What would a “Recovery Hub” look like?

May 24, 2012 2 Comments


I’m currently starting to ask people in online spaces that I visit what would be useful tools for them in their recovery from periods of mental distress.

I want to post a copy of some conversations going on in groups I’m a member of on Facebook, where some really interesting points have been made. Do join in with this discussion- the question posed is:

I wondered if you would be interested in helping me to start a conversation about what services and resources are useful to people who are in recovery after experiencing mental distress?

I’m hoping to be able to prove that service users and carers have some great ideas that they should try to develop- can I ask you to share any ideas you have?

Some initial thoughts-

  • Physical space in a non nhs setting to meet up for a coffee
  • Education/self management resources available to look at or take away
  • Computers and online access to search for your own resources, or build your support networks
  • Staff could arrange to meet you there for appointments, if you didn’t want to go to an nhs building
  • Training for you to develop and run your own groups to support each other
  • Help with getting funding for mental health projects you’ve thought of
  • Access to volunteering
  • Access to paid work, delivering training, speaking about mental health, as peer support workers
  • An online resource, maybe a social network? you could log in from your phone or at home?

None of these solutions would be right for everyone, and I’m sure you’ve got your own ideas- what do you think would be helpful?

The results in so far:

if you suffer with social anxiety the thought of being placed in a group with other people is enough to put some one back in hospital.

me:  if someone has social anxiety, is it helpful to have a range of resources online rather than recommend them come to a physical group?

more services that do home visits would be good – if you have social anxiety, for example, it would help to get to know someone in a “safe” place like your own home, talk about barriers to getting out and then have support (for as long as needed) to go out and meet people.

me:  like a “parachute” service that could be called out to visit at home? would this be mental health staff, or trained peer workers?

main thing would be consistency so you can learn to trust someone and they can take you to different places – maybe with the aim of being able to meet up with people who have similar problems in future

One of my bugbears is the lack of recognition that if you are chronically sick you are more likely to be socially isolated and suffer from depression

me: And equally, people with mental health diagnoses have poor physical health- perhaps we could include this too?

i live in a part of the city where there are very few facilities if you have mental health problems apart from GPs. the support groups, charities, outreach centres etc are mainly on the other side of the city which don’t necessarily have direct bus routes from where i live. buses are difficult when you have social anxiety, going to places you don’t know can be too frightening, and i can’t drive because i have epilepsy. The churches don’t provide much if you’re under 60 but don’t have young children. it’s easy to lose touch with friends when you don’t go out to work and can’t cope with going to the pub.

A consortium of employers in the regional areas that can come together and universally employ an individual in that the individual isn’t committed to a single one employer. This would benefit those employers during there occasional busy days or seasonal times and have a higher success rating for actually being able to maintain some form of employment for the individual.

me: this is exactly what mobility DLA is for to cover costs due to your disability such as taxis for trips to support centres (I know it’s a rotten time to be a DLA applicant, btw) So, for people with social anxieties, it’s important to either have safe ways to travel to a physical centre or hub- or there could be “parachute” visits out into community, or there could be a certain amount of online support for days when physical travel is just too hard? Does that reflect what you’re saying well enough?

me: That’s interesting, xxxxxx, so in your model, people would be “signed up” a bit like signing up to an employment agency? Then they could be allocated work for days that they feel able to do work? Like, sign in by 10 am for today’s work? I’m guessing those people would have to keep records- would they be self-employed, or employed on zero hours contracts?

a friend of mine said a couple of weekends ago there must be loads od small, medium and large companies that have all manner of tasks on projects that someone working from home could do that are hugely time critical but in alarge project needs doing at some point, but project workers, managers etc wouldnt employ someone to do one task,l but if lots of employer could do to an agency that is task focused with all manner of people with skills and knowledge. they work for the agency and the agency make sure the work is done…

I’m against be forced to do work I don’t want just because I feel well on a good day, I want to work but it has to be stuff I want to do other wise my mental state suffers, and being poked and prodded to do work is just putting pressure on people which they don’t need when they are ill, they need to get well first.

me: Yes, the power should sit with the person who has the difficulty as they are best placed to know their own limits. But lots of people want to get back into it- even feel that forced inactivity makes them worse, so lets not assume that this is all part of a sinister way to shove everyone off benefits- I genuinely want to have this conversation and hope to develop a DPULO to respond to this.

me: A bit like this, 
http://www.taskrabbit.com/
?

I make stuff at home I have about one good week in 3 where I manage to do stuff, the rest of the time I’m away with the fairy’s with anxiety much of the time or just resting as I suffer burn out. I would love to make money with my creativity, I have the skills but don’t produce enough of anything to make a living at this time.

Not an employment agency Claire they are a cost to the employers but a consortium of employers themself’s. More in the lines of a sponsorship employment.

yes in effect but for projects, businesses etc . My friend is a project manager, he has a tutorial guide to write, he doesn’t have time to do it but it has to be done before the project goes live. so he thought if he could assign it to an agency, who then finds the right person or offers it up to its clients and they say yes. then as long at is done by the end of the project say in 1 months time it doesn’t matter how long it takes as long as its done. there must be loads of tasks that need doing but no point employing 1 person for what is ordinarily a half-day job but to us is a big thing..

me: I was thinking WE could develop our own “agency” and supply people to work on projects? as part of the recovery process? would have to check out with DWP etc how it would work- but there should be a way of ensuring self-employment as a way for people to do some limited work, with Working Tax Credits as a back-up?

i have mobility DLA, but atm i’m too anxious to go somewhere that i don’t know at all. we could also do with drop-in centres for people who are fighting self-harm urges where they can get support and company. they could also have the ingredients to make that cake that the care team suggested you try …

an agency run by and for people with physical and mental health problems would be great.

Much of those things are already in place from the point of being a hospital patient to work therapy especially in my area any ways.

Not sure self-employment is the way forward especially with all the complexity of paperwork. Many simply wont be able to handle that.

if you have a problem with authority of any sort be self-employed, is an option, you can always get other people to do the paper work

The costs involved in forming agency’s will out weigh purpose and eventually fail.

At least if employers themself’s set this up people will have confidence that those employers are going to provide supportive environments from the outset.

me: I hope it’s okay with you guys, I’m capturing this (anonymised) conversation to keep it on record on my blog at claireot.wordpress.com

me: I agree, there are costs involved. It would be important to ensure we got funded to cover those costs. I think you’re right, we would have to get “sign up” from employers to provide work, but perhaps this would be an extension of the “Mindful Employer” project, or simply as part of their drive to reflect the diversity of the populations they work with?

An example. 33 employment positions I’ve been through in the past maintaining employment due to illness has been the biggest barrier. 18 of those employment positions had been with the same employer this despite walking out on that employer each of those 18 times due to having an illness. In between each of those employment positions faced sanctions of benefits time and time again. On the balance due to the sanctions it wasn’t actually worth carrying on with trying to gain employment as monies over the year balanced out no more than benefits any way.

me: yes, I think this experience is one many people will have shared. We started to work on this at the “Benefits Camp Hackday”. Our team were prototyping an app to use to enable people to show on a weekly basis what work they were able to do, and get their benefits calculated for weeks when they needed more support.

some where that would help do their paper work would encourage more people to start-up for themselves, and if someone failed to earn enough one week and some sort of system that paid and made up for the bad weeks would be good.

Very difficult to calculate an illness Claire one can be ill for months on end with no break then maybe only have a couple of good days. especially if part of the illness is that one is not able to measure time or unaware of time going by.

me: Yes, it is xxxxx and that’s why I think flexibility, and not “pushing” people before they’re ready would be important. But equally, it is important to set a “just right” challenge for people (e.g. as an OT that’s what the rehab would be aiming for) to help people along in their recovery. Perhaps what you’re picking up here is another, separate need, for early access to increased support when you feel like it’s slipping back again? Is that an accurate interpretation of what you’re saying?

