Most typical face in the world revealed (amid deep irony)

National Geographic Magazine has revealed what the most typical human on the planet looks like.…

There is a deep irony here (since we are talking about 'skin') in that as the global demographics flow across the decades to alter this typical face, there is a growing proportion of the population who hope that health and social care delivery is not typical and a 'composite'.

They hope that health, nursing and social care is truly personal and individual - taking in their preferences, needs and priorities.

Having said that though - would it be progress if everyone could expect at least to receive what is deemed a 'standard' level of basic nursing care that is in a way 'typical'?

more to follow - more will follow - are we ready?

Presentation London May 2011: The Future Role of Support Workers & Assistant Practitioners in Mental Health and Social Care

2011 looks like it will be busy:

In May I have been invited to present the Health Care Domains Model at a conference organised by M&K Update.

The Future Role of

Support Workers & Assistant Practitioners in

Mental Health and Social Care

My presentation will include:

Why does ‘having’ a framework matter?

• Explaining the health care domains model, its structure, knowledge domains and applications.
• How the model can support HCSWs to address personalised, integrated and holistic care. 
• The model in theory, practice and management – an illustration.

 There will be 10 minutes for Q&A too.

This is a great prospect as with Colombia this coming week.

KT-EQUAL future events - Ageing Research and Design 4 Health Conf.

Dear colleague,

KT-EQUAL is planning lots of interesting events in the next few months focused on aspects of ageing research.

Below are a few upcoming events that may be of interest to you, more information can always be found on our website.

Upcoming workshops include topics such as -

• digital inclusion
• ethical dilemmas
• and creative societies.

A flyer is available with more information about these exciting free events.

The I'dgo consortium has also confirmed the full programme for their seminar on An international perspective on the Built Environment for an Ageing Population: Issues in maintaining access to outdoor places on the 16th February 2011.

Another upcoming conference which is still accepting papers* is the Design for Health Conference in Sheffield Hallam University on the 13th-15th July 2011
http://www.design4health.org.uk/

We look forward to seeing you at some of our events in the future.

Best Wishes

Helen Haigh
KT-EQUAL Co-ordinator
University of Sheffield

PJ adds: *Kirsty Christer at SHU contacted me re. D4H to advise that submissions are open until 7th Feb.

Wonk - and the comprehensive health record

As the future unfolds the day will emerge when a 'wonk' - that is, "someone meant to know everything" (Prospect Magazine, Dec 2010, p. 19) is realised in software (or in a termin-ological mix with some "I'll be back" hardware).

The Internet is already envisaged as a giant global graph - a vast intelligence. The health care domains model provides a framework - a graph - to capture what someone or some group of people know about a situation. Policy, practice and values are often rightly based and measured against ideals. In health (and social-) care the comprehensive health record is the ideal. Throw information technology into the mix and you have an ideal of Platonic proportions.

Can you have a complete and ongoing record and still work smart and Lean?

I don't wonk, do you?

Call for Papers for the European Design 4 Health Conference 2011 + 6th CIPED

Lab4Living at Sheffield Hallam University is pleased to announce the Call for Papers for the  
European Design 4 Health Conference 2011. The conference will be held at Sheffield Hallam University from 13 - 15 July 2011, Sheffield, UK.

The conference will provide a platform for dialogue between designers, healthcare professionals, funding bodies, researchers and users. Submissions to the conference are invited, in the following forms:
Abstract submissions: extended abstracts that address the conference themes.
Exhibition proposals: exhibits of innovative artefacts or systems that make significant progress in design for health.
Visit www.design4health.org.uk . Join the conference mailing list for regular updates.

6º CIPED - Congresso Int. de Pesquisa em Design (6th CIPED - Int. Congress of Research in Design)

- to be held at the Fundação Calouste Gulbenkian, Lisbon, October 10-12, 2011:
An Agenda for Design. More details will be provided later, just keep the dates free!

