Money and Mental Health [ii] OVERSTRETCHED, OVERDRAWN, UNDERSERVED

Following on from - Money and Mental Health [i] Impact of Mass Unemployment Events (MUEs)

I have been familiar with the relationship between mental health and finance since student days in the late 1970s. Debt was and remains a profound and common problem. This can exacerbate existing mental health problems or it be the trigger - the straw that breaks the camel's back. From the report:

One in four people with a mental health problem is also in problem debt, and half of people in financial difficulties have a mental health problem (p. 13).

Finance still has this impact whether it is a lack of basic financial skills (literacy), life chances and opportunity or attributed to bad luck. Speaking of 'luck': I have frequently felt angry and frustrated with government policy. It is common sense and statistically inevitable that within the population there will be people who are vulnerable to addiction of many sorts. Why make it easier for those who are vulnerable to potentially loose everything? Not only that but money impacts all those in vulnerable groups, not just people in work. When we talk of health inequality what is the biggest factor? I've come across instances of elderly people receiving scam mail and not just the 'odd' post. While within Hodges' model below I have family as a resource, sadly this can also be part of a problem.

'Productivity' looms large in the report and draws a rueful smile here. In the NHS productivity and its increase is a constant requirement. In the general economy UK productivity is low and seemingly stuck. Successive governments have failed and now with Brexit productivity is still on life-support.

In the report 'financial fragility' is a very useful construct (as with circumstantial, rather than careless overspending). The public sector is also highlighted in this regard:

Forecasts suggest that 5.4 million public sector workers, one in six of the UK workforce, will be worse off in 2020 than they were in 2010 (p.16).

Before you view the report itself and the small conceptual sampling in Hodges' model, the report refers to the hidden epidemic that this report seeks to highlight and represent. This government and successive, nationally and globally need to get to grips - somehow - with the hidden economy - parts of which are blatantly obvious in the subterfuge around tax avoidance. This is another relationship that operates upon us all - employed, unemployed, young and aged - and which Hodges' model can also help illuminate.


Evans, K., Holkar, M., Murray, N. (2017) OVERSTRETCHED,OVERDRAWN, UNDERSERVED: financial difficulty and mental health at work, The Money and Mental Health Policy Institute, May 2017.

What follows is drawn from the report above - with a couple of additions:

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group - population

[May THE KNOWLEDGE ECONOMY]  (including nursing) MENTAL HEALTH hidden epidemic ... over two thirds (67%) of employees who are struggling financially report at least one sign of poor mental health that could affect their ability to function at work loss of sleep, poor concentration, reduced motivation, preoccupation Increased risk taking (impact - occupation...?) Guilt/shame Anxiety Low self-esteem Anger Frustration Fear Low mood Self-harm Suicidal ideation Insomnia Panic attacks Depression, Lethargy/apathy Substance misuse [... starts here!]

PRODUCTIVITY Physical effects of anxiety, stress, alcohol, smoking (increase, relapse), other substance misuse physical fragility (lack of resilience) Nearly half (45%) of all working days lost to ill health were a result of stress in 2015/16 – adding up to 11.7 million days across the economy. work access to:   "on-site exercise facilities, healthy  food and rest spaces" hidden morbidity

Influence of individual mental health on colleagues, team morale and cohesiveness fear of bailiffs - seen by others at my door pressure on relationships conflict at work family breakdown shame, guilt, stigma social support, friends, family, colleagues

WORK THE ECONOMY "Money and Mental Health will set out the case for employers to provide practical support to employees experiencing financial difficulty, and how this could boost the mental health, wellbeing and resilience of their workforce." "financial fragility" Creditor action poor performance, punctuality, reliability disciplinary action OCCUPATION HEALTH services - counselling / advice Individual's awareness of Rights the hidden economy

Thanks and Acknowledgement to The Money and Mental Health Policy Institute

World Happiness Report 2025

WORLD HAPPINESS REPORT 2025

. . . and looking ahead to WHR 2026 . . .

Prof Lord Richard Layard

Editor, World Happiness Report

In World Happiness Report 2024, we presented evidence of a concerning decline in the wellbeing of young people in Western industrialised countries.

