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

Open access: everyone has the right to knowledge

SOURCE: The Conversation

By Alessandro Demaio, University of Copenhagen; Bertil Dorch, University of Copenhagen, and Fred Hersch, University of Sydney

This week, we celebrate open access week – an event aimed at bringing attention to this rapidly emerging form of scientific publication and its ethical imperatives.

Traditionally, knowledge breakthroughs and scientific discoveries are shared through publication in academic journals. Peer-reviewed and highly competitive, careers are made and broken on the number and impact of these publications.

With the complex, long-standing hierarchy of journal ranking, scientific publishing is big business. From a distance, one might assume that scientific publications aim to maximise the dissemination of ideas, break down barriers to science and make knowledge accessible to the masses – but this is not actually the case.

The publication process

When a scientist, whether in the field, the laboratory or the hospital, makes a discovery, she puts her ideas into an academic paper and submits it to a journal. The journal’s editors decide whether it’s relevant to the scope of the publication, and if it is, they (usually) send it on to a small group of the researcher’s peers.

These are other specialists in the field who will read and give feedback on the paper. If they think the work is worthwhile, and they have no changes to suggest (which is seldom), then the paper will be published in a future issue of that journal.

At this point, no one has paid for anything. The authors don’t pay to submit the article, the journal doesn’t pay for the scientists’ work and the peer reviewers are voluntary. Even the editors are often unpaid, unless they can integrate this service into their professional work.

Journals seek remuneration through subscriptions or once-off access fees by the user – often in the order of US$30 per paper. Those of us lucky enough to have an affiliation to a university, or live in Denmark where the government spends many millions on subscriptions for the entire population can access scientific knowledge free of charge.

Open access

Open access publication differs in one very important way from “traditional” academic publishing. Instead of the individual paying to access an article, or buying a subscription, researchers pay for the publication of their work, often out of their research funds.

In the order of US$1,000-$2,500 per publication, this article processing fee is payable when and if the paper is accepted – and it’s routinely waived for researchers from low and middle-income nations.
This means that while the editorial and peer review process are the same as above, access to the published work is free forever and available openly (hence, open access) online.

The traditional publishing paradigm can be regressive and exclusive. Think for a moment how it works: I am a researcher, I do research in developing countries. What if I was to go there; take the time, resources, ideas or even blood samples from thousands of local people; take the information back to my university; access all the scientific knowledge I need in order to develop the work; and then publish my findings in journals for which there’s an access fee of one week’s wages for the people involved in my study.

Sure I might be able to send them a copy, but for the vast majority of people in that community, science remains out of reach. Now, these study participants may also have no internet access for open access sourcing, but many now do and at least the barrier to knowledge is not put up by the scientific community itself.

Similarly, in high-income nations, it’s still the wealthy, the highly educated or those at higher-education institutions who have greatest access to the vast majority of published science. How is this just?

And what happens when we add an additional layer of ethical consideration: that these researchers and their work is often is paid for by society, by taxpayers, through public funding. How can we then justify publishing it in academic media inaccessible to the vast majority who paid for it?

We can’t just blame researchers or the research community for this – and we’re not saying that because we’re researchers. Academic performance and assessment, in the large part, is determined by the amount and impact of one’s publications. The older “traditional” journals have greater histories and so researchers are almost coerced into publishing with these journals.

Some good news

The good news is that things are changing. In the first decade of the 21st century, we have seen an explosion in open access publications. During this time, we’ve observed a ten-fold increase in publications (almost 200,000 at 2011) and more than a six-fold increase in the number of open access journals, to almost 5,000.

Things are clearly moving in the right direction, but this impressive number still accounts for only around 20% of all publishing.

Simultaneously, global leaders have acknowledged the ethical dilemmas of our current system and backed open access. The European Union, for example, is currently piloting a project to encourage all EU-funded research to place their results in an open-access repository or publish them in open access journals.

And some nations, including the United Kingdom, Denmark and Australia, are either planning or implementing policies making publication of publicly-funded research in open access journals mandatory.

The call for change is being echoed by the academic community, which is asking for greater open access and the removal of economic barriers to science.

Research should be about furthering knowledge for all. And there’s no reason why open access publication shouldn’t be routine.

There are also strong economic arguments for investing in a knowledge economy. We are confident that with enough support, we will see more nations, companies and organisations mandating open access publication – a move that’s likely to bring social and economic benefits.

And who knows, maybe we’ll also begin to see the “traditional” academic journals change their business model and one day make knowledge open to all.

