, S., Colwell, L., Laker, C. et al. (2024) Mental health deserves better: Resisting the dilution of specialist pre-registration mental health nurse education in the United Kingdom. International Journal of Mental Health Nursing, 33, 202–212. Available from: https://doi.org/10.1111/inm.13236

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

World Mental Health Day & Hodges' model

Today is World Mental Health Day. Here are some mental health related concepts mapped to Hodges' model that I have encountered over the past few weeks (I could list many more of course).

INTERPERSONAL : SCIENCES

SOCIOLOGY : POLITICAL

depression, suicidal ideas, motivation, beliefs, agitation, assessment tools, understanding of treatment, communication skills, confusion, aggression, lability of mood, loss, disorientation, orientation, concordance, stress and vulnerability, observation, distress	risk assessment, electroconvulsive therapy benzodiazepines, anti-depresssants, side-effects, gait, pain, care environment,  diagnosis of depression, anxiety, dementia, records - behaviour charts, electronic health record, security
carer under stress, reassurance, counselling skills, respite care, family therapy empathy and rapport with residents (colleagues...), patient and relative engagement, activities, distraction, engagement, life history, touch, care strategies and recommendations, smiles, companionship	commissioning, funding of services, consent, integrated working effectiveness, referral-on, care vouchers, advocacy, service access, compliance, use of Mental Health Act, staff survey, gatekeeping - access to beds, work allocation, health & nursing in the media

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

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

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

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

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

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

READ: Cognitive, Physical, Social and Political ACCESS

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

Dear McKinsey and Company, Re. "The era of exponential improvement in healthcare?"

Re. Your article:

The era of exponential improvement in healthcare?

(By Shubham Singhal and Stephanie Carlto)

Technology-driven innovation holds the potential to improve our understanding of patients, enable the delivery of more convenient, individualized care—and create $345 billion to $420 billion in value by 2025.

Healthcare advances have delivered great benefits to society, bringing material improvements in average life spans and quality of life.¹ Yet these improvements have come at a cost—an ever-expanding portion of the US GDP is being consumed by healthcare expenses.² Could technology, enabling delivery of healthcare advances while improving affordability, be part of the solution? We have reviewed the evidence, done the math, and identified technology-enabled use cases that could create between $350 billion and $410 billion in annual value by 2025 (out of the $5.34 trillion in healthcare spending projected for that year³ ).

Read more ...

<>

But how would we recognise the era of exponential improvement in healthcare?

SELF - individual

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group - POPULATION

The exponential benefits realised 'elsewhere' in global, local and glocal health and healthcare systems finally sees the achievement of parity of esteem with mental health not only fully funded, but designated as the key that must be turned 4 happiness. Despite the diametrical opposition of this domain to the political domain, there is a breakthrough in policy makers and the body politic prioritising "The Long Now"

"Predictions of an exponential increase in people living with dementia in the coming 30 years require evidence-based strategies for advancing dementia care and maximizing independent living. However, the evidence required to inform priorities for enabling improvements in dementia care is rarely presented in a way that stimulates and sustains political interests."  Martin, O’Connor, & Jackson (2018).

Community-based healthcare becomes  the norm and the educational, preventive and sustainable ethos for health and healthcare systems is adopted globally. Look at the readiness and response-to potential epidemic crises, plus  interventions in population health.  Exponential benefits are accrued. Evidence - look at the number of  (new) hospital beds. The community IS the market.

Exponential growth in global healthcare funding, health information for all, access to universal health care.  Social Determinants of Health not just a vision: but enacted and ongoing #SDoH-X. Evidence - climate change slowing, air quality improving - the 21st Century truly begins ...

Martin, A., O’Connor, S., & Jackson, C. (2018). A scoping review of gaps and priorities in dementia care in Europe. Dementia. https://doi.org/10.1177/1471301218816250

My source:
email - McKinsey Insights

Hodges' model: a New Invention

Created in the early 1980s, Hodges' model is clearly not a -

'New Invention' P. Halling

While Hodges' model is not a new invention, we have always needed to way-find. Maps are very powerful and even more so now that the world is literally within our grasp. What forms of way-finding can Hodges' model encompass ...