Obviously, a child’s wellbeing matters for the same reason that any individual’s wellbeing matters. But wellbeing among children and adolescents is also critical since it is the best predictor of how happy said child will be in their subsequent life – with a higher predictive power than the qualifications which they might obtain.

There has been much debate about the reasons for such a downward trend, with many competing theories and policy recommendations. However, one explanation has captured public and political attention more than any other: social media.

Also in 2024, Jonathan Haidt, a social psychologist at New York University’s Stern School of Business, published The Anxious Generation, arguing that the decline in youth wellbeing is driven by a transition from a play-based childhood to a phone-based childhood. The book has been a best-seller and sparked heated debate, both in academia and the wider world.

As editors of the World Happiness Report, we have followed this debate closely, concerned that rigorous science was being overshadowed by shallow media narratives.

In World Happiness Report 2026, we see an opportunity to bring all sides of the debate together to establish the facts, clarify disagreements, and provide decision-makers with a balanced assessment of what we know, what we don’t know, and what should be done.

We’re encouraging researchers from across the world to submit chapter proposals focusing on the relationship between social media and subjective wellbeing before the deadline of Sunday 15 June. Full details are available on the World Happiness Report website.

My source: Email from info AT worldhappiness.report

Previously: 'happiness'

'International Nurse's Day' 2025 #2 - c/o ICN & WHO

State of the World’s Nursing Report 2025

State of the World’s Nursing

Report 2025

'As the world’s nurses celebrate International Nurses Day (IND), ICN issues a rallying cry to governments around the globe for urgent nursing support, following the launch of the second World Health Organization (WHO) State of the World’s Nursing (SOWN) report.

The SOWN report is a vital assessment of the global nursing workforce in the aftermath of the COVID-19 pandemic and underscores the urgent need for bold investments in nursing to address shortages, strengthen health systems, and promote global resilience and economic stability.

The SOWN report reflects ICN’s IND 2025 report, Caring for nurses strengthens economies, and related Survey of National Nurses' Association (NNA) Presidents, reinforcing the central role of nurses in achieving global health, including Universal Health Coverage (UHC), and calling for immediate action to address long-standing challenges. The SOWN data presents a mixed picture. It highlights progress in areas such as advanced practice and nursing leadership, but indicates gravely concerning continued workforce shortages, inadequate compensation and working conditions, poor mental health support, inequities in the distribution and employment of nurses, and failures to fully enable nurses as practitioners and health care leaders.'

Continued ...

Caring for nurses strengthens economies

Caring for nurses
strengthens economies

'As we face growing health care challenges, from ageing populations and rising chronic diseases to climate-related emergencies and deepening global inequalities, the need for a strong, sustainable nursing workforce has never been greater. We cannot meet these challenges without sufficient nurses who are themselves well-cared for and supported. ICN’s International Nurses Day report reveals the severity of our current nursing shortage and well-being crisis – and the path forward. ICN’s “Caring for Nurses Agenda” provides a comprehensive roadmap for creating environments where nurses, patients, and entire health care systems can flourish.'

Source: ICN

Learning Health Systems/AcademyHealth 2024 SUPPLEMENT now available

 Dear Readers of Learning Health Systems,

We are pleased to announce the first-ever Supplement Issue of Learning Health Systems! 

 

You may view the complete Supplement online at:

https://onlinelibrary.wiley.com/toc/23796146/2024/8/S1

 

Guest Editors for the 2024 Supplement were: 

Lucy A. Savitz,  Sarah M. Greene,  Michael K. Gould,  Harold S. Luft

 

The LHS/AH Supplement is the result of a collaboration and memo of understanding between Learning Health Systems (University of Michigan), AcademyHealth, and John Wiley & Sons.

 

***********************************************************

 

Guest Commentary

The Right Stuff:  Getting the right data at the right time and using that data to drive evidence-based practice and policy

 

Lucy A. Savitz,  Sarah M. Greene,  Michael K. Gould,  Harold S. Luft

May 27, 2024

 

Experience Report

Leveraging data to support health equity in an integrated delivery and finance system

 

Jane Kogan, Joan Eichner, Hyagriv Simhan, Erin Dalton, Alex Jutca, Beth Quinn, Jennifer Chaney, Anna Patterson, Donna Keyser

April 15, 2024

Continued...