Professor Peter Lansley, BSc, MSc, PhD, MCIOB, FCOT
Director, KT-EQUAL – Knowledge Transfer for Extending Quality Life
School of Construction Management and Engineering, URS Building,
University of Reading, Whiteknights, PO Box 219, Reading, RG6 6AW, UK

p.r.lansley at reading.ac.uk www.sparc.ac.uk (and my source).

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

Special Issue: The Challenges of Dementia: an International Perspective

Read the special issue on the -
Challenges of Dementia
- for free online!

This special edition of the International Journal of Geriatric Psychiatry contains a series of articles concerning current services and future plans for the care of people with dementia and their carers in a host of different countries. The articles reflect the myriad approaches in which various countries are improving the quality of life for people with dementia.

My source: Wiley

Frontline or tightrope?

As the various media outlets and commentators discuss health care, nursing, medicine and social care they often refer to the frontline -

Where exactly is the frontline these days (and nights)?

Who is on the frontline?

Is the frontline always visible?

Is there a 2nd, 3rd or 4th line?

Are there any gaps in the frontline?

Is it twisted at any point?

When health care economics is squeezed
how does this affect the frontline?

Does the frontline have an optimal tension?

If the frontline is Lean, in lean times
does it have a harmonic?

How has the frontline changed over
the past 20 years?

How is our frontline forecasting?

Is there space on that (front-) line for
partners, information technology,holistic
bandwidth, values, policy, safety ..., ....?

All doodles welcome.

Music Gym - flexes its muscles

Hi,

My name's Matt, and I'm the Roadshow Coordinator for Decoda with some information which I hope will be of interest to those of you in or around the area of Lancaster and Preston.

Decoda have been successfully running a Music Gym down in Hastings for the past five years, continually developing and refining their techniques and technologies, whilst building a rapport with those who attend week after week. Using an innovative combination of music, images, space and fun the Music Gym provides an effective, flexible platform to engage and entertain people with a variety of complex needs. It’s also a great opportunity for parents, carers and those they care for to meet others from the local area and socialise. Others have described us as:

'fantastic use of colour and music, very interactive and inviting.'

'A really intriguing and dynamic approach'

'An excellent resource – we need more like this.'

'A great range of innovative, creative equipment... lots and lots of fun.'

'... a wonderful innovative idea.'

We have been invited to bring the Music Gym to Lancashire this month, and so we’ll be at the Salt Ayre Sports Center in Lancaster on the 16th and 17th of August, and at the Caritas Deafway home in Preston on the 18th [Deafway, Brockholes Brow, Preston, Lancashire, PR2 5AL].

If you would like to see the gym in action prior to making a decision (Or just see it in action without attending), I see no reason why you would not be allowed to observe any of the sessions we’re holding at the Salt Ayre. I appreciate that it is very difficult to form an opinion of what we do without seeing it in action, and this is a really good chance to do so. The 16th has been set aside for children under 16 years of age, whilst the 17th is for adults. Preston is undecided to be totally honest, we were contacted towards the end of last month, and are in the process of ironing out the final details. One benefit of this is that it’s an ideal date for those individuals who require a less busy venue, as we have not that long to publicise it. It is however a smaller venue than the Salt Ayre, so we may not be able to have our full facilities on offer on that date.

The days have been divided into 5 slots each as follows: 10.00-10.45 11.00-11.45 12.00-12.45 13.00-13.45 14.00-14.45

From our experience in Hastings, I would predict that the 11.00 slot will be the quietest, whilst the 14.00 slot will be the busiest, should that have any bearing in your decision.

In our continuing efforts to bring this to as many people as possible we are offering these places at £7.50 each if booked in advance £10 at the door (carers come free), additionally where this may be helpful, siblings can attend the session for £2.50. This is a great opportunity for people in the local area to get together, try out the facilities and enjoy the real benefits of the Music Gym.

Places can be booked online http://www.decoda.org/node/50 by phone or by post (contact details below).

