Mother Pelican ~ Vol. 6, No. 10, October 2010

FYI ... the pelican journal of sustainable development has been renamed
*Mother Pelican* in honor of the *Human Being* she represents.

The October 2010 issue has been posted:
http://www.pelicanweb.org/solisustv06n10page1.html

Going Forward After the UN MDG Review Summit

1. Current Status of the Millennium Development Goals
2. Review of the "Keeping the Promise" Declaration
3. Timidity of National Governments and Global Citizens
4. Ms. Michelle Bachelet and the UN Women Entity
5. Sustainable Human Development and the MDGs
6. Links to Key UN and MDG Documents and Resources
7. Links to News and Reports about the MDG Summit
8. Current Research on Sustainable Human Development
9. A Meditation on Sustainable Human Development

Supplements:

Supplement 1: Advances in Sustainable Development
Supplement 2: Directory of Sustainable Development Resources
Supplement 3: Sustainable Development Simulation (SDSIM)

Articles:

Socioeconomic Democracy: A Psycho-Politico-Socio-Economic System, by Robley George.

Composition and Trends of Homestead Agroforestry in Bangladesh, by Sourovi Zaman et al.

Will Working Mothers' Brains Explode? The Popular New Genre of Neurosexism, by Cordelia Fine.

A Paradise Built in Hell: Communities that Rise to the Challenge of Disaster, by Rebecca Solnit.

We Need Millennium Development RIGHTS, Not Just Goals, by Phyllis Bennis.

Feedback is cordially invited!

Sincerely,
Luis

Luis T. Gutierrez, Ph.D.
The Pelican Web
Editor, Mother Pelican: A Journal of Sustainable Development
http://pelicanweb.org
A monthly, CC license, free subscription, open access e-journal

My source:
e-Network of Academia in Social Sciences (e-NASS)

Global health: Care logistics in-deed

Although the previous post -

Care Logistics: have model will travel ...

- differentiated between what we might term mechanistic and humanistic logistics, there is a great deal of overlap:

communications, time, priorities, purposes, service, quality, processes ....

Global health has featured on W2tQ and it is here that the true dimensions of logistics can be defined. I may be confusing logistics and scale, but if I am then the challenge of logistics presents itself by virtue of scale and in global health the focus upon populations, nations, medical conditions and physical environments, climates and topography.

While the Wikipedia page on global health does not explicitly refer to logistics it is there in the shadows: it contributes to inequality, illiteracy, poverty, public ill-health (and mental too), pandemics ...

Logistics is there in the light too; the torch of disaster relief, the many development organisations, the ethos and values of the Millennium Development Goals. ...

Drupal musings 16: 1% digital and analogue memories

At Drupalcon in his keynotes Dries Buytaert has highlighted that Drupal now powers approximately 1% of the web. While 1% is not much especially given the total size of the internet with its day on day, hour by hour growth this is nonetheless a significant milestone. Especially when Dries speculates on the growth of Drupal projected ahead to 2020.

Like all digital media Drupal is a tool that extends our personal and cultural memories. As all the keynotes showed Drupal, PHP, HTML[5] all have histories of their own and a role to play in providing a surrogate memory. The media and technology [IBM] regularly predict how technology will change our lives, including how we remember.

Amid such speculation memory still makes us who we are. You and I have a yesterday, today - and we pray - a tomorrow.

This is the bootstrap that counts

Bootstrapping or booting refers to a group of metaphors that share a common meaning:

a self-sustaining process that proceeds without external help. ...
en.wikipedia.org/wiki/Bootstrap

Striking then the news this week that - dementia costs 'equal to 1% of global GDP'.

PC footprints 1981 - 2010

At the Eden Project there is a sculpture which depicts the e-hardware an average Jo will use and dispose of in a lifetime (those teeth are made up of computer mouse). Overall this amounts to 3.3 tonnes.

I've listed this before on W2tQ, but my micro - PC footprint runs as follows:

• Sinclair ZX81 - 1981
• BBC microcomputer model 'B'
• BBC Master 128 - 1986
• Elonex 286 PC
• Dell 486 PC
• MacBook Pro - October 2008
  
• Evesham Pentium 4 PC - November 2002

This w/e after Drupalcon I am adding to my pile. I've managed very well, but it is definitely time for a new PC.

Additional link:
http://weeeman.org/html/impact/about.html

Retirement, memories of work & Bacon numbers

In the UK in July 2010 the much anticipated news about the government's plan to scrap the default retirement age in the UK from October 2011 throws up a complex future work place and nursing care space.