World Justice Report: a Plan for Equality and Prosperity Within Planetary Boundaries

Box 1: Combining Global Equality and Planetary Habitability

The Global Justice Report describes desirable future scenarios combining two key goals: socioeconomic equality (including full equality between countries, full gender equality in labour hours and pay, sharp compression of within country income and wealth scales, combined with fair access to education, health and political voice), and planetary habitability (aligning global resource use within ecological boundaries, including a limitation of global temperature rise below 2°C). 

To avoid climate catastrophes, we show that sufficiency is required: a structural transformation of the economy involving shorter working hours, a lower material footprint, a shift from material-intensive sectors toward relatively immaterial sectors such as education and health, and major changes in food systems and land use. Rapid decarbonization of energy systems is also necessary, as is the sharp compression of income and wealth inequality. This compression is both a social justice objective and a condition for financing necessary climate investment and human capital expenditure and for sustaining political support from bottom- and middle-income classes in both the North and the South. 

Box 2: Material and Monetary Accounting for Democratic Debate

Economy and ecology cannot be debated apart: every economic activity has a material footprint, every ecological policy shapes incomes and wealth. To make these links visible, the Global Justice Report uses multidimensional social progress indicators. We set quantitative targets for global socioeconomic justice by combining two complementary languages: material accounting (work hours, sectoral shares, education and health, energy systems, GHG emissions, land use, forest cover, temperature levels) and monetary accounting (income and wealth scales between and within countries, progressive tax rates). The report draws on two centuries of historical data on global inequality and resource use, and on the recent literature on social progress, climate and colonial reparations. 

The Global Justice Report proposes a quantitatively and institutionally grounded step toward global justice. It does not seek to close the debate: it offers a transparent basis on which citizens, unions, parliaments, and international bodies can debate, contest, and decide the course of the coming decades.

...

Chancel, L., Dietrich, J., Mohren, C., Moshrif, R., Odersky, M., Piketty, T., Somanchi, A., et al. (2026), The Global Justice Report: A Plan for Equality & Prosperity Within Planetary Boundaries, World Inequality Lab (gjp.wid.world).

individual

|
INTERPERSONAL : SCIENCES             

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

SOCIOLOGY : POLITICAL   

|

group 

SOCIAL JUSTICE

Previously: 'wealth' : 'poverty' : 'social justice'

 My source: BBC Radio 4 World at One.

 

 

RCN Congress: The Systems Table and the Missing Cog

Across two maillists: SDOH Social Determinants of Health and POHG Politics of Health Group a discussion and debate regards public health, longevity and policy, was provoked by a study:

'At least 80% responsibility for ill health in old age down to individual'

https://www.theguardian.com/society/2026/may/20/responsibility-ill-health-old-age-oxford-longevity-project-study

'... Individuals bear at least 80% of the responsibility for their ill health in old age, according to a report aimed at challenging the belief that physical decline is either inevitable or primarily the responsibility of the state.

The report, launched at the Smart Ageing Summit in Oxford last week, argues that individuals have far greater control over their longevity than is commonly understood. The authors call on the government to take legislative action on alcohol comparable to restrictions on smoking.

Living Longer, Better – the Oxford Longevity Project’s first Age-less report – was co-authored by an interdisciplinary panel of UK-based experts in medicine, physiology, ageing and education policy. It was sponsored by Oxford Healthspan.

The report’s authors, Sir Christopher Ball, Sir Muir Gray, Dr Paul Ch’en, Leslie Kenny and Prof Denis Noble, present the figure of 80% as a conservative estimate.

Ball, a 91-year-old former Parachute regiment officer who intends to reach 100, said: “Some have gone higher and said it’s approaching 90%. But I think 80% seems about fair.”The claim, however, has been described as simplistic and said to neglect wider arguments about whether people are genuinely in control of individual choices when it comes to issues including poverty, pollution and healthcare access.