Dr Alessandro Demaio is PhD Fellow in Global Health with the Copenhagen School of Global Health at the University of Copenhagen. In addition, he is a Director of the Global Steering Committee for the Young Professional Chronic Disease Network and NCD Action. For The Conversation, Alessandro expresses his own views only.
Bertil F. Dorch is currently senior executive adviser to the university librarian at Copenhagen University Library Services (part of The Royal Library, Denmark), and have previously been Head of Center for Research Support Services as well as a research scientist at University of Copenhagen (The Niels Bohr Institute), within the field of astrophysics.
Fred Hersch does not work for, consult to, own shares in or receive funding from any company or organisation that would benefit from this article, and has no relevant affiliations.


This article was originally published at The Conversation. Read the original article.

P( l ) AY: Spot the difference?

individual
|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL
|

group

Nurses get 1% pay rise MPs should get 10% pay rise, says regulator	NHS Pay Review Body (NHSPRB) Independent Parliamentary Standards Authority (IPSA)

BBC Radio 4: World At One 5 June 2015 clip Mark Field: "Many of my constituents wonder how it is that any MP could live on £70,000 a year"

Yahoo Finance: Sky News - UK Wage Growth Jumps To 2.7%

Definitions of: 'independent', 'upwards', 'downward', 'vocation'.

Source: link - The Guardian, and various media.

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

Simon Bottery's Long Read -

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

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

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

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

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group - population

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

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

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

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

#NHSMillion: From one quadrant to another three

The image below is from twitter and the #NHSMillion campaign which I've RT a couple of times on @h2cm. The graphic is repurposed here representing the NHS as an organisation with its Socialist founding. On twitter the arrow would point to the twitter account holder's name. In Hodges' model we can readily travel from the individual to the million and more; from personalised healthcare to population health:

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group-population

Within Hodges' model the arrow points to the INDIVIDUAL axis. The stress is placed on a person* and their experience of the NHS whether for themselves or a family member. Care should always encompass physical and mental health care, with emergency care prioritised firstly of course.

As an NHS employee I have been cocooned from many of the financial vagaries of the world. This does not mean I work for nothing, don't pay tax, have holes in my pockets ... On the contrary I'm frustrated and increasingly annoyed about austerity and the pay situation over the past 5 years and more. Interest rates, Brexit, the Euro, the $ ... all count here too. Healthcare does need to be paid for - one way or another. The cocoon refers to the effect of the founding core principles of the NHS:

• that it meet the needs of everyone
• that it be free at the point of delivery
• that it be based on clinical need, not ability to pay

As well as the four domains Hodges' model carries within its structure a series of interdisciplinary bridges as previous posts reveal; psycho-social, psycho-somatic - you get the picture.

A further tweet from @NHSMillion brings home the SOCIO-ECONOMIC and SOCIO-POLITICAL dimension of health and social care. The cocoon is ruptured, the vulnerability of the NHS's core principles and values is laid bare:

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group-population

We need to assure and ensure that the many can continue to make a difference to the one. Even as that gratitude is increasingly reframed as people learning how to stay well for longer and better look after themselves.

*The arrow is also pointing to the center of the model. Truly person-centered care should be able to demonstrate that full round of the four domains have been factored into any assessment, plan, intervention and evaluation with the spiritual also duly considered.

Ethnicity - Pay Gap: in Hodges' model

individual - self

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group- population

ETHNICITY -	PAY GAPS

WHO Health for All Film Festival 2020

Dear All,

The World Health Organization is launching its first ever film festival on 16, 21 and 22 May 2020. The WHO Health for All Film Festival invites independent film-makers, production companies, NGOs, communities, students, and film schools from around the world to submit their original short films on health. The submissions can be on any health issue and/or social and environmental determinants of health for the first two categories (non-fiction and animation). The third category focuses on nurses or midwives to pay tribute to the International Year of the Nurse and Midwife in 2020. Only films completed between 1 January 2017 and 30 January 2020 are eligible for the festival. Closing date for entries is 30 January 2020.

Many thanks to spread the word with the following online multilingual tools, the webpages contain the application rules and access to submission tool:

Youtube link to embed everywhere!

English: https://youtu.be/GporpcgO310

Spanish: https://youtu.be/nFW_n5UWwOM

More linguistic versions of this trailer to come in our Youtube channel.

Multilingual webpages (are available)

Social media kit: https://who.canto.global/b/MUT1S

I share with you, as well this media advisor note to all journalists

Dear Journalists,

The World Health Organization is launching its first ever film festival on 16, 21 and 22 May 2020. The WHO Health for All Film Festival invites independent film-makers, production companies, NGOs, communities, students, and film schools from around the world to submit their original short films on health. The Film Festival aims to recruit a new generation of film and video innovators to champion and promote global health issues. Films are a powerful way to raise awareness, improve understanding and encourage action.