Psyche's journey: All aboard!?

The journey that is life and death... within which and beyond is the arrival of love.

The anatomy and physiology of the human body - the journey called development.

The wound healing journey, the granulated path.

The many skills to become more acutely aware of and honed to be a more effective communicator.

The ways and means by which a clinical procedure MUST be followed - with the essential detours that must include psychological considerations and assuring that 

dignity, respect and privacy are upheld.

This ineffable stuff called information how do we arrive there from data?

From information what is the direction of travel to knowledge - 

is W1S D0M a postcode?

This ineffable stuff called evidence, where is that to be found 

and then by what routes can it be applied?

The journey of the health and social care record from blank to comprehensive.

The journey past the signage (paper ... IT systems) that denotes local vocabularies.

The student's journey from novice to expert.

The patient's journey from illness to recovery; relapse to recovery, 

through palliative care to end of life.

Transitions: from care at home, to hospital, home or residential setting.

The patient's journey to hospital: paramedics, ambulance, corridors and bays, 

accident & emergency, ward, transfers, home.

The patient's narrative journey repeated to own doctor, paramedics, nurse, another doctor, social worker, physiotherapist, occupational therapist (not as long as it used to be?).

Crisis informational: worry - going for tests, scan ... attending clinic for results.

 Informational and temporal compression of the above due to headwinds of pressure on beds.

Self-referral journey to destinations (services) and agencies to be confirmed.

The medication journey (not yet personalised) absorption, distribution, metabolism, and excretion.
The other medication journey that precedes (reconnoitre) rationale, information giving, consent, titration, established regime, withdrawal, medication stopped.

The terrible journey that sees family losing their loved ones twice over.

Explicit and implicit journeys how closely observed formally and informally.

The trip around the other hubs that also turn: the bed hub, social services hub...

The journey through the calendar that is reflected in so many diaries.

The journey called supervision and why is the start session square so hard to find - time for?

The journey called allocation from referral to assignment of care coordinator. 

The journey through procedure land which includes a territory called complaints.

There is the healthcare journey that claims respect as it is predicated upon the postcode.

The journey of idealism and legacy that is called integrated, 

person centred, holistic care and reflective practice...?

Care programme approach review - initial, intermediate, discharge meeting and community review.

The path clearly delineated but less (not yet) travelled

 - health promotion, preventive medicine, self-care, self-efficacy and health literacy (education).

The journey through so many environments: inner - outer space.
The journey that is hope... and Psyche's way-finder...

How many of the care domains of Hodges' model 

do you ensure you pass through - including the spiritual?

Of course, this list only scratches the surface...

All these journeys can be found and navigated through Hodges' model.

NORTH

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INTERPERSONAL : SCIENCES

WEST--------------------------------------- EAST

SOCIOLOGY : POLITICAL

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SOUTH

As for the sign 'New Invention'...

Last Saturday at 0700 I left WN4 and headed south for Hay-on-Wye. I arrived at 0930 after passing through Clun and the hamlet of New Invention. I returned with a box of secondhand books, including a couple on education history purchased on my last visit in November 2015. These were useful in the studies at Lancaster. Once sold, 22 books in all, I had £20. Six other books went to the charity shop. An enjoyable trip.

Photo by Philip Halling, CC BY-SA 2.0, Link

Mental Health Awareness (Second) ... (Hour) (Day) Week (Month) (Year) (Life) (History)

INDIVIDUAL

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INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