Nancy Krieger, professor of social epidemiology at Harvard TH Chan school of public health, said: “The report is to be commended for rejecting genetic determinism but it problematically avoids engaging with the societal determination of health and health inequities; the role of work, economic deprivation and government policies that give corporations free rein to sell unhealthy products.”

Steven Woolf, professor of family medicine and population health and director of the Virginia Commonwealth University Center on Society and Health, agreed, saying the paper “ignores and oversimplifies the actual, multilayered root causes of the conditions that foster poor health in a population”.

Woolf added: “There are factors affecting health that are beyond personal choice. So while it’s good to give people clear guidance on how their choices affect their health, it’s taking policymakers and others off the hook.” ...'

This provides me with evidence (well it would - wouldn't it^) on the need for, the purposes, and applications of Hodges' model.

More philosophically (perhaps), I'm reminded of the work of several academics - thinkers, Michel Serres stands out for me. Serres felt that positional adverbs were important, e.g. between, above, and under.

He also wrote of life (as per many philosophers), and the universe e.g. his writings on Physics and Lucretius - as flow - a river.

For new life, the options are seemingly infinite, far, far upstream: at source - not recognisable even as a trickle... but soon a rivulet, a stream, a river of so many tributaries.

As we grow older we get closer to the sea (of the 'eternal'), the options open to us shrink gradually, but ultimately radically - inevitably.

But looking back the turbulence, uncertainty, unpredictability (trauma and joy), all contribute, not just to where we end (up) but how this came about.

Life's signature at death.

In "Hodges' Health Career Model" 'health career' refers specifically to the idea of life chances (of course) and how other careers, education, work, retirement, caring (self - others - planet) .. are impacted through life and death's course.

This morning at RCN Congress, Liverpool (the home of District Nursing) there was discussion re. nurses being engaged in preparation for the next pandemic.

So often 'Nursing' is absent from the POLITICAL / POLICY table:

• Workforce planning
• Safety
• Higher Education?
• Research funding?
• Information / Health infomatics policy?

Speaking for myself, nursing is not interested in the four-course meal, but being involved and engaged in the after dinner discourse can be critical.

Politicians, policy makers, business, management consultants and lobbyists are so quick to point to and extol the 'SYSTEMS' perspective, and the need for 'systems thinking'.

Guilty of systemic neglect, they clearly have no idea of what a system is, an inability to appreciate and apprehend scope, scale and the 'whole'.

In mitigation (or not), for all groups: voice matters. Especially the voices of foresight, balance, advocacy, Their ability to ascend always proves an issue. 

Related papers listed in the sidebar:

Jones, P. (2008) Exploring Serres’ Atlas, Hodges’ Knowledge Domains and the Fusion of Informatics and Cultural Horizons, IN Kidd, T., Chen, I. (Eds.) Social Information Technology Connecting Society and Cultural Issues, Idea Group Publishing, Inc. Chap. 7, pp. 96-109.

Jones, P. (2009) Socio-Technical Structures, the Scope of Informatics and Hodges’ model, IN, Staudinger, R., Ostermann, H., Bettina Staudinger, B. (Eds.), Handbook of Research in Nursing Informatics and Socio-Technical Structures, Idea Group Publishing, Inc. Chap. 11, pp. 160-174.

Jones, P. (2012). Exploring several dimensions of local, global and glocal using the generic conceptual framework Hodges's model. The Journal Of Community Informatics. 8(3). Retrieved from https://www.academia.edu/3794699/Reflecting_on_the_glocal_through_the_conceptual_framework_of_Hodges_s_model

^Because these days you need to make every kernel - found or created on the continuum of evidence - count.

Previously: 'life chances' : 'health career' : 'Serres' : 'APPGs'

Liverpool, UK. RCN Congress 2026 - 
n.b. See you in Liverpool 2027?

Independent report - Ockenden review into maternity services at Nottingham University Hospitals NHS Trust

FINAL REPORT: 

'This independent review of maternity services at the Nottingham University Hospitals NHS Trust (NUH) considered the quality of care relating to newborn, infant and maternal harm at the trust.

This report covers the findings, conclusions and essential actions of this independent review of maternity services.

