Putting 'care' in a holistic frame

How many frames do you need?

*infocare: care demographics, directories, media, literacies...

care communication, self care, care ethics, care philosophy, emotional care, pastoral (green) care, therapeutic care, care beliefs, interpersonal care, MENTAL HEALTH CARE cognitive care, holistic care, care responsibility, care ecology	emergency care, physical care, care model, theory, plan, care assessment, evaluation, care curricula, intervention, care process, evidenced care, BASIC NURSING CARE intensive care, coronary care, special care baby unit, *infocare, nursing care, medical care, health care, e-care, surgical care
collaborative care, child care, personal care, older adult care, informal care, SOCIAL CARE, family care, care education, community care, care community, residential care, care dependency, abusive care, care risks	duty of care, care policy, care provision, inspection, standards, care economics, care outcomes, care legislation, care home, care contract, care advocacy, care quality, CARE AID, care qualification, regulation, State care, private care, care insurance, CARE RIGHTS, care service engagement, prison care

Don't forget the 5th, virtual, spiritual frame?

Where is that?
It is wherever you need it to be. ...

Additional suggestions welcome: h2cmng at yahoo.co.uk

Launch of the National Care Service in England

Source: Department of Health, 30/03/2010

In the biggest change to the welfare state since the creation of the NHS, everyone who needs care when they are old or disabled will get it for free, Health Secretary Andy Burnham announced today as he launched the National Care Service in England.

The National Care Service will be based on a principle of shared social insurance and will be funded by contributions from everyone in a fair way. The National Care Service will ensure people get high quality care when they need it and it will give peace of mind that savings and homes will be protected from the expensive care costs that arise from serious long term conditions, such as Alzheimer’s or recovering from a stroke.

Andy Burnham said:

“Today we are launching a National Care Service that is fair for all, ending the cruel care lottery we have today. Like the NHS, everyone will contribute and everyone will get their care for free when they need it. This is the biggest change to the welfare state since 1948 and, like the NHS, it’s going to take time to build.

“The National Care Service will mean that people will be treated with dignity and respect, people will have control and choice over their care and they will be helped to stay in their homes for as long as possible. People who have to live in residential care will, from 2014, get their care for free after two years and there will be more help to pay the residential costs.

“We’re not replacing the millions of carers or families who look after each other. They are the underlying principle of the National Care Service and we will better support them.

“We’ve already laid strong foundations through reforms over the past few years. But, with an ever growing older population – there will be 1.7 million more people needing care in the next 20 years – we must radically overhaul the way care is paid for and provided.

“I feel very strongly that this is a responsibility we must all help to shoulder. And it’s clear from what we have heard from the thousands of people who have given us their opinions on this over the past twelve months, that people agree. That’s why we know that the fairest way to help everyone who is affected by a serious disease, illness or disability is for us all to pay into a system so we get free care when we need it.”

The cost of care is currently a cruel lottery. No one has any way of knowing how much care and support they may need in the future. A 65-year-old can expect to need care costing on average £30,000 during retirement. However, some people, for example people with severe dementia, could end up needing care costing as much as £200,000.

The National Care Service will put an end to this unfair system. It will be built on strong foundations of recent reforms and will overhaul the way care and support is paid for and provided. It cannot be built overnight and will be phased in three stages:

Stage One
• Build on the best of the current system through reforms that are already underway and deliver the Personal Care at Home Bill.

Stage Two
• From 2014 extend the coverage of free care so that people will receive free care if they need to stay in residential care for more than two years.
• Set up a commission to support consensus and advise the Government on the fairest and most sustainable way that people can make their contribution to a care system which is free when they need it.
• Set up a National Care Service Leadership Group of expert stakeholders who will advise Government on the implementation of the National Care Service, focussing on the systems and business processes that need to be put in place to make the National Care Service a reality.
• Introduce a National Care Service Bill to set the legal foundations of the National Care Service.
• Enshrine in law for the first time nationally consistent eligibility criteria for social care helping to remove the postcode lottery of care that exists now
• Push forward with the prevention agenda and continue the drive towards personal budgets so that by 2012 everyone who would benefit from a personal budget will have one.
• Ensure accurate, relevant and accessible information about what people are entitled to, how the assessment process works and how to access care services is provided to everyone.
• We want to improve the gateway for accessing social care and disability benefits to make simpler and easier for people.
• Introduce a quality framework including a body to drive up quality in social care.

Stage Three
• The introduction of a comprehensive National Care Service that is free when they need it for all adults with an eligible care need, funded by contributions.
Following the biggest ever consultation on care and support that saw over 68,000 members of the public, carers and representative organisations have their say, it is clear that people believe it is right that everyone should contribute to a care system that is free when people need it– similar to the NHS. However, the necessary consensus on how people should pay into such a system has not yet been reached. A National Care Service Commission, will therefore be established to advise Ministers on the fairest and most sustainable way for people to do so.

Care Services Minister Phil Hope said:

“We must find a fair way of funding the National Care Service. The stakes are very high. That’s why we must have a clear consensus. We are setting up a commission to tell us what would be a fair way for everyone to pay into this new system.

“Everyone will pay into it in a fair way and in return everyone will then have peace of mind that their savings and homes will be protected from high care costs. The whole of society will benefit and the National Care Service will support individuals and families for generations to come.”

The National Care Service will have six founding principles. It will:

1. Be universal – supporting all adults with care and support needs within a framework of national entitlements.
2. Be free at the point of use – based on need, rather than the ability to pay.
3. Work in partnership – with all the different organisations and people who support individuals with care and support needs day-to-day.
4. Ensure choice and control – treating everyone with respect and dignity, ,putting people in charge of their lives.
5. Support family, carers and community life – recognising the vital contribution families, carers and communities play in enabling people to realise their potential.
6. Be accessible – easy to understand, helping people make the right choices.