If you require any more details, or have any questions at all please do not hesitate to contact me roadshow@decoda.org

Many thanks, Matthew Saunders, Roadshow Coordinator

Decoda - a social enterprise benefiting the local community South East Coast Regional winners of the Innovative Health and Social Care Technology Award at the NHS Health & Social Care Awards June 2009

Theaklen House Theaklen Drive St. Leonards on Sea TN38 9AZ Tel: 0845 2938354 websites: www.decoda.org www.musicgym.org www.myspace.com/decodamusicgym www.soundtherapy.org.uk BBC's South East Today film about the Music Gym is at http://www.youtube.com/watch?v=8j7v7pQ9kYQ

My source:
Foundation for People with Learning Disabilities

From: Harvard Business Review - The Four Phases of Design Thinking

I came across the following post on the Harvard Business Review Blog Network - The Conversation:

10:54 AM Thursday July 29, 2010
by Warren Berger

What can people in business learn from studying the ways successful designers solve problems and innovate? On the most basic level, they can learn to question, care, connect, and commit — four of the most important things successful designers do to achieve significant breakthroughs.

Having studied more than a hundred top designers in various fields over the past couple of years (while doing research for a book), I found that there were a few shared behaviors that seemed to be almost second nature to many designers. And these ingrained habits were intrinsically linked to the designer's ability to bring original ideas into the world as successful innovations. All of which suggests that they merit a closer look.

You can read the whole of Warren's original post, while below I have taken his focus concepts CONNECT, CARE, COMMIT and QUESTION and associated them to the care (knowledge) domains of Hodges' model. Following that there is a rationale. ...

connect	question
care	commit

Connect:Intrapersonal
Placed in the intra-interpersonal domain this is the domain of concepts, thoughts, ideas, creativity and innovation. This is the essence of Warren's reference to 'connect' -

Designers, I discovered, have a knack for synthesizing--for taking existing elements or ideas and mashing them together in fresh new ways.

The INTERPERSONAL links page also highlights other conceptual 'inhabitants' here; in particular knowledge management, the semantic web and psychology. If analysis and reduction is the outcome of the hard sciences, then here as Warren writes is synthesis, integration and invention. We can see how self-belief is critical to many innovators who pursue their dreams regardless of rebuffs by the establishment, to whom - within the health career model - they are also diametrically opposed.

Question:Sciences
The ability to question lie at the heart of human activity, and although thought and mind are represented in the interpersonal domain, questions also exemplify the output of human reasoning powers in the SCIENCES. Evidence based care depends on an ongoing process-ion of questions that drive research. Problem solving with its iterative sequence of assess (question), plan, action, evaluation (question). The health career model reminds us though of the need to consider not only quantity, logic and objective measures, but the role of qualitative research and methods.

Care:Sociology
Seeing Warren's inclusion of 'care' drew me to his post. Here he concludes:

Focus groups and questionnaires don't cut it; designers know that you must care enough to actually be present in people's lives.

Health and (social!) care are social activities. Our students are socialised into the professions and disciplines as they pursue their careers. Our work depends on the effectiveness of human communication and relationships. You can read about 'counselling' and only get so far; ultimately health care is experiential. It is something to be practised.

Commit:POLITICAL
Warren deals with the way designer's view risk and committing early to an idea and the project that might follow. For me 'commit' and being committed has explicit political - power - connotations. So, Warren's reference to commit in the sense of producing a model or prototype and working through problems can be extended. Invention and design may be cognitive pursuits, but they are non-trivial in that they must ultimately and literally be negotiated. Being able to 'commit' needs to be sanctioned. Individuals need to be empowered, or recognise when to either proceed or seek advice and guidance. Furthermore, Warren notes:

The designer's ability to "fail forward" is a particularly valuable quality in times of dynamic change. Today, many companies find themselves operating in a test-and-learn business environment that requires rapid prototyping. (?)

Perhaps the recognition in health policy of the need to balance negative and positive risk taking, self-care and personalised budgets can also be discerned in the above?

Acknowledgement:
Thanks to Warren Berger and HBR

College of Social Work

At the moment there is an ongoing consultation relating to the creation of a College of Social Work. Here is an explanation from the website - http://www.collegeofsocialwork.org.uk/

Welcome to the home of the campaign for an independent, professionally led national college of social work across the UK. This website is dedicated to supporting the development of a fully independent national College of Social Work which will seek to improve and support social work by providing leadership by and for the profession.

