Silver bullets & Magic wands: NHS shamed over callous treatment of elderly

There are none:

Silver bullets or magic wands - that is.

This ongoing news is very distressing for everyone.

I attended a sign-off mentors meeting yesterday afternoon and everyone takes this still relatively new role (outside midwifery) very seriously. It's a very parochial and a biased perspective, but I do believe that in teaching h2cm to the students that I come across they are better prepared to nurse, be a nurse and indeed question what nursing is to them and the public at large. This applies to all qualified nurses who try their collective utmost to instill positive values, safe practice and professional attitudes of the highest order.

Through h2cm I try to provide students with a reflective gravity assist.

As a student I recognised the gravity of what I was doing, or at least trying to do.

30+ years later I still need to do that.

If a student does not recognise the presence of gravity in the care environment, they cannot be effectively guided, navigate their way through it, warn of pending problems. They may not be able to work as an effective member of a team.

Collisions will happen. At the end (and start) of the day even if the student is sensitive to gravity waves and can snatch a Higgs boson out of the ether: mistakes do happen. Non-fatal though we pray, the public is very forgiving when the best efforts to deliver basic nursing care are made and that is the clear intent. This is why we are told if someone makes a complaint deal with it as quickly as possible.

The real deal isn't 'new'. It's the social and political contract called 'NHS'.

Without the necessary gravity assist students may not see, and may not hear what they should be sensitive to. Examples publicised in reports such as this (15 February 2011), by Health Service Ombudsman Ann Abraham shame us all.

Self awareness is a complex thing (rapport, reflection, empathy, emotional intelligence...). Self awareness is not a given. You have to check the switch is there, then be able to help them switch it on, and validate it - for the good of all. Failing that? Well - being prepared to fail a student too if you have to.

Information Revolution and Greater Choice and Control - webchat Nov 9

Put your questions about the Information Revolution and Greater Choice and Control direct to Andrew Lansley, Secretary of State for Health, on November 9 at 1.30pm.

People can ask questions in advance by emailing:
informationrevolution AT dh.gsi.gov.uk - or -

 by Tweeting their question, using the hashtag #inforevolution.

The webchat will be available from November 9 at www.dh.gov.uk/informationrevolution and you can watch the live Q&A on screen, ask questions and leave comments. We will also be tweeting Andrew Lansley's answers and the comments we receive. A transcript of the webchat will be available on the website after the event.

I would be grateful if you could bring this to the attention of any interested individuals or groups.

With best wishes

Anne Cooper
National Clinical Lead for Nursing
Office of the Chief Clinical Officer
NHS Connecting for Health
anne.cooper AT nhs.net
http://www.connectingforhealth.nhs.uk
NHS Connecting for Health supports the NHS in providing better, safer care by delivering computer systems and services which improve the way patient information is stored and accessed.
Additional link:
http://conversations.dh.gov.uk/2010/10/17/home/
My source:
British Computer Society Nursing Specialist Group

England: The future of the National Programme for IT

Department of Health - 09 Sep 2010 12:32
The future of the National Programme for IT
-----------------------------------------------------

A Department of Health review of the National Programme for IT has concluded that a centralised, national approach is no longer required, and that a more locally-led plural system of procurement should operate, whilst continuing with national applications already procured.

http://www.wired-gov.net/wg/wg-news-1.nsf/lfi/415392

My source: Wired-GOV

Frontline First campaign: cost-saving innovations whilst improving patient care

Dear Peter,

Innovations are the key to saving the NHS money. Every day, nursing staff on the frontline are finding new and better ways to deliver patient care.

As one nurse recently wrote to us:

"Without a working knowledge of clinical care provision how can ideas be practical and ensure quality of care is maintained? Nurses are in a prime position to look at care provision to identify better ways of working and therefore identify cost savings without sacrificing patient care and experience."

As part of our Frontline First campaign, the RCN is collecting examples of cost-saving innovations at NHS services across the UK. What nursing solutions have you seen in your workplace that could achieve savings without sacrificing patient care?

http://generalelection.rcn.org.uk/innovation

There are two ways the NHS can find billions of pounds in efficiencies:

discover innovative ways to save money
or
make cuts to staff and services

Every day, UK nurses are helping to devise and implement cost-effective solutions saving their employers money and helping to protect jobs. We've already heard from dozens of nursing staff who told us about innovations in their workplace, from changes to day-to-day practices to
whole new ways of working.