Contacts: Department for Health Email: NDS.DH at coi.gsi.gov.uk

Additional links:

DoH: 30 March 2010, The White Paper, Building a National Care Service

The Big Care Debate

Workshop & CfP: The post-Fordist Care Regime

A workshop series organised by the Centre for Philosophy and Political Economy (CPPE), School of Management, University of Leicester, UK
Workshop 1: The Business of Care

Keynote Speaker: Silke Roth (Southampton)

Convened by Vanessa Beck, Steve Brown and Fabian Frenzel

CPPE, School of Management, University of Leicester, UK

Date: 10th December 2015

Certain transformations in our political economic landscape can be distilled according to regimes of care. Fordist care was provided primarily by female ‘free labour’ within the family context, while the state played a large role through institutions like schools, pensions, prisons and hospitals. By contrast the private sector role was rather limited although, of course regimes are uneven and varied across different countries and social sectors. The post-Fordist regime of care was triggered, in part, by a rebellion against the invisible and unvalued nature of female ‘free labour’ in the care domain, for example in housework or child care. Demands for more autonomous, neither market nor state based forms of care were made and realised in new social and urban movements that pursued attempts to create new forms of social reproduction and care in communes, housing co-ops or self organised childcare. Despite the progressive impetus of many of these initiatives, it is possible to see, with hindsight, how demands for autonomous care were subsumed within the general move away from state provision and towards privatisation as well as individualisation of care responsibility. In the post-Fordist regime the provision of care is increasingly organised around the needs of capitalist valorisation. This drive towards privatisation is ostensibly about efficiency and budgetary restraint, the underlying motives, however, may well be more diffuse, pointing to the opening of new sources of surplus value capture for a growing sector of market oriented care provision.

Yet as the State outsources care jobs (in prisons, health, schools, etc), the organisation of markets has taken on specific characteristics. This includes the internationalisation of the care regime with transnational businesses of care, a transnational labour force and the expanding mobilities of care receivers. A further aspect is the increasing financialisation of care, which includes the creation of ever-new financial vehicles, from Private-Public Partnerships to social impact bonds that aim at ensuring efficiency in the care sector but often do the exact opposite. Both nationally and internationally we witness the renewed mobilisation of ‘free labour’. Unlike in the Fordist regime of care, this now aims at volunteers across age and gender groups and framings such as the ‘big society’ and 'international volunteering'. Beside this unremunerated work we see increasingly precarious conditions of labour in the care sector, often migrant labour, on zero hour contracts and minimum wages. The precise composition of this labour market is another area of interest. What novel forms of organisation are emerging in response to our present regime of care? And what resistance is emerging?

Finally, although price is often taken to be the primary concern of post-Fordist care provision, the quality of care cannot be ignored, though it is difficult to measure. Beyond a private industry of care provision we also find a new ‘industry of measurement’ that claims to assess the value and quality of privately administered care. The organisation of these new organisational patterns and industries of care are the subject of this workshop.

We invite papers that interrogate the shift to a post-Fordist care regime. We are interested in a variety of scales, from local to global in which this shift becomes visible and invite contributions from across care sectors broadly defined, from health (including mental health) to housework, from medicine to (social) housing, from education to welfare. We are interested in analyses of businesses of care, including care evaluation and financialisation, in investigations of the labour of care, national and international, waged, ‘free’ and precarious and the struggles of this labour. Finally we are also interested in receivers of care and their responses to the post-Fordist care regime.

Organisation:
The broad scope of the call is intended to allow for a comprehensive investigation of the post-Fordist care regime. Some of the threads of this workshop will be picked up in two following workshops that chart ‘Alternatives of Care’ and the ‘Cosmologies of Care’, to be announced separately in due course.

Please submit abstracts of up to 750 words to describe your paper. Invited papers will be presented in Pecha Kucha style. Presentations consist of 20 slides that have to be presented in 20 seconds each. (Follow this link to find more information on Pecha Kucha). The organisation of the day aims to encourage shared discussion and the format of Pecha Kucha allows for succinct presentations. Papers will be commented on by our invited keynote Silke Roth as well as the three workshop convenors. We also invite all speakers to submit outline papers (of about 2000 words) to be shared among participants prior of the workshop.

Dates:Please submit abstracts to ff48 AT le.ac.uk by the 30th September 2015. We will respond by mid October 2015. Presenters should submit an outline paper (of max. 2000 words) by the 1st December 2015 to circulate among participants of the workshop.

We also plan to facilitate a publication of full papers from the event.

The workshop is free of charge, and refreshments and lunch will be provided during the day. A limited number of travel bursaries is available. They will be targeted at presenting PhD students and researchers without access to institutional funding in the first instance. Please indicate if you would like to be considered for a travel bursary as you submit your abstract.

---------------------
Dr Fabian Frenzel
Lecturer in Organisation
PRME Officer
School of Management
University of Leicester
LE1 7RH
UK

My source:

Dr Vanessa Beck via ESA-ALL AT JISCMAIL.AC.UK (some extra text also emboldened as relate to Hodges' model).

Reading the signs - Idealised Care

With the axes of the health career model labelled and the care domains - that fall between - identified, what can we read into and from the health career - care domains - model?

What basics of care and caring can we find there, what assumptions can we jump upon?