Employer sponsorship at minimum based on existing individuals levels of benefits as an outset. With further sponsorship being paid above an achieved hours gained. With all sponsorship based on the level of minimum wage.

me: Hmm, I think this would need some thinking through. I’m not clear what employers would see that as a “good deal” for them, and it sounds a bit like “Workfare Plus”, can we have a bit of a think about how that would be attractive to employers to sign up?

I’d love to help in anyway I can and I think it’s a fantastic idea x

Far from workfare. If a group of employers came together and employed one individual in a coup sponsorship it would actually be cheaper for them all round paying the rate of minimum wage.

In another group, asking the same question,

having bosses who are supportive when you are going thru depression i had to walk from my job because i was not getting any support at all it was on ly when i did what i did then the support came but it was little bit late

me: That’s a great point. So, could a service be provided that helps employees to approach their mental health needs with their employers/ and a complementary service that educates employers how to manage sickness/ support for employees with mental health be part of the package (and stuff about Equality Act etc)? Could it be this is delivered by people who have been through it, who could call on staff expertise as needed? Or just staff? Or just peers?

i think bosses need to be sent on awareness courses to pick up on the first signs of depression it would have helped me big style if i was given the help from the get go i really would like to help others who are going thru what i went thru would like some more info claire it’s so good that your able to help people i wanna do the same maybe volunteering

me: I think for anyone with long-term illness or experience of mental distress, there’s so much we can offer to others who are going down the same road. And you’re right, there’s so much we could do to raise awareness for employers about how to retain staff who become well. Or better still, how to put things in place to protect their workers from becoming ill, if at all possible! So, I see there being a training need (we could deliver to employers) an advice need (for people going through it or carers) and a peer support or “buddy” need (to keep you going when times are tough)- but access to volunteering and even paid work opportunities to get involved with this stuff, not just sharing our stories for free.

I’m serious about this project. It’s clear to me that people with experiences of distress have every right to be involved in service re-design and they have valuable skills and experiences to contribute. I’m actively continuing to continue this conversation, and I would love to hear your views in the comments. Do feel free to comment anonymously if you prefer.

Filed under Commons, Occupational Therapy, Recovery Tagged with , , , , , , , , , ,

#MindTech- Thoughts and Reflections

March 31, 2012 1 Comment


This post discusses the recent Mind Tech Unconference, a transcript of the back channel discussing the day can be found in my previous post 
http://claireot.wordpress.com/2012/03/31/mindtech-the-unconference-grabchat/

There are several issues that I immediately wished to comment on, namely, commissioning criteria in the new health economy, how this is impacted on by the ides of  #mentalhealthpound, the scope of using Apps to support mental health, social prescribing, and the place of the social enterprise in poulation based mental health promotion activity.

Commissioning

This point in time is fairly unique, in terms of the transitions happening in healthcare commissioning I was reliably informed at the #AHPNorth Conference this week by very senior members of the Department of Health just how the new commissioning environment is likely to work. Currently, the system of tariffs for work done has contributed to the “Cinderella” nature of mental health services, as well as thorny issues in attempts to implement Payment by Results etc. One of the salient points is that rather than rely on these historic tariffs as a system for commissioning care, we are more likely to see population based commissioning coming to the fore. Now, one of the advantages of this is that (in theory) it then becomes possible for a successful mental health promotion service to be commissioned, if they can show an effect at  population level for reducing the incidence of mental illness, and a reduction on other areas of the service such as inpatient admissions. This has huge implications for the work of organisations working to promote good mental health such as Moodscope and Mindapples, who both presented information at the Mind Tech event. I’m not clear about the outlined ideas of the #mentalhealthpound presented at the event, but look forward to exploring these and looking at how this in combination with the commissioning environment means we can address funding issues relating to many fantastic projects that many people like myself wish to engage with.

Apps

We all know that the recent MapsandApps project run by the Department of Health was a huge success, and that it really shifted some thinking about how to use crowdsourcing and technology to help to address health inequalities, and to promote good health. In my opinion, this benefit has hardly been touched on in health services, and particularly in mental health services. There are concerns with the Informatics agenda related to this. Who owns the information uploaded by the patient? What are the ethics of allowing the app development company to be selling this (anonymised) information on as another income stream? If these issues are worked out, how do they impact on how our statutory services are funded-will they be expected to pursue similar revenue streams using their valuable data?

It is also worth noting that apps and devices that can take advantage of gaming theory could have an impact on adherence to treatment regimens, perhaps even medications compliance. We know that there is a cost impact to this- as people adhering to treatment regimes and medications schedules are cheaper to engage in health services. If we see the wholesale adoption of gamification in tech applications in health and mental health, how will this affect the bottom line of organisations delivering care?

We know the future is co-morbidity. In the same way that we are now comfortable with APIs that mash up data from several social networks, could we see implications in Telecare and Telemedicine as APIs are developed that mash up data gathered by different specialists, different healthcare providers, that bring personalised, granulated information down to the point of care delivery by doctors and healthcare providers? What does it mean for the de-professionalisation of medical and therapeutic services when these APIs become available to the general public? Will they result in greater self-care, or will they result in people choosing to treat themselves rather than engage in formal healthcare provision?

Social Prescribing- or Occupational Therapy?

I was interested to read one of the first blogs produced upon reflection of the Mind Tech event, by Puffles (working, as ever, with his Bestest Buddy). To read the blog, please see here
http://adragonsbestfriend.wordpress.com/2012/03/30/mind-tech-unconference-30-march-2012/

I can’t resist adding one of my favourite photos from Mind Tech: here is @Puffles
lovely to meet @Puffles2010 and his charming handler at #mind... on Twitpic

Picture from @Gandy’s FlickR site, used with thanks.

Bestest Buddy has frankly documented his own difficulties with managing his menetal health, and gives us a great insight into tunderstanding of the nature of mental illness. He describes:

one of the big challenges I faced was getting away from the idea that a short course of medication was going to solve things. It didn’t and it hasn’t. If anything, it’s made me realise that medication in my case has only suppressed the worst of the symptoms and that a longer term recovery is only going to be achieved through a tailored/personalised combination of other things.

Bestest Buddy relates his idea

Conditions such as moderate to mild depression and anxiety by their nature affect and are affected by the lifestyles that we lead. Every time I’ve been through an acute period of anxiety, depression or generally being ‘a mess’ I’ve tried to pick myself up by trying new actions and activities to deal with it.

When I read this sentence, I was struck by the notion that if I had been asked to define what mental health occupational therapy does, my definition would have been very close to that of Bestest Buddy’s idea of social prescribing.

giving patients and GPs the option of looking at what activities might be beneficial for patients I think would be brilliant. Rather than a course of medication and a few sessions of counselling alone, what about things that can complement such treatments? And how about making them on the NHS? This could include things like exercise classes, cooking classes covering things such as foods that help and hinder conditions such as anxiety. It’s one thing saying ‘avoid X,Y & Z’ but quite another to build it into a lifestyle.

It is clear that despite the wish of the public for activity based intervention to mediate mental health difficulty, this is not associated with Occupational Therapy treatment We have to ask ourselves as a profession, why is this? Despite our rich and growing evidence base within the profession and the related dicipline of occupational science, why is the message not getting through to the general public about what we do? How can it be that people who are engaged in mental  health treatment, and who are in attendance at events with other members of clinical staff are not being informed that what they are talking about is occupational therapy?

