Older People with High Support Needs want more Choice and Control in How they Live their Lives

A new paper has been published today (to coincide with International Older Person's Day) by the National Development team for Inclusion (NDTi) to share findings from a two year project which is aiming to increase the voice, choice and control of older people with high support needs. This includes older people living in care homes and those living at home with a lot of support.

Around 1 million older people live in residential care and sheltered / supported housing. Older people want to have a broad range of options for their care and support, yet there seems to be widespread reluctance to develop and adopt new ways of thinking about and working with older people with high support needs. Traditional forms of service provision still dominate. As our society ages, the way we think about ageing, older people and disability needs to change to reflect with this demographic reality and the expressed wishes and desires of older people themselves.

The paper is from a 2 year project taking place in 3 local authorities in the South East Region of England. Local organisations and communities are working together to ensure options and opportunities are developed which support independent living and increase voice, choice and control for older people with high support needs. (See notes to editors for more information on the project and NDTi). The project is supported by ODI as one of the commitments in the Independent Living Strategy, which states:

Older disabled people must have the same options and opportunities for independent living as anyone else and the Strategy contains a number of commitments which will help achieve this goal.

The paper is :

- 'South East Regional Initiative on Increasing the Voice, 

Choice and Control of Older People with High Support Needs - Emerging Lessons'.

It summarises the findings to date from this project and has been written particularly to inform local authorities and partners about the work, to help them to achieve better outcomes for older people as well as best value in the use of public services and resources.

The paper highlights findings and messages about the priorities for ensuring older people can exercise greater choice and control over their support, including where and how they live. It also identifies some of the issues and barriers which get in the way of this happening.

A summary of the paper has been produced as an 'NDTi Insight' - part of a series of 2 page highlights of the most important learning from pieces of work carried out by NDTi.

This is available at the NDTi website on the following links:

www.ndti.org.uk/publications/ndti-insights/ndti-insights.aspx

Alternatively try: http://snipurl.com/181twm

Helen Bowers, Head of the Older People and Ageing Programme at NDTi and author of the paper said:

"The same level of commitment given to transforming health and social care is now required to transform expectations and experiences of older people with high support needs across all public services, including in residential care. Current debate in this area tends to focus on funding pressures and extending traditional services, rather than how we conceptualise, design and deliver support that promotes citizenship and transfers power from professionals and organisations to individuals, their families and friends."

To find out more, contact:- Helen Bowers, Head of Older People & Ageing Programme, National Development Team for Inclusion Magnolia House, 21a Stour Road, Christchurch, BH23 1PL Tel. 01220 471423 helen.bowers at ndti.org.uk
or
Rob Greig, Chief Executive, National Development Team for Inclusion - Head Office, Montreux House, 18a James Street, West Bath, BA1 2BT Tel: 01225 789135 rob.greig at ndti.org.uk

My source:
The Choice Forum

Community Informatics and Older People: A Call for Papers

This call for papers is for a special issue of the Journal of Community Informatics on ICTs and Older Persons. Examples of activities using ICTs for support of the elderly in Less Developed Countries are particularly encouraged.

Community Informatics and Older People: A Call for Papers

If you have an article (or an idea for one) contact
Geneloeb Aronin, Ph.D. by July 15th geneloeb at gmail.com.

The peer-reviewed Journal of Community Informatics (www.ci-journal.net) is inviting submissions of articles for a special issue on community informatics and elderly. Community Informatics is concerned with the use of Information and Communications Technologies (ICTs) to enable and empower local communities including for personal, social, cultural or economic development of and within communities.

There has been a recent a surge in the use of ICTs involving the geriatric community, elderly and those associated with their care or needs. This activity has taken several forms, including: the elderly communicating with others by computers and other technologies; technical devices used to monitor needs or send warnings; information from governments is now available online including training programs for older people to access such information; and the use of ICTs to support community caregivers for the elderly, self-help and self-care for the elderly, and as an infrastructure for the development of virtual community connections among the elderly and between the elderly and others are burgeoning areas of community care and in some places part of the public health system. We would very much welcome explorations and systematic (and other) accounts of these processes and others.