Here is a list ... (which also illustrates how the model grows with the learner) :)

• Health, well-being and social care are not declared in the face of the model, this suggests the model is high-level - generic.
• Health care (here) has at least seven disciplinary degrees of freedom:


• Sciences (biology, physics, chemistry)
• Politics
• Psychology
• Sociology
• Spirituality

• Health and social care theory and practices are reductive.
• Health care involves the traversal of space - distance.
• Health and social care has the potential to be depersonalising and alienating.
• Health and social care is simple and complex.
• The environment is inherent within the model in its varied forms.
• There is a moment of imbalance within the INDIVIDUAL - GROUP.
• Context is essential as a means to situate care (co-ordinate in an 'x','y' sense).
• The means is provided to situate the care context in a person-centred way.
• This model provides a template for personal and group reflection (shallow or deep).
• The model is open in terms of the final content, the content as expressed in care approach, philosophy, discipline, description (concepts, problems, priorities, strengths, a 'mash-up') is not dictated.
• In acknowledging the existence and primacy of the individual (located at the top so - must be important), the model provides a (potential) focus and vehicle for individualised, personalised, person-centred care.
• Whilst individualised care is at the center of care theory, practice and management, it cannot be defined purely by virtue of the INDIVIDUAL-group axis and the claim of an associated INTRA-INTERPERSONAL care domain.
• The individual must also be considered as a POLITICAL entity, a citizen, a legal entity that falls under the auspices of human rights. As such the individual is someone who can (or has previously) expressed their choices, wishes as to their health, care, well-being, best interests.
• Being an INDIVIDUAL within the family of humankind - 1 of some 6.x or > 7 billion - this person is unique and deserving of highest quality care, dignity and respect that should be accorded to all people.
• Health and social care whilst organisationally distinct (POLITICAL - POLICY) are to the INDIVIDUAL and carers (GROUP) concurrent, transparent and ideally integrated activities.
• Physical care (SCIENCES) can be, and is, defined in mechanistic terms; for example, time (objective), events, place, outcomes, observations / data (discrete, quantitative).
• Physical care is hence primarily objective.
• Emotional INTERPERSONAL care can be, and is defined in humanistic terms; for example, time (subjective), communication, responses to events (behaviour), feelings, beliefs, relationships (SOCIAL), expectations, fears, observations / data (subjective, qualitative).
• Physical care, emotional care is often mediated through the SOCIAL domain and the group - the family unit.
• Since this model indicates an initial structure and content the model is of potential use as a reflective resource for novice through to expert.
• The model is generic and as such not limited to health and social care.
• Such is the generic nature of the model it can support all learners in lifelong learning.
• The Spiritual is not there: it is ineffable. It is everywhere, everything, every'I' and everynow.
• Time is inherent in several forms within health and social care.
• The economics of health care is infused to all the domains, notably in the first instance to the SCIENCES and SOCIAL domains.
• The economic effects upon the individual in a humanistic sense, may be remote, but is inverse in terms of its impact.
• The model reinforces dualism: mind - body (but cognitively innoculates also).
• In highlighting boundaries, dichotomy, limits the model can stress the need for integration.
• The model suggests an antipodean fracture in relationships*: the patient and clinician (across physical care and mental health) inhabit the Northern hemisphere; while the carer (public), manager and policy maker the Southern.
• Health and social care is grounded in human communication (and that which is mediated).
• 'Sense making' must be a key issue in health and social care.
• Given the scope of the model, technology must be making a major impact across all fields of health and social care.
• The model can simultaneously represent the SOCIO- and the -TECHNICAL.
• A great many (potentially - all) values and standards are inherent in the model.
• This model can be represented using many media.
• This model is open to the Management Consultant's delicacy alphabet soup, i.e. using letters to represent approaches / methods, e.g. 4P's, 4C's.
• Health and social care can also be described holistically.

*Clearly, given the relationships and issues that arise this bears further examination and discussion.

This list is subject to revision - addition.

Image source:
http://en.wikipedia.org/wiki/File:Antipodes_LAEA.png

Person-centred care [PCC]: is it really happening? c/o National Voices

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group

PCC = what’s important to the individual, is co-ordinated around their needs and involves them in decisions. "To be person-centred, that care needs to work together to wrap around all the needs of the individual in a holistic way. Sadly, our report found that neither the NHS nor adult social care can demonstrate co-ordination of care, despite ‘integrated care’ being a key goal of all national and local leaders over the past five to 10 years. The way health and care services work must change to reflect the needs of the population. It would be a start to recognise that co-ordination of care is an important factor, and that we need to be measuring whether it is happening."	(many) Definitions = 5 key indicators of pcc:  good information, good communication, involvement in decisions,  care co-ordination  and care planning. Service user reported data from 19 nat. surveys NHS:  in primary care, only 39% of patients said their GP was ‘very good’ at involving them in decisions. What’s more, personalised care planning doesn’t really happen. Only 3% of GP patients with one or more long-term conditions reported having a written care plan, suggesting that opportunities to deliver personalised care in the NHS are being missed.
"Personalisation of care is more advanced in adult social care than in the NHS, with 89% of adult social care users reporting that the care and support they received helped them to have control over their daily life. Similarly, 63% of people using a social care personal budget said that this had improved their ability to make everyday decisions. Participation and control of decisions is well-established in adult social care, with just over 90% of those using community adult social care saying they were involved in decisions about their care and support needs." (See original post - report for important additions)	20+ years policy  England Care Act 2014 National Voices coalition of health and care charities  report ‘Person-centred care in 2017' No National data on this... "It is clear from our report that a strategic overhaul of how care is measured is needed. Rather than single-service, single-setting, activity measures, more credence needs to be given to the experiences of the people who rely on services. Only then can we help local systems succeed in offering personalised, integrated and holistic care. Whilst there have been some advances in the delivery of person-centred care, there is still a long way to go before the policy rhetoric matches the reality experienced by people."

Interprofessional Collaborative Care Will Be Key to Meeting Tomorrow’s Health Care Needs

Maryjoan Ladden, Ph.D., R.N., F.A.A.N., Robert Wood Johnson Foundation Senior Program Officer

A little over a year ago, the Institute of Medicine’s landmark Future of Nursing: Leading Change, Advancing Health report put forward a series of recommendations for transforming the nation’s health care system. Among them was a call for a system in which “interprofessional collaboration and coordination are the norm.” That’s no simple assignment in a system that often operates in silos, from schooling through practice. But a number of innovators around the nation are already making headway.