This is a topic we may cover on the #OTalk #occhat hashtags on Tuesday nights as part of our regular weekly peer-supervision Tweetchats. I think its an issue that deserves some of our attention. The analysis, prescription, and grading of activity to facilitate health really is the bread and butter of what we as OTs can offer. In the new health ecology, we need as a profession to start to stand up and define ourselves in terms that the public can understand- perhaps social prescribing should be added to our list of core competencies? I certainly believe that this is in line with advice I have taken on board from Karen Middleton, the Chief Health Professions Officer at DH after listening to her rousing speech at the AHP North conference.

Social Enterprises in Population Based Commissioning

Taking on board the Section above looking at commissioning, it becomes clear that this is a real opportunity for ex-NHS staff, service uers, mental health activists, and social entrepreneurs who want to make a shift into promoting mental health rather than waiting for mental illness to develop. It’s my belief that this commissioning environment will start to have an impact on the number of Social Enterprises, and the reach that they will have- moving out from community development activities into health promotion, and hopefully into peer-support networks commissioned to mediate mental illness.

I’m working on an interesting Social Enterprise idea which uses peer-support, in combination with appropriate APIs and my Occuaptional Therapy background to both promote good mental health and to catch the early warning signs of mental illness developing. Although it is a worrying time for people who care about healthcare in our Country, I am beginning to think that if we do get this sea-change in the nature of commissioning decisions, then we can see the stage opening up for players like myself and many others, who find their innovative ideas are very difficult to develop within traditional statutory services, and within the big voluntary sector organisations. We are nimble and agile in our peer-to-peer solutions to these issues, perhaps our time has come?

Filed under AHP, Anxiety, Commons, Conference, CPD, Depression, Evidence based practice, Inpatient Services, Recovery, Reflection, Social Media Tagged with , , , , , , , , , , , ,

#AHPNorth Conference- Just Do It!

March 29, 2012 2 Comments


I was fortunate enough to attend the AHP North Conference in Leeds held on 28th March 2012. We gathered from across the North of England in order to examine the role of AHPs (Allied Health Professionals) in the new health environment we face, with particular referene to the QIPP (Quality, Innovation, Productivity, Prevention) agenda, the new Commissioning situation, and Service Redesign that we must now get involved with.

Prominent speakers included Prof Ieuan Ellis, Dean of the Faculty of Health Sciences and Professor in Healthcare Education, Leeds Metropolitan University: Co Chair of the AHP Professional Advisor Board, Edna Robinson, MD of the NHS Clinical Commissioning Community, Bob Ricketts CBE: Director of Provider Policy (DH), Karen Middleton, the Chief Health Professions Officer (DH), Sir David Nicholson, the NHS and National Commissioning Board Chief Exec.

We all are aware of a sea change in health and social care. It’s not just about the recent Health and Social Care Act (DH 2012), we know the demographic challenges ahead for the country mean that our health and social care systems are no longer fit for purpose. We are particularly concerned to move the focus away from hospitals and into the community, in recognition that better support for the frail elderly and for people with mental health issues, who are not served well by our hospitals.

I was able to use the power of social media in order to open up the proceedings of the conference to the wider public- resulting in a comment from Sir David Nicholson, the Chief Executive of the NHS, that he had never been asked a question by the public through Twitter, and perhaps it is time that he was!

I hope you will find it interesting to read the impressions of the day surrounding the #AHPNorth tag- I feel it gives a sense of what went on. If anyone would like to generate a Storify of the prominent themes they notice, please do so, and please do leave your comments below.

Please find below the grabchat of the day’s Tweets.

Involved …

Top resources …


http://www.rightcare.nhs.uk/index.php/2012/03/nhs-could-save-money-and-provide-better-care-by-involving-allied-health-professionals/


http://www.improvement.nhs.uk/SevenDayWorking.aspx


http://www.improvement.nhs.uk/LinkClick.aspx?fileticket=RJk4n5%2fG6wk%3d&tabid=56


http://www.leeds.nhs.uk/Downloads/Corporate/Health%20and%20Wellbeing%20Board%20Fact%20Sheet%20November%202011.pdf


http://www.commissioningboard.nhs.uk/files/2012/02/Commissioning-Intelligence-Model-v13.pdf


http://www.guardian.co.uk/healthcare-network/2012/mar/21/nhs-reform-radical-approach-co-production