The submissions can be on any health issue and/or social and environmental determinants of health for the first two categories (non-fiction and animation). The third category focuses on nurses or midwives to pay tribute to the International Year of the Nurse and Midwife in 2020. Only films completed between 1 January 2017 and 30 January 2020 are eligible for the festival. Closing date for entries is 30 January 2020.

More information: https://www.who.int/film-festival

Access the application tool

Contacts:

REBOUX, Gilles - rebouxg AT who.int

GUERRA, Jaimie Marie - guerraja AT who.int

All my best regards.

Isabelle Wachsmuth

Universal Health Coverage and Health Systems

World Health Organization

Geneva, Switzerland

Office: +41 (0)22 791 3175

Web: www.who.int

RCN Congress 2019 ii "We are all Global Nurses"

The debate about public sector vs. private sector healthcare touches all healthcare professionals. There is no escape. Despite this, from my 40+ years in the NHS - the NHS can act as a cocoon. It's as if the walls are adorned with "Keep Calm and Carry On". For some of us there is a 'keep your head down' mentality. While as a nursing assistant and student nurse, the words "Make sure you join COHSE, NUPE or the RCN" rang out; it was the day job, learning and family that had my attention. I wish I'd got to Congress decades ago.



You can't do everything and this lack of involvement is a blessing in a way. For example, without ever taking anything for granted, I never imagined I would need the help of my union/professional body. When I did and 'we won' thanks to a brilliant RCN Rep. Being represented has this quality to it. Unless, you are an activist, it is a newsletter, journal, annual pay discussion, but this opened my eyes. As a consequence, I encourage students, even more so and others to ensure they are represented and get involved.

To Congress itself: I was surprised and disappointed to hear several years ago about the RCN's cessation of links to the International Council of Nurses [ICN]. Further surprise followed when a Congress debate revealed it was five-six years ago in fact:

Members vote to allow RCN to leave international nursing body

£600,000 is 'politics' in the raw for membership and the RCN Council. The cost of ICN membership  was debated at Congress. There are various arguments. This seemed a break on many levels; social, political, psychological and scientifically.

(Bizarrely, perhaps this state of affairs says something in support of reflection. When the latter is accused of fostering navel-gazing, finance and value for money ... speak volumes, but the RCN's global isolation is navel-gazing realised aggravated by the ongoing psychological experience of Brexit.)

In championing Hodges' model as a global resource for healthcare and education, my parochial perspective from Wigan Pier has felt acute. Online I've long nurtured links with global nursing and healthcare groups: HIFA, HIPNET, GANM, Nursing Now and others. In workshops with nursing students and other disciplines, the ICN and global nursing context is always stressed (the ICD too). [After all, as students and lifelong learners these people do have the World at their feet.]

The relevance of Hodges' model increases daily and - my bias aside - the model's significance is crystalised in this issue for the RCN and its members. As noted in the debate John Gilmore raises the matter of refugees. For those in crisis through natural disaster, conflict and crime amid chaos there is geopsychiatry and the mental health implications for children and future generations of this 'lived experience'. As we await further news on this, below I have mapped key elements of the debate in Hodges' model:

There is a digital archive for members to watch the debate.

individual - self
"My backyard"

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group- population
"The WORLD of Nursing"

Philosophical: Values, Philosophies of Care Mental Health Mental Health of Nurses Parity of Esteem - geoPSYCHIATRY Ethel G. Fenwick and others [ Health Education & Promotion, Sustainability ]	The 'GEO-' in Nursing Nursing logistics Research; Collaboration, Multi-center, Evidence, The 'UNIVERSAL' in UHC Definitions of Nursing Roles Skills & Knowledge Coding & Classification initiatives Global: 20,000,000 nurses ICN predates RCN 'transparency'
The Nursing Community "Voice" 1899 ICN formed SOCIO-[Economic] status of nurses The global: Community of Practice Collegiality Cooperation Collaboration Fellowship "We are all global nurses."	'political' POLICY: Workforce, Migration, Recruitment crisis Safe Staffing (National, Global) Medical Emergencies, Climate change Working groups: Standards, Issues Funding, ICN, RCN and other bodies Support for Developing Nations LMIC The Scope of Nursing Stewardship ICN - Membership model PAY restraint, austerity As of 2013: £614,470 / £1.42 per member Business case

How do you measure the impact of an organisation?