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POPULATION

Thoughts Beliefs Emotions Mood... Motivation, Confidence Memory, Experiences, Trauma, Grief Mental Health - Reasons for Referral Assessment Self-help     Self      Self-stigma Learned Helplessness Psychological Theories & Therapies Sleep  Coping  Concentration self-harm risk, specialist services Surviving OR Thriving? Vulnerability Debate: Ethics, Diagnosis, Philosophy of Care PSYCHO-	Systematic diagnosis Evidence-based Care, Treatments Effective Treatment, Outcomes Drugs, Side Effects Local access (200+ miles for a bed?) Demographics - Research Data, Information, IT Records Emergency (MH Crises) Services Referrer's Knowledge of Care Pathways Debate: Pathologizing, Big-Pharma Evidence Based measures SOMATIC - BIOLOGICAL
SOCIAL Group Therapies Community Family Friends Relationships - Social Network Risk  Behaviour  Safety Mental health as a Social Construct Stigma Folk theory UNDERSTANDING Specialist Sociological Theories prediction uncertainty expectations Social Norms      Conformity Culture, Ethinicity, Education Anthropology Quality of Life	POLITICAL Power         Mental Health Law Review of Mental Health Act? WAIT! Government Policy Targets Gate-keeping ????RING FENCED???  ? Funding of Services ? ??  Parity of Esteem  ?? ???RING FENCED???  Community Care - Beds - In-patients Mental Health Services Primary, Secondary, Tertiary Mental Health Professionals Human Resource Planning Work

NHS Corridor Care – Urgent and Emergency Care Daily Situation Reports

If politicians & policymakers regularly 'walked'
 all the corridors of Hodges' model -
 they would see the false economy 
of their combined incremental works.

Incremental? Yes, in first being a 'temporary measure', then having a deleterious impact as the duration per patient and number of patients on corridors increased.

Now to the situation when the standard of care is unsafe, sub-standard, and denigrates the NHS as a social institution.

The fact of insufficient beds and its effect on care (pathways) and patient (and family) experiences severely affects staff morale, as they recognise subtle abuse, a precursor to structural and attitudinal changes that foster, encourage and establish institutionalised harm.

Staff also realise that they risk being de-skilled, 're-educated' -
becoming less compassionate ... (a 'lesser Nurse') as corridor care 
and its consequences are normalised.

Ignoring demographic trends and without an alternative concerted 
preventive/health education and health promoting plan, this is the result 
of the health and social care funding and policy
of successive governments, enacted by NHS management.

NHS England: Corridor Care – Urgent and Emergency Care Daily Situation Reports
https://www.england.nhs.uk/statistics/statistical-work-areas/corridor-care-urgent-and-emergency-care-daily-situation-reports/

"Model hospital": Where to find 5mins per shift? (footprints - transformation?)

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Mental health	8,500 beds blocked costing NHS providers around £900m per year 5 mins
Social care	Operational productivity and performance in English NHS acute hospitals: Unwarranted variations £280m delayed transfers of care independent sector expenditure costs £482m lack of data (still!) Stepdown facilities

"On staff rosters, Lord Carter said he found cases in which trusts were squeezing nurses on to weekday shifts in order to make up their weekly hours, and said 

 improving productivity by five minutes per shift could save as much as £280m." (p.11)

<>

Model - hospital : Model - community care : Model - self-care?

Scope of disciplines

Scope of nursing... (draft paper)

Scope of footprints

Scope of transformation?

Additional link:
NHS England (March 2016) Sustainability and Transformation Plan footprints, Ref: 04902.

My source: 

Dunhill, L. (2016) Carter: be masters of your fate, Health Service Journal, 10 February, 126: 6475, 10-11.

"Jason and the adventure of 254" c/o Wellcome Collection

"A work by artist Jason Wilsher-Mills is displayed at the Wellcome Collection ahead of the opening of a solo exhibition at the London museum. "Jason and the adventure of 254" reimagines the gallery space as a hospital ward and features huge sculptures, illustrations and interactive dioramas that draw on the artist's experience of becoming disabled at the age of 11.

The exhibition's title alludes to 2.54pm at Pinderfields Hospital, Wakefield, on August 1 1980, when Wilsher-Mills watched from his hospital bed as his parents were told he was suffering from an autoimmune condition brought on by a bout of chicken pox.

The free exhibition opens tomorrow (21st March) and runs until January." p.2.