Based on a review of over 2,500 family cases that formed part of this investigation, the final report outlines:

• local actions for learning that staff at the trust must do
• system-wide learnings
• immediate and essential actions to improve maternity and neonatal care

The Independent Maternity Review (known as the Ockenden review) was led by Donna Ockenden and involved a multi-professional team of more than 160 reviewers. The review team held individual meetings with over 500 families, and more than 830 current and former staff at NUH engaged with the review.'

https://assets.publishing.service.gov.uk/media/6a3bb59c4c7605ab567238ec/ockenden-report-review-of-maternity-services-nottingham-university-hospitals-nhs-trust-e-lay.pdf

https://www.ockendenmaternityreview.org.uk/

individual

|
INTERPERSONAL : SCIENCES             

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

SOCIOLOGY : POLITICAL   

|

group

listening	Communication Processes  Health Systems
mothers families experience	LISTENING staffing funding

Previously: 'maternity' : 'risk' : 'safety' : 'compassion'

Report - Integrated care for patients and populations: Improving outcomes by working together

I've posted on integrated care previously on W2tQ. The core recommendations of this New Year  report on integrated care are:

• government policy should be founded on a clear, ambitious and measurable goal to improve the experience of patients and service users and to be delivered by a defined date
• patients with complex needs should be guaranteed an entitlement to an agreed care plan, a named case manager responsible for co-ordinating care, and access to telehealth and telecare and a personal health budget where appropriate
• change must be implemented at scale and pace; this will require work across large populations, significant reform and flexibility to take forward different approaches.

Publication prompted Time to integrate words with action by Chris Ham and Jennifer Dixon (HSJ 5 January pp. 16-17 - and my source for this news). The report and mention of measures of integrated care that include patient experience provoked further reflection.

Integration in health and social care should be considered critically over the past 25 years and more (but that's a thesis). Evolution in policy matters, but there is a deep archaeology that illustrates the policy aspiration - practice gap the reports priorities seek to address. A comment in response on the King's Fund's site notes the need for (strategies, methods and) a framework. While no magic wand there is a framework that can at least unify disciplines, public and policy makers. And act as a bridge between words and actions.

Integration needs a shared and agreed origin.

(A point* around which disintegration turns)

Although brief (20 pages) the report is an excellent source for references (3 pages) that includes:

Kodner D, Spreeuwenberg C (2002). ‘Integrated Care: Meaning, logic, applications, and implications – a discussion paper’. International Journal of Integrated Care, vol 2,
Available at: www.ijic.org/index.php/ijic/article/view/67 (accessed 13 December 2011).

Kodner D (2009). ‘All together now: a conceptual exploration of integrated care’. Healthcare Quarterly, vol 13(Sp), pp 6–15.

Leutz W (2005). ‘Reflections on integrating medical and social care: five laws revisited. Journal of Integrated Care, vol 14, no 5, pp 3–12.

As we try to integrate words and actions we need to remember:

how we dice and slice influences the scope of integration.

We'll explore this more soon.
*Points?

Nick Goodwin, Judith Smith, Alisha Davies, Claire Perry, Rebecca Rosen, Anna Dixon, Jennifer Dixon, Chris Ham Integrated care for patients and populations: Improving outcomes by working together. Report to the Department of Health and NHS Future Forum from The King’s Fund and Nuffield Trust

Project 2000: The Judge Report 1985

Somehow, or perhaps that is being kind, I have a feeling that sources on the history of 'recent' nurse education may come to the fore. It is interesting that the guest editorial below reflects itself on the preceding 25 years. Not just several cohorts of students, careers, but a whole life-time. 

We must hope today, that British nurse educators can find more security, if not the contentedness described by Rye in 1985 ...

'The main principles for policy change contained in the commission's report are as follows.

1 The uncoupling of education from service. Students should no longer be employees of the National Health Service. Nursing education should now be part of the main-stream of higher education, students being financed through a suggested bursary system.

2 A single level of basic nurse qualification leading to registration.

3 Curriculum development (as discussed in chapter 4 of the report) must take into account the need to retain certain speciality options, and prepare students for practice both in hospital and community settings. It creates the possibility of direct entry into district nursing, health visiting and midwifery. 

