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

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

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

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

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

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

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

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

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

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

 Reference to (Cronje and Fullan, 2003):

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

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

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

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

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

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

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

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

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

Many thanks to CUP for the copy.

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

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

Integrated Health and Social Care Data: GIS torch

Last month the HSJ announced plans to integrated health and social care data (July 5th, pp. 6-7). The purpose is specific to support care commissioning, but ...

The related topic of integrated care is a round-robin element of policy debate. It may go quiet for a time, but it is there, needing to be fed in successive governmental and policy turns.

You might reasonably expect that integrated health and social care data, would be a by-product of integrated care. So the fact that data integration remains a 'to-do' demonstrates the patchwork nature of care integration and the many levels by which it can be defined: commissioning, practice (within domain) across care domains, budget, teams - disciplines, service organisations, care and education, public involvement and data.

I hope the integration of health and social care data at the commissioning level might also put data into the hands of clinicians and social care teams - integrated of course!

The local insights that could flow would represent a real, tangible benefit. The news item stresses the potential value for commissioners. There are as ever several caveats:

• To what extent can health and social care staff influence the shape of the dataset?
• Is it crystallized (centralised) already?
• Can the new role for councils in public health finally ignite the GIS torch to illuminate what is really happening in the local community?

It happens that:

data 'integration' 

also = data 'orientating'

So - come on policy people, commissioners and managers, don't leave the workforce out of the loop. Staff on the ground are disoriented enough by the relentless pace of change. They need a sat-nav for care. Give them the torch they need.

What is that you say? They don't have the time to critique their (integrated) practice, to formulate their questions. And anyway - they don't have the access or the skills to use the informatics resources, let alone the nous to interpret the data! Well, if that is the case then shame on you.

Hodges' domains and the 'audience'

In Tuesday's post on the NHS health library services four key purposes cited in the report were listed:

1. Clinical decision making by patients, their carers as appropriate, and health professional
2. Commissioning decision and health policy making
3. Research
4. Lifelong learning by health professionals.

It is encouraging to see that my assumptions about the scope of Hodges' model can be identified elsewhere. This is clearly the case with the four key purposes above and the four introductory pages  to Hodges' model - listed as follows:

library purpose -|- h2cm audience -|- h2cm knowledge (care) DOMAIN

patients, carers (person-centred) -|- Individuals -|- INTRAPERSONAL
commissioning ... policy making -|- Policy makers, Managers -|- POLITICAL
research -|- Students, Researchers, Lifelong learners -|- SCIENCES
health profs as lifelong learners -|- Society, Public, Learning culture# -|- SOCIOLOGY

# The SOCIO- in socio-technical

Papers in process, book reviews and volcanoes

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

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

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

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

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

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

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

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

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

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

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

HSJ Editorial 22 March 2007: Finance

Before my son's bike race at Darley Moor on Saturday*, I picked up the latest Health Service Journal and flask of coffee. Reading the editorial I was struck by the sequence of the two items and my experience or lack of it.

The first item 'Consistency and agreement are needed to spread success' concerned the Commons Public Accounts Committee report on financial management and its conclusions. These included the need to share lessons learned from successful financial turnaround programmes plus (paraphrased):

The performance of the finance function is too patchy, inadequate in more than a quarter of organisations. There are recurring problems with recruitment, training and development with the central issue being the role of clinicians in financial management.

The much desired engagement here is between senior clinicians and management. The recent BBC 2 series Can Gerry Robinson Fix The NHS? demonstrated the all-to frequent gulf between managers and senior clinicians.

Returning to the HSJ editorial: payment by results - the much vaunted tipping point for clinical engagement in finance has (thus far) not tipped. For mental health there's still time, but then déjà vu kicked in. Quite a few years ago I remember getting ready to catch micro-commissioning and run with it, but the pass never came. It is happening in some places, with big brother macro-commissioning. I was pleased and yet disappointed. Pleased because at the time I was Team Leader for a Community Mental Health Team for Older People and I - quite typically then and now for such posts - also had a caseload. The disappointment followed from recognition that not only had a learning opportunity been lost, but a management learning opportunity to boot.

Amid the taste of coffee irony filtered through: that missing tipping point, the need for wider cultural changes (service line accounting) and clinically in mental health (and elsewhere) the focus on risk. People 'at risk' must not fall through the net. Well I don't know the details of service line accounting and the like, but I do know that while planting trees provides instant results, it is labour intensive and risky compared with sowing seeds. After all - never rely on one prong when several can help get your point across...

