Reading the signs - Idealised Care

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

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

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

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


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

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

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

This list is subject to revision - addition.

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

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

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group

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

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

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.

NHS clinical informatics best practice marketplace 25th March 2010 Waterside, Watershed, Bristol

An opportunity to share innovations and experiences in the field of clinical informatics that can make a real difference to patient care.

25th March 2010 - Waterside, Watershed, Bristol

A collaboration between:

UK Faculty of Health Informatics and Bristol Royal Children’s Hospital -

Dear Colleague,

We would like to invite you to participate in an innovative new meeting which aims to bring together clinicians and social care staff from various backgrounds, who are involved with real world informatics solutions.

Many of the themes that we will be covering at our first market place are focusing on sharing informatics solutions that have already made and can make huge differences to patient safety and the overall quality of care.

The 6 main areas that we plan to cover on 25th March we hope are of huge interest, potential and at times frustration for NHS and Social Care staff, patients and carers. These are:

1. E-prescribing with decision support in secondary care

2. Clinical incident reporting systems and clinical audit tools

3. The development and use of community based information systems spanning across mental health, long term conditions and social care

4. Telecare and the use of teleconferencing in patient care

5. Clinical portals, patient portals and the use of clinical dashboards

6. Medical simulation and its use in clinical learning and development

The features of the proposed market place are very distinct from existing conferences and trade exhibitions in that it will be:

• Clinically focused – the issues that we are trying to find solutions to and share lessons learned from are led from a clinical viewpoint rather than a technical or sales perspective. There will be suppliers present but they will all have been invited along by Health or Social Care service provider.
• Focused on real experience of what already works – too often NHS staff have felt frustrated by suppliers promoting technical developments that haven’t actually yet been deployed in UK health and care settings. This market place is designed to share what has already been tried and tested in different parts of the NHS and Social Care from across the UK from a clinical/service perspective.
• Free of charge – the event is funded by the UK Faculty of Health Informatics and has been organised in partnership with Clinicians from Bristol Royal Children’s Hospital and academics from the University of the West of England. The personal details used when registering will not be shared with any other suppliers i.e. no follow-up sales calls or invitations to demonstrations
• Provide access to established Communities of Practice – if you want to progress ideas or issues more you will be able to sign up for free membership of an on-line community based on the Department of Health’s Informatics Directorate’s eSpace platform as well as other groups in order to keep in touch with other people that you have met on the day.

Format and structure:

Although the market place will be open all day from 9.30am until 5pm, unless you are a presenter or exhibitor you only need to attend when you wish to or are free to.

Short presentations on each of the 6 main themes will take place throughout the day from 10am until 4pm in a separate auditorium adjacent to the market place. You can attend as many of these interactive presentations as you wish.

We will have a limited number (around 16) stands for participants and their associated suppliers to demonstrate their solutions

The event is designed for staff working in Medical, Nursing, Pharmacy, AHP, Social Care, Informatics, Senior Management, Communications or Education and Training roles.

Support for back-fill and travel costs will be available to NHS and Social Care staff who exhibit a solution and/or share their experiences at one of the plenary sessions.

Organisation and next steps:

The event has been organised by 5 members of the UK Faculty of Health Informatics, including:

Bruce Elliott – Co-ordinator of the UK Faculty of HI/ Programme Manager – DH Informatics Policy & Planning, ... bruceelliott at nhs.net

If you would like to share your experiences at the event please contact leon.rushworth at nhs.net by Friday 29th January 2010.

You can book your place at the event by registering at ...

We hope that it is of real interest to you.

Kind regards

Bruce Elliott

The UK Faculty of Health Informatics purpose is:
To stimulate the uptake and application of Informatics research and development within UK Health and Social Care services in order to improve the quality of care for all.
This is done through providing opportunities for anyone with a passion for applying their Informatics knowledge and experience in practice to participate in:

• an engaging on-line discussion forum
• vibrant face to face events and meetings
• writing relevant and stimulating reports and papers
• sharing their own research findings

c/o The King's Fund: Making sense of integrated care systems, integrated care partnerships and accountable care organisations in the NHS in England

When I see a 'model' I ask myself; what does this mean in itself? What is its purpose? I also (invariably) ask how does it relate to, or how might it support the theory and application that might underpin h2cm?