At the moment if a member of the staff in the NHS needs a psychiatric assessment and admission, then there is often a protocol that determines how their care is managed. Various factors are taken into account. For example, the work history of the person and the distance of available beds. This may entail admission for them to another area. Such arrangements help protect the staff member, their families and the local staff for whom being both carers and colleagues could be quite difficult.

Over two decades I have encountered health professionals who are diagnosed with dementia maintained in the community - in their homes - and in residential care. So far I have not known these individuals in their work capacity and professional lives. This is due in part of course to the incidence of dementia increasing with age and my previous status as a spring chicken. Today of course things have changed:

• Early onset dementia is more common as the overall older adult population rises.
• Suddenly (well at least after October 2011) we may find - despite the physical and emotional demands of the job - that the staff in residential and nursing homes are also older - working through that previous work | retirement barrier.
• There's another change: now I am a mature chicken.
• I wonder what the churn rate is in our nursing homes?
• While we usually think of high turnover for staff and the associated poor quality of care. As care and nursing homes are also businesses there are two churn rates:
• - senior and junior staff leave the sector, or move to other homes;
• - residents are moved for reasons of re-location - increased care needs, and the choices of family.

So....? Amid all this I wonder how many workers in the care sector working their extended years may potentially come across former work colleagues? This could be a delicate and haphazard negotiation. ...

Additional link:
The Oracle of Bacon

Achieving the health-related MDGs. It takes a workforce!

Dear colleagues,

With reference to the upcoming MDG Summit and the UN Global Strategy for Women's and Children's Health, Dr Manuel Dayrit would like to share with you the above-mentioned page that was published today on the HRH website, which highlights the human resources for health situation in the 49 focus countries.

Achieving the health-related MDGs. It takes a workforce!
Link: http://www.who.int/hrh/workforce_mdgs/en/index.html

Density of doctors, nurses and midwives in the 49 priority countries
Link: http://www.who.int/hrh/density_chart.pdf

Please note that the link to the chart is:
http://www.who.int/hrh/fig_density.pdf

Kind regards,

Rebecca Bailey on behalf of Dr Manuel Dayrit
Rebecca J. Bailey, MSPH, CEd
Technical Officer
Health Workforce Education and Production
WHO/HSS/HRH

My source:
Ellen BONITO: bonitoe at wpro.who.int
GANM (Global Alliance for Nursing and Midwifery): GANM at ibp.wa-research.ch

<->

In Mevagissey, Cornwall last month browsing in Hurley Books, I came across a copy of Maps and Diagrams: Their Compilation and Construction by F.J. Monkhouse, et al. (1967). At three pounds - a historical bargain. Prompted by the charts above I will scan the cover and share some of the text/ideas here in the near future.

I was saddened to see that in Padstow The Strand Bookshop has closed - apparently in January 2009. As a listed building who knows perhaps it might smell of books once again!

Cost savings: 4-fold literacy = care literacy

The RCN's campaign I posted yesterday highlights the belief in and potential of nurses to 'think out of the box'.

There are many people, in many walks of life who are currently racking their brains and flipcharts to come up with ideas for cutting costs. In addition to the RCN, the government has its on-line campaign with the 'Spending Challenge'.

As for nurses there is an extra rabbit to pull from the hat: improving patient care.

Media discussion about the cloned beef - food supply story this week brought a point regarding the relative scientific literacy of the general population of USA and UK. This prompted me to consider discipline based literacy, what usually passes for 'basic grounding in ...' or competency. ('Literacy' has already been corrupted, now for another kick.)

For nurses with their subject disciplines, which can be represented in the health career model - what current public sector health (and social) care requires (demands!) is care literacy.

It is the ability of nurses (and other professionals) to be aware of what happens in the two adjoining boxes, or that one remote enclosure that can simultaneously engender and deliver:

• new insights - creativity and innovation;
  
• holistic integrated care;
• care literacy;
• and - cost savings that can still improve patient care.

See also:
http://hodges-model.blogspot.com/search/label/literacy

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.

EHR Software Market Share Analysis & UK residential care / nursing home sector musings

Last month (20th May 2010) Chris Thorman, who blogs about EMR systems at Software Advice, e-mailed me (copied below). Could I mention his recent EHR post on my blog?