http://digihealthcon.wordpress.com/about/

Related tags …

#ahpnorth #nhs #leeds #ahp #socent

See Twitter for more tweets, people, videos and photos for #AHPNorth

@claireOT Here at #AHPnorth . Filter me if you don’t want to read about it!(Wed, 28 Mar 2012 09:05:17 +0000)
@claireOT When you (clinicians) use an NHS resource, you are acting as a commissioner of services in the new system – Edna Robinson #AHPNorth (Wed, 28 Mar 2012 09:16:37 +0000)
@claireOT Being good doesn’t lead to long term stability- the people in the NHS have no idea how insecurity feels, compared to SocEnts etc. #AHPNorth (Wed, 28 Mar 2012 09:17:28 +0000)
@claireOT Ahp’s aren’t great at marketing themselves, what’s the added value you bring? #AHPNorth (Wed, 28 Mar 2012 09:18:46 +0000)
@claireOT Note to self: I really need to have a conversation with my CCG! #Leeds #AHPNorth (Wed, 28 Mar 2012 09:19:52 +0000)
@claireOT Commissioners really want clinicians to lead and be involved with SocEnts to provide services in the new system #AHPNorth (Wed, 28 Mar 2012 09:20:28 +0000)
@claireOT It may be worthwhile to contact the individual clusters of GPs to have conversations about clinical commissioning #AHPNorth (Wed, 28 Mar 2012 09:21:28 +0000)
@claireOT The ordinary, everyday needs, not the big, sexy, elaborate needs are what the commissioners want to hear about #AHPNorth (Wed, 28 Mar 2012 09:23:26 +0000)
@claireOT Only 40% of the practice list ever walk through the door of the GP surgery. #AHPNorth (Wed, 28 Mar 2012 09:24:58 +0000)
@claireOT What about talking to practice managers about the ordinary, every day needs of people you see? Call it “”volume”" #AHPNorth (Wed, 28 Mar 2012 09:25:47 +0000)
@claireOT The public are wise.nthey will work out how to influence the new commissioning environment #AHPNorth (Wed, 28 Mar 2012 09:26:39 +0000)
@claireOT Am I the only person tweeting from #AHPNorth ?(Wed, 28 Mar 2012 09:26:58 +0000)
@claireOT Fantastic context in those tweets via Edna Robinson, MD of the NHS Clinical Commisioning Network. Any questions? #AHPNorth (Wed, 28 Mar 2012 09:28:01 +0000)
@claireOT Come on, there must be people wondering about how #socent s work in the new system? #AHPNorth (Wed, 28 Mar 2012 09:29:04 +0000)
@claireOT Half of GPs haven’t been in practice for 5 years. They are not Gods! Don’t be shy- speak up! #AHPNorth (Wed, 28 Mar 2012 09:30:06 +0000)
@mikechitty @claireOT #AHPNorth CCGs attitudes to #socent and risk will be fascinating to watch.(Wed, 28 Mar 2012 09:30:30 +0000)
@claireOT Difference in attitude, to a socent, 3 years is stability. The NHS is used to *permanence* #AHPNorth (Wed, 28 Mar 2012 09:34:09 +0000)
@claireOT Sustainability comes from a range of patrons, scale will help with sustainability not just panic marketing #AHPNorth (Wed, 28 Mar 2012 09:34:56 +0000)
@claireOT The work providers might well end up employing AHPs #AHPNorth (Wed, 28 Mar 2012 09:35:55 +0000)
@MarkOneinFour That’s a very good point RT @claireOT Difference in attitude, to a #socent , 3 years is stability. The NHS is used to *permanence* #AHPNorth (Wed, 28 Mar 2012 09:36:17 +0000)
@claireOT We have to be fleet of foot, stop hanging on to dinosaur leaders, and promote the innovators! #AHPNorth (Wed, 28 Mar 2012 09:36:36 +0000)
@claireOT How do the health and wellbeing boards work? … #AHPNorth (Wed, 28 Mar 2012 09:37:44 +0000)
@claireOT … It’s all about the local leaders, of orgs, of local authority, who is advocating for you? Anywhere? Reputation not funding #AHPNorth (Wed, 28 Mar 2012 09:38:34 +0000)
@claireOT Community services are critical to new ways of working, keeping people out of hospital #AHPNorth (Wed, 28 Mar 2012 09:42:19 +0000)
@mikechitty @claireOT what are the scale of aspirations to shift investment from secondary to primary care? #AHPNorth #manyhavetried (Wed, 28 Mar 2012 09:43:20 +0000)
@claireOT Crumbs, he’s going to talk about The H&SC Act…. Not exactly a sympathetic crowd, I would imagine…. #AHPNorth (Wed, 28 Mar 2012 09:43:45 +0000)
@claireOT Easy to read guide to the Act on provider side, please see links given at the end- ill tweet it later for you guys x #AHPNorth (Wed, 28 Mar 2012 09:44:35 +0000)
@claireOT Provider agenda- FTs will have more freedom from Monitor, it will promote fair competition, will prevent cherry-picking, #AHPNorth (Wed, 28 Mar 2012 09:45:30 +0000)
@claireOT …FT will be able to undertake partnerships with SocEnts as a result of the income cap from private work. #AHPNorth (Wed, 28 Mar 2012 09:46:09 +0000)
@claireOT Frail, older people are not provided well in community, leading to admissions to hospital. We have to solve this #AHPNorth (Wed, 28 Mar 2012 09:46:46 +0000)
@claireOT Long term conditions, improve primary care, but involve service users in self management, use technology #AHPNorth (Wed, 28 Mar 2012 09:47:19 +0000)
@claireOT 10% of Mental health nhs services are now provided by SocEnts of ex-NHs staff #AHPNorth (Wed, 28 Mar 2012 09:49:43 +0000)
@claireOT Personal budgets in health, and choice of service, and direct payments, to ensure the care commissioned by people #AHPNorth (Wed, 28 Mar 2012 09:51:04 +0000)
@claireOT Publishing quality information for public, for commissioners. Or you won’t be commissioned. Stark. #AHPNorth (Wed, 28 Mar 2012 09:53:04 +0000)
@claireOT Integrated services will be commissioned, whole pathway approach, rather than each individual element. Will promote partnerships #AHPNorth (Wed, 28 Mar 2012 09:54:27 +0000)
@claireOT People don’t want to die in hospital. Need joined up care for end-of-life #AHPNorth (Wed, 28 Mar 2012 09:54:56 +0000)
@mikechitty @claireOT How does this work for new startups who will have no data to share? Do they need 3 years accounts too? #AHPNorth (Wed, 28 Mar 2012 09:55:46 +0000)
@claireOT McKinsey report was spot on in terms of where we need to transform services to cope with less money in the system #AHPNorth (Wed, 28 Mar 2012 09:56:19 +0000)
@claireOT @mikechitty suspect they want them to get in bed with established partnerships and submit joint bids. Will ask, tho #AHPNorth (Wed, 28 Mar 2012 09:57:04 +0000)
@claireOT @claireOT @mikechitty long answer… Basically, procurement systems will be simplified to open up to any qualified providers #AHPNorth (Wed, 28 Mar 2012 10:02:14 +0000)
@claireOT @claireOT @mikechitty so this will be easier than previously. But they will not negotiate on quality, services must prove they #AHPNorth (Wed, 28 Mar 2012 10:03:05 +0000)
@claireOT @claireOT @mikechitty can meet minimum national standards. Or can be subcontracted by big providers if can undercut nHS provision #AHPNorth (Wed, 28 Mar 2012 10:03:46 +0000)
@claireOT @claireOT @mikechitty or, can form consortia, which may be with other SocEnts or vol sector, or event FTs #AHPNorth (Wed, 28 Mar 2012 10:04:16 +0000)
@claireOT @claireOT @mikechitty finally, take business advice at every stage! #AHPNorth (Wed, 28 Mar 2012 10:04:32 +0000)
@claireOT Difficulty with tariffs when trying to bring in tele- consultations with consultants and telemedicine this will now change #AHPNorth (Wed, 28 Mar 2012 10:05:38 +0000)
@claireOT Nhs commissioning board and monitor will drive increasingly aggressive tariff reform in 2014-15, to push for this #AHPNorth (Wed, 28 Mar 2012 10:06:26 +0000)
@claireOT Current tariffs are not working to drive innovation. Local groups could go after population commissioning on a pathway basis, #AHPNorth (Wed, 28 Mar 2012 10:07:10 +0000)
