What comes over the hill?

By its name, it is clearly an offshoot of GIRFEC, the Scottish Government's illegitimate answer to all the problems facing children from pregnancy to adulthood, 'Getting It Right For Every Child'. This new program expands on that concept even further. So what is GIRFEA and who does it affect?

Last weekend we received the first information about this new program in the form of a meeting agenda. The full text is as follows:

Getting it right for all adults (GIRFEA)

Monday, January 23, 2017

Purpose of the event:

This event will bring together developments across NHS Highland around the Adult Practice Framework, Getting it Right for Every Adult (GIRFEA) and the role of the lead professional. By the end of the day, NHS Highland's adult practice model has been agreed and will be rolled out, tested and fine-tuned over the next 12 months.

Target participants:

AHPs, SWs, nursing professional leaders and managers involved in supporting, managing, or working with integrated district teams.

agenda:

09:00 GIRFEC: What Works and Lessons Learned Bill Alexander

0930 GIRFEA: Development Update Pat Tyrrell

1000 Lead Professional Roles: Updates and Explanations

1030 Adult Practice Framework Joanna McDonald

1100 Community Planning Partnership/Lead Specialist Jan Baird

1115 Break

1130 Setting direction: GIRFEA agrees on three priorities each for adults.

Practice Framework and Lead Professional Claire Wood/Pat Tyrrell

1245 Lunch

1330 Collaborating with Others: Group Feedback Joanna McDonald

1415 Achieving Results: Agreeing to the “Plan”. resource management;

People, Performance and Risk Pat Tyrrell

1500 Self-Leadership: Leading Change Alison H/Kate PQ

1600 finish

With opening remarks from GIRFEC apostle Bill Alexander, it was immediately clear that this was a descendant of GIRFEC's approach to children and families. (I wonder what it is lesson Did he learn? )

But what is “The Plan”? What does this new plan involve? There are only a few clues at this point.

The pilot program ran in Dumfries and Galloway from 2012 to 2014. It was called “Putting You First.” Some of the information will be revealed in the published minutes.

PYF Seamless Care Workstream Wednesday, July 3, 2013 10:30 a.m. Conference Room 4, Crichton Hall

4 Treat the elderly correctly

Graham Abrines provides an update saying it is difficult to agree on health indicators for older people and this may take time. GA is also looking to see if there is the ability to assign this to some people on the team. We noted that a single point of contact for older adults (in the GIRFEC model) would be highly beneficial. Action: GA providing updates in August

define it that way happiness “It might take a while.” This is not surprising, bearing in mind that one of the leading proponents of well-being defined it as:

Well-being is not about going to the beach and lying down. It's a kind of dynamic dance, there's always movement, and it's the function of that movement that actually brings about a true level of happiness.

– Nick Marks, Radio 4, January 7, 2012.

The “single point of contact” is GIRFEC’s “designated person”. During the no-designate campaign, we learned that the key question is: Who is the point of contact for? Is it a means of providing improved services and communication to better provide the care that patients choose, or is it a way of providing improved services and communication to better provide the care that patients choose, or is it a way of providing improved services and communication for patients, or for the state rather than for the individual, as in the case of a designated person? Is there a single point of contact for this?

PYF Seamless Care Workstream Wednesday 8 August 2013 11:30am Rocher South, Crichton Hall

5 Respond appropriately to the elderly

The GA advised that the correct terminology should be: “Treat all adults correctly” (emphasis added). Scoping has begun and the GA has determined that £25,000 is required to free up social work resources for up to six months to develop the concept, as well as funding to support individuals with their work, including meeting accommodation costs. We advised that up to £5,000 was required for resources. , travel expenses approved by GA for costs over £250. This funding was agreed on the condition that the project outlines the following model: Shanari principle: • Safe • Healthy • Active • Nurtured • Achieving • Respected • Responsible • Included

Therefore, a month after the difficulty of defining well-being was acknowledged, the SHANARI indicator was adopted directly from GIRFEC, which made it a condition for funding. In other words, an order from the Scottish Government. This comes against the backdrop of the UK Supreme Court's particular focus on well-being and shanari in its judgment on nominees. Their conclusions were dire.

“Happiness” has no definition. The only guidance on its meaning is provided by Article 96(2), which enumerates eight factors to be taken into account when assessing well-being. The elements, known by the acronym SHANARRI, mean that children and young people are or will be “Safe, Healthy, Achieving, Nurturing, Active, Respected, Responsible, and Inclusive.” . These elements themselves are undefined and, in some cases, highly ambiguous. For example, children and young people are 'achieving' and 'included'.