Please take a moment to report any cost-saving innovations you've seen at the workplace:

http://generalelection.rcn.org.uk/innovation

Thanks for speaking up and helping to protect patient care.

Yours sincerely,

Janet Davies
Director of Nursing and Service Delivery

My source:
Subject: Improving patient care
From: "Janet Davies, Royal College of Nursing"
Date: 04 August 2010 16:53:30

The cost of anholistic care

Being 'holistic' in care delivery can seem anachronistic, paying homage to new age thinking and practices. Paradoxically, being holistic in nursing can also mimic an admin exercise that amounts to ticking the boxes. So for Hodges' model - have you visited all the care domains?

• INTERPERSONAL care ✓
• POLITICAL care ✓
• PHYSICAL care ✓
• SOCIAL care ✓

Advanced discharge planning is many things:

• idealised care;
• standardised care;
  
• evidence of policy, targets;
• sign posting for the care pathway;
• an essential care aspiration that emphasizes the individual's strengths and resources.

As Wimbledon once again reaches its climax we observe that a fast serve needs to be prepared for a fast return of serve.

Last month 23 June, 2010 The Guardian, Society Guardian featured The high cost of return:

Hospitals could lose up to £1.5bn of NHS funding a year because of the government's decision to penalise those where patients return within 30 days of being treated. That is the conclusion of research conducted by health analysts Dr Foster into the potential impact of the tough new policy. It warns that NHS trusts face large potential losses, the biggest could reach £28.7m, as a result of the new approach. In all, 146 acute, specialist and mental health trusts could lose out. Denis Campbell, p.3.

Apparently -

Andrew Lansley wants to force the NHS to provide better care in hospitals and mental health establishments, to keep treating patients there until they are fit to leave and to work more closely with community-based healthcare professionals, such as GPs and district nurses, to ensure sick people receive more help with their convalescence after discharge and so are less likely to return to hospital. "Making hospitals responsible for a patient's ongoing care after discharge will create more joined-up working between hospitals and community services and may be supported by the developments in re-ablement and post-discharge support," he says.

I hope in reading the above you have a sense of my frustration in that the health career model can encourage and support timely reflection that can help achieve holistic, integrated - coherent care.

If the model was shared
- a common resource -
across disciplines and available to patients and carers
then the potential benefits (and savings?) are even greater.

Clinical Informatics in the North West – the start of a new era!

This meeting is free and open to all, but please notify your intention to attend to: phil.paterson at bcs.org.uk
Please forward this email to colleagues who may be interested ...
============================================

Thursday, 1st July 2010, 6.15pm light buffet, 7pm talk
Clinical Informatics in the North West – the start of a new era!
Speakers: Dr Andrew Coley, Dr Asad Sadiq, Mr Bibhas Roy, Dr Sydney Schneidman, Dr Rhidian Bramley, Dr Amir Hannan
Organiser: BCS Health Northern
Venue: Manchester Conference Centre, Sackville Street, M1 3BB
Directions: www.manchesterconferencecentre.co.uk/location/

HICAT - a new approach by NHS Northwest – is this the start of a new era for Clinical Informatics in the region?

The HICAT are the Health Informatics Clinical Advisory Team at NHS North-West:

• Dr Andrew Coley is the Senior Clinical Officer.
• Dr Asad Sadiq is a consultant psychiatrist and Mental Health IT lead.
• Mr Bibhas Roy is an orthopaedic surgeon and Secondary Care IT lead.
• Dr Schneidman is an A&E consultant and Lorenzo clinical IT lead.
• Dr Bramley is a consultant radiologist and Diagnostics IT lead.
• Dr Hannan is a GP and the Primary Care IT lead.

We will describe the HICAT Mission Statement and the principles used to help deliver the next generation healthcare using IT to help deliver care. We will describe what we are doing for Clinical Informatics across the board in the North West and what impact we expect from the initiatives and efforts to have on clinical practice in the region, both short term and long. We will explain how our work will benefit patients. The speakers will be happy to discuss our plans and expectations with a knowledgeable audience and to take note of helpful feedback.