@claireOT Heres the outcomes I want, here’s my population, who gives me an overall cost efficient solution for a long term contract? #AHPNorth (Wed, 28 Mar 2012 10:07:45 +0000)
@claireOT Creative ways to guarantee the clinicians prevent hospital admissions, taking tariffs away from treatment towards outcomes #AHPNorth (Wed, 28 Mar 2012 10:09:00 +0000)
@mikechitty @claireOT the value of ‘business advice’ in such a new environment is questionable. #AHPNorth (Wed, 28 Mar 2012 10:09:26 +0000)
@claireOT Now up, Karen Middleton, the most senior Govt advisor representing AHPs Chief Health Professions Officer #AHPNorth (Wed, 28 Mar 2012 10:10:58 +0000)
@claireOT AHPs are known as a professional group the downside, is that we don’t put ourselves forward! #AHPNorth (Wed, 28 Mar 2012 10:12:39 +0000)
@claireOT “”get down and dirty”" was a bit too much, so we have decided “”just do it”" is our driving statement #AHPNorth (Wed, 28 Mar 2012 10:13:25 +0000)
@claireOT No more talk about the Bill, or the system architecture, we just have to get on with the context we’re working in #AHPNorth (Wed, 28 Mar 2012 10:14:12 +0000)
@claireOT Middleton says “”Adapt or Die”"- previous paper #AHPNorth – this is true, if a bit dramatic!(Wed, 28 Mar 2012 10:15:08 +0000)
@claireOT @BAOTCOT you might be interested to follow my #AHPNorth tweets today, very interesting speakers!(Wed, 28 Mar 2012 10:15:46 +0000)
@claireOT Number of over 85s will double in the next 20 years and over 65s will represent 20% of the population #AHPNorth (Wed, 28 Mar 2012 10:17:59 +0000)
@claireOT The future is co- morbidity. Multiple problems that need solving concurrently #AHPNorth (Wed, 28 Mar 2012 10:18:21 +0000)
@claireOT Over 50% will be musculoskeletal, over 20% mental health #AHPNorth (Wed, 28 Mar 2012 10:19:00 +0000)
@claireOT The impact of digital technology can cancel out these pressures #AHPNorth (Wed, 28 Mar 2012 10:19:21 +0000)
@claireOT Fantastic- she’s blowing the minds of everyone here by talking about granularity in personalisation of care #AHPNorth (Wed, 28 Mar 2012 10:20:22 +0000)
@claireOT Patients testing themselves at home. Porting imaging to anywhere in the world #AHPNorth (Wed, 28 Mar 2012 10:20:48 +0000)
@claireOT This isn’t a five year QUIPP programme. This is radical and permanent re-definition of delivery of health services #AHPNorth (Wed, 28 Mar 2012 10:22:51 +0000)
@claireOT We just have to get on with providing seven- day services #AHPNorth it also saves money. Length of stay is reduced.(Wed, 28 Mar 2012 10:30:13 +0000)
@claireOT Start to use cost- benefit analysis. You must understand your business model #AHPNorth (Wed, 28 Mar 2012 10:31:07 +0000)
@claireOT What is being professional about? It includes using the money wisely! Every pound results in better quality care #AHPNorth (Wed, 28 Mar 2012 10:32:43 +0000)
@claireOT Salami slicing and cuts is not the aspiration of QUIPP. This is unsustainable. We’ve got to be radical. #AHPNorth (Wed, 28 Mar 2012 10:34:01 +0000)
@mikechitty @claireOT Not enough to be great healthcare provider – have to be a great business manager too #AHPNorth #painfullesson (Wed, 28 Mar 2012 10:35:02 +0000)
@claireOT Not to speak up if you see or hear bad practice is colluding and is itself unprofessional have “”the conversation”" #AHPNorth #OTalk (Wed, 28 Mar 2012 10:54:34 +0000)
@claireOT Professionalism extends onto social networking sites. If you see an AHP or nurse in compromising position on Fb, you should talk #AHPNorth (Wed, 28 Mar 2012 10:56:03 +0000)
@claireOT I’m in a QIPP workshop now at #AHPNorth , expect a tweet pic with some kind of chart on it before lunch!(Wed, 28 Mar 2012 11:02:00 +0000)
@WhoseShoes Interesting tweets: claireOT from #AHPNorth – incl great providers needing excellent approach to business as well as caring #socialcare (Wed, 28 Mar 2012 11:03:04 +0000)
@claireOT RT @mikechitty : @claireOT Not enough to be great healthcare provider – have to be a great business manager too #AHPNorth #painfullesson (Wed, 28 Mar 2012 12:16:17 +0000)
@claireOT Now Sir David Nicholson: chief exec of NHS and national commissioning board #nhs #AHPNorth (Wed, 28 Mar 2012 12:29:47 +0000)
@claireOT This guy is very warm in his manner, and he is breaking with tradition and is not in a suit! #AHPNorth (Wed, 28 Mar 2012 12:30:40 +0000)
@claireOT Reminding us to focus on outcomes for patients in the face of the Act #AHPNorth (Wed, 28 Mar 2012 12:31:25 +0000)
@claireOT Demand for services goes up about 4% each year, due to demographics, tech advances and expectations of patients #nhs #AHPNorth (Wed, 28 Mar 2012 12:33:47 +0000)
@claireOT No healthcare system has ever succeeded in meeting the challenge that is asked of us. We have to go down the innovation route #AHPNorth (Wed, 28 Mar 2012 12:34:30 +0000)
@claireOT 1st element only we can do some things, nationally, e.g. Management cost reductions. Generates a third of the saving #nhs #AHPNorth (Wed, 28 Mar 2012 12:35:54 +0000)
@claireOT 2 a third from everyday efficiencies #nhs #AHPNorth (Wed, 28 Mar 2012 12:36:16 +0000)
@claireOT 3 a third from service change, service redesign. We have to do this, or more has to come from cuts. #nhs #AHPNorth (Wed, 28 Mar 2012 12:36:54 +0000)
@claireOT Up to a third of people in hospital beds don’t need to be there, if we had better community services and social care #AHPNorth (Wed, 28 Mar 2012 12:37:37 +0000)
@claireOT Specialisation, I.e. concentrating specialists in one location e.g stroke in specialist units #nhs #AHPNorth (Wed, 28 Mar 2012 12:38:22 +0000)
@claireOT We can move away from the medical model and therefore speed up the way we rehabilitate people #nhs #AHPNorth (Wed, 28 Mar 2012 12:38:59 +0000)
@InHealthAssoc @claireOT intrigued that not one speaker has mentioned working WITH patients and communities? #AHPNorth (Wed, 28 Mar 2012 12:39:35 +0000)
@claireOT GP practices are population based. This is the basis of the commissioning. Huge contact with pts, 90%of all contact in 1ry care #AHPNorth (Wed, 28 Mar 2012 12:41:30 +0000)
@InHealthAssoc @claireOT sorry to bang on: but language is interesting “”WE have to speed up way WE rehabilitate people”". Us and them. #AHPNorth (Wed, 28 Mar 2012 12:41:41 +0000)
@claireOT GP practices can make small changes which have a massive impact across the system #AHPNorth (Wed, 28 Mar 2012 12:42:36 +0000)
@claireOT But, primary care must work with other profs in CCG to try to define the population based re-commissioning underway now #AHPNorth (Wed, 28 Mar 2012 12:43:31 +0000)
@claireOT Soe services are huge- we need to build networks, we need to strengthen them, support them #AHPNorth #nhs (Wed, 28 Mar 2012 12:44:11 +0000)
@claireOT Clinical senates- looking at huge geographical regions to see how care is working #nhs #AHPNorth (Wed, 28 Mar 2012 12:44:52 +0000)
@claireOT We need to find a mechanism to impove community services. We’re trying to do this through AQP #AHPNorth (Wed, 28 Mar 2012 12:48:23 +0000)
@claireOT “”We need to engage with public and patients to make t his happen”" good! #AHPNorth #NHS (Wed, 28 Mar 2012 12:49:18 +0000)
@claireOT Work together as teams across the system. Build clinical networks. Build clinical senates #AHPNorth (Wed, 28 Mar 2012 12:51:22 +0000)
@claireOT Never forget mid-staffs. We. Can never allow this to happen. Focus your attention on patient care #AHPNorth (Wed, 28 Mar 2012 12:52:50 +0000)
@claireOT “”Engage people in the process, so that they feel part of it”" <I’m doing my best! #AHPNorth (Wed, 28 Mar 2012 12:53:28 +0000)