Their work is the subject of a new policy brief from the Robert Wood Johnson Foundation, part of its Charting Nursing’s Future (CNF) series. The brief delves into what the IOM recommendation means for health care systems, offers case studies of several collaborative care models already in place, and examines the implications of the recommendation for how we train nurses and other health care professionals.

According to the brief, Implementing the IOM Future of Nursing Report–Part II: The Potential of Interprofessional Collaborative Care to Improve Safety and Quality, the “silo” approach must soon give way if we are to meet coming health care challenges. For example, chronic conditions are increasingly common—not surprising given an aging population. But the health care system is poorly structured to provide the sort of coordinated care and preventive services needed to give these patients quality care while reducing costs. Some health care institutions are gearing up for the challenge.

• In Boston, where Harvard Vanguard Medical Associates developed its Complex Chronic Care (CCC) program, primary care has become interprofessional, collaborative and noticeably more efficient. Each CCC patient is assigned a nurse practitioner (NP), a registered nurse with advanced education and clinical training. The NP consults with all the patient’s subspecialists and incorporates their guidance in a single plan of care. The NP then manages and coordinates that care, connecting patients to nutritionists, social workers, and other professionals as needed. The model is dynamic, allowing patients to meet more or less frequently with the NPs and their primary care physicians, who remain responsible for the patients’ overall care.
  

• In New Jersey, the Camden Coalition of Health Care Providers is “revolutionizing health care delivery for Camden’s costliest patients,” according to the brief. These individuals, sometimes called super utilizers, typically rely on hospital emergency rooms for care. Not surprisingly, such patients account for an outsized share of local hospital costs, often with diagnoses that would have been more properly handled in a primary care setting. The Coalition developed its Care Management Project to reduce these unnecessary emergency room visits by treating patients where they reside, even when that means treating them on the street. A social worker, NP and bilingual medical assistant work as a team to help patients apply for government assistance, find temporary shelter, enroll in medical day programs and coordinate their primary and specialty care.
  

Training the Next Generation to Collaborate

Of course, the silo effect usually begins in school. In May 2011, six national education associations representing various health care professions formed the Interprofessional Education Collaborative (IPEC) and released a set of core competencies to help professional schools in crafting curricula that will prepare future clinicians to provide more collaborative, team-based care. Such efforts are already under way at a number of institutions.

• Maine’s University of New England has developed a common undergraduate curriculum for its health professions programs in nursing, dental hygiene, athletic training, applied exercise and science, and health, wellness and occupational studies. The curriculum includes shared learning in basic science prerequisites and four new courses aimed specifically at teaching interprofessional competencies.
  

• In Nashville, Vanderbilt University is also pursuing an interprofessional education initiative that unites students from the medical and nursing schools with graduate students pursuing degrees in pharmacy and social work at nearby institutions. Students are assigned to interprofessional working-learning teams at ambulatory care facilities in the area.
  

• The Veterans Health Administration (VHA) is piloting an interprofessional initiative, as well, focused on preparing medical residents and nursing graduate students for collaborative practice. As part of the initiative, five VHA facilities have been designated Centers of Excellence and received five-year grants from the U.S. Department of Veterans Affairs. Each VHA Center of Excellence is developing its own approach to preparing health professionals for patient-centered, team-based primary care.
  

• In Aurora, Colorado, the University of Colorado built its new Anschutz Medical Campus with the explicit objective of creating an environment that promotes collaboration among its medical, nursing, pharmacy, dentistry and public health students. It features shared auditorium and simulation labs, as well as student lounges and other dedicated spaces in which students from different professions can pursue common interests such as geriatrics in a collaborative fashion.
  

Such initiatives are clearly the wave of the future, if only because the pressures of caring for a larger, older and sicker population of patients in the years to come will drive efforts to identify efficiencies. In the words of Mary Wakefield, PhD, RN, head of the Health Resources and Services Administration, “As the health care community is looking for new strategies and new ways of organizing to optimize our efforts—teamwork is fundamental to the conversation.”

...

My source: Matt Freeman (PRS)

Two workshops on Infrastructures in Health Care

'Infrastructure' is a word of our time with both reductionist and wholist connotations. The 4P's of PROCESS, POLICY, PURPOSE and PRACTICE can be found here together with at least several C's: COMMUNICATION, CO-ORDINATION, COLLABORATION and COMPLEXITY. So, here for 2009 is an infusion of the socio-technical at two health infrastructure events:

Call for Papers: 2nd International Workshop

Infrastructures for Health Care: Connecting practices across institutional and professional boundaries

June 18-19, 2009, University of Copenhagen, Denmark

Scope
The 1st international workshop: Infrastructures for Health Care was held at the Technical University of Denmark in June 2006. It attracted researchers, health care professionals, IT professionals, administrators, and others engaged in the development of infrastructures and new, integrated applications and services for improving the quality of health care services. The purpose of this 2nd international workshop is to continue this forum for discussing current issues and trends related to the integration and coordination of health care practices across institutional, organizational, and professional boundaries.

The health care sector is characterized by a worsening shortage of personnel and endlessly growing costs caused by the development of new treatments in combination with rising demands for treatment, which are associated with an aging population and an increase in chronic diseases. Against this backdrop, policy makers, health care professionals and researchers show an increased interest in innovative systems of care, which improve communication, coordination and collaboration among patients/citizens, care providers in primary care and specialty services (clinics, hospitals, emergency departments, old people's homes etc.). Concepts like shared care, integrated care and continuity of care are indicative of ambitions of creating coherent and effective health care services for patients that require complex - and often long-term - care. Although these concepts are often used in relation to projects that seek to enhance communication, coordination, and collaboration around particular patient groups, they also have bearing on more general visions of reorganizing health care.