This 3-year course would have educational credibility as it will be at diploma level, the first year being a foundation programme, furnishing a basis for informed choice later. The second year would contain practical placements (in the community, adult nursing and mental health). It would consist of three modules, the first to be based in a community setting, the second (focused upon the nursing of adults) in a hospital setting, and the third in a variety of environments related to mental health. Roughly 30% of the time will be dedicated to carefully supervised practice in clinical settings. The final year will be characterized by increased specialization. The opportunity to make a selection from a number of available modules will equip each successful student to become registered and to take up work either in an institutional or non-institutional setting. The academic award will be that of Diploma in Nursing Studies. 
...
This new approach to nursing education will not create a 'generic' nurse, but will prepare students to work in their chosen speciality in hospital or in the community. If nurses are to respond to the changing patterns of health care, it is critical for future development that preparation for working in the community takes place in the basic diploma programmes. This may be seen as one of the more controversial implications of the report, but the profession must address itself now to these matters, as nursing education must become more flexible and capable of change to meet the needs of clients.'

See also: #RCN26 RCN Congress - Nurse Education 

Rye, D.H. (1985), THE EDUCATION OF NURSES: A NEW DISPENSATION. THE REPORT OF THE RCN COMMISSION ON NURSING EDUCATION. Journal of Advanced Nursing, 10: 505-506. 
https://doi.org/10.1111/j.1365-2648.1985.tb00540.x

Royal College of Nursing (Great Britain)., & Judge, H. G. (1985). The education of nurses : a new dispensation. Royal College of Nursing. (Classed as a Book.)

See also: https://wellcomecollection.org/works/p889dx97

https://eprints.hud.ac.uk/id/eprint/10084/1/ouseycontent_9838.pdf

Careif report: The Health Needs of the Indo-Caribbean Community in the United Kingdom

'The Indo-Caribbean community has played a key part in the life of the United Kingdom, but this has not often been recognised. Little is known about this populations’ physical and mental health needs and its experience of health and social services in the UK.

This report, The Health Needs of the Indo-Caribbean Community in the United Kingdom, examines the history of the Indo-Caribbean community in the UK, the prevalence of mental health conditions among the community, barriers to accessing mental health services, and the existing services available.'



Includes:

"The absence of a unique category designating ‘Indo-Caribbean’ as a unique category in the UK Census was identified as a major barrier to obtaining vital epidemiological data on the UK’s Indo-Caribbean population."

Above text:
https://www.careif.org/news-and-events/2025-10-9-careif-report-the-health-needs-of-the-indo-caribbean-community-in-the-united-kingdom

n.b. 
In my community mental health nursing career in Chorley, Preston, and West Lancashire as services were established, the diversity of the local populations was evident, but there was an assumption that many communities were essentially 'closed': one explanation for lack of referrals from specific racialised communities - was that some communities 'looked-after their own'.

Of course this can be racism (acute or subtle), an excuse for inaction, delayed response, lack of action - outreach and translation services. There were marked examples of intervention. I have seen first-hnad interpreting and translation services in action since full-time retirement and the services offered are amazing for the insights and care delivery they can facilitate. Is this why we also need mental health nurses and the team? To translate in challenging circumstances, even by being there, seeking avenues, giving time - especially in instances of psychoses and doing so safely (for all)?

In addition to the main body of Careif's report and its recommendations, it may be helpful to consider the report's key terms relating them to the domains of Hodges' model? I also note reference to the bio-medical model as an explanatory framework. A conference abstract has been submitted today for April 2026, highlighting the need for bio-psycho-socio-political model / framework (Hodges' model - of course?).

See also:

RCN North West Multicultural Group

REPORT: Creative methods to envision nursing practices addressing AMR - c/o RIPEN

Between the summer of 2018 and October 2019 a group of nurses from various disciplines and roles took part in a series of research workshops in Glasgow and London, culminating in a policy workshop event at the RCN in London. It was a pleasure and a challenge to be able to contribute and learn about this very urgent and global issue.