Mr Robinson's series revealed that other clinicians can act as change agents. Shifting the risk context to finance, how many clinicians fall through the management net? OK, hands up, if like me seeing a bottom-line makes you blush? My 1st line management course was some twenty five years ago. Six, or seven years later saw me on a not-quite-a-middle-management-course. Then I listened out for him, but LEO (Leading Empowered Organisations) never knocked on my door. Yes, I could have chased this. ... If clinicians are soft-wired to take detours around financial centers, somebody had better make sure those seeds are carrots.

The second item concerned joint working - asset-sharing between the NHS and local government and the journal's features on patient-public involvement, population health-NHS-Local Authority, joint strategic needs assessments. It just struck me that there's so much we don't understand about the functioning of these distinct organisations. Will integration help, or is it creating another layer of complexity? I'm all for encouraging and nourishing new ideas, but how does your garden grow with too much nitrogen?

Up to a few years ago I had something in common with Alan from TRON:

"I don't even balance my checkbook on downtime."

Finances looked after themselves. Not any more: cue pension wake up call and we are all tax-payers...

Seriously though, where do we want our intelligence to be in 10-20 years time?

Imagine financial reports that also relate to local public (mental) health outcomes. Maybe these exist in some places? Now that's a code disc that really would summon in a new order. Make financial information relevant to the clinical practitioners who make up the [ holistic ;-) ] multidisciplinary team then the trees will start walking.

*Punctured!

Nick Edwards (2007) Comment, HSJ, 22 March, p.3

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

Hello,

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

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

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

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

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

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

Thank you and best wishes,

Razina

Razina Hussain

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

e. razina.hussain AT nihr.ac.uk

Central Commissioning Facility

Grange House

15 Church Street

Twickenham

TW1 3NL

My source: HIFA

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

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

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

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

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

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

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

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

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

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


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

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

Nursing: magnetic Force 5

Back in 2009 I came across a post - Nurse magnets crucial for recruitment and retention about the 14 Forces of Magnetism:

In 1983, the American Academy of Nursing conducted a survey of 163 hospitals to learn why some hospitals attracted and retained well-qualified nurses who were devoted to quality patient care.

The 14 Forces are listed and described by the ANCC. The forces themselves include:

• Force 1 Quality of Nursing Leadership
• Force 2 Organizational Structure
• Force 3 Management Style
• Force 4 Personnel Policies and Programs
• Force 5 Professional Models of Care
• Force 6 Quality of Care
• Force 7 Quality Improvement
• Force 8 Consultation and Resources
• Force 9 Autonomy
• Force 10 Community and the Hospital
• Force 11 Nurses as Teachers
• Force 12 Image of Nursing
• Force 13 Interdisciplinary Relationships
• Force 14 Professional Development

The professional, organizational, and political (policy) emphasis of the 14 forces is obvious and becomes clear when each is weighed in terms of where it sits within the domains of h2cm.

Try it as an exercise. ...

Recruitment is ALL about magnetism.

If you are unsure, ask a magnet about the meaning of retention.

Demographics are already applying pressure upon these forces of magnetism. Not just when referred to explicitly in the USA within organizational media; but globally. Demographics is another magnet - it approaches with increasing force.

From here in the UK (and readers elsewhere) we have to exercise care when models are mentioned. While the theorists and philosopher's of nursing nail their definitions to the mast (h2cm?) there remains a models muddle, not just in the variety of models of care, but in the levels at which they operate. This is not a criticism, it's an observation - consider Force 5:

Force 5: Professional Models of Care
There are models of care that give nurses the responsibility and authority for the provision of direct patient care. Nurses are accountable for their own practice as well as the coordination of care. The models of care (i.e., primary nursing, case management, family-centered, district, and holistic) provide for the continuity of care across the continuum. The models take into consideration patients’ unique needs and provide skilled nurses and adequate resources to accomplish desired outcomes.

In the US in particular 'models of care' (moc) often refer to finance and accountability of costs (the market process), in the UK moc might refer to commissioning. In Force 5 the addition of 'Professional' (as the original author's no doubt recognized) is crucial. If you repeat the above exercise, plotting Force 5 on the Health Care Domains Model then you see how Force 5 works for nursing and remains to this day a great achievement as a yardstick for quality, assurance and retentive power.

In the almost 30 years since the research on the 14 Forces, I do wonder though if there is a need to imbue the following with magnetic properties:

• person-centred care;
• self-care;
• carers and public engagement;
• prevention;
• public (mental) health
• and informatics?

Yes, many of the above can be assumed to lie within the existing Forces 1-14. Health and social care are not static. Nursing has much to contend with from the level of the individual practitioner through to the group within an organization. The 14 Forces of Magnetism are well established in the USA and deservedly so, they clearly deliver.