Infrastructural arrangements - such as electronic patient records, classification schemes, accounting systems, communication standards, and quality systems - play a crucial role in these new models of care, and it is increasingly hard to imagine integrative initiatives that do not have a strong IT component. This raises a multitude of questions about the - actual and imagined - role and impact of IT and other infrastructure components in the development of patient-oriented, integrated healthcare services.

We wish to highlight how new infrastructures - socio-technical assemblages - simultaneously connect existing practices, influence and change these practices, and create entirely new practices in health care work (e.g. related to the maintenance of the infrastructure itself). What characterizes infrastructures in health care? What role do they play in transforming and reorganizing health care and in creating new actors in health care? How are infrastructures established and maintained? What is the impact on work practices, organizational structures, cost effectiveness, quality of care, etc.?

Topics of Interest
Our aim is to bring together researchers, health care professionals, IT professionals, administrators and others involved in establishing infrastructures and/or developing new, integrated models of healthcare. We seek practical case studies as well as empirical and theoretical research contributions. Topics of particular interest include, but are not limited to the following:

* Infrastructures as socio-technical achievement in health care
* Health care organizations and infrastructures
* Infrastructures and new patient practices
* Designing infrastructures for health care
* Economic aspects of infrastructures for health care
* Myths of infrastructures
* Infrastructures and politics
* Managing infrastructures

We encourage potential participants to submit an abstract (3-500 words) describing the contribution before March 1, 2009. Abstracts must be submitted by email to
infrastructures2009 AT sundhedsITnet.dk

After the conference, a selection of the contributors will be invited to submit a full paper to an edited - and fully reviewed - book or special issue (to be decided).

List of important date
Submission of abstracts 2nd of March 2009
Notification of acceptance 1st of April 2009
Deadline for registration 15th of May 2009
Conference 18th - 19th of June 2009

Workshop Co-Chairs
Finn Kensing, University of Copenhagen, Denmark
Jørgen P. Bansler, Technical University of Denmark
For abstract submission and further information, contact
infrastructures2009 AT sundhedsITnet.dk
We are looking forward to an exciting workshop!
==================================

The other event is in April (and has already closed in terms of submissions):

Health and Care Infrastructure Research and Innovation Centre

HaCIRIC International Conference 2009 -
Improving healthcare infrastructures through innovation

2-3 April 2009, Hilton Metropole, Brighton

The conference will bring together researchers and practitioners from across disciplines and countries with different healthcare systems to focus on how to use innovation to improve the delivery and operation of healthcare infrastructure. Areas of particular interest include:

Integrating infrastructure and service planning
Can we translate service planning into infrastructure asset planning more effectively? Are moves towards greater contestability and a local devolution of responsibilities making this harder? What lessons are there from different national health systems? What tools, models and performance metrics are appropriate?

Stimulating innovation in infrastructure provision
How can procurement and incentivisation models be designed to deliver innovation? Can policy targets be used more effectively? How do we ensure that innovation is embedded on a sustainable basis? How can the design process be more effectively used to generate innovation? How do we capture and diffuse knowledge of innovative solutions?

Examples of infrastructure innovation targeted at key problems
Healthcare acquired infection is an example of an area where a multi-disciplinary approach embracing service delivery, behavioural and infrastructure change is needed. We are interested in case studies and research reporting on how this has been tackled, as well as the methodological challenges in conducting such research.

Social Inclusion: Transnational Organization of Labour, Mobility, and Senior Care in Central and Eastern Europe

Dear colleagues,

Social Inclusion has just released a new issue, fully open access, and all articles are free for you and others to read, download and share.

Transnational Organization of Labour, Mobility, and Senior Care in Central and Eastern Europe (2026, Volume 14)

Edited by Ewa Palenga-Möllenbeck, Dóra Gábriel, Olena Fedyuk and Kristine Krause

Complete issue: https://doi.org/10.17645/si.i533

Table of Contents:

Transnational Organization of Labour, Mobility, and Senior Care in Central and Eastern Europe
https://doi.org/10.17645/si.13078
By Ewa Palenga-Möllenbeck, Dóra Gábriel, Olena Fedyuk and Kristine Krause

Migrant Live‐In Care Workers in the Global Care Chain: Results From an Online Survey
https://doi.org/10.17645/si.11728
By Silvia Wojczewski, Simona Ďurišová, Sabine Pleschberger, Anna Ernst, Rojin Bagheri, Kathryn Hoffmann and Viktoria Adler

Selling Care Skills? The Multiple Meanings of Training for Polish Live‐In Care Workers in Germany
https://doi.org/10.17645/si.11909
By Roxana Fiebig-Spindler

The Invisible Hand of Care: A Typology of Brokerage Actors in Migrant Care Labour
https://doi.org/10.17645/si.11953
By Ewa Palenga-Möllenbeck, Ivanna Kyliushyk and Roxana Fiebig-Spindler

Care Extractivism Beyond Households: Migration and Care for Older People in the Post‐Yugoslav Semi‐Periphery
https://doi.org/10.17645/si.11975
By Majda Hrženjak

Caring Communities in Urban Hungary: A Civil Society Perspective
https://doi.org/10.17645/si.12023
By Dóra Gábriel, Bettina Török and Noémi Katona

Care Under Constraint: Unmet Care Needs Among Older Adults in Romania
https://doi.org/10.17645/si.12028
By Mihaela Hărăguș and Ionuț Földes

Skill Construction and Challenges of Professionalization in the Hungarian Home Care Market
https://doi.org/10.17645/si.12029
By Noemi Katona and Dóra Gábriel

The Right to Care and Support: From Care Theory to Human Rights Law
https://doi.org/10.17645/si.12056
By Maroš Matiaško