Here from the RIPEN website is a description and link to the report:

March 2020: New report:  Creative methods to envision nursing practices addressing AMR

A report on the use of arts and humanities approaches to co-design healthcare service innovation
 
The RIPEN project has asked: “How can relevant arts and humanities approaches help nurses to re-envisage their infection control practice ecologies in response to antimicrobial resistance?”. Our new report shows how we addressed this question, focusing on the creative methods used and lessons learned. We hope this will be useful for nurses and other healthcare professionals, designers and artists, educators, researchers, policy activists, and anyone else with an interest in the arts and health.

Please feel free to download, share and feedback any comments.

A video is also available on the website.

"Train midwives as nurses" - Ockenden

Re. Ockenden Report

Catching up on the newspapers, I noticed in the Times reporting of Ockenden calling for midwives to train as nurses first. Provoking debate about nurse education.

Within maternity services there are problems with continuity of care and skills in dealing with complex cases:

'Maternal Deaths 

60. The Review examined 27 maternal deaths that occurred between 2006-2024. Five cases fell outside of the Terms of Reference of the Review. Of the 22 remaining cases, reviewers identified failures in care that may have or substantially impacted on the outcome in six deaths. 

61. The profile of maternal deaths at NUH over this period broadly aligned with the known demographics and causes as identified by MBRRACE. 11 of the deaths occurred to women living in the most deprived areas of the city and 14 occurred amongst women who were not white British.

62. The common failures reviewers identified that might prevent future maternal deaths included: listening to women and families and acting promptly on concerns; continuity of care particularly for those with additional social/medical complexities; robust clinical governance to ensure timely information sharing across organisations and prompt access to imaging for women presenting with concerning neurological symptoms.' xiv

AI Overview (Ecosia) suggests that although direct entry to midwifery has always been possible(?), the English National Board created the pathway some 39 years ago.

The Ockenden Report describes how in combination health systems, culture, leadership and training can contribute to compassion fatigue (p.313).

When you look at Hodges' model and our languages, a great many challenges for curricula, training and education programmes can be found. The most powerful of what can be progressive, or threats are invariably mechanistic:

• shorten
• bypass
• shortcut
• cutting corners
• short-circuit

Nursing must always move forward, continuous professional development is built on this principle. In the late 70s and 1980s post-registered qualifications were held in high esteem. Especially midwifery, paediatrics, health visiting, emergency and intensive care. 

Clearly, decision and policymakers can underestimate the value of basic nurse training. Having an idea since childhood is brilliant, but at interview saying you're compassionate and want to make a difference will soon be tested. Sometimes as a student rather bluntly, as with a first placement in forensic nursing. I wonder how many students have been lost there? I'm sure the majority will cope, manage, enjoy and prosper, but I've seen the student peers who miss these cohort members on subsequent learning experiences. What preparation is employed?

Basic nurse training, is just that. Demonstrating competence in communication, awareness of basic needs and how these are expressed behaviourally. What interpersonal skills and knowledge are needed. As highlighted before, the director of nurse education worried about those of us who worked as nursing assistants risked being trained in poor care. Not recognising 'bad practice', a 'poor attitude', not using observation and most important of all listening: to what is said and unsaid. When I started I remember thinking about not responding - as individually programmed to do so, through a reflex action. That was a worry back then. 

While the news in the Ockenden Report is bleak. The depth of the report (for me) is manifest in identification of not only socioeconomic factors, but sociotechnical too (with five mentions) and the critical interplay of seeing (and hearing!) the individual amid the collective:

'2. Fetal monitoring

Rather than reflecting simple failures of individual interpretation, growing evidence suggests that intrapartum fetal monitoring is best understood as a complex sociotechnical practice, shaped by system design, workload, team dynamics, guideline variability and organisational culture.119 Continuous CTG itself has well-recognised limitations, including poor specificity for predicting long-term neonatal outcomes and substantial inter- and intra-observer variation in interpretation.5 Reviews of intrapartum care are therefore unavoidably influenced by retrospective bias, with greater apparent clarity afforded by knowledge of the outcome than was available to clinicians at the time. 