Well thanks Chris! It is very encouraging to learn that W2tQ is seen by others as an infocare centre and valuable media avenue. It is very difficult for me to comment on this USA based analysis which is detailed at:

EHR Software Market Share Analysis

- but here are some thoughts. ... This is a great piece of work-in-progress which acknowledges the problem of being 100% comprehensive and coherent given the task, plus the market's spread and dynamics.

My perspective is UK and my full-time work as a nurse gives me a limited outlook on health IT markets as a whole. Nonetheless I value efforts to capture such data in order to better understand the health informatics industry and grasp the bigger picture. As Chris notes this project is challenging, the post is also an appeal for help. While a great proportion of surveys are commercial in motivation, the e-community and e-media can now add value by pointing out the gaps and other data sources. The comments that conclude Chris's post ably demonstrate this.

I would very much like to read something similar for the UK, including the use of information systems in the residential and nursing home sector (any suggestions welcome). It still amazes me how many care homes - including those that are part of large business groups - do not use a 'resident' information system.

Perhaps the new - post-election - health ICT market in England will see new opportunities?
(See post re. 1 July 2010 NW England BCS - British Computer Society meeting).

In ICT terms the care / nursing home sector to me seems passive; it is content to be waited-upon by primary care and the hospital based systems. If they are not engaged on this level can they (and others, e.g. commissioners) argue that they are integrated? I think not.

Care homes need to realize that a dedicated information system could pay dividends in terms of assessment; continuity of care (transfer of care); quality of care; client, family and staff engagement, reporting to inform commissioning, inspection and marketing. When we talk of a patient's viability, there is also the question of the future viability of this market sector amid competition, economics, standards and costs ... ?

Buyer sought for Loyd’s Nursing Homes Group’s 64 care homes
Catherine Boyle, Times Online, 21 May 2010.

Chris' focus is the EHR market, very much concentrated upon physician, medical and medical billing coding  applications. This is reflected in the search facility on the Software Advice website. The search is constrained and directed, driven of course by the underlying database of companies, their applications and reviews. Markets are, however, defined by their boundaries and the way they change over time. Anticipation of that change is a gift indeed.

The personal health record (PHR) lies outside the scope of this Software Advice post, since as per WikiPedia:

It is important to note that PHRs are not the same as EHRs (electronic health records). The latter are software systems designed for use by health care providers. Like the data recorded in paper-based medical records, the data in EHRs are legally mandated notes on the care provided by clinicians to patients. There is no legal mandate that compels a consumer or patient to store her personal health information in a PHR.

This work by Chris and respondents helps to establish and define the boundaries. The EHRs in question are not purely institutional (e.g. hospital-based), the vendors cater for varying numbers of users, in different care settings as you can see on the site's 3-stage search. So while I cannot add anything as such, I wonder if there could (should) be scope for residential care in there?

Or perhaps the EHR market is not viable when it comes to older adult* residential care?

Heaven forbid that the transatlantic (and global) EHR market is ageist!

Thanks again Chris.

*Residential care is also needed for younger adults too.

From: Chris Thorman
To: " Peter,"
Sent: Thu, 20 May, 2010 18:57:41
Subject: Blog post idea for your blog

Hello Peter,

I hope you've had a good week. I just finished a blog post about market share in the EMR industry and I wanted to give you a heads up about it. Here is the link:

http://www.softwareadvice.com/articles/medical/ehr-software-market-share-analysis-1051410/

In the article, I broke down:

• The size of the outpatient EMR market;
• What EMR vendors have the most physicians using their system; and,
• What EMR vendors have the most practices using their system.

As I'm sure you can imagine, it was a tough project to get accurate numbers on. I was hoping you could mention my article on your blog to get more eyes on it so we can clear up any discrepancies. Sort of a "crowd sourcing" project if you will. I'd also be interested to read your thoughts on our findings.

Would you mind mentioning my post?

------------------------------------------------------------
Chris Thorman
Senior Marketing Manager
Software Advice
www.softwareadvice.com
chris at softwareadvice.com

As one chapter closes another opens ...

Even if that chapter number is 15, 20 or even the penultimate - when it comes to older adults entering or residing in residential and nursing care facilities this is not just an excuse for a euphemism roll call:

'the end of the road',
'Club Medicated',
'Eldergarten',
'the final chapter', ...

Residents and their families all too frequently find that care needs are not static. The book is far from complete and ready for review. Their health (and we had better add well-being) status changes constantly. A care home's ability to cope and meet an individual resident's care needs adequately in safety without comprising other residents and staff must be continually evaluated. A person's condition may improve psychologically and yet their physical health calls for more nursing care that is physically driven; or vice versa. Trying to anticipate care needs what can be several years in advance is very difficult.