In February 2018 The King's Fund posted this item on integrated care systems. It wasn't just the 2x2 figure that caught my eye, but the axes and the additional amber tab (figure 1). Pondering for a time I have transposed this to Hodges' model below figure 1. Beneath that, I've provided an explanation for the altered schematic; recognising that as with h2cm such models are idealised representations.

c/o The King's Fund

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group

Individual care management Care for patients presenting with illness or for those at high risk of requiring care services	Population Health (systems) Improving health outcomes across whole populations including the distribution of health outcomes [Improving population health outcomes requires multiple interventions across systems]
'Making every contact count' Active health promotion when individuals come into contact with health and care services	Integrated care models Co-ordination of care services for defined groups of people (eg. older people and those with complex needs)

INTRA- INTERPERSONAL:
Individual care management has been changed from care services and individuals to this domain, which conceptually preserves the original placement. In h2cm as can be seen the interpersonal domain combines the individual and humanistic. In the 4Ps this domain also includes 'purpose'. Whenever possible it here (individual motivation) that self-care and self-efficacy and staying as well as possible relies on the patient's awareness and education about their condition and level of health literacy. There is recognition now that children need some awareness of mental health issues and the law needs to protect what images and content youngsters are exposed to on social media. So, ultimately 'how I manage myself' has a major bearing on the 'whole care management enterprise.' The focus on 'high risk' also denotes a need for an assessment and one that is part of the move to parity of esteem in respect of physical and mental health.

SCIENCES:
I have shifted Population Health (systems)from population to this (physical) individual domain, on the basis that our research, as in, quantitative and qualitative, needs to be synthesized and then ultimately generalised - across populations. While complex systems cannot be taken apart it is from the sciences (including social sciences) that evidence-based practice flows. There should be a feedback loop here, research that also takes into account the multiple interventions across systems (the amber tab in figure 1) and the outcomes achieved.

POLITICAL:
The King's Fund's figure 1 stands as it is of course, but I have 'moved' Integrated care models most radically. If there is no organisation, rules, order, policy, procedures ... then things will NOT happen (as they should). Agreement is also needed on definitions for reasons of standards, measures and accountability. Such matters are political (even if ignored - kicked in the long-grass). For services that are evidence-based (as just mentioned in SCIENCES) we need when possible for health and social care policies to also be evidence-based (for reasons of efficiency, equity, effectiveness and equality). While we cannot 'break' complex systems we can break models; 'health care systems' need to break ("be broken whilst still in flight") in order to be transformed for the 21st century.

SOCIOLOGY:
Making every contact count I have placed in the h2cm's Sociology domain. To me this initiative remains with care services, but I have switched this from individual to group-population within h2cm. Health care education places constant emphasis (research, CPD, mandatory training) upon interpersonal - communication skills and this is where clinical and social care interactions and interactions ultimately count. It is here that trust, the 6Cs, unconditional positive regard ... are 'counted' in qualitative terms. If the psychological represents the theory of psych-social intervention, it is in the social outcomes and benefits were the practice is (truly) delivered. It is also here that partnerships are forged and social capital found.

In social care as an example, the integrated care model should politically permit - allow for a sufficiently skilled and remunerated work-force (socially valued?) with sufficient time to ensure that every contact really does count.

<>

Forty years in the NHS suggests that when ever 'integrated care' is being written and even spoken about, then the context should be indicated at the same time; so at least - integrated care^1-5 as above?

'integrated' as in -

• philosophy (ethics, morality, values)
• spiritual (values) (and part-whole of 1-5)
• political - policy, government funding
• economically - commissioning (models of care, sustainability)
• management
• care delivery
• team organisation
• community involvement
• patient involvement
• health literacy, health promoting

...?

Accessibility: apologies that there is no equivalent text to figure 1.

My source: https://twitter.com/TheKingsFund/status/1093556280248147969

"Integrated - care": What's in a word, or two?

This blog post was sat in 'drafts' since 28/01/2007 (yes, I know what that suggests). It concerns an issue, or more properly a theoretical and experiential aspiration in health AND social care that should in truth have provoked many papers for Hodges' model by now.

In the almost 18 years since, I wonder about the total number of papers devoted to this subject, the service's delivery, policy, outcomes, reviews and reports on integrated care? In nursing theory, philosophy and the start of many 'learned papers', it is customary to begin with a definition of terms. What happens when we divide 'integrated care' and first treat integrated and care separately? Does this aid our understanding? Do we divide and conquer? Is there a difference in results? Conceptual analysis would see us do both, and conduct a literature search.