The College of Social Work will lead the development of the profession and represent it in discussions with organisations that regulate, train, work with, and are affected by social work.

For further information on BASW or the campaign for the national college of social work, please visit http://www.basw.co.uk for the latest news, information and updates.

Take part in discussions online in BASW's member-only forum at MyBASW Exchange

If you would like to get in touch with your local BASW office, please find our contact details at http://www.basw.co.uk/contact

For several decades social workers have been my colleagues on the ground floor, doing the 9-5 turn and more. I once started a talk to a local constabulary on service development and thought the reception was a bit odd: the introduction met with a frosty tone in high summer. Things settled when I revealed I was a nurse, not a social worker. The audience highlighted the need - this was well over a decade ago - for more effective out-of-hours access to social work and mental health service colleagues. Things have improved markedly and with ongoing re-organisation pressures on the NHS and social services, the need for radical change has now shifted to social work itself.

I do hope the new College of Social Work will consider the health career model as a potential foundational and lifelong learning resource. The qualities and relevance of the model to the social work profession are manifold, and include the model's being:

• person-centred -
• the model is also socially oriented (25% of the model concerns the 'social' agenda);
• recognizes the oppositional experience of person - state / law;
• can support reflective models of practice for new learners and established staff;
  
• the vulnerable can be represented there - infants, adults, older adults ...;
• multidisciplinary in scope, or phrased another way - discipline neutral;
• multi-contextual in scope, individual (self), group (family, community), service (resources, policy), budgets (financial), recovery, strengths, information-education, quality and outcomes (reporting);
• a currency to support interprofessional education and training, and -
  
• prior to the above provides a tool for curriculum development.
  

Best wishes to our social work colleagues as they set out on their own journey, which can also provide a vehicle for sharing.

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

Welsh Assembly Government invites proposals New Ideas Social Research Fund

The Welsh Assembly Government is inviting proposals under its New Ideas Social Research Fund. The fund aims to support small research projects that address themes which have clear relevance to the strategic objectives set out in One Wales: a progressive agenda for the government of Wales. The deadline for submission of proposals is 4 June 2010.

A grant of up to £10,000 can be applied for, payable in two instalments - the first on submission of an interim report and the second on completion. We would welcome proposals that involve match funding from other sources.

Please visit -
http://wales.gov.uk/about/aboutresearch/social/news/newideas/?lang=en

- for more information and details on how to apply.

Regards,
Ina
SRA Co-ordinator

Ina Zuncke
Social Research Division / Yr Is-Adran Ymchwil Gymdeithasol
Department of the First Minister and Cabinet / Adran y Prif Weinidog a?r Cabinet
Welsh Assembly Government / Llywodraeth Cynulliad Cymru
Email/ E-bost: Ina.Zuncke AT wales.gsi.gov.uk

Welsh Assembly Website http://wales.gov.uk/about/aboutresearch/social/news/newideas/?lang=en for guidance.

<->

Although I do not live in Wales (but have Welsh connections) I sought permission from Ina to post this item as it reminded me of the research project I still carry around and have raised here previously.

Working in community mental health I've been struck on several occasions by the impact of sudden re-locations that older people make amid the trauma of the loss of their partner. The effect of bereavement and moving home on them, their family has dramatic consequences, depression, anxiety, stressed relationships, relapse of physical health problems. What are embryonic relationships with new GP and social care services are also severely tested. Perhaps others can pick up this subject wherever you live? Given the capabilities of research today, the relevance of findings could be further increased spreading the research across multiple sites, towns, cities and contrasted with rural settings?

Reading the signs - Idealised Care

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

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

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

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


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

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

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

This list is subject to revision - addition.

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

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.

Launch of the National Care Service in England

Source: Department of Health, 30/03/2010

In the biggest change to the welfare state since the creation of the NHS, everyone who needs care when they are old or disabled will get it for free, Health Secretary Andy Burnham announced today as he launched the National Care Service in England.

