A Service Model For Delivering Care Closer to Home.

Upton Surgery (Worcestershire) has developed a flexible and responsive service model that facilitates multi-agency support for adult patients with complex care needs experiencing an acute health crisis. The purpose of this service is to provide appropriate interventions that avoid unnecessary hospital admissions or, alternatively, provide support to facilitate early discharge from secondary care. Key aspects of this service are the collaborative and proactive identification of patients at risk, rapid creation and deployment of a reactive multi-agency team and follow-up of patients with an appropriate long-term care plan. A small team of dedicated staff (the Complex Care Team) are pivotal to coordinating and delivering this service. Key skills are sophisticated leadership and project management skills, and these have been used sensitively to challenge some traditional roles and boundaries in the interests of providing effective, holistic care for the patient. This is a practical example of early implementation of the principles underlying the Department of Health’s (DH) recent Best Practice Guidance, ‘Delivering Care Closer to Home’ (DH, July 2008) and may provide useful learning points for other general practice surgeries considering implementing similar models. This integrated case management approach has had enthusiastic endorsement from patients and carers. In addition to the enhanced quality of care and experience for the patient, this approach has delivered value for money. Secondary care costs have been reduced by preventing admissions and also by reducing excess bed-days. The savings achieved have justified the ongoing commitment to the service and the staff employed in the Complex Care Team. The success of this service model has been endorsed recently by the ‘Customer Care’ award by ‘Management in Practice’. The Surgery was also awarded the ‘Practice of the Year’ award for this and a number of other customer-focussed projects.

Defrauding Daughters Turning Deviant Wives? Reading Female Agency in The Merchant of Venice

Brabantio’s words “Look to her, Moor, if thou hast eyes to see:| She has deceived her father, and may thee” ( Othello , 1.3.292–293) warn Othello about the changing nature of female lo yalty and women’s potential for deviancy. Closely examining d aughters caught in the conflict between anxious fathers and husbands-to- be, this article departs from such paranoid male fa ntasy and instead sets out to explore female deviancy in its legal and dramatic implications with reference to Shakespeare ’s The Merchant of Venice . I will argue that Portia’s and Jessica’s struggle to evade male subsidiarity results in their conscio us positioning themselves on the verge of illegality. Besides occa sioning productive exploration of marriage, law and justice within what Morss (2007:183) terms “the dynamics of human desir e and of social institutions,” I argue that female agency, s een as temporary deviancy and/or self-exclusion, reconfigures the ma le domain by affording the inclusion of previous outsiders (Anto nio, Bassanio and Lorenzo) .