Now is the opportunity to examine model practices of ICT to benefit communities of older persons and their families, to support their care and their caregivers within communities and to suggest new ways in which ICTs can be used to maximize community based initiatives and opportunities.

Articles in the planned issue will focus on the use of ICTs for personal, social, cultural or economic development of, and within, communities for the elderly. We would look to include paradigms for reaching out to elderly people who can not yet access ICTs for these benefits; demonstrate improved technical frameworks for community based ICT applications; show the effectiveness of applications and new ways technology may be applied. Examples of activities using ICTs for support of the elderly in Less Developed Countries are particularly encouraged.

What other ideas and suggestions do you have? Email the co-ordinator for this issue,
Geneloeb: geneloeb at gmail.com

With Best Wishes for an Even Better Day

Gene-loeb
Gene-loeb Aronin, Ph.D.

Development of a robotic health assistant to the management of malaria among nomads

The following very interesting item was posted on the Healthcare Information For All by 2015 [HIFA2015] list (I have added some formatting and links).

Dear All,

We received a Grand Challenges Exploration grant (a Gates Foundation initiative) for the development of a robotic health assistant to the management of malaria among nomads whose access to health service has always posed a concern. A robotic health assistant was constructed using aluminum casing. The device has three components: an interactive non-replaceable section that processes information and provides output. A replaceable laboratory containing supplies for qualitatively distinguishing between fevers associated with malaria and those that are non-malaria and a second replaceable component, a dispensary containing analgesics, ant malaria [*] and antibiotics for treating different types of fevers. The user communicates with the device using three buttons and receives feedback in Fulfude the nomadic Fulani language. The device interviews the user, processes the user’s responses and gives instructions. The accuracy of the information provided by the patient (user), and the ability of the user to carry out the instructions are critical to illness outcome. The device is solar-powered, is able to repeat previous instructions as many times as the patient desires, and provides referral.

Ten such robotic health assistants (ROBODOCs) were deployed among two main groups of nomads (those with previous experience using communication devices such as handheld mobile phones and those without such experience). The volunteer user was given basic information on the use, the switch-ON button, charging the device, and replacing the components. The user contacts a Field Assistant with hand-held mobile phone who in turn alerts the Research Supervisor whenever a case is managed. The Supervisor holds a phone interview with user and beneficiary patient at the end of the consultation with Robodoc as part of the quality assurance.

Robodoc was withdrawn after three months of deployment. Members of the community, beneficiaries and users were interviewed. Each device was examined for durability in the field. The ten units managed more than 80 cases of fever and appropriately diagnosed and treated 90% of them. Previous experience with using a modern communication device was not an important factor in the use of the Robodoc. The nomads found the device very useful and made suggestions on how it may be used for the management of several other health problems besides fevers.

We are keen to publish the findings from testing the device in a peer-reviewed journal. Does anyone have an idea of any journal that may be interested in this sort of research?

Oladele Akogun

HIFA2015 profile: Oladele Akogun is a professor of public health parasitology at the Federal University of Technology, Yola, Nigeria and Principal Scientist at the Common Heritage Foundation/Nigeria. He has spent over 24 years carrying out research and community service on access of community populations to health care delivery among marginalized populations. He is a pioneer researcher and contributor to the development of the community directed intervention approach to health service delivery now used in onchocerciasis control in Africa. With a Grand Challenges exploration (GCE) grant from The Gates Foundation, he is leading a team to develop a robotic health assistant for the management of malaria among nomads. He sits on two committees of the WHO/African region and on 5 committees at the Federal Ministry of Health, Nigeria. He has worked at various times as consultant to Constella-Futures, Africare and WHO where he worked for a year as Technical Adviser. He has made presentations to the African Regional Ministers forum on Primary Health, the US Congressional subcommittee on international aid and PAHO. He holds a PhD (1991) from the University of Jos and a Master of Public Health (2008) from the University of the Western Cape, South Africa. Some of his views are expressed in http://blog4globalhealth.wordpress.com/bios/akogun1/
akoguno AT yahoo.com