One may wonder why the Scottish Government ignored this finding. Why are we pushing these vague and undefined concepts as the core idea of ​​a new plan for “all adults”? And what about the name change? It is no longer targeted at “seniors” (75 years and older), but “adults” (18 years and older).

I don't know the reason for this change. It seems to open society as a whole to an early intervention agenda, one in which the state acts before problems arise due to statements from state officials that attribute problems to individual actions and choices. However, this is GIRFEC's experience, and there is no explanation for the name change, even though it has a huge impact. It simply “is.” Another edict from above, another government demand that the bureaucracy was willing to adopt, whatever its logical contradictions.

Some of the concerns driving this policy are mentioned in several documents currently available.

The Scottish Government is working to enable health, social care and third and independent sector partners to deliver regional plans that aim to make better use of collective resources. In conjunction with the 'Formation' strategy) we have established a Transformation Fund. Strengthen services for older people and transform the way health and care services are delivered.

It's about care for the elderly (or at least it was from the beginning), scarce resources, and “change.”

Providing safe, effective, person-centered care and communicating it across multidisciplinary and partner agency teams requires us all to change the way we record, share, and communicate patient care. There is.

Information is key:

Understand the need for pacing. This challenge is not about the future, it's about now. We are already beginning to see and feel the impact of projected demographics, disease profiles and financial pressures within the system. Again, contrary to traditional methods of applying service improvements, we need to find new ways to quickly build momentum and accelerate the pace of change. Doing this requires rethinking how change is introduced, scaled up, and deployed across complex systems that transcend organizational and professional boundaries.

It is urgent and fundamental.

make difficult decisions. Ultimately, transforming a service requires making “difficult decisions.” Difficult decisions include reductions or changes in services that have a significant impact on people or groups of people, significant reductions or discontinuation of established clinical procedures/treatments, current or potential, due to the application of new evidence or thresholds. Includes reductions or changes in services. Controversial..

That will involve “difficult decisions.” It is unclear what exactly constitutes a difficult decision. One thing we can be sure of is that they are difficult because they lack the free consent and approval of those most directly affected.

The components of GIRFEA are therefore well known, including early intervention, seeking explicit cost savings, and operating a change agenda.

Signs such as “trials of small changes” are seen Deming Management techniques adopted from the manufacturing industry will be adopted. Most impressively, we have a “single point of contact” and use health status as a defining indicator. All these are miserable GIREFC Agenda.

What do you create when you put this together? It's too early to know for sure. The GIRFEC approach was thus rolled out across the public sector. A few groups, including the homeschool community, sounded the alarm, but people generally didn't know what was in place. It was only when there were attempts to legislate this process (and use legal enforcement to force compliance) that the full horror of this plan became apparent. We now know that a clear decision has been taken to introduce GIRFEC in all professions, including education, medical social work, etc., before informing people. Getting It Right For Every Adult appears to be rolling out in stealth as well

The justification for change is the obvious failure of the existing system. Twelve percent of patients experience a decline in ADL function (activities of daily living, a medical term referring to people's daily self-care activities) between admission and discharge. Delirium after hospitalization occurs in 4-29%. Every year, 500 patients suffer hip fractures in hospitals in England and Wales. The nosocomial infection rate is 5-10%. 19% of hospitalized patients have one or more side effects. And everywhere and at any time, the economic laxity of the welfare state creates financial pressures that require urgent action.

The direction of this change is set in secret. It doesn't give people the opportunity to make informed choices, and ultimately it doesn't treat those people as customers who receive services, whether it's children, the elderly, or perhaps even all adults, which should be improved. Treat it as a product. This is a core error in thinking. A collectivist mindset is at work. This is what could turn the growing GIRFEA into a monster that threatens the prosperity of humanity in every sense of the word as the terrifying GIRFEC from which it was born.

And we must be careful not to forget how Max Weber praised civil servants.

“The honor of a public servant is vested in his ability to faithfully carry out the orders of superior authorities, as if the orders were in accordance with his beliefs. This is the case even when the authorities insist on their orders despite the civil servant's reprimands.'' This type of conduct means for public servants “moral discipline and self-denial in the highest sense.'' I will.

Therefore, there is no resistance from within the system. As we saw with the Children and Young People Act, which introduced the nominee system, there will be little support from political sources. It's up to the people to kill whatever comes over that hill.

Main image: world skills uk (CC BY 2.0)