In practice, (and clinical - especially) we often use words in rather lackadaisical way. Not surprising really, after all we've got a job to do! When pronouncements are made regards health and social policy I hear it as good intentions. I also reach for my soap box. It is often hyperbole, rhetoric. The same applies to the related idea and ideal(?) of holistic care, and person-centredness. I'm biased, of course, but I believe that Hodges' model can help to scope, and define these idealised features of health and social care (and education). As noted, people don't have the luxury of time to stop and deliberate on the precise meaning of the language they routinely use. As noted, at the end of the day - if it gets the job done then that's sound.

In a poll of words that are both much used and the meaning taken for granted integrated must be near the top for several reasons:

• its seniority: it has been around for decades.
• its scope across sectors and day-to-day life.
• our dependence on its fulfillment.

N-Gram suggests some possible insights into integrated and related forms of care:

https://books.google.com/ngrams/graph?content=integrated+care,holistic+care,person-centered+care&year_start=1800&year_end=2022&corpus=en&smoothing=3 

[Trying to embed, results in 1/3 white space at the bottom?]

It seems that integrated care [IC] has been a standing agenda item in health and social care media, education, the workforce, conference, exhibition and policy for several decades. Perhaps, things have calmed somewhat? So either IC is either very important, complex, a hard thing in practice or maybe it's all of these and more besides? IC is a undeniably a compound concept. Is this a cop-out though? You declare something 'compound' then sit back - job-done? I've suggested the same of threshold concepts in health (and probably other contexts?). Time will tell. In the meantime I have reflected on 'integrated care' across the domains of Hodges' model:

self

|

INTERPERSONAL : SCIENCES              

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

SOCIOLOGY : POLITICAL   

|

other

INTEGRATION OF: PRACTITIONER; Team; service; org... Philosophy* assessments threshold for acceptance into service (referral criteria) patient experience & engagement health education / literacies programmes spiritual research involvement	INTEGRATION OF: health record (e- or paper) location - team base care disciplines geographical area referral sources assessments - tools/scales data and statistics research involvement
INTEGRATION OF: HEALTH & SOCIAL CARE public engagement hospital  carer (parent/guardian) experience community services social care - NHS family experience public engagement in research Patient / Public Community Advocacy Treat demand :: Support prevention	INTEGRATION OF: funding leadership / management accountability - complaints (not the same thing!) outcome measures ILLNESS - PREVENTION / education self-care <> planetary care -  Sustainability assisted dying! palliative care! Public - Private - Voluntary Sectors Provider :: Purchaser [Systems] All-Party Parliamentary Groups^

*ethics, values.

^One aspect of so-called 'joined-up government'.

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

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

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

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

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

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

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

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

continued ... 

Call for Papers (i) Community Development and Preventative Care With Older People: New Values and Approaches

Editors: Fiona Verity, Frances Barker, Mark Llewellyn, Simon Read, and Jonathan Richards

Deadline for Abstracts: 15 March 2023
Deadline for Articles: 31 July 2023
Publication of the Issue: January/March 2024

Social Inclusion, peer-reviewed journal indexed in the Social Sciences Citation Index (Web of Science; Impact Factor: 1.543) and Scopus (CiteScore: 2.5), welcomes new and exciting research papers for its upcoming issue "Community Development and Preventative Care With Older People: New Values and Approaches," edited by Fiona Verity (Swansea University), Frances Barker (Solva Care), Mark Llewellyn (University of South Wales), Simon Read (Swansea University), and Jonathan Richards (University of South Wales).

The subject of this thematic issue is a prevention agenda in social care for older people, with a focus on community development values and approaches. Though current policy direction across many countries suggests opportunities for re-imagining how prevention may be best conceptualised, numerous studies have highlighted that there remains considerable confusion and disparity in how this plays out in practice. 

Prevention in social care can be implemented from mixed starting points, i.e., economic objectives, social justice objectives, and look different in practice. Included within this broad agenda are community development approaches and service delivery models driven by the needs of older people in their communities/localities, and collectively focused on common concerns and solutions.