Senior Care in Wartime Ukraine: A Fragmented Continuum of Arrangements Inside an “Unpromising Sector”
https://doi.org/10.17645/si.12060
By Oksana Dutchak, Olena Fedyuk and Anna Oksiutovych

Bounded Transport, Mobility Justice, and Claims for Recognition Among Live‐in Care Workers
https://doi.org/10.17645/si.12191
By Petra Ezzedine

In Times of the Market and Community Shift: On Live‐In Care and Caring Communities
https://doi.org/10.17645/si.12295
By Brigitte Aulenbacher, Klaus Wegleitner, Jonas Hagedorn and Bernhard Emunds

Care Outsourcing From Germany to Central and Eastern Europe
https://doi.org/10.17645/si.12319
By Kristine Krause, Veronika Prieler, Hanna Horváth, Matouš Jelínek, Mariusz Sapieha, Zuzana Sekeráková Búriková, Petra Ezzeddine and Luise Schurian‐Dąbrowska

Imagining Care: Transnational Inequality and Older Age Prospects for Ukrainian Caregivers in Italy
https://doi.org/10.17645/si.12324
By Oksana Dutchak, Olena Fedyuk and Anna Oksiutovych

The Winding Road to Professionalisation: Care Work in Romanian Nursing Homes
https://doi.org/10.17645/si.12326
By Neda Deneva, Ionuț Földes, Denisa Ursu and Mihaela Hărăguş

The Limits of State Control in Regulating Live‐In Care Work in The Netherlands
https://doi.org/10.17645/si.12375
By Siënna Hernandez, Kristína Bartošová and Franca van Hooren

Home Care for Sale: Marketisation and Social Change
https://doi.org/10.17645/si.12737
By Attila Melegh

Kind regards,

Mariana Pires
Cogitatio Press, Portugal
si AT cogitatiopress.com
Social Inclusion
https://www.cogitatiopress.com/socialinclusion

My source: COMPLEXITY-PRIMARY-CARE list

"Care Package" 4 the C.21st ?

"The CARE Package was the original unit
of aid distributed by the humanitarian organization
CARE (Cooperative for Assistance and Relief Everywhere)."

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group - population

Disaster Conflict Refugee context? Individual choices -  facilitating autonomy  whenever possible - Sign Language? Mental health Care Plan includes relapse prevention /  Staying well / Self care Mental capacity / Decision making Physical health check Patient Reported Outcomes* Specific management of medication - lithium, psychotropics and safety completed and health literacy demonstrated with support if needed. Making Every Contact Count - in every care context Psychological therapies  One narrative: told recorded once Cognitive access: Health Information Access to my health record My Care - Why? Understanding, Awareness C[P]-Suite "I Consent" - My data, Genetic Profile, Reimbursement? INTEGRATED -

Disaster Conflict Refugee context? Avoid admission, over-treatment Quaternary Prevention Preparation for Admission? Physical Care Plan includes relapse prevention /  Staying well / Self care If in-patient THEN is medication ordered and ready for discharge? e-Prescription? Electronic Health Record Mobility - aids, Transport Advice / instructions Wound /  Dressing management Making Every Contact Count - in every care context Clinic location: urban / rural  transport  Virtual - Telemedicine, e-Health m-Health Patient Reported Outcome Measures Patient involvement in Research Trials Physical therapies - access Physical access services/devices? - CARE ?

Care IN the Community? Housing :: Homeless? Pre-discharge home visit - e.g. Occupational Therapy? Living alone? Safety Carers involved with due  consent in care planning.  Engaged in recognition and role of warning signs and actions to follow. Recovery, Rehabilitation, Reablement Awareness and shared competency in medication, in event of physical illness. Patient/Family audit of clinical record: accuracy if/when appropriate BUT check completed. Plan of care - activities, groups, information, arts, studies,  volunteering. Carers assessment Social care. Advance (anticipatory) care planning Progress (this time) PRO* Introduce respite care, day care, volunteering Avoidance of admission: this time :: next time?

[Finance of Health Service Delivery] Care Package for specific groups / populations / circumstances:  Forensic, Prison, Homeless,  Substance Misuse, Veterans Need for interpreter, advocacy? Feedback on care experience: patient and carer(s) Management of Belongings, Cash Community care - follow up instigated - introductions made with continuity of care (personnel) were possible. Communication with (family) GP/Doctor Out-of-hours services  and contact details. Patient & Carer invited to phone purely as a trial-run. Law - Policy? 72 hour, 7 Day - follow-up at home. Incidents - Complaints? Apologies? Organisational Learning  Welfare - Employment Data capture and reporting of care spell/episode. De-identified. Reports submitted stats. Reporting plans to Public re. Health Services Public involvement in Services

The above is not comprehensive and in itself begs questions of scope and what is a 'comprehensive' care package?

The mapping above to Hodges' model includes many assumptions - existing health service provision, governance, finance, housing, social infrastructure - social determinants of health and how these are mitigated (if at all).

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

Compass-ion and care cartography

Are you a -

Care surveyor?
Care commissioner?
Care architect?
Care assessor?
Care appraiser?
Care philosopher?
Care manager?
Care publicist?
Care gatekeeper?
Care journalist? Care mentor? Care ecologist? Care informatician?
Care provider?
Care student?
Care planner?
Care archivist?
Care governor?
Care wright?
Care cartographer?
or is that - Care mapper?
....

or just a -

CAREr?

What c+mpass do you use to navigate the CARE -

curriculum
reflections
dialogues, records, policy, IT systems,
access
outcomes ...
?

Book for review: i "Philosophy of Care - New Approaches to Vulnerability, Otherness and Therapy"

Among the questions that research might answer regards Hodges' model I have in mind:

• At what age can Hodges' model be introduced in the general curriculum?
• Is there consistency in how people view/interpret and apply Hodges' model?
• How simple is it (or complex)?
• Is it a meta-model?
• How can Hodges' model relate to the spiritual?