2020 - International Year of the Nurse

20:20 vision IS global

https://en.wikipedia.org/wiki/Keep_Calm_and_Carry_On

Public vs. Private health care: sustainable integrated health and social care

OK the title here is a cheat as the focus is social care not health. That said given the overlap -  dependencies - and appeals for health and social care 'integration' this basically makes the terms synonymous - at least in this context.

The debate about the merits between public and private care provision in the residential and nursing home sector is a constant dialogue. At the moment it is once again a cacophony. It will die down. It will be back. I've never worked for the private sector and of course as with the events of the past week in Bristol both public and private sector have their horror stories to tell.

The debate is supposed to be about quality, but the noise of the dialogue and terrible events disrupts and distracts us from the real issues of training, motivation, personal ethics, values, human resources, pay, care environments and yes - quality of care.

We live in evidence based times and yet the weight of evidence seems to lie in the interpersonal and science care domains, not necessarily in that order.

There is evidence in the social care domain and the political care domain:

the news catches it. 

There is a test though - call it ultimate viability. This is what must support those real issues.

This test is the same one that allows us to say how disgusted we remain with the financial institutions that adorn our lives. Whether in the form of a necklace ("on credit"), or a ball and chain ("already in debt") there is a tab to pick up.

If the private sector is failing in some quarter, or in jeopardy where is the pressure felt? The government, local authorities ... will be on stand by. As with the banks, health and social care are also grounded in the social and political care domains (you could call that the public bottom line).

Reliance on private equity might prove the basis of corporate undoing in the residential and nursing care sector. There must be evidence of economic - financial care management standards that can provide assurance? When we talk about sustainable health care, we must assure that the social care service is itself sustainable. Surely care of older adults, care of the vulnerable is mission critical? Then those other vital care issues can be addressed (and urgently!):

funding, status	investment, training, recruitment and retention, human resources, pay, finance, economics,  human rights

People talk about there being a bigger picture.

There is always a bigger picture.

Environment, Social, Governance [ESG]

As Greeta Thunberg arrives in New York for the:

CLIMATE ACTION SUMMIT, 23 SEPTEMBER 2019

... it is interesting to consider not just where 'health' sits within business and commerce, but the themes and issues that it has reached. Now, we are more aware of the dependencies, for example air quality, physical and mental health, but we are still to finish the chapter titled: "The Damage Done".

'Capitalism' remains rapacious in terms of resource use (ironically if the market and prices are cyclical) and we must acknowledge all of economics, from stock exchanges, to cities, to villages in developing countries, but the challenge remains to transform the geometry of our economics to that of a sustainable circle. As per the climate debate, in some instances, we might close certain industries and leave some classes of minerals, elements, fossil fuels in the ground. We should accept that while some economies are more circular than others, sometimes you cannot circle a square?

Below is an investment hierarchy in which I have highlighted health. Education, literacy and environmental awareness are, if not issues (which they are, especially their respective economics) they are much needed individual actions to achieve progress.

The media notes that next month's summit will include 'world leaders'. I wonder how many business leaders will be present? This would be an indicator of corporate social responsibility, looking very positive in the annual report (even if the self-regulation has not yet achieved homeostatis). If you can advise with figures, or if I find the information later next month I will post here.

MSCI ESG Key Issue Hierarchy

3 Pillars	10 Themes	37 ESG Key Issues
Environment	Climate change	Carbon emissions  Product carbon footprint  Financing environmental impact Climate change vulnerability
	Natural resources	Water stress  Biodiversity & land use  Raw material sourcing
	Pollution & waste	Toxic emissions & waste   Electronic waste Packaging  Material & Waste
	Environmental opportunities	Clean tech  Green building   Renewable energy
Social	Human capital	Labor management   Health & safety Human capital development Supply chain labor standards
	Product liability	Product safety & quality  Chemical safety Financial product safety  Privacy & data security  Responsible investment  Health & demographic risk
	Stakeholder opposition	Controversial Sourcing
	Social opportunities	Access to communications  Access to Health care Access to finance   Nutrition & Health
Governance	Corporate governance*	Board* Pay* Ownership* Accounting*
	Corporate behavior	Business ethics Anti-competitive practices Tax transparency Corruption & instability Financial system instability

* Corporate Governance Theme carries weight in the ESG Rating model for all companies. In 2018, we introduce subscores for each of the four underlying issues: Board, Pay, Ownership, and Accounting. https://www.msci.com/documents/10199/123a2b2b-1395-4aa2-a121-ea14de6d708a

My source (MSCI ESG Key Issue Hierarchy p.27):

Norrington, J. (2019) Future Proof Investments, Investors Chronicle, 18-25 April. pp.24-28.