[*Notes from HIFA2015 moderator:
1. I think this should read 'antimalarials'.
2. A picture of the device in action is available on the Gates Foundation website at:
http://www.gatesfoundation.org/global-health/Pages/grand-challenges-explorations.aspx
'Oladele Akogun of the Common Heritage Foundation in Nigeria is testing a 'fever kit' for use among nomadic populations. The device is equipped with simple diagnostic tools and prerecorded treatment instructions in the native language to help nomadic caregivers accurately diagnose and treat fevers in a way that reduces mortality and drug resistance.' Thanks, Neil PW]
(In re-posting I have added the image at left.)

Goodbye to David McKendrick an 'old' friend and personal reflections

The past three years have been quite challenging both personally and professionally.

Professionally as an IT secondment came to an end in 2007 and brought with it positive and negative changes. The positive of moving back to clinical practice, the negative the vagaries of clinical banding and the Knowledge and Skills Framework which many health sector organisations are still attempting to fully implement. On a personal level, I am now also divorced. Working on the community for so many years - just over the border of my clinical patch - was a gift of convenience in terms of the children's schooling and playing taxi driver.

While there was a very objective interview panel I feel I owe having my current job to my friend David McKendrick. This fact now scares me witless that this was back in 1985 when my eldest son was born. I was so wrapped up in this life-changing event that the secretary phoned to ask if I did want the job. The organisation I still work for has changed its title and status umpteenth times it seems and I have had several roles over the years, including research and service development projects. The truth is though that when it comes to work, this journey began at Chorley with David and that is essentially where I am still at.

I was really shocked then when Sue, David's wife phoned with the news that David had died earlier this month. I'd kept in touch with David through the years. Due to my new domestic circumstances I moved back to Ashton-in-Makerfield - living not far from David and Sue - in July last year. David was so helpful, patient and supportive as I have progressed through the divorce.

We both worked at Winwick Hospital, Warrington, UK and I am pleased I went along this summer to a reunion and saw David in his element with friends, Sue and a pint. I also managed to take quite a few photos which will now be extra memorable for so many of us. Although I didn't work with David at Winwick, as already suggested he was my boss on the community mental health team at Chorley, Lancashire from October 1985 through to his early retirement due to illness.

We shared a love of IT and coding as enthusiasts. In the early 80s David called to my parents home when I'd bought a BBC micro, an upgrade from a Sinclair ZX81. David contributed so much to health IT, through his work with Open Software Library, computer aided learning and his pioneering bulletin board. David was also a co-organiser of a computer based training conference at Keele University 1987-88. Open Software Library distributed several computer programs I wrote on the BBC micro. One thing that makes me smile is the way in the late 80s early 90s I got my underpants into a bit of a twist over the copyright. Now reflecting back, David was a real Gent in how he handled that, my concerns to which he listened, accepted and explained. There was a lesson there also in terms of Hodges' model and Brian Hodges' worries over the same. Where might the model be now, we often pondered, if it had been driven hard from the outset!

When David retired it wasn't the same. Of course you know the job changes constantly, but there was a real loss of impetus: from warp to impulse drive. David was much liked and respected as a boss and colleague. If you were professional in your approach put the clients, carers and families first then he left you to get on with the job. That said his recognition for accountability and governance was communicated and shared by the team. He used an Amstrad micro to produce statistics on the number of home visits, injections and many other details. David was ahead of the informatics game in recognising the value of information for service planning, development and improvement. When David was off a while I kept this effort going for a short while until duties dragged me elsewhere. David's early IT work was published in the Community Psychiatric Nursing Association journal, an association (now the MHNA) which he helped established initially.

I can see us all walking from the team office at Eaves Lane hospital (long gone now), up through the tunnel to the main hospital for the regular team meeting. That was a golden age of sorts, when all the community nurses came together. David was always keen on that. You were a member of a team and everyone was valued and had a role to play.