This talk should appeal to all with an interest in the use of Informatics by clinicians and the impact that can have on the quality and safety of patient care and the efficiency of services provided through the NHS.

Everyone welcome to attend this FREE event
but please notify your intention to attend to
phil.paterson at bcs.org.uk

If you have any queries on anything BCS related then please do not hesitate to contact me. Also, if you know of any IT events that would be of interest to fellow members, then please let me know.

Regards,
Andrew Mohan,
Chairman,
BCS Manchester Branch.
Andrew_Mohan at bcs.org.uk

www.bcsmanchester.org.uk
The Branch's website has details on all of its events and links to the other BCS groups that operate in the Greater Manchester area.

http://twitter.com/bcsmanchester

Prognosis for NPfIT remains uncertain - 21 May 2010 - Computing

While the coalition government’s Programme for Government reiterates previous commitments around technology and civil liberties, IT procurement and broadband rollout, it is noticeably silent on the future of the NHS National Programme for IT (NPfIT), with no mention of Conservative promises prior to the election to dismantle the "NHS supercomputer" or the Liberal Democrats' pledge to scrap large parts of the NPfIT.
...

Prognosis for NPfIT remains uncertain - 21 May 2010 - Computing

CARE: Whether NHS or Social Care ...

C	A
R	E

Whether -
NHS or Social Care^*
what
C.A.R.E.
is crying out for is a
universal, shared, holistic and wholly integral conceptual framework.
Then and only then will the currencies^# of care be
transferable, translatable and transforming!

* Private, 3rd sector, religious order, or social enterprise ...
# Currencies does not just refer to finance.

BBC R4 Friday 8th Jan: NHS Punters Speak Out

This programme (episode 1) is on BBC Radio 4 on Friday 11.00:

With the help of dissatisfied NHS patients, Liz Barclay asks if the growing popularity of online feedback can really make a difference to standards of health care and treatment.

The culture of customers offering brickbats and bouquets to service providers has now extended beyond hotels and coffee chains to the NHS. Hospital rating websites invite patients to grade their hospital stay out of five stars, and to leave comments about the care they received.

Liz invites NHS patients who have used one of these patient rating websites to discuss their experiences and puts their points to the hospitals where they were treated.

She asks if the idea of online feedback can be really be applied to our health service and if it can genuinely improve standards of care. Critics suggest the sites are merely window-dressing and that NHS patients are not 'consumers'. Some health professionals claim that the sites can easily just become places where personal scores are settled against NHS staff.

<->

Introductions to Hodges' model for different audiences -

"Patiency" (person-centred care)	Health, Social Care professionals (inc. all in a student capacity)
The Public, Citizens	Managers, Policy Makers

These introductions will be re-written for the new website and represent possible projects for volunteers / students...?

New education bodies created to promote innovation in the NHS

Health Innovation and Education Clusters (HIECs)

New bodies that combine the expertise of industry, health and education have been formed to promote innovation in the NHS, Health Minister Ann Keen announced today.

Health Innovation and Education Clusters (HIECs) are cross sector partnerships between NHS organisations, the Higher Education sector and blue chip companies such as BMW, GlaxoSmithKline and BT.

Through joint working HIECs will provide professional education and training and promote innovation in healthcare by speeding up the adoption of research. They will also provide professional education and training.

Over £11 million will be given to the 17 successful applicants that were chosen by an Independent Award Panel Chaired by Sir Alan Langlands, Chief Executive of the Higher Education Funding Council for England.

Health Minister Ann Keen said:

“HIECs are special partnerships that draw on the wealth of skills and experience of their members to improve the development of high quality care and services by quickly bringing the benefits of research and innovation directly to patients.

“These projects will attract and encourage the best talent who can recognise and rapidly adopt new and innovative healthcare and treatment.”

Independent Award Channel Chairman, Sir Alan Langlands, said:

“The standard of applications has been really high and we have been impressed by the high profile names that want to be involved in improving NHS care.

”HIECs will drive up quality standards in education and training and ensure fast adoption of innovation for the benefit of local people.