This thematic issue will canvass questions such as:

• What can be learnt from social care preventative practices with older people that use community development approaches?
• How might older people be part of a reimagination of a preventative agenda in social care?
• What can social enterprises and cooperatives contribute to advancing a prevention agenda in social care?
• What might the marketisation of service delivery systems (e.g., individualised/direct payments) mean for community development solutions and approaches?
• How can prevention in social care be better conceptualised?
• What has been learnt from the impact of the COVID-19 pandemic on older populations to inform a prevention agenda in social care?

Authors interested in submitting a paper for this issue are encouraged to read the full call for papers:
https://www.cogitatiopress.com/socialinclusion/pages/view/nextissues#PreventativeCare

Abstracts welcome by 15 March 2023.

Kindest regards,
Mariana

Mariana Pires Social Inclusion Cogitatio Press 1070-129 Lisbon Portugal New issues (open access): Vol 11, No 1 (2023): Disability and Social Inclusion: Lessons From the Pandemic
https://www.cogitatiopress.com/socialinclusion/issue/view/332 Vol 10, No 4 (2022): Networks and Contested Identities in the Refugee Journey
https://www.cogitatiopress.com/socialinclusion/issue/view/331

My source:
EUROPEAN-SOCIOLOGIST list

Post ii: https://hodges-model.blogspot.com/2023/02/h2cm-relational-ontology.html

Putting 'care' in a holistic frame

How many frames do you need?

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

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

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

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

Additional suggestions welcome: h2cmng at yahoo.co.uk

1 in 3 will be older adults by 2025 in Japan

In June Dr Mayumi Hayashi described Japan's vision of 'total care' for its older population in HSJ. The article that prompts this post follows another with lessons for England.

Referring to a "2025 vision" this forward thinking has its roots in established systems of healthcare set up in 1961 and social care established in 2000 (p.25).

Care integration is not new as a fundamental issue in health and social care. It is for me a career legacy issue. As a student nurse it was discussed and debated, closely allied with multidisciplinary and holistic (joined up physical and mental health) care. Even now 37 years later it will drive many arguments and policy deliberations in the run up to the next election here.

Many nations are faced with stark demographics. As the population ages and works its way through wooden blocks, Rubik cubes, it is the population pyramid that takes on increasing significance.


Dr Hayashi lists the need for inclusion, integration and continuation of four components that are essential to the realisation of this vision:

• maximising the integration of healthcare and social care;
• promoting policies for prevention and outreach together with safeguarding;
• embedding supported living programmes and dementia friendly community initiatives; and
• addressing “late life specific” housing needs.

I have mapped these to Hodges' model below:

individual
INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

group

embedding supported living programmes and dementia friendly community initiatives	integration of health and social care
"late life specific" housing needs (integration of health and social care)	promoting policies for prevention and outreach, together with safeguarding

It becomes clear to see in Japan, China and other nations how telecare and smart homes have a role to play. Getting the basics of integrated care resolved firstly is the prerequisite whatever the culture.

Where achieved the integration of health and social care can act as a diagonal brace as it straddles two care domains. Perhaps the model also reflects the ongoing challenges of parity in esteem in mental health care and physical care; and the funding ambiguity for people living with dementia as opposed to other medical conditions?

In January 2014 the FT Weekend magazine also featured an article on ageing in Japan.

Hayashi, M. (2014) Japan's vision of a 'total care' future looks bright, Health Service Journal, 124, 6404, 25-27. 

FT magazine cover image:
https://www.facebook.com/financialtimes/photos/a.10150157857040750.297340.8860325749/10152119294570750/?type=1

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

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

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

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

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

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

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

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

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

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

 Reference to (Cronje and Fullan, 2003):

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

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

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

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

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

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

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

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

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

Many thanks to CUP for the copy.

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

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

Integrated Health and Social Care Data: GIS torch

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

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

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

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

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

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

It happens that:

data 'integration' 

also = data 'orientating'

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

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

Nurses - Ask 5 complimentary questions

I received an email from RCNi subject heading - 'Q. What questions are nurses asking?'

An invitation to sign-up and ask five free questions: https://rcni.com/ask 

Question 1

Is there a model of care, or nursing that encompasses the sciences, mental health, sociology and political domains of care?

Several models of care and nursing frameworks integrate diverse domains beyond purely biological aspects, encompassing scientific, mental health, sociological, and even political dimensions. These models emphasise a holistic approach to patient well-being, recognising the complex interplay of various factors in health outcomes.