It is one of those intangible questions - as to how many care homes carry dual nursing registrations and so will be able to provide not only the current level of care, but future elderly mentally infirm care needs if required. The reasoning being that an internal move is far less traumatic than finding a new home? So, what is the state of care moves?

If we have no information about this
then we know nothing.

What might this tell us about an individual's health career and the health career - likely care trajectory - of conditions such as dementia?

Of course our assessments are, and can only be determined (a keyword if there ever was one) in the here and now. This is the priority, while also trying to anticipate the future if we possibly can.

There is undoubtedly a great need for research here. Research that spans the many care dimensions which residents, their families, care home staff and other multidisciplinary team members must balance. These include quality of life, physical, mental and spiritual care, economics, demand and supply and our very notions of care quality and holistic care.

Only then - for all unique individuals - can we write an epilogue that befits each of those preceding chapters.

Image: M.C. Escher crystal ball

Injustice: Why social inequality persists by Daniel Dorling

I first came across the work of (Prof.) Danny Dorling in the 1990's in connection with workshops on visualization in the social sciences and Geographic Information Systems (GIS). The other week I read a feature on his (very timely) book in the Society section of The Guardian (O'Hara, 2010).

You do wonder exactly where we are in policy terms given the interval since the Black Report. Dorling's book then sounds like a must-read, with the information posted below from the publishers.


In addition in Waterstones at the weekend I found The Spirit Level, available on their 3 for 2 offer. The links also posted below with an insightful 2009 review of The Spirit Level by Daniel Ben-Ami on sp!ked; plus a related LGC & HSJ event:

Implementing the Recommendations of the Marmot Review:
Reducing Health Inequalities

Injustice: Why social inequality persists

About This Book

Few would dispute that we live in an unequal and unjust world, but what causes this inequality to persist? Leading social commentator and academic Danny Dorling claims in this timely book that, as the five social evils identified by Beveridge are gradually being eradicated, they are being replaced by five new tenets of injustice, viz:

• elitism is efficient;
• exclusion is necessary;
• prejudice is natural;
• greed is good; and
• despair is inevitable.

In an informal yet authoritative style, Dorling examines who is most harmed by these injustices and why, and what happens to those who most benefit. Hard-hitting and uncompromising in its call to action, this is essential reading for everyone concerned with social justice.

"His attack on elitism and despair is impressive, his factual evidence undeniable." Rt Hon David Blunkett MP

Additional resources for Injustice: http://www.policypress.co.uk/injustice_appendix.asp

Dorling, D., Orford, S. and Harris, R. (1998) Visualization in the Social Sciences, A Report for the ESRC/JISC Advisory Group on Computer Graphics, AGOCG Technical Report No 41 (ISSN 1356-9066). Report as a PDF

O'Hara, M. (2010). Why Britain's battle to bring down social inequality has failed, p.1 of the SocietyGuardian section of the Guardian on Wednesday 21 April 2010.

The Spirit Level: book

The Equality Trust, established by the authors.

Distorting the spirit of equality, sp!ked review of books.

Greenspan wins Dynamite Prize in Economics

Alan Greenspan has been judged the economist most responsible for causing the Global Financial Crisis. He and 2^nd and 3^rd place finishers Milton Friedman and Larry Summers have won the first – and hopefully last — Dynamite Prize in Economics.

In awarding the Prize, Edward Fullbrook, editor of the Real World Economics Review, noted that “They have been judged to be the three economists most responsible for the Global Financial Crisis. More figuratively, they are the three economists most responsible for blowing up the global economy.”

The prize was developed by the Real World Economics Review Blog in response to attempts by economists to evade responsibility for the crisis by calling it an unpredictable, “Black Swan” event. In reality, the public perception that economic theories and policies helped cause the crisis is correct.

The prize winners were determined by a poll in which over 7,500 people voted—most of whom were economists themselves from the 11,000 subscribers to the Real-World Economics Review. Each voter could vote for a maximum of three economists. In total 18,531 votes were cast.

Fullbrook cautioned that not all economics and economists were bad. “Only ‘neoclassical’ economists caused the GFC. There are other approaches to economics that are more realistic—or at least less delusional—but these have been suppressed in universities and excluded from government policy making.”