“The flexibility of the HIEC model means that the vision of each one is appropriate and specific to its local area.”

The HIEC concept was originally developed by a group of leaders from the NHS and university sector during the NHS Next Stage Review as one of the ways to deliver high quality healthcare.

Ends

For the full press release click here.
(Includes details of the HIECs per Strategic Health Authorities)

My source: NHS-HE-FORUM at JISCMAIL.AC.UK

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 -
(the latter - part of Bristol University Hospitals NHS Foundation Trust)

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, Tel: 0778 6705 955 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:
http://www.connectingforhealth.nhs.uk/events/2538

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

Membership and attendance at all Faculty events is free of charge.
To apply for membership go to:

http://www.espace.connectingforhealth.nhs.uk/community/nhs-faculty-HI

(many) Care Transitions and The Little '-' That Could

Some people looking at Hodges' model may believe that the model perpetuates the dichotomies of old:

Human --- Machine
Individual --- Group
Sick --- Healthy
Supply --- Demand
Home --- Hospital
Self care --- Nursing care

In the 1990s as a community mental health nurse I was involved with a group of general nurses looking at ways of improving:

• discharge planning
• continuity of care

These issues remain and with the dichotomies of care above we can see how Hodges' model can assist our thinking and planning about transition. Not just one transition, but several.

This past week I was fortunate to attend one of a series of workshops -
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, Leeds, UK

Organised by the UK Faculty of Health Informatics and the BCS Socio-Technical Group

The event was very good, stimulating and challenging. In the closing debate the appeal of 'socio-technical' and how to market a much needed joined-up approach in health IT came down at one point to the difference between:

'socio-technical' and 'sociotechnical'

In trying to find an alternative title, the hyphen was lost, and whilst it is not a crucial issue - for me that hyphen represents the axes of Hodges' model. Hodges' model acts as a high level aide-mémoire and that little hyphen can perform the same trick. The hyphen reminds us of the differences. The dichotomies that need to be navigated and negotiated in our dialogues about care AND caring. These are most evident in transfers and transitions (after all - "getting out of bed is a risk").

There are mini and macro transitions. Care pathways are not yellow-bricked unbroken splines from cottage to cottage hospital. They should be tortured if they do reflect person-centered experiences and needs.

Some transitions are process laden and repetitive, such as drug administration and must be protected - free from interruption. Although grounded in a social exchange of (correct) identities: a registered nurse, the right patient, right drug, right dose, right duration and right time these can be framed within the SCIENCE domain. That is where (for me) the conventional 'drug round' can be found. Counselling is another transition (if effective it also moves people on). Counselling can be found in the INTRAPERSONAL domain - close to the border with SOCIOLOGY.

Other transitions and transfers are more involved:

• person's home to attend day care (for the first time!)
• person's home to residential home
• hospital ward to home
• home encounter with the crisis team
• telecare consultation
  
• ...

Care is constantly passed hence the need to write and record. Passed from -

person-to-person
team-to-team
team-to-carer
time-to-time
discipline-to-discipline
self-care

This is the outcome that is sought. Ultimately passing responsibility back to the individual and when applicable their family. Having formal integrated care pathways is one thing, but they are never truly continuous, clear and true. And as they say crossing bridges you may have to break step and surely different disciplines march to different tunes? Today though the most audible tune must be socio-technical. ...

Additional link: The Little Engine That Could

Image source:
Drug round tabard http://internet-workwear.co.uk/acatalog/Drug_Round_Tabard.html

Nursing management consultants & being optically challenged

Being somewhat optically challenged at present (need new glasses!) I have nonetheless managed to sort some old papers. I came across a more recent news item from the Nursing Times 8 September, p.3 by Sally Gainsbury. What use is late news?

I raise this now because public sector health finance provides the impetus, so this subject is perpetual motion. It is also reported ongoing by HSJ. I refer to this not to take sides, but to acknowledge that politically there is a need to make decisions and find the required £20bn efficiency savings. The news line reads:

DH told 1,500 district nurses could go with no damage to patient care

The item focuses on a report for the DoH produced by McKinsey management consultants. The government has distanced itself from the reports recommendations, but the need for action remains. The Nursing Times news item includes two clocks (with the total nursing time available depicted as 1 hour) that break down the time spent on patients on general medical wards and community wards. While this is just one aspect of a report of more than 100 pages, the findings are of great interest. ...