• Social Model of Health: This model focuses on salutogenesis, examining what contributes to health rather than just illness, by considering broad social, economic, environmental, and cultural influences on an individual's well-being .
• Person-Centred Nursing Framework: This framework extends beyond individual biological health to include the person's intricate cultural context, family, spirituality, and life experiences, defining health as encompassing intellectual, social, and spiritual dimensions .
• Biopsychosocial Model of Care: This approach integrates biological, psychological, and social factors to address a patient's holistic needs, moving beyond the biomedical model's sole focus on physical illness .
• Dual Registration Degrees: Educational programmes for nurses and social workers combine life sciences with social work principles, law, and policy, preparing professionals to understand factors influencing health, social justice, structural inequalities, and anti-discriminatory practises .
• Multidisciplinary Team (MDT) Care Model: While not a nursing model itself, the MDT approach enhances patient care by integrating expertise from various professionals, including specialist doctors, nurses, psychology counsellors, dietitians, and pharmacists, to deliver individualised treatment plans and coordinate care .

Modern healthcare increasingly recognises the necessity of comprehensive care models that extend beyond traditional medical approaches. These integrated frameworks, including the social model of health, person-centred nursing, and the biopsychosocial model, provide a foundation for understanding and addressing the multifaceted nature of health, incorporating scientific, mental health, sociological, and policy-related aspects to improve patient outcomes. [Five references provided - hence poor formatting in transfer.]

Question 2

What model of care has the conceptual scope to critique parity of esteem in mental health nursing?

Critiquing the concept of parity of esteem in mental health nursing requires models that move beyond a purely biomedical focus to embrace holistic, person-centred, and culturally sensitive approaches. These models emphasise equality, social justice, and comprehensive care, addressing the historical imbalance between physical and mental health provision.

• Biopsychosocial Model: This model offers a conceptual framework to critique parity of esteem by considering biological, psychological, and social factors in a patient's health, aiming for holistic needs rather than just biological ones . It contrasts with the biomedical model, which has historically led to paternalistic decision-making in healthcare .
• Culturally Sensitive and Competent Care: Essential for critiquing parity of esteem, culturally sensitive care requires nurses to appreciate diverse cultures and adopt personalised, flexible approaches to mental health support . Culturally competent care, underpinned by equality and diversity principles, involves behaviours and attitudes that value patients' diverse backgrounds, improving satisfaction and outcomes .
• Person Centred Care: This approach is crucial for addressing the historical paternalism in healthcare, ensuring patients participate in decisions about their care and re viewed as individuals with unique experiences rather than just labels or symptoms . Recent mental health reforms, such as the Mental Health Bill 2025, aim to embed person-centred and equitable care further .
• Holistic Care: The Nursing and Midwifery Council (2024) emphasises assessing spiritual needs to provide effective holistic care, recognising that "seeing the whole person supports better care" . This aligns with the biopsychosocial model's aim to meet holistic needs and challenges the organisational and practice divisions between mental and physical healthcare .

Effective critique of parity of esteem in mental health nursing necessitates a shift towards models that integrate biopsychosocial, culturally sensitive, and person-centred approaches. These frameworks are vital for fostering equality, social justice, and comprehensive care, moving beyond traditional biomedical limitations to address the full spectrum of patient needs. [Eight references.]

I'll leave it there. I think. PJ

<>

My emphasis: In the spring I tried to engage and see if I could write a short article about Hodges' model for RCNi. After an online chat and following up by email, Hodges' model isn't for them apparently. It was kindly suggested that I try another journal.

I must improve my prompt writing.

I must improve my prompt writing.

I must improve my prompt writing.

I must improve my prompt writing.

Nurse, you must improve your prompt writing ...

Social Care in the UK BBC Radio 4 - starting Monday

On Monday BBC Radio 4 will begin a special month-long feature on the future of social care.

Two programmes Women's Hour and You and Yours will take what sounds a very in-depth and challenging look at current plus future social care provision and the issues that concern us all. Podcasts will be available.

They are very keen to hear of people's experiences as a carer or people receiving care:

Have you been affected by cuts in care provision?
Have you had to arrange care; what has the experience been like?
Do you have examples of best practice?
Tell us your experiences.

There are also recent reports to listen to:

• Reform of social care funding
• The half a billion pound scheme to help people arrange and organise their own social care.

• Provision is shrinking
• Councils cutting back on care.