The dynamics of life and death

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group

dynamic care?	dynamic care?
dynamic care?	'dynamic pricing'

Cavet emptor!

Beware -

 you get what you pay for; but do you get what you pay for?

Previously on W2tQ - 'dynamic'

STUDY: Bailed out and burned out? The financial impact of COVID-19 on UK care homes for older people and their workforce

 Via CHPI:

This research is the product of a collaboration between Warwick Business School, University College London and the CHPI, funded by the Economic and Social Research Council. 

The two year study examined  the financial impacts of the pandemic on UK care homes for older people  and their staff. It is based on an analysis of hundreds of company accounts, interviews with care home staff and a survey of over 600 care home workers.

 

Key findings

1. Without £2 billion of government support, and care workers working longer and harder, the sector would almost certainly have collapsed financially during the first year of the pandemic. That emergency funding helped to stabilise care homes early in the pandemic. Some even increased payments to investors: a quarter of companies increased dividends, by 11%.  
2. Since the peak of the pandemic, the care home sector has faced a financial crisis due to the removal of government financial support despite continuing COVID outbreaks, workforce shortages and inflation.  
3. Government support focused on keeping care homes financially viable, with only a small proportion devoted directly to supporting staff who were working in extreme circumstances. As many as 4 in 10 care home staff reported financial problems related to working in care during the pandemic. 
4. The financial impacts on staff varied by ownership type and size. Staff experiences were more positive in not-for-profits and smaller organisations on a range of measures. 
5. Staff valued in-person support from colleagues, managers, and external professionals 

Recommendations

1. Improved contingency planning for the financial impacts of future pandemics and their consequences for staffing, including creating a standby emergency social care workforce.  
2. Sustained government support for care homes coping with the lasting impacts of pandemics. 
3. Public funding for care, including emergency support during pandemics, should take account of evidence showing varying outcomes by ownership type and should seek to promote forms of provision that offer both good care and good jobs.  
4. Government and employers should improve pay and conditions for care staff, in general and especially during pandemics (including recognition payments, enhanced sick pay and overtime rates).  
5. Government should work with employers topromote a better understanding of how care staff experience their working lives, for example through an annual national workforce survey and to ensure adequate personal, professional, and clinical support is accessible to social care staff, particularly during a pandemic.
   
   

Fotaki, M., Horton, A., Rowland, D., Ozdemir Kaya, D. & Gain, A. (2023) Bailed out and burned out? The financial impact of COVID-19 on UK care homes for older people and their workforce. Coventry: Warwick Business School.

Listen also ... BBC Radio 4 Today 0652.50 

https://www.bbc.co.uk/sounds/play/m001kx5m

What is 12.5% of Nursing's effort?

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group - population

skills, responsibility, accountability, 6Cs, morale, motivation, trust, self-esteem	12.5% ?
	"What happens here?"

And .. all embedded within, surrounded by ... the Spiritual domain...

  Fair Pay For Nursing

Find out more about the Fair Pay for Nursing campaign and how you can get involved

#FairPayForNursing

What it means to me / us.

RCN Congress 2026 & RCN North West Multicultural Group (NWMG)

England's North West is certainly in the news at present, on two counts:

1. The current Labour party machinations in the Makerfield ward;
2. and RCN Congress in Liverpool.

 As I attend Congress a key focus is the debates and how I can relate these to Hodges'model - (with some links to previous posts):

1. Nursing as a STEM profession
Matter for discussion submitted by the Eastern Board
That this meeting of RCN Congress discusses the recognition of nursing as a STEM (Science, Technology, Engineering, and Mathematics) profession, valuing the scientific, technical and analytical expertise of nurses.

STEM - science : technology : engineering : mathematics

2. Safe, ethical, person‑centred nursing
Resolution submitted by the Cheshire Branch
That this meeting of RCN Congress calls on RCN Council to urgently develop and implement a UK‑wide framework for realistic person‑centred care, ensuring that nursing practice is safe and ethical.

safe : ethics : person-centred 

3. Regular redeployment
Matter for discussion submitted by the Wiltshire Branch
That this meeting of RCN Congress discusses the impact of the daily redeployment of nursing staff on morale, team work and patient safety.

re- deployment

4. Unpaid hours
Matter for discussion submitted by the North East London Inner Branch
That this meeting of RCN Congress discusses the culture of nursing staff missing breaks and working beyond their contracted hours.