However, despite this, a sociotechnical understanding does not negate the importance of examining individual cases in which intrapartum monitoring was demonstrably substandard. National inquiries and confidential reviews repeatedly describe cases involving sustained failure to recognise pathological fetal heart-rate patterns, delayed escalation despite repeated triggers, and missed opportunities for timely intervention. 2,3,120,121 These cases cannot be explained solely by the inherent limitations of CTG or by hindsight bias.' p.143.

It is quite shocking to hear this conclusion: the need to train as a nurse first. Counterarguments: where is the evidence(?!) - have followed. But then if you undervalue and miss the fundamentals (see Hodges' model!) then individuals, families, communities, students, practitioners, services and systems suffer.

Previously: 'maternity' : 'report' : 'safety'

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

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

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group

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

Social Impact Bonds (SIBs) in Health

The following text is from the report:

Social Impact Bonds
A new way to invest in better healthcare

PURPOSE

This report is about the potential applicability of Social Impact Bonds (SIBs) in the health field. The SIB is a financial mechanism where investor returns are aligned with social outcomes. The SIB is based on a
contract with government in which the government commits to pay for an improvement in social outcomes for a defined population. Investors fund a range of preventative interventions with the goal of improving the contracted outcomes. If and as the outcomes improve, investors receive payments from government.

To widespread interest, the first SIB was launched in September 2010. Its aim is to reduce reoffending among short sentence male prisoners leaving Peterborough prison.

Social Finance believes that the reach of the Social Impact Bond model is wider than Criminal Justice. We asked Professor Paul Corrigan, a leading health adviser, to assess the suitability of the SIB model for
the NHS. This report presents his thoughts. We hope that his report provokes a thoughtful debate on how, or alternatively if, financial mechanisms such as Social Impact Bonds, might fund new interventions, improve people’s well-being and ultimately lead to a real change in the health system.

https://yoursri.com/users/570478ce8443743bff8b7e51c4d7ba60/b8984d6a364dadf0ff6c5d869f8f0cb8/@@download/fs


My original source: HSJ

Health Informatics Review Report published

Published yesterday here in the UK by the Department of Health:

The Health Informatics Review Report builds on the Next Stage Review by describing how informatics is supporting the delivery of better, safer care of patients, improving the NHS through better research, planning and management, and empowering patients to make more informed choices about health and care.

A Health Informatics Review Implementation Report will be published in the autumn 2008.

Document purpose: Policy
Gateway Reference: 10104
Title: Health Informatics Review Report
Author: DH
Publication date: 10 July 2008

Report - Health Misinformation: Public Perceptions of Threat to the UK

A London School of Hygiene & Tropical Medicine report

Published: 28 September 2026

Authors: Pete Wilton & Dr Ben Kasstan-Dabush

Foreword

The London School of Hygiene & Tropical Medicine (LSHTM) has a long track-record of developing innovative approaches to countering false or misleading health information (health misinformation). While health misinformation has always been with us, in the last few years changes to the technological and political landscape have enabled it to spread further and faster around the world, threatening to undermine trust in health experts and institutions.

That was why in January 2025 LSHTM launched a new initiative focusing on fighting dangerous health misinformation in the UK through interventions in the media, online, and on social media. While misinformation is global the response often has to be national or even local and what we quickly realised is that there is still a lot we don’t know about the prevalence and impact of health misinformation in the UK.

How equipped are Britons to identify false or misleading health claims? What do they do to factcheck if these claims are true? Are our fears about the harms of health misinformation on the UK population justified? And, if they are, who is being harmed and how can we help them to protect themselves? These were just some of the questions we had.

Of course one survey was never going to give us all the answers, but we believe the findings detailed in this report are an important first step towards gathering some of the ‘missing evidence’ on health misinformation in the UK. We hope that this report will help to motivate and inform all those working to make ours a healthier, stronger society.

Professor Liam Smeeth
Director, London School of Hygiene & Tropical Medicine

Continued . . .

My source: BBC Radio 4 Woman's Hour - 36mins 
https://www.bbc.co.uk/sounds/play/m0032qn8

'How can medical misinformation harm women, and how do we combat dangerous myths? Nuala McGovern is joined by former consultant breast surgeon and cancer survivor Liz O'Riordan and Dr Rachael Kent, whose academic research focuses on the impact of digital technology on mental and physical health.'