The National Care Service will be based on a principle of shared social insurance and will be funded by contributions from everyone in a fair way. The National Care Service will ensure people get high quality care when they need it and it will give peace of mind that savings and homes will be protected from the expensive care costs that arise from serious long term conditions, such as Alzheimer’s or recovering from a stroke.

Andy Burnham said:

“Today we are launching a National Care Service that is fair for all, ending the cruel care lottery we have today. Like the NHS, everyone will contribute and everyone will get their care for free when they need it. This is the biggest change to the welfare state since 1948 and, like the NHS, it’s going to take time to build.

“The National Care Service will mean that people will be treated with dignity and respect, people will have control and choice over their care and they will be helped to stay in their homes for as long as possible. People who have to live in residential care will, from 2014, get their care for free after two years and there will be more help to pay the residential costs.

“We’re not replacing the millions of carers or families who look after each other. They are the underlying principle of the National Care Service and we will better support them.

“We’ve already laid strong foundations through reforms over the past few years. But, with an ever growing older population – there will be 1.7 million more people needing care in the next 20 years – we must radically overhaul the way care is paid for and provided.

“I feel very strongly that this is a responsibility we must all help to shoulder. And it’s clear from what we have heard from the thousands of people who have given us their opinions on this over the past twelve months, that people agree. That’s why we know that the fairest way to help everyone who is affected by a serious disease, illness or disability is for us all to pay into a system so we get free care when we need it.”

The cost of care is currently a cruel lottery. No one has any way of knowing how much care and support they may need in the future. A 65-year-old can expect to need care costing on average £30,000 during retirement. However, some people, for example people with severe dementia, could end up needing care costing as much as £200,000.

The National Care Service will put an end to this unfair system. It will be built on strong foundations of recent reforms and will overhaul the way care and support is paid for and provided. It cannot be built overnight and will be phased in three stages:

Stage One
• Build on the best of the current system through reforms that are already underway and deliver the Personal Care at Home Bill.

Stage Two
• From 2014 extend the coverage of free care so that people will receive free care if they need to stay in residential care for more than two years.
• Set up a commission to support consensus and advise the Government on the fairest and most sustainable way that people can make their contribution to a care system which is free when they need it.
• Set up a National Care Service Leadership Group of expert stakeholders who will advise Government on the implementation of the National Care Service, focussing on the systems and business processes that need to be put in place to make the National Care Service a reality.
• Introduce a National Care Service Bill to set the legal foundations of the National Care Service.
• Enshrine in law for the first time nationally consistent eligibility criteria for social care helping to remove the postcode lottery of care that exists now
• Push forward with the prevention agenda and continue the drive towards personal budgets so that by 2012 everyone who would benefit from a personal budget will have one.
• Ensure accurate, relevant and accessible information about what people are entitled to, how the assessment process works and how to access care services is provided to everyone.
• We want to improve the gateway for accessing social care and disability benefits to make simpler and easier for people.
• Introduce a quality framework including a body to drive up quality in social care.

Stage Three
• The introduction of a comprehensive National Care Service that is free when they need it for all adults with an eligible care need, funded by contributions.

Following the biggest ever consultation on care and support that saw over 68,000 members of the public, carers and representative organisations have their say, it is clear that people believe it is right that everyone should contribute to a care system that is free when people need it– similar to the NHS. However, the necessary consensus on how people should pay into such a system has not yet been reached. A National Care Service Commission, will therefore be established to advise Ministers on the fairest and most sustainable way for people to do so.

Care Services Minister Phil Hope said:

“We must find a fair way of funding the National Care Service. The stakes are very high. That’s why we must have a clear consensus. We are setting up a commission to tell us what would be a fair way for everyone to pay into this new system.

“Everyone will pay into it in a fair way and in return everyone will then have peace of mind that their savings and homes will be protected from high care costs. The whole of society will benefit and the National Care Service will support individuals and families for generations to come.”