work

5. National safety standards for lone working
Resolution submitted by the Health and Safety Reps Committee
That this meeting of RCN Congress calls on RCN Council to lobby for the implementation of national safety standards for lone working, ensuring access to appropriate safety equipment, technology and protocols to protect staff across all care settings.

lone working

6. Accountable, compassionate and psychologically safe leadership
Matter for discussion submitted by the Cheshire Branch
That this meeting of RCN Congress discusses how the RCN can help create a culture where accountability, compassion, and psychological safety coexist, enabling managers to lead effectively while ensuring all staff feel respected and protected.

accountability : compassion : leadership 

7. Misinformation in health care
Matter for discussion submitted by the Women's Health Forum
That this meeting of RCN Congress discusses misinformation in health care and the impact this has on the nursing workforce.

misinformation : information disorder

8. Confidence to address racism
Matter for discussion submitted by the South West London Outer Branch
That this meeting of RCN Congress discusses how to build the confidence of nursing staff in addressing racism.

confidence : racism

Once again the North West Multicultural Group will have a stand:

The RCN North West Multicultural Group (NWMG) creates a community for members across the region from multicultural ethnic backgrounds to connect with each other, share their lived experience, knowledge and diverse ideas that help drive change around racism to ensure that their various organisations is the best place to work.

Membership is open to RCN members of Royal College of Nursing from multicultural backgrounds and their allies.

Mission statement: 

The aim of the North West Multicultural Group is to stand against racism and discrimination by using members lived experiences, encouraging organisations to be anti-racist and with the support of allies.  

Aims and objectives: 

• To raise the issues around race, discrimination and equality in the workplace and to find potential solutions. 
• To challenge misconceptions about people from different ethnic backgrounds.
• To recognise the skills and contribution to care for people from all backgrounds make.
• To acknowledge that racism is a social construct that needs to be eradicated together.  Together we are stronger.
• To be a platform for black, Asian and minority ethnic staff and allies to work collaboratively to address racism in practice.
• To help amplify the voice black, Asian and minority ethnic staff.
• To be role models, set examples as allies and develop confidence.
• To provide training and support about anti-racist practice.
• To work with the RCN to support campaigns to make sure communication is fit for purpose and acknowledges any cultural differences. 

Your executive team:

Chair: Olanike Babalola
Vice Chair: Susan Owen-Naz
Communications Officer: Mark Anthony

9. Advanced nursing practice
Resolution submitted by RCN Council
That this meeting of RCN Congress agrees that the RCN will act upon attempts to undermine advanced nursing practice.

advanced : practice : theory

10. Protecting nurse education
Resolution submitted by the Education Forum
That this meeting of RCN Congress asks RCN Council to lobby UK governments to protect nurse education from university sector economic pressures.

protect

11. Quality of clinical placements
Matter for discussion submitted by the Students Committee
That this meeting of RCN Congress discusses ways in which the quality of clinical placements can be ensured and consistent across all 4 countries.

quality : placement

12. Bank rates
Resolution submitted by the South Yorkshire Branch
That this meeting of RCN Congress demands that employers pay nursing staff bank shifts at their substantive rate.

pay

13. Are external reviews meaningful?
Matter for discussion submitted by the Midwifery Forum
That this meeting of RCN Congress discusses whether external reviews and inquiries are genuinely driving meaningful improvements in safety across health and social care.

inquiry : review

14. Improving acute mental health crisis services for children and young people
Resolution submitted by the London Board
That this meeting of RCN Congress calls on RCN Council to lobby UK governments to improve the provision of services to children and young people presenting in acute mental health crisis.

children : mental health

15. Access to specialist pain services
Matter for discussion submitted by the Pain and Palliative Care Forum
That this meeting of RCN Congress discusses access to specialist pain services and the role of the registered nurse in caring for those in pain.

pain

16. Palliative and end-of-life care
Resolution submitted by the Pain and Palliative Care Forum
That this meeting of RCN Congress calls on RCN Council to lobby UK governments to ensure everyone living across all 4 nations has access to specialist palliative and end-of-life care.

palliative

17. Accessible and affordable travel
Matter for discussion submitted by the North Central London Inner Branch
That this meeting of RCN Congress discusses what accessible and affordable travel means for the nursing workforce.

18. Uptake of physical health checks
Resolution submitted by the Public Health Forum
That this meeting of RCN Congress requests RCN Council to lobby UK governments to improve the uptake of physical health checks for people with learning disabilities and serious mental illnesses (SMI).

serious mental illness (SMI)

19. Eye donation
Matter for discussion submitted by the Greater Glasgow Branch
That this meeting of RCN Congress discusses the role nursing has in eye donation in end-of-life care planning.

eye : vision

20. 35-hour week
Resolution submitted by the Lothian and Borders Branch
That this meeting of RCN Congress calls on RCN Council to instigate a campaign for a maximum 35 hour working week for the nursing workforce.