GENERAL WARD: 15 mins Physical care; 10 mins Psychosocial care; 35 mins non-patient care.
COMMUNITY NURSES: 17 mins Antenatal activities; 13 mins Postnatal; 27 mins npc; 3 mins other and classes.

I have not worked on a general or mental health ward for a long time, but I was surprised to see the time spent on patient being less on the wards than the community - 25 minutes v. 30 minutes. There are challenges in comparing different clinical areas, but I would have thought travel, administration - including paper and e-record data entry would impinge much more on community. On mental health wards there has been an effort to free nurses to nurse - with protected time? So pause for thought there - but only for a moment....

Thinking about community - providers will no doubt vary in the way (district) nursing teams are organized, the location of their bases and how that impacts average journey times. Districts also vary in the way the population is distributed, especially those neighbourhoods were social and economic deprivation is higher and need may be increased.

This is why access to GIS (geographical information systems) by team managers and members is crucial and should not just be some esoteric academic and intelligence artifact. While we should not under estimate the potential use of GIS to inform inpatient care, it is community services that are best placed to benefit from improved intelligence, planning and decisions.

There is a long thread here and the politicians of all parties know it leads into the forest ....

For example, much can be read in a single word "... McKinsey found that only 15 minutes was on the "physical care" of patients while the remaining 10 minutes went on "psychosocial" care, such as talking to patients." I hope that 'only' does not suggest that talking to patients is 2nd best, even though basic nursing care is the factor in the news regarding public perception of the quality of nursing care. This is a constant problem as we move to outcomes. Are we going to have patients saying - "The physical care was excellent, but I felt like I was in a religious retreat. Nobody hardly spoke, explained anything." Patient education, self care, staying well, the effective use of medication and treatment ... is predicated on psychosocial engagement.

What is also very troubling is that cost savings might mean detrimental changes in the skill-mix; the ratio of qualified to health care assistant staff. Some of the best 'natural' nurses I have worked with and work with today are dedicated HCAs. They have a major role and contribution to make, but if safety gains are to be maintained and improved upon then 'safe' skill-mix is critical.

Given the present demographic, 'nurses' are not new to cuts. In the public sector cuts are part of that perpetual motion I mentioned at the start. What frustrates is working on the holistic care mosaic to produce something that is safe, effective, quality care; then as we come to finally add the threads - clinical supervision, PDP, health IT, outcome measures, public engagement we have to unravel and start again.

Image source used with permission and thanks: D L Ennis. Visual Thoughts http://dlennis.wordpress.com/

Innovation and the 'middle' in NHS computing

Let's start with a quote:

Information systems are no longer associated mainly with data processing; they are increasingly seen as a management tool and an aid to action. This means that the costs of failure are much greater, and these costs are incurred when expensive systems are not used or are inadequately used. Surveys have shown that in as many as half of systems there are large gaps between users' expectations and the system's performance.

When do you think the above was written?

Here's the reference:

Mumford Enid (1991) Need for relevance in management information systems: what the NHS can learn from industry. BMJ. June 29; 302(6792): 1587–1590

1991: quite sobering really.

Previous - part-time - work reviewing data standards proposals focuses the mind in terms of the role of standards in interoperability, service impact and other essential assessment qualities. As the NHS has sought to implement standards as with the National Programme for IT you are also aware of the clamour for creativity and innovation. Innovation is there in the title of agencies.

I have long pondered about the extent to which - like Nature and vacuums - standards abhor innovation and creativity. How much is the 'standard' about doing things by the 'book' ... page 57 : para.3 ...

My eye caught the viewpoint piece in this week's Computing -

If you approach the world positively, a downturn is a good time for innovation. The shortage of people and money can create the pressure that leads to creativity. There are three areas where action will help organisations succeed in exploiting IT to enable business innovation:

Kick out Prince2

What more is there to say about innovation and Prince2? The focus of the Prince2 project management methodology – on organisation and control, and defining what to deliver before you have begun – is death to innovation. It is a bad solution trying to solve the wrong problem. It takes the IT profession in the wrong direction if we want to contribute to business innovation. It has to go. The agile development movement provides much stronger foundations for succeeding with projects that result in business innovation.