In the political and economical heat of an economic recession, however; magnets may reach their particular^* Curie point. Then they cease to work.

The constant bangs and knocks of change, the incessant hammering of party politics and the 'market' on the door of "high quality nursing care" can also take its toll on magnetism.

Nursing needs to take care.

Related post on Healthcare IT News:

Top 10 trends for 2011 include IT, new care models

*OK it should be constant, but like our patients these magnets are not all the same - they have varying levels of vulnerability.

To follow some definitions from an olde book.

‘Prevention Demonstrator’ - GM Live Well

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

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

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

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

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

Continued ...

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

⍚

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

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

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

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

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

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

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

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

individual

nhm	ohm + nhm
nhm	nhm (+ ohm!)

group - population

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


nhm: The nhm (symbol: +).

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

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

The humanistic and mechanistic in patient transport & safety

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group - population

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

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

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

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

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

See also:

Carli Brosseau and Alex Lang

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

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

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

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

h2cmng AT yahoo.co.uk

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

My source:

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

— Alex Thomson (@AlexBThomson) July 25, 2020

Workshop - Delivering High Quality Health Care for All: Bringing the social and technical together...

My SOURCE: SOCIOTECH at JISCMAIL.AC.UK

Dear Colleague,

Please find details attached of a Think Tank focused on developing socio-technical approaches to the provision of healthcare (in the context of the National Programme for IT in the NHS).
Please note that attendance is restricted to around 30 people and that anyone wishing to contribute will need to apply (as specified in the attachment) - which follows below PJ.

Thanks and best wishes

Chris
P.S. please feel free to circulate these details to colleagues who you think may be interested. Thank you.

Professor Chris W Clegg
Centre for Socio-Technical Systems Design
Leeds University Business School
University of Leeds
Leeds
LS2 9JT
c.w.clegg at leeds.ac.uk

Delivering High Quality Health Care for All:
Bringing the social and technical together for a joined-up approach to deliver supporting systems and technologies
10th/11th December 2009

Call for contributions to an event organised by the UK Faculty of Health Informatics and the BCS Socio-Technical Group

Core idea
This 2-day Think-Tank event has been set up to discuss and report on how Health and Social Care employers and other key stakeholders in the Informatics field might bring about a joined-up approach to the implementation of electronic health records, one that brings together changes both in technology and in the social practices around it.

Rationale
The National Audit Office’s report on “Delivering successful IT-enabled business change” see: www.nao.org.uk/publications/nao_reports/06-07/060733es.pdf and the University College London Evaluation report on the Early Adopters of the Summary Care Records project (see: https://discovery.ucl.ac.uk/id/eprint/6602/1/6602.pdf) both highlight the challenges of implementing technology-based projects within a fixed time line and how this can reduce the opportunities to get a more “user-centred” approach to change.

In many sectors of the UK economy the drive to get the technology ‘on desk, on time, and on budget’ can mitigate against developing a full understanding and consideration of how the changes may be of real practical value to users and customers.

It is increasingly recognised that ‘technology-push’ will not be enough in its own right to achieve the full benefits and efficiencies that are being sought in service delivery. Rather, we need to bring about innovations both in the technical systems, and in the working practices, work roles and processes that surround them. Put bluntly we need a more joined-up approach to change. This has been variously called ‘user-centred’ or ‘socio-technical’ or ‘holistic’.

Objectives
The objectives of this event are to discuss and subsequently report on –
• What does such a joined-up approach mean in practice?
• What examples exist from across the UK Health and Social care sector where such approaches have been used?
• Who has to do what, to make it happen consistently across the NHS and Social Care services?
• How will we know if it is succeeding?

Organisers
The event has been organised by the UK Faculty of Health Informatics and the BCS Socio-Technical Group.

The event will be chaired jointly by Professor Chris Clegg, Chair of the British Computer Society’s Socio-Technical Group the and Doctor Beverley Ellis, Joint Vice-Chair of the UK Faculty of Health Informatics.

Getting involved as a contributor or delegate at the event
If you wish to attend the Think Tank, please submit an Expression of Interest (EOI) to Bruce Elliott, Co-ordinator of the UK Faculty of Health Informatics at bruceelliott@nhs.net by 28th September 2009.

Your EOI should include brief summary (of up to 200 words) of your role, experience and expertise in this context.