David recognised my interest (and yes skill -- thanks David!) in computing and sent me on a health care computing conference held in Manchester 1986. I wrote a report and have attended and presented at the HC-XXXX series on several occasions since. We often shared books, papers and plans around technology developments and when to build or buy that next PC.

I really, really can't believe David has gone. He was (very) widely read and we loved knocking ideas around always wondering about what sort of clinical / nursing application might have a future. I only learned since his passing of his excellence as a student nurse. When he qualified as a Registered Mental Nurse (RMN) he was awarded the Gold Medal. He was always keen to read my writing efforts and discuss the same. I remain really impressed with his website on Winwick Hospital - Winwick Remembered. While there is much in the old institutions to say good riddance to and never again this IS social history and as BBC R4's In the Mind featured there is much to record and document. In 2006 David got in touch with a query regarding relatives of patients from Winwick trying to trace details of their family members. I posted his inquiry on the psychiatric nursing list.

Over the past year or so, we met a few times at Tom & Gerry's the local pub with David riding there on his bike: magic!! Sitting at that usual table (near the plug) sad, but lots of smiles too.

I arrived late to politics and I much admire his involvement in community work, the Three Sisters Recreation area project in Ashton. While I enthused over 'community informatics' David was practicing it, engaging with others. I'm sure I don't appreciate the extent of his efforts, the youth club - helping make IT available to youngsters, environmental projects, and the community forum.

I am truly thankful for having met David, for his friendship, support and guidance over the past 18 months and the years before. If I've three regrets:

1. I never did take my guitar around; as I realise now how good David was - McKendrick's Moonshiners no less - I clearly missed a lick there!
2. Also never did find and show David the old photos from Winwick hospital - the show we put on as students.
3. Being able to explore Ashton Heath, the types of heather and the bees there.

Regular readers here know of the hyperbole over the new website, well now if I ever do create the new website - maybe we'll know why...

David - I'll miss you pal and miss you already!
As the new decade begins bless you, Sue and your family and friends...

Peter

===================================
From: Richard Lakeman, richard.lakeman at dcu.ie
To: Peter Jones h2cmng at yahoo.co.uk
Sent: Mon, 14 December, 2009 14:40:27
RE: [PSYCHIATRIC-NURSING] David McKendrick - CPN - CPN Manager, Winwick & Chorley, UK

I’m sorry to hear about David, Peter. Thanks for letting us know. I never met David, but he marketed some software I wrote for some years and He was a pleasure to deal with.

Regards
Richard

Sheltered housing, care domains, ADLs, telecare and wardens

Shelter is a basic human need, one rendered acute when people are forced to flee their homeland. On a rather different level in the UK there is currently quite a debate about sheltered housing and the withdrawal of live-in wardens. This 'debate' has even progressed to judicial review.

I've visited many clients when the warden has appeared at the window or door to check that things are aok? Such has been the time keeping and client's faith in their clock that on occasion it could have been Kant walking by. It is often helpful to invest some time and get to know the warden, too see what they know not just about 'care of older adults', but about their residents many of whom become friends. We need to remember what a difference an individual can make in these situations. The clue is in the title 'sheltered housing' which in Hodges' model spans the interpersonal and sociology care domains. I've illustrated this below:

Suddenly, the advent of telecare, video and mobile comms and resulting benefits raise the possibility of service 'duplication' at a time when cost savings are sought in social care. Alternately, we might ask if some overlaps in service provision are good insurance? For the people in sheltered housing and their relatives what did sheltered mean to them when they first viewed the facility, what does it mean now? As is the case with day care centre managers, the more dynamic wardens really do make a difference to these communities of individuals. As Peter Sellers showed us sometimes for a gardener - or a warden - just Being There is reassurance enough.

Hodges' model can be used as a reflective device for this real-world bricks and mortar example of a clash between the humanistic and mechanistic care domains.