21. Inappropriate delegation
Matter for discussion submitted by the Berkshire Branch
That this meeting of RCN Congress discusses the delegation of health care tasks to school staff and non-health care professionals.

22. Access to medicinal cannabis
Matter for discussion submitted by the Cheshire Branch
That this meeting of RCN Congress discusses the impact of current NHS prescribing practice on access to medicinal cannabis.

medicinal cannabis

23. SPA time
Resolution submitted by the Wiltshire Branch
That this meeting of RCN Congress calls on RCN Council to lobby for the inclusion of Supporting Professional Activities (SPA) time in all nursing job-plans.

See: https://www.rcn.org.uk/Congress/Agenda 

Are there any lessons from this exercise? Well, I have no posts tagged 'donor', or 'medicinal cannabis' - to make an important distinction. Something to correct and try to follow this week. 

See you there ...?

(I may need to reduce the link-count here.) 

Fallacies of Work as Imagined: c/o Steven Shorrock - HSJ Patient Safety

I came across the following image on twitter. The tweet is also copied below.

This post is prompted by one from 'The Varieties of Human Work' on the Humanistic Systems blog 05/12/16 by Steven Shorrock. The focus is understanding and improving work, and in his opening there is a sense of very large net having to be deployed to capture all the disciplines and dimensions that are invariably involved in work.

"One of these is the simple observation that how people think that work is done and how work is actually done are two different things. This observation is very old, decades old in human factors and ergonomics, where it dates back to the 1950s in French ergonomics (le travail prescrit et le travail réalisé; Ombredanne & Faverge, 1955) and arguably the 1940s in analysis of aircraft accidents in terms of cockpit design (imagination vs operation). Early ergonomists realised that the analysis of work could not be limited to work as prescribed in procedures etc (le travail prescrit), nor to the observation of work actually done (le travail réalisé). Both have to be considered. But these are not the only varieties of work. Four basic varieties can be considered: work-as-imagined; work-as-prescribed; work-as-disclosed; and work-as-done. These are illustrated in the figure below, which shows that the varieties of human work do usually overlap, but not completely, leaving areas of commonality, and areas of difference."

The varieties of human work.

It immediately struck me how well the diagram can be translated and transposed on to Hodges' model on several levels and as per Steven Shorrock's excellent post. I acknowledge I am playing with language, but initial thoughts included:

1. As per Shorrock: the difference between how people think about work and how work is actually done.
2. Shorrock explains how for example 'work-as-imagined' draws on the other forms of work.The level of overlap in between the forms of 'work-as-' is as diverse as the contexts that arise and constantly change.
3. There are many 'gaps' identified in Steven's post [not in the sense of a fault with his post]. A subset of these may relate to the theory-practice gap which was one original purpose of Hodges' model, to help close this gap.
4. Orders of scale: from a single action to a whole job and its specification.
5. The way the 4Ps process, policy, purpose and practice can be used (I identified the 4Ps within Hodges' model, one per care domain, many years ago).

As has been pointed out to me (on twitter) the context here is 'work' and not healthcare, but as Steven notes there are many disciplines, with commonalities and differences. I am really grateful to Steven for his post, in which he also stresses the overlap. 'Work-as' is a flux. Hodges' model can be viewed through time as series of frames. Below are some rather unstructured notes [musings] relating and extending the context of Shorrock's image and post to Hodges' model:

individual - self

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group- population

'Work-as-Imagined': Of the four P's I have placed 'PURPOSE' here, since the individual's purpose must (ideally) achieve synergy with colleagues and the organisational objectives and goals. 'Work-as-Imagined' involves thought (and so is infinite in variety) whether use of imagination is day-dreaming, or radically innovative. Until AI does take over, this is the 'meta' - cognitive domain. Amid many, Shorrock makes an important point in how we imagine the work other disciplines do. Often so many stereotypes follow that are often revealed in referrals and expectations. Shorrock highlights this at the macro level of policy makers [lower right in #h2cm] having to imagine the operational aspects of work; and the simplified accounts of surgery for a patient by anaesthetist and surgeon (while meeting the requirements of informed consent). This domain may be 'work-preserving' in humanistic terms as it is the realm of tacit knowledge, creativity and innovation. Although the artifacts of simulation are ultimately produced in the SCIENCES domain, they are 'imagined' in case studies and scenarios. Shorrock helps make it clear how much of work is theorised and practised virtually, but with recourse to imagination not technology. Mental illness and the systemic - organisational response is mediated diametrically in Hodges' model. Ongoing critique of psychiatry and mental health services in some quarters appears to suggest that being unable to work-as-imagined here, means loss of self and identity that is then outsourced and effected by proxies and advocates. [Discuss?]	'Work-as-Prescribed': Reading 'prescribed' literally then drugs and other physical treatments arise here in the SCIENCES domain. The 4'P is PROCESS suggestive of procedures, specifications, instructions and formal rules. Process is important allied with PURPOSE in that if (your) can be described formally, by a set of rules then you may be vulnerable to your job being taken by a robot through 'robotic process automation'. When I started in the NHS in the 1970s there was a shift taking place from being task-oriented (mechanistic) to individual/patient-centred (humanistic). Shorrock notes how there are relatively fewer examples of work-as-prescribed. Developed nations are waiting to see how many existing jobs are lost to AI and robots, but how many new ones emerge. (Can the developing nations 'skip' several prescriptions?) Here, we also apply time to work. The past, current work and the future. Will we still work the same hours? Is there a lesson in '0' hour contracts? An obvious aspect of work is day vs. night shifts. 'Work-as-Prescribed' also reinforces the presence and context of the SOCIOLOGICAL domain. Now, conferences are devoted to 'social prescribing'. By its nature this is more often than not 'public' and therefore 'disclosed'. Citizen science and patient involvement provide a further angle on work-as-prescribed. As does what is prescribed (especially in what is used) must to some degree influence what is proscribed in what is not used.
'Work-as-Disclosed' Sharrock writes concerns how work is explained and communicated. This will also involve teaching formally and health professional to patient, carer and public.  The challenge is that thinking about work and actually doing work is a SOCIO-POLITICAL act - transaction (as the literature demonstrates). Socially, whether or not someone is working is also disclosed in their domestic  comings and going to work. The socio-political dimension is evident in the assumptions that follow homeless peopleand their apparent 'staying' (many do work?)? There are those who opt not to disclose at all and live off-the-net. SOCIO-ECONOMICALLY there are constant references to 'pay-gaps' especially by those groups and their representatives most affected by low pay and austerity. While the social care workforce toil in the community, social care funding, provision and integration is pushed into the long grass that is green papers. Despite the social value and importance of this work, the status of this sector is signalled - disclosed as poor. Nurses globally are campaigning to establish in law the requirement for safe-staffing levels. Sharrock alludes to the challenge of nursing as PRACTISED on the 'shop-floor' and ongoing studies on staffing - establishments and skill-mix. In the 1980-90s expert systems specialists interviewed workers  in an attempt to understand the knowledge acquisition and elicitation associated were their profession - community of practice. These humanistic care (knowledge) domains reflect the qualitative approach to research. Work-as-disclosed also communicates to would-be future recruits. How are the aspirations of teenagers and mature entrants first experienced, discussed and carried forward socially?	'Work-as-Done' simultaneously speaks of power, employment, accountability and regulation.  As four conceptual spaces #h2cm indicates the 'distance' between concepts that shifts according to context. The space that work takes place within and how people are managed, organised, controlled for efficiency with reminders, queues, appointments, and waiting areas are signs of the institution. The person was a long way from the creators of the Victorian asylum, even as they sought to establish (stamp?) a 'standard' level of care. What difference does it make when work-as-done is bound to an individual and collective sense of duty? The counterpoint is precisely [mechanistic] work-as-done. Work-as in shift completed and recorded - clocked as such. Work-as-done: the 12 hour shift or as already mentioned work-as-NOT-done due to the flexibility afforded by zero hour contracts. Work-as-done also denotes [scientifically] the concepts of power, energy and effort. So, work-as-done must result in personnel actually feeling 'done': burnt-out when safe-staffing is not assured. The old saying: "If it is not documented it was not done.", springs to mind. Shorrock refers to surgery and loss of life. What was 'done' and what does an inquiry reveal? What is actually done and the way it is done if varies - contravenes 'norms' rules then there is a issue of whistle blowing. The question then becomes was the work done as it should - must - be? The 4P in this domain is POLICY.  Perhaps a box-tick here also accounts for 'work-as-' elsewhere?

#HSJpatientsafety Fallacies of work as imagined. More info on Steve’s great blog https://t.co/i5TCs6CLvJ @StevenShorrock

— Iain Moppett (@IainMoppett) July 3, 2019