@claireOT Seek out disadvantage and make sure they get the same healthcare as anyone else. Fantastic ending. Questions? #AHPNorth (Wed, 28 Mar 2012 12:54:13 +0000)
@claireOT @InHealthAssoc take some comfort from the fact he is the big guy…. #AHPNorth (Wed, 28 Mar 2012 12:54:36 +0000)
@claireOT Question re starting a clinical dialogue with GPs when the orgs are stopping/ trying to control it? #AHPNorth (Wed, 28 Mar 2012 12:55:39 +0000)
@claireOT I am in the same room as the guy in charge of the #NHS . If you want me to ask him anything, now is the time! #AHPNorth (Wed, 28 Mar 2012 12:56:17 +0000)
@claireOT @InHealthAssoc he comes over really well, I’m probably not making it clear. He’s wearing a jumper #radical #AHPNorth #NHS (Wed, 28 Mar 2012 12:57:18 +0000)
@claireOT Foundation trusts that haven’t re-designed services on innovative lines, they will be in big trouble. Rethink business model #AHPNorth (Wed, 28 Mar 2012 12:58:36 +0000)
@claireOT local, integrated, community based, focussed on recovery, this is the future #AHPNorth (Wed, 28 Mar 2012 12:59:25 +0000)
@claireOT Incentives and payments are being changed to reflect this I.e. getting back to work not completing an operation #AHPNorth (Wed, 28 Mar 2012 12:59:56 +0000)
@claireOT @RobWebster_LCH any q’s for the nhs big guy? #AHPNorth (Wed, 28 Mar 2012 13:00:59 +0000)
@claireOT Ooh he is talking about the leaked risk register #AHPNorth (Wed, 28 Mar 2012 13:01:23 +0000)
@rose_red_121 RT @mikechitty : @claireOT Not enough to be great healthcare provider – have to be a great business manager too #AHPNorth #painfullesson (Wed, 28 Mar 2012 13:01:27 +0000)
@claireOT We have to share resources across the system #AHPNorth (Wed, 28 Mar 2012 13:02:34 +0000)
@claireOT @InHealthAssoc he has never been asked a question by a tweet before! #AHPNorth (Wed, 28 Mar 2012 13:09:09 +0000)
@claireOT This is a hugely important part of the service redesign we want to see, patients are the experts! E.g diabetics #AHPNorth (Wed, 28 Mar 2012 13:10:40 +0000)
@claireOT @InHealthAssoc investing in expert patients is a critical part of this, it will be driven by CCGs #AHPNorth (Wed, 28 Mar 2012 13:11:06 +0000)
@claireOT @InHealthAssoc also, get involved with your local health and wellbeing boards, this is where you may effect change #AHPNorth (Wed, 28 Mar 2012 13:11:35 +0000)
@claireOT @InHealthAssoc citizens panels might be used to come up with radical and interesting ideas through the health & wellbeing boards #AHPNorth (Wed, 28 Mar 2012 13:12:20 +0000)
@claireOT Gandhi room is our venue. We can take advice from him. Be the change. #AHPNorth (Wed, 28 Mar 2012 13:13:05 +0000)
@claireOT Doing a bit of paradigm shifting in the room, they are all reacting about the idea of tweeting what were talking… #AHPNorth (Wed, 28 Mar 2012 13:13:57 +0000)
@claireOT @InHealthAssoc yes, I think he meant “”people”", anyone can get involved in H&W boards #AHPNorth (Wed, 28 Mar 2012 13:35:01 +0000)
@claireOT @InHealthAssoc no, the tariffs are still reflecting the old situation but they are addressing this and it will change soon #AHPNorth (Wed, 28 Mar 2012 13:35:57 +0000)
@claireOT @InHealthAssoc well, it is true. But there is no reason why they can’t go AQP and bid or subcontract to deliver services, now #AHPNorth (Wed, 28 Mar 2012 13:37:49 +0000)
@claireOT *waves* to @naomimcvey good to see you at #AHPNorth today, do @ me anytime for a chat x(Wed, 28 Mar 2012 13:39:35 +0000)
@NHSImprovement Brilliant speech at #AHPNorth by Sir David Nicholson – all work together to improve services for users(Wed, 28 Mar 2012 14:15:25 +0000)
@claireOT That’s your lot from #AHPNorth , #spoonie #fail I’m on my way home for a nap x(Wed, 28 Mar 2012 14:17:02 +0000)
@FestivalofPHUK RT @NHSImprovement : Brilliant speech at #AHPNorth by Sir David Nicholson – all work together to improve services for users(Wed, 28 Mar 2012 14:23:27 +0000)
@NaomiMcVey RT @NHSImprovement : Brilliant speech at #AHPNorth by Sir David Nicholson – all work together to improve services for users(Wed, 28 Mar 2012 14:29:40 +0000)
@NaomiMcVey @claireOT good to meet you at #AHPNorth – great use of social media for Sir David Nicholson Q&A!(Wed, 28 Mar 2012 14:33:26 +0000)
@claireOT RT @NHSImprovement : Brilliant speech at #AHPNorth by Sir David Nicholson – all work together to improve services for users(Wed, 28 Mar 2012 14:43:30 +0000)
@claireOT ” @NHSImprovement : AHP North of England – helping develop services for patients: 7 day working:
http://t.co/81aw5EXM
 #7dayworking ” #AHPNorth (Wed, 28 Mar 2012 14:44:48 +0000)
@claireOT ” @NHSImprovement : #AHP North National Commissioning Picture, Edna Robinson, NHS Clinical Commissioning Community #Leeds ” #AHPNorth (Wed, 28 Mar 2012 14:45:24 +0000)
@claireOT ” @NHSImprovement : AHP North of England – developing #stroke services for patients: psychological care:
http://t.co/UklcWdBh
 ” #AHPNorth (Wed, 28 Mar 2012 14:45:44 +0000)
@claireOT ” @dgfoord : “”NHS could save money and provide better care by involving Allied Health Professionals”"
http://t.co/5aXgOLXJ
 #QIPP ” #AHPNorth (Wed, 28 Mar 2012 14:46:35 +0000)
@claireOT ” @NHSImprovement : #AHP North of England – Karen Middleton: AHPs – just do it! @DHgovuk ” #AHPNorth (Wed, 28 Mar 2012 14:46:50 +0000)
@claireOT ” @NHSImprovement : #AHP : Number of very old people will significantly increase in future – impact on #NHS services we deliver” #AHPNorth (Wed, 28 Mar 2012 14:47:03 +0000)
@claireOT ” @NHSImprovement : #AHP : 2 priorities – drive up quality of services and deliver savings to meet future demand” #AHPNorth (Wed, 28 Mar 2012 14:47:19 +0000)
@claireOT ” @NaomiMcVey : @claireOT good to meet you at #AHPNorth – great use of social media for Sir David Nicholson Q&A!” < thanks very much ;-) (Wed, 28 Mar 2012 14:48:10 +0000)
@claireOT MT”" @CIHM_Becky : @claireOT @inhealthassoc depends what HWBB thinks it’s for. keep asking what value they intend to generate” #AHPNorth (Wed, 28 Mar 2012 14:49:06 +0000)
@claireOT @CIHM_Becky you know me, I’m a “”disrupter”" in the Health system #Christensen #AHPNorth (Wed, 28 Mar 2012 14:50:19 +0000)
@claireOT @CIHM_Becky next time, I suspect more Tweeting will happen ;-) @robwebster_lch #AHPNorth (Wed, 28 Mar 2012 14:51:01 +0000)
@claireOT RT @NaomiMcVey : Interesting day #AHPNorth , key themes: get in there, transform services & focus on outcomes, patient engagement & QUALITY @claireOT @thecsp (Wed, 28 Mar 2012 14:51:09 +0000)
@claireOT ” @mikechitty : This Health and Wellbeing Board factsheet should make everything clear
http://t.co/7bLKy4vC
 #Leeds ” #AHPNorth (Wed, 28 Mar 2012 14:51:44 +0000)
@claireOT @CIHM_Becky @mikechitty so, how do I get in to talk to the HWBB? #Leeds #AHPNorth (Wed, 28 Mar 2012 14:52:41 +0000)
@claireOT ” @GdnHealthcare : NHS reform: a radical approach through co-production?
http://t.co/8H28Tyxe
 ” #AHPNorth (Wed, 28 Mar 2012 14:53:06 +0000)
@claireOT Also managed to do a bit of promo for #digihealthcon at #AHPNorth
http://t.co/Goijz1mL
 @digihealthcon (Wed, 28 Mar 2012 15:04:12 +0000)
@claireOT @anniecoops there was a little muttering about “”journalists”", but overall the reaction was positive #littlewin #AHPNorth (Wed, 28 Mar 2012 15:23:53 +0000)
@claireOT ” @mikechitty : @claireOT @CIHM_Becky This one is lovely as well
http://t.co/fHl7Dac3
 ” <er, that helps ;-) #AHPNorth (Wed, 28 Mar 2012 15:24:49 +0000)
@FlmCd RT @NHSImprovement : Brilliant speech at #AHPNorth by Sir David Nicholson – all work together to improve services for users(Wed, 28 Mar 2012 16:57:32 +0000)