Additional link: International Human Rights Day 2009

Original dwelling image from: http://www.cherokeemedicineman.com/dwelling.html

Film image source IMDb

h2cm - Being at the center of things [I]

The center of Hodges' model can represent many things:

an epistemological nexus for the transdisciplinary dependencies of our times
multidisciplinary coffee shop
self-care engagement stage
the chaos of all things
holistic harmony
integrated idyll*

More down to Earth and acknowledging this cruciform '+' structure as a mythic device, in addition to searching for the mysteries of the universe at the center we can also place the 'well' person there.

As the previous post on ADLs suggests the 'well' person can function on a basic level and has negotiated the four axes and the four and five fold knowledge domains. They can therefore be considered (sufficiently) wholly integrated. We are all travellers, constantly traversing these domains of experience consciously, unconsciously, expertly or with the awkwardness that denotes the novice.

Conversely and reflecting the model's utility: it is also possible to locate the unwell individual in the center too. In this instance the placement suggests impoverishment of experience, ongoing personal and social stasis and in the case of substance misuse the presence of specific disruptive focus and preoccupations. The person becomes lost to their potential, stuck in a 4:5-fold minima. They continue to travel chronologically, but the journey is spiral, self-iterative and diminishing by return.


However: what you can see you can change, or come to terms with.

*from Greek eidyllion, little picture (h2cm as a snapshot).

Image source: http://www1.lsbu.ac.uk/water/protein2.html

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

Relationships matter: Society Guardian & The WSJ

Re. Charles Leadbeater's State of Loneliness, The Guardian, Society, 01.07.09

The cover of this weeks Society Guardian immediately caught my eye with its picture (I wonder which corner of which care domain this lady is sat in?):

The text initially passed me by; then yesterday I caught up, it seems the business model quest in one sector is having a domino effect with new models needed elsewhere including health and social care.

Leadbeater's piece reminded me of Lean thinking the improvement process with its drive to identify value, reduce waste and repetition. ... His text points out that:

More efficient services quickly move in and out of people's lives, but they don't really change how people live. That is one reason why we have not made deep inroads into the most deprived communities, the most troubled families, the most intractable social problems. Services manage and process people and problems, but only rarely allow people to change their lives. Service solutions are ill-suited to the emerging challenges of the rise of long-term health conditions, diseases linked to lifestyle and diet, ageing or climate change. You cannot deliver a solution to an epidemic of diabetes the way that DHL delivers a parcel.

So any model, method that is primarily process centered may find itself compromised - providing just one cylinder's worth of power in a four cylinder engine. In Hodges' model I have identified the 4Ps. PROCESS, PURPOSE, POLICY, and PURPOSE (to which we must now add PROBITY). It will be interesting to see how value is defined across service forms of engagement, intervention (including signposting) and the new set of outcome measures to follow whether local, national, service-reported or patient reported outcome measures. Leadbeater continues:

The key will be to redesign services to enable more mutual self-help, so that people can create and sustain their own solutions. The best way to do more with less is to enable people to do more for themselves and not need an expensive, professionalised public service. Enabling people to come together to find their own, local solutions should become one of the main goals of public services. Services do a better job when they leave behind stronger, supportive relationships for people to draw on and so not need a service.

So Jo(e) Public needs to reflect, compare, evaluate, learn, collaborate and make informed decisions in order to stay well amongst many other things. They need to be engaged holistically.

Where is the model for this...?

I believe I know.

The Wall Street Journal has something to add here The Doctor Will Text You Now and relating to my earlier posts on 'Beware Reflex Moves'. Relationships matter, but if nurses are out there assessing, assessing, assessing who is doing the education, dividend added therapy outcome focused?

If e-health is going to make a real contribution in augmenting and freeing high value care resources then this in turn depends on the value invested in relationships.

Louis Petrillo, 57, a psychologist in Westfield, N.J., says he regularly turns to his family’s doctor, Robert Eidus, for online advice about his frail 90-year-old mother, who finds office visits difficult. His son who is away at college also used an online visit when he had sinus problems. “I can get into his virtual office anytime,” says Dr. Petrillo. He feels the online care works well largely because Dr. Eidus knows his family members’ regular health complaints.