“Some of these rebels also did what neoclassical economists falsely claimed was impossible: they foresaw the Global Financial Crisis and warned the public of its approach. In their honour, I now call for nominations for the inaugural Revere Award in Economics, named in honour of Paul Revere and his famous ride. It will be awarded to the 3 economists who saw the GFC coming, and whose work is most likely to prevent another GFC in the future.”

Dynamite Prize Citations:

Alan Greenspan (5,061 votes)
As Chairman of the Federal Reserve System from 1987 to 2006, Alan Greenspan both led the over expansion of money and credit that created the bubble that burst and aggressively promoted the view that financial markets are naturally efficient and in no need of regulation.

Milton Friedman (3,349 votes)
Friedman propagated the delusion, through his misunderstanding of the scientific method, that an economy can be accurately modeled using counterfactual propositions about its nature. This, together with his simplistic model of money, encouraged the development of fantasy-based theories of economics and finance that facilitated the Global Financial Collapse.

Larry Summers (3,023 votes)
As US Secretary of the Treasury (formerly an economist at Harvard and the World Bank), Summers worked successfully for the repeal of the Glass-Steagall Act, which since the Great Crash of 1929 had kept deposit banking separate from casino banking. He also helped Greenspan and Wall Street torpedo efforts to regulate derivatives.

The poll was conducted by PollDaddy. Cookies were used to prevent repeat voting.

For further information and interviews email: pae_news@btinternet.com

My source: (with additional links and image) Ciresearchers.net

Image source: http://sveccha.wordpress.com/2007/11/19/laws-of-and-black-swan/

Hodges' model: POLITICAL domain resources

RCN UK 2010 General Election 6 priorities - framed in Hodges' model

Please sign up: NURSING COUNTS

The RCN's 6 priorities hit the POLITICAL sweet-spot. In the table below I have related each of the priorities to a care domain of Hodges' model with a rationale that follows:

Give nurses time to train	Protect the Nation's health
Improve care for those with long term conditions	Standing up for staff who speak out Safer staffing levels Sustain health care investment

Timeout from the clinical arena for training is always a political issue. It is also at the behest of the individual. This includes individual practitioners and their managers.

The public's health (and mental health) is of course grounded in the group, but is initially framed by evidence, knowledge and preventive medicine.

Long term conditions may impact the quality of life of the individual concerned, but the effect on carers and the social ripples are also profound.

The Demand - Supply equation in health care may be reduced to raw, mechanical numbers, but they quickly become the political football of investment statistics.

So many false economies in stretching the more expensive resources when it comes to staff AND patient (carer) safety. Skill mix and staffing levels are vital for job satisfaction, service development, quality and safe outcomes.

Motivation and intent may be concepts exercised by individuals, but the political environment must support nurses who speak out for high standards of care, safety, the public good.

HoNOS, checklists and semi-structured interviews

Mental health services not routinely (and formally) using HoNOS (Health of the Nation Outcome Scales) are gearing up with a push to implement the scale across services by April. HoNOS has been around for a long time almost 20 years so it is time it earned its keep. Perhaps high quality tools take time to emerge from the noise and chatter of the care marketplace? ;-)

Although they are available, I've been putting a presentation together to help get to grips with HoNOS in the role of a trainer. The evidence for the validity and benefits of using HoNOS is well established, with the HoNOS family of scales boasting global usage and development:

• HoNOS for working age adults
• HoNOS65+ for older people
• HoNOSCA for children and adolescents
• HoNOS-Secure for use in health and social care settings secure psychiatric, prison health care and related forensic services, including those based in the community)
• HoNOS-LD for learning disabilities
• HoNOS-ABI for acquired brain injury (ref.)
  

The number of assessment, intervention and evaluation tools available to clinicians AND managers begs the question (ironically): is there 'space' in the toolkit for yet another tool? If HoNOS can help establish a coherent currency for mental health commissioning beyond the block contract then this is most welcome. Mental health services need to move forward on several fronts. There is a timeline running with completion of this difficult task in its sights.

One set of guidance for HoNOS points out that:

The scales are not used as a checklist or semi-structured interview, but form a brief record of severity.

There is some succor there then, since Hodges' model is a checklist and a quad-structured interview there is still a role for a global conceptual framework.

There's nothing like a full and tidy set of tools!