Ashurst, Colin, Viewpoint: How to use IT to enable innovation, Computing, 5 November, 2009.

Of course there IS a world of difference between information standards and project management standards, but there is no escape from the need for (effective) management of transition and change WITH business continuity. Within that management - engagement approach (as per agile) -

+++++++ socio-technical +++++++

- perspectives, as highlighted by Mumford (and others) all those years ago must have a place.

Additional links:

Computing, Letter of the week, UK is cursed with an anti-innovation culture, 5 November

BCS Sociotechnical Specialist Group

eHealthNews NHS Bury Primary Care Trust Goes Live with iSOFT Lorenzo RC 1.9

Basic Nursing Care @ the X-roads?

Basic nursing care:

It sounds straight forward enough doesn't it?

And yet according to news today here in the UK (The Independent) some nurses it seems fail to deliver safe, effective and efficient care of the required standard. This sorry news was reported by The Patients Association. The cases cited are upsetting and represent the care and behaviour of a minority of nurses, although there was a debate as to the 'true' numbers the report findings may represent.

The worrying point here though is this highlights not just a lack of basic nursing skills and knowledge, but a blatant disregard for the needs of vulnerable individuals and a sense of humanity. Even with NVQ's in the UK and equivalent programmes elsewhere when it comes to high standards of care we can take nothing for granted.

A commentator on the radio asked if the nursing profession is at a crossroads?

It is.

This crossroads is also a target that nursing must hit -
not most of the time -
but every time and for every person.

In truth of course, all professionals should constantly find themselves at the crossroads.

So, where next for nursing and who has the map?

Original image source:
http://www.thesignlady.net/signs/images/warningsigns/W2-118X18CrossRoad.jpg

Memo to America's Right

Please do not treat the UK's NHS as a
political football and yes I mean 'football'
(there's enough of that o'er here without
you sticking your ten cents worth in!).

Do not underestimate the -
knowledge, skills, creativity and dedication -
of its staff, or how it is perceived, valued and loved by its People.

Yes, the NHS is not without its faults (it is also true we are not all Angels), but amid the signs of wear, the aged splinters -

we do not forget the middle,
the constant called change,
or the challenges that beckon in the 21st century.

Image source: Allproducts.com

Additional links:

BBC News Bloggers debate British healthcare

New York Times 2008 Paying Patients Test British Health Care System

NHS fundamentals: a conference + some fundamental thoughts...

I received notice from the Health Service Journal of the following conference:

Fundamentals of the NHS

Get up to date with the latest changes in NHS structure, policy and reform

25th November 2009
Manchester

Does the rapidly changing world of the NHS leave you feeling overwhelmed? Do you need a solid introduction or an up-to-the-minute refresher to firmly underpin your understanding of all the recent policy changes, reforms and agendas?

Whether new to the world of the NHS or simply in need of clarification over recent advancements - this essential Health Service Journal learning forum provides a whistle-stop tour of where the NHS is now and where it is heading in the future. ...

<->

The HSJ's NHS focus is clear just from the snippet above.

As to the 'fundamental' in health care, well, I still wonder how (since August 1977*) with all this talk of:

• multidisciplinary care
• integrated care
• continuity of care
• holistic care
• individualised care

- there is still NO fundamental model, NO universal conceptual framework applicable for the whole of health and social care. Yes, there is the nursing process, CPA, SAP, CAF. ... We have and benefit from - it must be said - the NHS Core Values, Patient Charters. ...

But where is the conceptual primer, the underlying substrate that can be applied implicitly or explicitly, whatever a person's age, discipline, ethnicity, beliefs, employment, financial means, legal status, location. ...?

More than ever we need a model that is not just the preserve of nurses and their colleagues, we need a conceptual tool that is part of education programs world wide: helping to preserve individual, family and community in health and well-being.

Conceptual models are so abstract. Strange then that a model - simple, basic, underlying, fundamental - is needed that is much more substantial than a chapter in a book, or paper in a journal.

This conference is in Manchester.

Manchester - where Hodges' model was first taught.