If older adults move home and need new primary care services, what are most probably(?) well established patient - doctor (patient - primary care team!) relationships are not just undermined they are undone! A person's sense of community is fractured. ...

Yes that image speaks volumes.

Do read the two articles mentioned - excellent.

Image source: Guardian

Mathews, A.W., The Doctor Will Text You Now, JULY 1, 2009, The Wall Street Journal Interactive Edition

Bee in my bonnet and a place to call home

For some years (over a decade) I've had a bee in my bonnet about the impact of relative-ly sudden house moves that older adults often make following sudden bereavement.

This prompted a first and no longer maintained website 'Beware Reflex Moves'.

This rather silent issue still stands and is arguably growing in volume.

There are surely a series of studies to be made here. Like most forms of life, the patient-nurse encounters of all those years ago have evolved: the ability of Jo(e) Public and their families to independently visit, select and move their relative into residential care is a new factor.

Self-funding frees up valuable resources as people can essentially circumvent the formal assessment processes of social services (and health), negotiating directly with the home of their choice for a place. This place may be many, many miles away from what was home. Amid increasing demand this arrangement works well much of the time. When it fails though, the impact is a personal and social catastrophe that can also reverberate across two health and social care economies. The person's original social services and their new location - that of their family.

Here the 'diagnosis' may not just be bereavement reaction / depression, but dementia too.

So, the advice remains beware of reflex moves.

Wish those bees had stayed in that bonnet - they might be safe now.....

Image source with thanks: http://www.flickr.com/photos/lelonopo/2378726643/

Self-care in e-space and the need to Impress

Working with older adults you realise how unselfish a group they are with regards to their care needs: "spend the money on the children who need it, they are the future."

You also realise that although there are growing numbers of 'silver surfers' (sorry) and their number will swell - the use of digital technology by the general public remains yet another potential source of inequality.

Many years ago I came across HealthSpace (UK) as a fledgling approach and application. I was really impressed as it underlined the need for a generic conceptual framework for health and social care - from senior school through to older age.

It is often said that effective communication needs a channel that is noise free - well here in Hodges' model is a resource to reduce noise for health information across many contexts:

• education
• prevention
• consultation
• social marketing
• self-care
• care planning, evaluation and management
  
• carer support
• supervision

Demographics also underlines the opening remark in this post and for older adults and many younger that matter of choice arises when it comes to the deployment of digital technology. Yes, many forward thinking people will readily jump on board and use ICT to study, learn, commission, record and co-ordinate their own care - or that of a relative. But what about those who will not use HealthSpace or another personal health records [PHRs]?

For those who do not want to engage - are they to be literally pressed into service? Obviously not - and besides recruitment to the UK services is growing. Jokes aside though the pressure to get the public to add value to their own care is critical to the future sustainability of the health and social care system.

Which brings me back to HealthSpace and the following news on e-Health Insider:

'HealthSpace expansion plans shelved'

Last year’s Health Informatics Review outlined a wide-ranging role for HealthSpace, but the DH has now done a U-turn and demanded more evidence of the site’s value to patients before pushing ahead with further expansion.
...
An outline business case worth £80m to £90m – one source puts the figure at £98m - had been developed by CfH, which was to have been submitted to the Treasury earlier this year.

However, the DH is understood to have spiked the business case, seeking more evidence for the value of HealthSpace, which has not received the backing of Christine Connelly, director general of informatics.

Dr Neil Bacon, founder of the doctors’ website doctors.net and the patient website iwantgreatcare.org, said he was unsurprised that the DH had shelved its plans.

“I think this is their way of quietly getting rid of it,” he told EHI Primary Care. “In the commercial world, if a solution with more than 250,000 potential users had only been used by 400 people it would already have been put out of its misery.”

Dr Bacon said he believed there was a clear and growing demand for patients to manage their own health records but that innovative, entrepreneurial solutions rather than government-led solutions would meet that demand.

More to follow no doubt - but do take care even now if you live by the coast ....