Filed under AHP, Conference, CPD, Interprofessional practice, Leeds, Recovery, Twitter Tagged with , , , , , , , , , , , , , ,

#benefitscamp hack day at Westminster Hub @FutureGov

February 21, 2012 10 Comments


I was intrigued to see the hack day advertised through my networks, hosted by the Westminster Hub and Future Gov, and the invite list looked like it contained a good mix of people from all different walks of life. I knew I wouldn’t be able to attend in person, so I thought I would test out my theory that it would be possible to participate in an event like this entirely online. The advertising led me to believe I wouldn’t be the only one participating in this way, so I thought it would be a great experience.

I also believed that my dual perspective as a healthcare professional and as a person with a disability and limiting condition meant that my insight might be of value to the group, although I wasn’t sure I was expert in any particular area. I thought that at the very least I could contribute my skills in group facilitation and help the other participants voices to be heard. So, with a mixture of excitement and trepidation, I waited for the day to approach.

I feel strongly that the population of this country support the right of its citizens to fair treatment and a basic level of income no matter what our personal circumstances are. It is my concern that we are facing a political narrative that the economic crises we face are as a result of an “overindulgent” welfare state. I disagree with this opinion. I believe that the welfare state guarantees the basis of many of our freedoms in this country, and is a marker of our civilization.

As a person with a disability, it is important for my self-esteem to work. However, I am unable to work in the way that I did before I became disabled. My situation is not unusual, I have met many people online who wish to have the right work- work which suits their personal circumstances, the adjustments they have to make to accommodate their health and disability, work that is supportive of their recovery and which promotes self-esteem and societal regard. This may, or may not, include paid work. Volunteering and community work, caring responsibilities, childcare, study, all these activities are grouped under the heading of “productivity” for occupational therapists, and when I discuss work, these activities are all implicit under that description.

The hack camp decided on several themes that were important to the people in the room and the people online. These were:

1. Money saving and sharing

2. Personal data

3. Local impact

4. Better communication / information

5. Collaboration and peer to peer support

6. Skills and volunteering

7. Jobs, flexible working and enterprise

8. Better admin

Through conversations with the people involved, I decided that the group that I most naturally belonged in was the jobs, flexible working and enterprise group.

Here is a little further description of the group aims:

7. Jobs, flexible working and enterprise: be allowed to get income from work around benefits system, home working for people with disabilities, support for people to start their own business, post a profile of yourself and make employers find you, new types of jobs as old work models outdated, confidence-building to encourage people to have confidence to apply for jobs

  • Home Work Net – “Bring your service back in house – Literally!” – Home Working
  • Bring in an enterprise scheme, reduced or no rate for 2/3 years.  Possible tax concessions
  • People allowed to work flexibly on benefits – like consultancy
  • You should be so lucky – profiles to show skills, employers come and find people – reverse recruitment
  • Welfare/benefits sat nav.  Given skills, it plots path through to desired job outcome based on what other people with similar skills have done
  • How can the benefits system better reflect the changing patterns of work – FLEXIBLE
  • How can we reduce the stress of the application process?
  • @janetedavis: confidence-building to encourage people to have confidence to apply for jobs (using social media/web)
  • @CathyAitchison: the concept of ‘jobs’ is outdated – need a way of thinking which counts/values all areas in a person’s life via a paid job, freelence, voluntary, care (family) – could an electronic system manage a person’s ‘credits’ of all kinds?

Participation in this group was incredible. The members of the group were spread all over the country, from the Isle of Wight to Newcastle, (@creativecrip @claireot @nancyrowena @janetedavis with two members on-site at the Westminster Hub (@Lisybabes and @Lucy_Watt)

Incredibly, within the space of an hour, our team had developed a website (currently kindly hosted by @creativecrip) which used a bespoke logo and presented our findings in blog format.

The site is still under construction, but provides a space where we may return to our findings and refine them with reference to future funding opportunities or other ways to develop our ideas. Having a skeleton site up and running in the short time available is, in itself, testament to the currently underused skills and abilities of people with disabilities, who are currently excluded from making choices in the jobs market that fit their circumstances.

We worked on our presentation as a Google Doc, which meant that it was hosted in the cloud and accessible to all of us for editing and commenting.

We talked about our presentation using Skype chat facility, which meant we were able to share our opinions and improvements for the project as we went along.

Our presentation was a mock-up of a user interface for a website or mobile application which detailed how we thought we should develop the ability for the benefits system to accommodate the various different work patterns likely for those with fluctuating conditions.
If you would like to view it, it is available below.

I have to mention the amazing job that Lucy and Lisa did in facilitating this in the physical space of the workshop. We online participants felt as involved as if we had been there in person- we had as much influence on the project development as the people in the room. I felt it was an important model of inclusive practice, which still seems to be an alien concept for so many events when simple adjustments such as these made our participation possible.

Participants in the group were:

Lucy Watt (@Lucy_Watt)

Lisa Egan (@Lisybabe)  
http://wheresthebenefit.blogspot.com/

Lisa Ellwood (@CreativeCrip) 
http://uk.linkedin.com/in/iconicimagery

Nancy Farrell (@nancyrowina) 
http://www.nancythroughthelookingglass.blogspot.com/

Janet Davies (@janetedavies)

Filed under Digital Inclusion, Interprofessional practice, Recovery, Social Inclusion, Social Media, Web 2.0 Tagged with , , , , , , , , , ,

An experiment in Social Media in Clinical OT practice Growing Together 3- Growing shoots

January 4, 2012 1 Comment


I’ve posted a couple of blogs about my experimental use of Social Media in Clinical OT practice (see part1 and part2). Today’s post discusses the first foray into the use of Social Media.

As I discussed in the first blogs, I visited other groups both within the city and more widely. During these visits, I took photos to share with our group members when we talked about what we could learn from other groups. These photos were also included in reports I made about the visits, which were uploaded to the Staffnet site discussed in the previous post. They made the reports more interesting, and also made my service users more likely to connect with the reports, when I printed them out to share with them a little like magazine articles.

Service users wanted to be involved. They wanted reports like these relating to their project. In response to service users asking if we could take photos of our progress, and to enable the participants in the group to share this progress as they wished, I took photos with my smartphone.  Initially, we only shared the photographs during the tea break with each other, but then I considered the use of a photo sharing social networking site in order to share the photos more widely with family and friends of group members. We talked about how to do this, and settled on using FlickR, a free social media tool for sharing photographs. This would mean they could share their progress with others, all that was required was internet access.

As health service employees we have a duty of care for everybody that uses our services, including protecting their data. Mindful of our Information Governance issues, this was cleared by our IG department, and clear boundaries set for the use of cameras to record progress. Consent forms were developed to capture informed consent from service users before they were photographed. Part of  gaining the informed consent was to discuss what we could do with the pictures  and what kind of boundaries I was operating under in terms of what information would be photographed. We made sure that the majority of the photos we took didn’t have “patient identifiable information” on them (faces, distinctive tattoos) because this made the Information Governance issues much easier to handle, and it made our service users comfortable with the process. Of course, if people didn’t wish to be photographed, we would respect their wishes.

We started to take more pictures, uploading them to the FlickR site we had set up.

As we developed the project and they became more comfortable with what was happening, they did ask to be photographed on occasion. One particularly memorable photo was of a young man holding a crop of onions he was proud of harvesting! Because of our informed consent proceedure, the subjects of the photos (if identifiabe) got a second chance to decline their permission for publication on FlickR, but if they agreed, my clinical reasoning was that it was okay to publish.

Disabled people and people with mental health issues are often socially excluded, and I felt that including the photos within the larger social network was a way to combat some of that exclusion, in our own small way. We had set up a group that was non-stigmatising- it didn’t carry “health” branding, and our group members had as much right to occupy the virtual space as any other community group. Had we encountered any adverse comments or increase in social difficulty for the group members as a result of this, we could have taken alternative action. But we didn’t.