My B.A.(Joint Hons) is in Philosophy and Computer Science, so the 'Philosophy of Nursing' is a preoccupation. In January 2022 I discovered:

J. Braga & M. Santiago de Carvalho (Eds.), Philosophy of care: New approaches to vulnerability, otherness therapy. Springer.

I requested a copy but ever distracted did not register any further action beyond acknowledgement and being forwarded. Discovering I'd missed this, I picked it up again. I must admit two years ago I was expecting a book with 'care' in the nursing, medicine, health context. Revisiting the 'blurb' I saw that this is not the full picture. Last year and this however drawn to conferences that combine the environment and religion this book really did fit the bill. Requesting a 'review copy' so late in the publishing cycle presents a challenge. 

Hodges' model provides a long-tail, surely a defining property of a lifelong learning resource? This plus a history of cataract surgery brought a print copy and many thanks to Daniela Rohrmann and team. I've now reached Part V, chapter 19 and 'medical care'.

The book's physical quality (printed hardcopy) is up to Springer's usual high quality standard. The fact that much of the contents have, I believe, been translated appears to show at times, in one chapter especially, with missing, or additional words. Perhaps this also reflects proof reading, an important part of production I would have thought (and still best not left to AI)? The font and print size is very readable and the format and design - architecture - of headings and layout are inviting and engage the reader. There are Any problems with grammar, flow were readily overcome. 

In meeting this text I oscillated in expectation - philosopher of care, as in the clinical context; and then the spiritual, pastoral. Which is it? The emphasis is on the latter with the final part focussed more on medicine. The book has extended my appreciation of 'care' in the wider sense, it is rewarding and well-worth reading.

"Finally, the fifth part – Care and Therapy – examines issues relevant to medical

care. This volume would be remiss if it did not take therapeutic care into account.

Practical and theoretical knowledge mutually influence each other. This highly specialized

domain imparts a significant amount of the status that care is given in our

daily lives. Thus, in this last part, the previous themes of otherness and ipseity converge

systematically. Through the theoretical emphasis that is placed on the issue of

suffering – whether it concerns physical illnesses or those of the psychological and

psychiatric realm – the authors of these chapters show us the urgency of thinking

about therapeutic care practices in the light of a theory of intersubjectivity, where

the disease itself and its cure are understood within the communication processes

and not only as exclusively technical-scientific processes." p.vii. (Introduction).

Don't worry I'm not going through each chapter, but Chapter 1 is a fascinating read, the title 'Care: A New Arrival in the History of Philosophy?' https://link.springer.com/chapter/10.1007/978-3-030-75478-5_1 presented an immediate challenge. For me, love, compassion, philosophy - as the love of wisdom, knowledge, what it is be, think, exist, the human condition and more all imply 'care' including care of thought and argument. I'm probably begging the question and I realise the Peirron's purpose is more specific, nuanced. I'm reassured though as care is defined by three criteria:

"(a) care is contextual and anti-essentialist... The characterization of care requires a great deal of attention to the precise details of each situation (Tronto, 2012: 35)."

"(b) care is relational and accepts that human beings , other beings, and the environment are interdependent  (Tronto, 2012: 32)."

"(c) In human societies which would like to assume the equal value of all human life, care needs to be democratic and inclusive  (Tronto, 2012: 36)." p.6.

I must read Tronto - who work has elevated vulnerability as flagship concept of her politics of care (Tronto, 2009) (p.8); 'dialectical' too (p.10). The book is full of many leads, the writing scholarly and authoritative.

With some studies in education and philosophy the pragmatic school of thought quickly surfaces. I see Hodges' model as a pragmatic solution. In addition to the 'pragmatics of care', Peirron opens the door even further in respect of 'care':

"Giving through care involves much more than what is described in the interactional framework of exchanges characteristic of homo economicus (economical animal) paradigm. Giving is not exchanging because care involves so much more than just the provision of a service. Care, as understood as a politically relevant anthropological position, is thus very different from a Hobbes-inspired anthropology which supposes a social epistemology based on a an atomistic approach to individuals. It provides a fundamental interpretation of our social intelligence by thinking it, starting from a relational anthropology within which the concept of vulnerability plays, as we will see, a strategic role. A pathetics of care rethinks the balance between reason and feeling, argument and emotion in the spirit of the tradition of Scottish philosophy, in order to allow a "different voice" to be heard in the analysis, the description, and the support of the human world." p.7. 

The pathetic view of care requires a language, methods, aesthetics that can manage 'the singularity of an enduring life history' (p.10). This equates for me with the health career in Hodges' model.

As usual below I've mapped some concepts to the domains of Hodges' model. I will add to this post too.

Individual

|

      INTERPERSONAL    :     SCIENCES                   

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

 SOCIOLOGY  :    POLITICAL 

|

Group

contextual anti-essentialist relational situated	context human being, other being  and environment - interdependent
context interdependence care in human societies  equality within human societies	context situated human societies are democratic and inclusive

See also:
body & soul - Book: Philosophy of care: New approaches to vulnerability, otherness therapy

Leapspace? Why not ...?

Referred to a paper in an email: https://doi.org/10.1016/j.jclinepi.2026.112401.

- I noticed an invitation to try Leapspace. 

So I leapt (with much editing - for formatting here). ...

 

Copilot steps

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("Hodges' model" OR "Hodges model" OR "Hodges' health career model" OR "health career model" OR "care domains model") AND (nursing OR healthcare OR "health care" OR education) AND (domain* OR component* OR framework OR concept* OR definition*)

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What are the conceptual definitions, domains, and components of Hodges' model in nursing and healthcare education?

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("Hodges' model" OR "Hodges model" OR "care domains") AND (diagram* OR figure* OR visual* OR schema) AND (teach* OR education OR curriculum OR learning) AND (critique OR adaptation* OR application*) AND (method* OR framework OR discussion)

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How is Hodges' model represented, taught, and adapted in nursing or healthcare education, including diagrams and critiques?