Additional links:

Google Health

HealthVault Microsoft

DIY doctors: patients can boost NHS's value, 30 April 2009, HSJ, Paul Corrigan

Digital Britain

The Impress Service

The Royal Navy

Image source: Press Gang stamp

Guidance: Breakthrough to real change in local healthcare - a guide for applications to create Health Innovation and Education Clusters (HIECs)

6 May 2009: The Department of Health is investing £10 million in the introduction of Health Innovation and Education Clusters (HIECs) across England. HIECs will be partnerships between NHS, higher education, industry and other public and private sector organisations. They will support the spread and adoption of innovation locally and strengthen professional education and training.

This guide describes the vision for HIECs, the role of HIECs in education and training, how HIECs will support innovation and the application process. This starts a period of informal dialogue with strategic health authorities (SHAs) and prospective HIEC partners, leading to expressions of interest in early September 2009 and a final announcement on the first wave of HIECs in December 2009. SHAs are co-ordinating applications and, as part of the process, they are arranging regional stakeholder events.

Contact details for the SHA in your area are included.

Published by Department of Health, UK

1st Contact: ET and care on the front line

ET as in 'extraterrestrial' may seem remote from nursing and health care, but where there's a will....

Health and social care appears to become ever more specialised with each turn of the policy machine. People's lives are experienced as being ever more complex. Health care is filled with uncertainty and the public present with multi-diagnostic, person-centred, choice bearing, (usually) recovery directed problems, needs and strengths.

Pity then the care workers on the front line, at the point of 1st contact. Like the baseball catcher it helps if they can field the knowledge and skills required to cover physical, mental health and possibly learning disabled clients. You have to hope that coaches recognise that Hodges' model can help the team be aware and fully prepared to cope with 1st contact supporting and facilitating what follows. So, how does your team get to grips with complex care?

Additional links:

Baileff, A. (2004) Developing high quality first contact nursing in Southampton NHS Walk-in Centres. At, Innovations in Partnership, Practice and Education, 3rd Annual Scholarship Conference, Portsmouth UK, 2 Jul 2004. Southampton, UK, University of Southampton. http://eprints.soton.ac.uk/9197/

Declaration of Principles Concerning Activities Following the Detection of Extraterrestrial Intelligence http://www.setileague.org/general/protocol.htm

Image and source: Louisville Slugger OXFB Omaha Pro Series 13 Inch First Base Baseball Mitt from http://www.anacondasports.com/

Transcultural health & Hodges model

Text by Larson et al. (2001) is presented below with a suggested placement of
Bradshaw's (1972) typology of social need on to the four care domains of Hodges' model:

INTERPERSONAL : SCIENCES
SOCIOLOGY : POLITICAL

Felt need: The needs as perceived by members of the group.	Normative need: The group fails to meet an objective, universalistic standard. Technical definitions of need such as the Australian National Mental Health Standards are examples of normative need.
Expressed need: Through their behaviour, group members have demonstrated a need, often by lengthy queues for services or failure to attend a service.	Comparative need: The group is demonstratively worse off than another group. Comparative need is usually demonstrated through routinely collected statistics, which is problematic for small ethnic groups whose identities are rarely recorded (p.336).

Bradshaw’s framework is still widely used. The important distinction is one between the ‘top-down’, professional-derived definitions of normative and comparative needs, on the one hand, and the felt and expressed needs, interpreted as the ‘bottom-up’ expression of experiences and attitudes, on the other (p.336).

See also Larson et al. discussion of 'thin' and 'thick' needs.

(The fact that this typology can be described in terms of 'top-down' - 'bottom-up' also highlights the socio-technical potential of Hodges' model.)

References:
Bradshaw, J. (1972). The concept of social need. New Society, 19(496), 640–643.
Larson, A., Frkovic, I., van Kooten-Prasad, M., Manderson, L. (2001). Mental Health Needs Assessment in Australia’s Culturally Diverse Society, Transcultural Psychiatry, 33(3), 333-347. Abstract.

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