Ref. http://www.gpsa.org.au/media/docs/mentalhealth/honos_information.pdf

DoH: Honos health of the nation outcome scales report on research and development July 1993 - December 1995

Additional links:

The UK Routine Clinical Outcomes in Mental Health Group

The NHS Information Centre: Mental Health Minimum Dataset

RCP references

Kiva: Money isn't everything, but it helps - especially in health

In health care we readily appreciate, but still need reminding of the link between wealth - health and poverty. The Black Report and the review some 25 years later is writ large in many student essays, reports and policy aspirations including the latest Labour government.

What we do forget is economics as a problem not just in peoples health, but in establishing a business. Despite the creativity and innovation an entrepreneur can demonstrate, venture capital companies will say "Great idea! Come back when you've got your first sales". This was noted on this week's The Bottom Line on BBC Radio 4.

If it's a real chicken and egg dilemma for innovators in the UK and developed nations, then imagine how difficult it is in countries like Somalia, Uganda, The Democratic Republic of the Congo, Tajikistan, Senegal, and Tanzania, ...?

For people with the aspirations of starting a business that initial, start-up finance is critical not to developing some 21st century technology prototype, but business ventures that we often take for granted in our developed towns and cities clothes, consmetics, food production and sales.

Kiva.org is a great idea. David my old boss brought them to my attention, but now it's time to hop on board.



UPrinting.com is an avid fan and lender on Kiva.org and they are having a blogathon end of January and so this is my effort. If you are new to Kiva there is a short video about how a small loan from people like us can help entrepreneurs gain an opportunity they might not otherwise have.

A Fistful Of Dollars: The Story of a Kiva.org Loan from Kieran Ball on Vimeo.

Kivaworld.com provides a world map so you can readily understand the scope of Kiva and the basics of the way it operates: fund raising, funded, in repayment, paid.

Health and medicine feature in the projects and in the groups of lending teams which you can also join. There are other agencies who ally microfinance with health protection. Health and microfinance already boast a prolonged debate and literature.

With the help of my sponsored links and partners here on W2tQ, I am joining the Kiva community this weekend. Microfinance can make a huge difference to individual lives and now Kiva and its worldwide supporters are creating their own records as revealed on the Kiva blog.

As UPrinting pointed out in announcing this event, your money is able to do good again and again. Sometimes it is not enough to just 'maintain a link' as always it's about making a difference. ...


Additional links:

Kiva Friends

Hodges' model: POLITICAL links (activism, democracy, development, economics, health policy, community informatics...)

http://ffhtechnical.org/services/scalable-delivery-models/microfinance-and-health-linkages

Matt Flannery, Kiva and the Birth of Person-to-Person Microfinance, Innovations, Winter/Spring 2007, 2, 1-2, 31-56. (doi:10.1162/itgg.2007.2.1-2.31).

http://www.mitpressjournals.org/loi/itgg

Call for case experiences on capacity development - final 2 weeks to enter

Dear Peter,

The Impact Alliance is working closely with the UNDP to gather capacity development experiences from around the world as part of the 'Capacity is Development' campaign. The members of our network have some amazing experiences to share, and this is a great opportunity to showcase your hard work, grow the knowledge base of what works and influence policy makers. We look forward to hearing from you!

The United Nations Development Programme is pleased to announce the opening of the 'Capacity is Development' Knowledge Fair and invites you to share your experience. The knowledge fair seeks to collect experiences on policies, investments and programs that have proven successful in driving human and institutional capacity development in diverse settings around the world. These experiences will feed directly into the 'Capacity is Development' global event.

We invite you to submit an entry by Friday, 5 February, 2010.

Your entry can take the form of a short two-page case story, video or image.

The top five finalists will be awarded an expense paid trip to personally showcase their work at the 'Capacity is Development' global event in Marrakech, Morocco 17-19 March, 2010.

Entries should attempt to illuminate through words or images the impact of capacity development in practice. While diverse expressions of capacity development are welcomed, there is a special interest in gathering stories from three priority focal areas:

• Sub-national capacity development: local solutions, national strengths.
• Capacity development in post-conflict and transitional situations.
• Fostering the rise and resilience of middle-income countries.

For more detailed guidelines and online entry forms please visit:

www.capacityisdevelopment.org/knowledgefair or contact us at capacityisdevelopment@gmail.com for any questions or to simply alert us about an interesting experience.

Please forward this message to other networks and colleagues.

The UNDP Capacity Development Group is working in partnership with the Impact Alliance and LenCD - Learning Network on Capacity Development to implement this initiative.

(I am adding a link to this event at the POLITICAL domain resource page.)

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

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

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/