Please note we are seeking people from a range of stakeholder groups including:

• Acute Hospitals
• Suppliers
• Health and Care Commissioning organisations
• Primary and Community Care Providers
• End users of nationally-led systems, e.g., CMS, SCR, ECR
• Connecting for Health, Informing Healthcare and the Scottish Government’s E-Health Programme
• Academics
• Patient Leads

In the event that we are over-subscribed, we will select people so as to provide an appropriate balance of experience and expertise, to ensure the Think Tank can meet its objectives.

Please make it clear in your EOI if you would also like to present a short paper at the event. In such a case please also add a brief abstract of your proposed paper (of up to 200 words).

If you have been allocated a place you will receive written confirmation along with a copy of the final programme by 16th October 2009.

Associated papers
In November 2009, a Position paper capturing some of the Key Challenges in adopting Socio-Technical approaches will be shared with the participants to identify some of the key issues that will be addressed at the event.

Following the event, up to 5 contributors to the event will be commissioned to write papers on the topics and issues emerging, with the aim of informing key stakeholders in how Socio-Technical approaches can be utilised effectively across the NHS and Social Care. These papers will be completed by the end of January 2010, for inclusion in an overall Briefing report. We will also be actively exploring avenues for wider publication in order that the good ideas can be spread and acted on.

Location
Weetwood Hotel and Conference Centre, Leeds

Hodges model: indicative concepts in Substance Misuse Care

Hodges' model
in substance misuse services

psychological dependence vulnerable individuals, education, risk, assessment, review, motivation to change, harm reduction,  motivational interviewing, appreciative inquiry, life skills, education, advice, feedback withdrawal, aggression, hallucinations, change, drug use history, measures, care pathways, contract, rapport, empathy	substance profiles, abuse, signs physical dependence, health status, pregnancy, research methods, evidence, diagnosis, co-diagnosis, staff awareness, statistics, drug-treatments, triage, screening, scientific advice, dissemination models: stepped care, training, forensic science - mental health, classification, interventions, physical access, stepped care models
dependents, family, social network social attitudes, vulnerable communities, community projects, self-help, e.g. A.A., socio-economic depreviation, systemic - family, group therapies Advertising, housing, casual drug use, work, employment, benefit incentives, re-integration, inclusion, community, neighbourhood policing, drug culture, media	supply, cost of drugs - alcohol health & social care policy, service interfaces, statistics Drugs strategy, funding, X-agency working, funding, GP contract, commissioning, "client contract-plans", National Treatment Agency, NICE, Home Office, legislation, crime, offending, re-hab. / specialist teams / treatment facilities, Government data, community prescribing, employers

Alcohol: Messages in bottles, domains and anagrams

The perennial health news item that is alcohol has bubbled and overflowed this week. In 1987-88 I visited several nearby alcohol services in Blackburn, Preston and Salford with a questionnaire to compare and contrast with Chorley which at the time had no dedicated alcohol services. There was Alcoholics Anonymous AA and Al-Anon, but nothing specific through health beyond community psychiatric nurses. The project was for the CPN(Cert.).

Back then I remember a Consultant Psychiatrist saying that the level of alcohol consumption is directly related to cost. The literature I read also drew attention to historical comparisons. I think it was Alcohol Concern who supported this view and called for urgent action. Of course all that was some 24 years ago. Incredible that there is some movement in 2012. In 2007 the taxi driver from Elounda to Heraklion airport described the movement and horizontal stasis that adorns the pavements (and spills onto the roads) of Malia as we zipped by. The Brits do have a problem. A Consultant physician highlighted this from a hospital ward on BBC Radio 4 news today.

Don't get me wrong: I like an occasional drink but my enjoyment of alcohol has been tempered over the years by several experiences:

• An early party aged 15 (and at a church social club) preloading was already in vogue. No sooner were a group of us sat at a table than someone threw up on the table. It was alcohol.
• Biology and human biology lessons helped instil the impacts of alcohol.
• Having to say 'goodbye' to clients with a drink problem, duly referred by their GP. I cannot support them in their drinking after several attempts to effect change.
• Appreciating the link between drink and risk behaviours.
• Working with people whose 'ill-health career' has seen them having to live with, but not themselves recognise Korsakoff's syndrome.
• Seeing people over three decades who cannot be supported in the community with their family, relatively young for residential care, but given a lack of specialised facilities - there they frequently are.