Sometimes, the things which matter in a therapeutic group are not the things we carefully plan for. Within this group, the wildlife that we saw around us became a real hot topic of conversation, and this was another great opportunity to take pictures to share.

We also had a regular visitor in the form of our Allotment cat.

Many people with disabilities and mental health issues don’t have pets because they fear they either cannot afford to look after them, or they have lifestyles which mean they wouldn’t be able to offer the care they feel the animals need. This was the case for several of our group participants. However, they all felt very affectionate about the Allotment cat, and he seemed to return their affection. He would visit during every group, and was inevitably fed and offered a saucer of milk by the group. He would then make his way from knee to knee, offering every group member the opportunity to give him a stroke or two. Who knows what effect this affection has on a person with limited social skills?

At this point, I felt I needed to learn more about Social Media, in order to really maximise how we used it within the group; so I attended a local Social Media Surgery. I am immensely grateful for the help I received there. I felt encouraged to venture further into the realms of social media.

What are your views about using photo sharing social media with mental health service users? Please share in the comments.

To find out our next steps, watch out for my next post.

Filed under Digital Inclusion, FlickR, Occupational Therapy, Recovery, Social Inclusion, Social Isolation, Social Media Surgery, Stigma Tagged with , , , , , , , ,

Censorship, or Duty of Care? “Little Feet”, Blogging on an Acute Mental Health Inpatients Ward.

January 4, 2012 26 Comments


This blog is inspired by a post I have read today by @Chaosandcontrol, who blogs as Little Feet. Please do read the original post and comments in their entirety, and excuse me for quoting from it in addition.

Here, Little Feet describes her actions in  password protecting her entire blog:

I was readmitted to hospital on 28 December and discharged today (3 January). On 29 December, I was notified by staff that my blog had come to their attention. Staff read through the archives and my phone was confiscated for 24 hours. I made a verbal agreement with staff that I would not blog while I was in hospital.

She then posted about how because of this lack of privacy, she no longer felt safe to continue with her blog. She has currently stopped. I have so many things to say about this short statement. Im afraid they may come tumbling out helter skelter, so please bear with me.

Staff probably defend their actions by claiming they are acting to protect either the organisation (and staff), the patient, or the other patients. Each of these defences relies on slightly different clinical reasoning. Let me go through them.

First, let us consider Maslow’s famous hierarchy of needs.

An individual travels up this pyramid  from a baseline of meeting physiological needs, through safety, then social and emotional needs towards self expression and self actualization. By transferring the principles contained within this model, we can look at the organisation’s equivalent succession of needs within the social space, using a term coined by Jeremiah Owyang at the 2011 Leweb conference in Paris- the ‘Social Business Hierarchy of Needs’

If you haven’t got 20 minutes to watch the video, you could look at the Slideshare presentation.

climb-the-social-business-hierarchy-of-needs-leweb-keynote-2011?player=js

What we can learn from this is that the hospital in which Little Feet found herself was still concerned with the bottom layers of the pyramid- those regarding security and safety, whilst Little Feet had progressed past these layers in her digital interaction and was performing at a much higher level, concerned with self-exppression and self- actualisation.

We can see  that because of this disconnect in the digital literacy of the staff and organisation, and the population it is serving, the efforts by the staff to take control of the situation by using their power over their patients was (expectedly) experienced as oppressive by Little Feet, and also by the blogging community leaving comments on Twitter and on the blog itself. I am sure this was not the way they wished to be experienced, as I am sure they are good people who are just terrified by this new technology and way of communicating. But actively preventing someone from operating on the higher levels of Maslow’s pyramid is never going to be experienced as anything but oppressive, and services need to wake up to this fact and work out how to deal with their concerns about safety and move along in their own journey with social media.

Learning about patients from sources other than from within the clinical relationship and information from friends and family WITHOUT EXPRESS PERMISSION is not on. We are able to work that out from first principles, because one of the pre-eminent concerns of healthcare professionals is consent. Without consent, we must tread very carefully in what we do, using reflection, interdisciplinary learning, and close regard for the legal and policy framework for what we do (e.g. sectioning, deprivation of liberty). Little Feet did not consent for the staff to read her blog. They did not happen across it as a blog by an unknown individual, they had inside knowledge at the time of reading of Little Feet’s clinical presentation. That’s not cricket.

It’s unethical- In the same way that we would be justifiably angry if we found someone has read a secret diary, EVEN IF WE LEFT IT OPEN ON OUR INPATIENT BED we can have an expectation that clinical staff will form their clinical opinions based on presentation, symptoms, and medical history.

Discovering additional information about our clients is one of the cautionary tales warning clinical staff (and teachers for that matter) off from using SNS. The belief is that learning these insights will damage the therapeutic relationship, and cloud the (supposedly impartial) process of developing a diagnosis or formulation. That’s why your GP probably won’t friend you n Facebook.

It’s not that digital sources of information are irrelevant- but THIS SHOULD BE EXPRESSLY CONTRACTED WITH THE PATIENT.

What we present to the world is a series of faces, like the sides of a prism. None of them entirely explains our essential essence, each one is slightly different. How Little Feet appears in her blog is quite different from how she appears to her clinical team, I’m sure. After all, they are presented with a real life, flesh and blood version, perhaps with tears, anger, occasional incoherence, and frustration with the inherent power imbalance of mental health treatment- just like you or me in a mental health crisis.

The clinical team need to focus on the clinical presentation if they are to avoid bias, prejudice and all sorts of personal opinions from creeping unseen into the clinical situation. That’s why we have such developed conventions for clinical consultation. Contracting to source additional information pertinent to the clinical relationship could be appropriate, but it must be done with consent.

So, we can see that protecting the patient by removing her ability to express herself and self-actualize runs counter to the principles of recovery, which are about supporting progress up Maslow’s pyramid, not forcing someone down it. We have also seen how clinical treatments should not use information gleaned from  relationships outside the clinical arena without consent.

Protecting other patients is a little more difficult, in that we know that they will have a range of digital literacies and understanding of the consequences of being referred to within the blog. They will all occupy different levels of Maslow’s hierarchy. Confidentiality is a complicated issue, becase someone can be identified by a clinical picture (if unusual enough) just as easily as from a photograph. The difference here is that the staff hold the responsibility for protecting confidentiality, service users do not. That is why at the start of clinical group work, protecting confidentiality is generally introduced as a ground rule- to make sure it is in the mind of the participants.

However, what exactly are the patients here being protected from? In fact, there is no difference between Little Feet’s potential to discuss her descriptions and those of other patients. It is the medium of the descriptions that worries the staff.

Where conversations about services are confined to individuals, organisations feel happier because they are perceived as less threatening. What is frightening for the organisation about digital media is related to their lack of understanding of it, as discussed above. The old ‘command and control’ model of communications is so prevalent in health organisations dealing with digital media because they are operating in an unfamiliar medium and are just on the initial steps of Maslow’s pyramid.

There is excellent clinical practice out there, and there are both practitioners and organisations whoa re prepared for the journey they must take in understanding social media. But there are so many others who still haven’t framed the question, never mind worked out an answer.

Little Feet’s blog has served a critical purpose with the final post. It illustrates the difficulties that are facing health organisations who are treating individuals with much higher digital literacy than themselves. It’s time we woke up and started to play catch up in this arena.

What are your experiences of this?

If you would like to know how I can help your organisation or clinical staff move on in their understanding of digital and social media, get in touch at tech4health(at)gmail(dot)com.

Filed under Blogging, Inpatient Services, PTSD, Recovery, Reflection, Risk, Social Media, Society, Web 2.0 Tagged with , , , , , , , ,

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