INDIVIDUAL
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HUMANISTIC  --------------------------------------  MECHANISTIC      

 SOCIOLOGY  :    POLITICAL 

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GROUP

	'Figure in the bed', 2024, part of Jason and the Adventure of 254, an exhibition by Jason Wilsher-Mills at Wellcome Collection. Gallery Photo: Benjamin Gilbert. Attribution-NonCommercial 4.0 International (CC BY-NC 4.0).

Body of work, Artist relives diagnosis, Financial Times, 20 March 2024, p.2. 

Previously - 'beds'

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

If the book's title does not suggest the challenge to come then perhaps the editor's "Our apology" just might.

The editors declare the limitations of their apology as mental health nurses (mhn) given the precariousness of life, the environmental situation, the power of global corporations and how the industrial-military complex can also affect and define the role and work of mental health nurses. It is clear, that for example, the past decade (at least) of mental health service provision and development has been impacted by political and socioeconomic trends. The reduced number of mental health beds; the subsequent phenomena of out of area referrals (that also redefine 'area'). This past month, commentators have pointed to the lack of a work-force plan that should precede NHS Long Term Plan.

From the start the vocabulary here is rings of 'anti-psychiatry' and seeks, if not redress, then redesign of formal mental health services. Anyone putting the book down at this stage would be doing themselves, patients, carers, health and social care and their own learning a great disservice. Clearly, it is not only that existing services are reductionist, invalidating, self-serving, drug-pushing and re-traumatising; but the editors stress it is how they are all too often experienced.


As a mental health nurse the introduction and apology gets to heart of the matter, if not the mind. All of what mhn's do is tinged with coercion; whether with people on locked wards or those in their own home. The list of what mental health nurses are party to is a long one and makes difficult reading: the detention and restraint of people and administration of antipsychotic depot medications. The profession hides behind the ethics of acting in a person's 'best interests'. The negative impact of this experience is not just limited to a vulnerable minority who are in most marked emotional distress, but others as the book attests. If this suggests a caveat, there are several, as I hope this review across several posts will reveal. That custard cream shared with a patient (person, householder, tenant, citizen...) in their home will never taste the same. So, more on that to follow and not just to address any sense of trivialisation, but the many caveats that apply.

The editor's frame their apology outlining the basis for mhn: as a profession, a university degree, codes of conduct and accountability. p.viii As a 'profession in our own right' the critical thinking we espouse (yes - here too) and are supposed to exercise has failed to question and counter the increase in detention and the assault on mental health services themselves. At one stage I believed there was some coherence to mental health policy development, but if it is there now - it is intangible in its quality. MHS have not developed progressively as might have been anticipated if not exactly predicted. As a new Community Psychiatric Nurse in 1985 I am now a 'Community Mental Health Nurse', what else might my colleagues and I have become? At the end of the day we may longer return to the hospital (Winwick, Eaves Lane, Ribbleton - all gone), but what are we returning to when we go back to the office, the base? There is an office move in this book; and the final chapter considers the profession's very title.

The editor's apology does not just set the scene, it places mhn and all practitioners on the stage - front and center. This RMN (SRN) (to be ageist for a moment) is all too aware that despite all the talk about the need for integrated, holistic, person-centred care they are, more often than not, still lacking. I've come to see these as 'legacy issues', but that is another 'book'?

The book itself has 260 pages in total. The cover of my (softback - as above) is a pleasing contemporary design. The mainly white cover is already a suffering grey as it's been on numerous trips. Thirteen chapters follow the apology and an introduction. There are notes on the editors and contributors. The print is an excellent size and the overall format easy on the eye. Even if lightly edited, the editors have done a good job as the chapters cohere. Two indices cover names and subjects and are sufficient. So with chapter 1 beckoning I was all-eyes and ready page turning...

Thanks to PCCS Books for my review copy.

Part ii

Part iii

Part iv

Bull, P., Gadsby, J., Williams, S. (Eds.) (2018) Critical Mental Health Nursing: observations from the inside, Monmouth: PCCS Books. ISBN 9781910919408