Hopefully the policy turn will have a positive impact extending beyond news headlines:

Minimum alcohol price planned for England and Wales
http://www.bbc.co.uk/news/uk-17482035

Alcohol pricing: politics under the influence 
http://www.guardian.co.uk/commentisfree/2012/mar/23/alcohol-pricing-politics-under-influence?newsfeed=true

With the prospect of an alcohol and a new NHS information strategy in England you hope that some dots can be joined. Here are a few:

INTERPERSONAL : SCIENCES

SOCIOLOGY : POLITICAL

Motivation    Psychological effects Attitudes to risk         Predisposition Personality     Education    Vulnerability	Data     Evidence      Public health Physical effects    Dual diagnosis Research       Violence - statistics
Social contradictons and attitudes - 'image' Upbringing       Cultural attitudes  Marketing          Media	Cost per unit      Services        Funding   Cost to health budget      Reporting Policy   Lobbying   Taxes   Commissioning

Beer label c/o http://www.beerlabelizer.com/

'Real Stout' = 'Sale Tutor'

"healthcare finance" - September 2022

 INDIVIDUAL

|

 INTERPERSONAL    :     SCIENCES               

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

SOCIOLOGY  :   POLITICAL 

|

GROUP

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

Whole Theory - The Bigger Picture - Holistic Approach?

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

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

Source: @HFMA_UK

Conventions used in this 'Care Facility'

... with apologies to the many book prefaces.

The following caregraphical (typographical) conventions are used in this care facility:

italic

Indicates new terms to the resident, patient, and family - often also described as jargon. These may include abbreviations, medical, nursing terms and words in fashion determined by academia and management. Some jargon may be twice removed from the resident, patient, and family since the medical and nursing staff cannot themselves fully apprehend the terms. These twice removed terms are frequently economic (such as 'commissioning' and 'funding').

Constant width

Used for care planning that is termed as being 'person-centered' and holistic. In print (the policy folder reality here) being constant and a standard width refers to care plans that are unadorned: a template format or proforma.

Constant width bold

Used for emphasis in care programming and declarative care <-> patient interfaces (interactions) such as "Sit down George!" Or whoever is trying to get up and walk about.

Constant width italics

Used by appropriately trained, person-centred and integrated teams and the idealistic (including exponents of 'holistic bandwidth') to show plans and care interactions that are client defined whenever possible and truly reflect high quality person-centered care.

Call for Papers: The Digital Movement in Nursing

Call for Papers: FOCUS The Digital Movement in Nursing

Focus Edition Guest Editor

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

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

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

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

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

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

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

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

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

More details ...

High Intensity Networks - serenity integrated mentoring SIM model of care

individual
| 

 INTERPERSONAL : SCIENCES 

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

SOCIOLOGY : POLITICAL

| 

 group

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

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

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

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

^#Website not provided: "Service Temporarily Unavailable" 

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

My source: Twitter - various

 

Zero, One, Fifteen, (Thirty, Sixty...?)

SOCIETY

care-S S-cares

context: UK news media 15 minute carer visits to elderly clients

INTERPERSONAL : SCIENCES

SOCIOLOGY : POLITICAL

individual

Reflecting on Social Care with Hodges' model

The one, self, me, a person. Carers: ethics (and common sense? when is 15 minutes of 'fame' enough?), demonstration of rapport, empathy, dignity, loneliness, independence. Carer stress. Job satisfaction. Staff knowledge and skills. Observation. Mental state. Mood. Choices - personal preferences. Personal - carer's values. Cognition - Re-cognition. Case review. Individualized care? Expressed concerns (wither...?)

theory: task vs. person-centered care mechanistic aspects of care, travel, geography, arrival, tasks, plan, recording, constraints - esp. time, practical problems encountered. Number of carers involved. Safety. Protective clothing. Seasonal factors. Evidence base? Best practice? Relapse rates? Telecare role? Physical mobility - movement. Systems, processes, logistics and scheduling. Degrees of freedom - flexibility. Data, information, datasets. Admissions - depth of data?

practice: task vs. person-centered care Caring relationship building, trust - very personal - intimate care, subjective: time with someone I like / don't like? Relatives experience. Social care infrastructure - community centers. Ability to go out shopping with a carer. Media: BBC 2 Newsnight 7/10/13; The Times; C4 News. Social contact. Social mores (time?)

Policy, professionalism, recording, outcome measures. Agreement - care plan. Care reviews. Ban on 15 minute visits? Management. Standards. Supervision. Zero hour contracts. Pay and conditions. Staff turnover. Vulnerable adults. Personal development, training. Risk of organization's reputations being damaged. Corporate responsibility, values. 'Value for money'. New commissioning systems. Advocacy (position significant). Whistleblowing. 'Francis effect' increase in nursing posts. HSJ, 25 Oct 2013, p.6. 'Funded establishment'.

group - population

Discount the contract, you can then 'discount' the individual worker and the client.

Care Relationship = Care Transaction

Wikipedia: "15 minutes of fame"

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