The National Care Service will have six founding principles. It will:

1. Be universal – supporting all adults with care and support needs within a framework of national entitlements.
2. Be free at the point of use – based on need, rather than the ability to pay.
3. Work in partnership – with all the different organisations and people who support individuals with care and support needs day-to-day.
4. Ensure choice and control – treating everyone with respect and dignity, ,putting people in charge of their lives.
5. Support family, carers and community life – recognising the vital contribution families, carers and communities play in enabling people to realise their potential.
6. Be accessible – easy to understand, helping people make the right choices.

Contacts: Department for Health Email: NDS.DH at coi.gsi.gov.uk

Additional links:

DoH: 30 March 2010, The White Paper, Building a National Care Service

The Big Care Debate

Walls, Lines, Dykes and Health Care

We are accustomed to defensive care and medicine.


Costs aside it seems the driving mantra (always served with a smile) is avoid risk at all cost; but we also recognise the need to balance risk in its negative and positive forms.



When it comes to thinking about care though we need to be open to new ideas, territories and opportunities and what being defensive means in practice and theory in the 21st century.



Additional links:

http://en.wikipedia.org/wiki/Offa%27s_Dyke

It is unlikely that the Dyke was constructed as a defensive earthwork. No army of the period could defend a 120 plus mile long earthwork. It is more likely that the Dyke was constructed as a political statement of power and intent.

http://en.wikipedia.org/wiki/Great_Wall_of_China

Romeo and Juliet – the care home version

Octogenarian versions of Shakespeare's lovers to feature in Bristol production

Directed By Tom Morris

Fresh from co-directing the West End hit, War Horse, and Tom Stoppard and Andre Previn's orchestral experiment Every Good Boy Deserves Favour at the National Theatre, Tom Morris' own theatrical exploration of Bristol Old Vic begins with a project that has been twelve years in the making: Juliet and Her Romeo, the story of a flourishing love affair in one generation, crushed by the financial and political concerns of another.

Developed since 1997 in collaboration with Minder producer Sean O'Connor, the production uses Shakespeare's text, but casts our lovers in their 80s, with their anxious children, not their parents, seeking to prevent an imprudent and costly match.

With Sian Phillips as Juliet and Michael Byrne as Romeo, this production invites a generation of actors of global stature to play great Shakespearean roles which they never thought they'd play again. Tim Barlow, Terry Taplin and Michael Medwin return to Bristol Old Vic as Tybalt, Benvolio and Paris. Dudley Sutton makes his debut on the Bristol Old Vic stage as Mercutio.

What family has not wrestled with the question of how we care for our parents as they become older and frailer? Who will love them? Who will support them? Who will pay for their care?

And with that care, what controls should we apply? If we have taken power of attorney, what about the freedom to fall in love, to give gifts, to marry unwisely?

As Ben Power's recent two-handed exploration of passionate love remembered in old age demonstrated, Shakespeare's text is a powerful love story for any generation.

Signed, Captioned and Audio Described Performances.

Signed performance: Sat 10 April 2.30pm

Captioned performance: Sat 17 April 2.30pm

Audio described performance: Sat 24 April 2.30pm

Additional link:

BBC Culture Show

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.

Currencies and travel in health and social care

Before the advent of the euro, holidays in Europe were that bit more exotic. Having to buy and adjust to another currency - and not just one - was part of the novelty and fascination of travel.

Health and social care have their own currencies (and yes, read that as there being integration here too!). Most of the currencies are national given the efforts to standardise, with examples such as, length of stay, referral to treatment and more recently in residential care and elsewhere continuing care and its occasionally truculent neighbour 1-to-1. Unfortunately, like land masses, these currencies can also suffer from continental drift.

Dissemination (use in the wild) lack of review and ongoing attention to standards, benchmarks and definitions can see a currency drift in its application and subsequent reporting (affecting perceived utility, value and impact). The value of a currency can be diminished over time as it no longer acts as a unit of difference.

So enjoy your travels, but beware the risks while you vive la difference, especially in your work!

Image source: http://www.artlebedev.com/mandership/77/