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Performing natural language search
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What applications and critiques of Hodges' care domains framework have been reported in nursing and healthcare practice?

Done

Generated by LeapSpace, Thu Jul 09 2026

Hodges' health career - care domains - model

Hodges’ Health Career – Care Domains – Model is a generic, practice-based conceptual framework for health and social care that organizes thinking into four knowledge/care domains: science, political, sociology, and interpersonal. It is presented as broadly applicable across healthcare contexts and is used to structure reflection, critical thinking, and care planning. [1] [2] [3]

Core domains

Domain	What it covers	How it is used
Science	Cause and effect, evidence, costs, benefits, and trade-offs	Helps frame the “hard” evidence side of care and service decisions. [1]
Political	Policy, systems, and structural influences on care	Helps connect care to wider health and social policy contexts. [1] [4]
Sociology	Social context, culture, stigma, and relationships	Helps explain how social factors shape health and illness experiences. [1] [5]
Interpersonal	Therapeutic relationships, patient/carer engagement, and human interaction	Supports person-centred and relational practice. [1] [2] [6]

What the model is for

• It is described as universal in structure and adaptable to many healthcare settings, including informatics, dementia/palliative care, forensic mental health, and oral health. [2] [3] [4] [7] [8]

• It helps practitioners map concepts into domains, build a mind-map-like structure, and support reflective practice and critical thinking. [3] [9]

• In forensic mental health nursing, it is proposed as a way to guide assessment, decision-making, and recovery-oriented practice. [2]

Bottom line

Hodges’ model is best understood as a four-domain lens for integrating clinical evidence, policy, social context, and relationships into one framework for care and reflection. Its main value is not in prescribing a single care process, but in helping users think more holistically and systematically about health problems and care systems. [1] [2] [3]

Confidence level: High — multiple sources consistently describe the model’s four domains, generic structure, and broad healthcare applications.

References

1. Fox, Siobhán, FitzGerald, Carol, Harrison Dening, Karen, (...), Timmons, Suzanne (2017) Better palliative care for people with a dementia: summary of interdisciplinary workshop highlighting current gaps and recommendations for future research. BMC Palliative Care. https://doi.org/10.1186/s12904-017-0221-0

2. Doyle, M., Jones, P. (2013) Hodges' Health Career Model and its role and potential application in forensic mental health nursing. Journal of Psychiatric and Mental Health Nursing. https://doi.org/10.1111/j.1365-2850.2012.01961.x

3. Jones, P., Wirnitzer, K. (2022) Hodges' model: The Sustainable Development Goals and public health - Universal health coverage demands a universal framework. BMJ Nutrition, Prevention and Health. https://doi.org/10.1136/bmjnph-2021-000254

4. Bettiol, S., Jones, P., Onyedikachi, H.A., Kernohan, W.G. (2026) Bridging Gaps in Oral Health Frameworks: Mapping With Hodges' Health Career - Care Domains - Model. Journal of Public Health Dentistry. https://doi.org/10.1111/jphd.70034

5. Jones, P. (2008) Exploring serres' atlas, Hodges' knowledge domains and the fusion of informatics and cultural horizons. Social Information Technology: Connecting Society and Cultural Issues. https://doi.org/10.4018/978-1-59904-774-4.ch007

6. Merritt, M.K., Procter, N. (2010) Conceptualising the functional role of mental health consultation-liaison nurse in multi-morbidity, using Peplau's nursing theory. Contemporary Nurse. https://doi.org/10.5172/conu.2010.34.2.158

7. Jones, P. (2009) Socio-technical structures, 4Ps and hodges' model. Nursing and Clinical Informatics: Socio-Technical Approaches. https://doi.org/10.4018/978-1-60566-234-3.ch011

8. Jones, P. (2011) Socio-technical structures, 4Ps and hodges' model. Clinical Technologies: Concepts, Methodologies, Tools and Applications. https://doi.org/10.4018/978-1-60960-561-2.ch215

9. Jones, P. (2025) A Generic Model and Conceptual Framework to Prime Curiosity Across Health and Social Care Disciplines to Facilitate Lifelong Learning. Journal of Evaluation in Clinical Practice. https://doi.org/10.1111/jep.70252

Follow-up Suggestions 

What are the key components of Hodges' health career care domains model?

How does Hodges' model apply to interdisciplinary health care practices?

What are the implications of Hodges' health career care domains model for patient-centered care?

Book for review: v "Philosophy of Care - New Approaches to Vulnerability, Otherness and Therapy"

I think this is the final post for Philosophy of Care (think! There is so much more ...). There are other chapters more salient to me personally, but for Hodges' model and the collective human enterprise, I think chapter 5 by Virginia Held is the most important. There's not just a chapter, but three in Part II 'Care and Economy'. I appreciate the reminder of Kate Raworth's Doughnut Economics which challenges;"the dominant assumption of the economy as a machine". I notice on Twi/X Kate Rowarth reflects on the UK's election:

The book 'Doughnut Economics' opens with the story of Yuan Yang who, as a young economics student back in 2008, was challenging the outdated theory she was being taught. Last night she was elected as the first-ever MP for Earley & Woodley. Huge congratulations @YuanfenYang!

    https://x.com/KateRaworth/status/1809216007518507248

I gave Keir Starmer a copy of Doughnut Economics just 10 days before he became Labour Party Leader. So will the book make it onto his bookshelves in Number 10? More importantly: will policies for a regenerative & distributive UK become real under this government?...

     https://x.com/KateRaworth/status/1809235013403136029

While in Philosophy of Care, another three words stood out:

"'Big-picture thinkers'^, Raworth notes, have offered alternative visions, but they have been dismissed by the field of economics." p.102.

continued ...