• The unseen workforce
• Unpaid carers could save the government £87 billion a year.

• Transition Care
• Who pays for a disabled child’s care after 18?

• The future of social care
• You and Yours special

Bye for now...

Abstract [working] Hodges’ model as a mathematical object, a lens for social care and inclusion: category theory or category mistake?

There's a clearer idea now - an abstract - something to aim for in July:

Call for Papers - Community Development and Preventative Care With Older People:
New Values and Approaches

Not yet fully fledged, but then Spring [N] still beckons ...

Hodges’ model as a mathematical object, a lens for social care and inclusion:
category theory or category mistake?

Abstract

The health and social care sectors include disciplines that inevitably fall under the combined aegis of the sciences and humanities. This paper examines social inclusion across Snow’s ‘Two Cultures’. The method is interdisciplinary and descriptive utilising a generic conceptual framework known as Hodges’ model. Rather than Hodges’ model acting as a model of, and for care, here the model is used to investigate how social care can be better conceptualised. While mathematics is a mandated competency in healthcare, the subject, as for the general population, is one preferably left at school. The question posed is: What happens when Hodges’ model is treated as a mathematical object? A challenge for reader and author alike, the purpose is to seek new insights into social inclusion, value, values and development through a relational and dialectic strategy with diagrammatic support, also signposting future avenues of study.

Given ongoing demographic pressures for many nations, is there an additional danger of two intergenerational cultures? Is prevention enough; and can we improve understanding of what can be termed ‘legacy issues’ in health and social care? Can we simultaneously reduce the focus to Simmel’s ‘dyad’, and yet open new avenues for discourse and description? Can we expose the epistemological and ontological dimensions of social inclusion and the life (and death) experience of older adults? Inclusion and exclusion are implicit parameters within the model, its original purposes being person-centredness and recognition of health as political. References and resources, in the form of a template and bibliography are provided.

<>

Still much more to do ... heaven knows what the result will be - and do? Even as I keep the call 'in mind', it may not 'fit' the intended journal at all. Non-predatory, and no article processing charges is essential. Brevity, conciseness ... the order of the day. I can't even hide behind "A little knowledge is a ...": I know nothing - but I'm sure there is some-thing here and in #h2cm.

If anyone is interested in writing something quite different and challenging, then please get in touch. There may (realistically imho) be two-three papers here?

From the call:

"As Rapoport highlighted in the 1960s, however, translating the unified view of prevention associated with public health into social welfare is inherently problematic. This remains the case. Preventative social care and support necessarily operate in complex and dynamic systems, generally where knowledge of causation and the consequences are unclear, and an imaginative application of care needs and contexts is required.

Though current policy direction across many countries suggests opportunities for re-imagining how prevention may be best conceptualised, numerous studies have highlighted that there remains considerable confusion and disparity in how this plays out in practice."

I have held on to the following article from Computing, March 19th 1987 and still learning from Durham and colleagues' journalism:

 "Sometimes a highly abstract, unifying mathematical theory underlies a whole set of scientific or engineering subjects. ...

Category theory is one such subject. Sometimes described as an algebra of algebras, it plays a unifying role in discrete mathematics. Discrete mathematics is a general heading for all the mathematical subjects which deal with jumpy, lumpy entities. Most of the mathematics used in the theory of digital computing is of this kind.

Another unifying subject, homology theory or differential topology, is less well known to computer scientists ... Homology theory is a unifying theory in continuous mathematics, which is the name given to everything that deals with smooth and stretchy entities.

Durham, T. (1987) Over the Horizon.
Working out the algebra of algebras, Computing, 19 March. pp.28-29.

[According to Bowden,] 'category theory and homology theory are fairly close things. The big difference is that homology theory includes information about the topology of the space that it describes.

Category theory is just about information. Homology theory is about information and structure, the structure of something.'

Space itself is not something we usually think of as possessing structure. But space does impose limitations on the kinds of behaviour that can be exhibited by things like electric fields and currents, or electromagnetic waves." p.28.

Durham, T. (1987) Over the Horizon. Working out the algebra of algebras, Computing, 19 March. pp.28-29. (Sorry no issue / volume nos.).


See also:

Call for Papers (i) Community Development and Preventative Care With Older People: New Values and Approaches

Call for Papers (ii) Community Development and Preventative Care With Older People: New Values and Approaches