For the sake of future health - a universal model should be one of the fundamentals:

our tools
and values
should indeed deliver
right on the doorstep.

* As a Nursing Assistant awaiting entry to Warrington School of Nursing, Winwick Hospital.

Please note: This blog post is not sponsored nor
endorsed by HSJ, its publishers, or the event sponsors.

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: http://www.ucl.ac.uk/openlearning/documents/scrie2008.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

NHS data breaches: the 'cogeography' of who and where?

Computing this past week featured an item (extract below with link) -

Five more NHS trusts involved in serious data breaches
Written by Tom Young
Computing, 17 Jul 2009

Privacy watchdog the Information Commissioner's Office (ICO) has found five more NHS organisations in breach of the Data Protection Act.

The Royal Free Hampstead NHS Trust reported the loss of an unencrypted CD initially thought to contain medical treatment details of 20,000 patients from the hospital’s cardiology department.

Chelsea and Westminster Hospital Foundation Trust reported the theft of an unencrypted memory stick containing 143 patient details including sensitive medical information.

And Epsom and St Helier University Hospital NHS Foundation Trust has been storing hospital records insecurely for nearly two years following data being transferred between hospitals. ...

Straight away reading this I thought of my previous post about cogeography and commented accordingly (which registered twice - oops!). In light of the previous post here's that comment with some additions....

Such events merely (without trivializing) highlight the human capacity to ERR big(gish) time. Is it not possible for tech to help? If info systems through to mobile devices had a sense of where they are and their status as carrying sensitive data recognised through digital IDs - plus additional meta-dynamic data, then 'cogeographic awareness' might result?

I blogged about this with ref to conceptual spaces.

This would be an artificial example and would make it possible for data previously designated as confidential, sensitive, - HOT data if you will - to self-destruct, 'e-vaporate' if it found itself beyond a given combined virtual or physical environment be that hospital, Trust boundary, SHA, or National border...? This capability already exists no doubt in the security services (although sometimes you wonder) or as suggested in the realms of 'MI' and '007'.

Cogeographic or (cogneographic) may be a neologism and seeks to conjoin the cognitive (cognition) involved in defining, representing and using concepts in conceptual spaces; AND the finding that knowledge is invariably situated - that is knowledge has a geography.

Copies of NHS and social care
data could - should - MUST
have a geography too...?

Another comment rightly questioned the ability to put personal data on
CDs and other media in the first place. Amid the emergence
of renewed debate about the future of e-health
records, clinicians may have a professional
duty to demand cogeographic
properties no
less ...?

Image source: http://www.tapintoquality.com/facts/glossary-d.html

Happy Anniversary 20th July!!

Additional links: Political domain

Open for applications: USA based Quality Improvement Fellowships

Dear NHS W2tQ readers,

Do you know of a clinically qualified NHS leader with a proven track record in quality improvement?
Do they have the potential to drive change and promote quality at a high level?

The Health Foundation's Quality Improvement Fellowships are now open for applications. Fellows will have an opportunity to spend a year in the USA working with the Institute for Healthcare Improvement (IHI) based in Cambridge, Massachusetts, studying the best international practice in quality improvement.

The fellowship includes:

• participation in the clinical effectiveness programme at the Harvard School of Public Health
• a personalised programme of taught and interactive learning at IHI
• active participation in the leadership teams for key IHI initiatives
• significant involvement in authorship and publication of research and improvement work
• strategic planning sessions to enable effective integration of a fellow's learning to better meet the needs of their home organisation

The Health Foundation will provide fellows with an allowance to support relocation, travel, visa and and USA healthcare costs, as well as replacement staff costs for their employing organisations.

Who can apply?
We are looking for senior NHS leaders who are clinically qualified and have a strong track record of achievement in the field of quality improvement.

Applicants must have the enthusiasm and potential to promote quality improvement nationally and to build organisational capability to drive quality improvement to higher levels of performance.

Please pass this information on to individuals who may be interested in applying.
The deadline for applications is 16 October 2009.

Visit Quality Improvement Fellowships or email awards@health. org.uk to find out more.

My source: Mental Health Informatics - SIG RCPsych via Stephen Thornton, The Health Foundation.