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.

Re-negotiating Ideologies of Bilingualism on the Margins of Education

This article reports on an ethnographic study carried out in three interrelated sites: two contrasting secondary schools and a Youth-Club (the principal focus of this article), in an area of southwest Wales. This article highlights the incongruence between the language at home and the language of the school and posits that the relationship between language use at school and in the wider community needs to be problematised and questioned far more than has been done thus far. This study questions whether school-based ideologies and school-based practices are re-negotiated or contested on the margins of education and whether this re-negotiation and contestation plays an important role in whether a young person chooses to use Welsh or English outside of school. It will be argued that recreational spaces, even though loosely connected to schools as institutions, function as more open spaces where institutional ideologies are actively reworked and renegotiated, either through choosing to use English or by mixing and blending different aspects of linguistic resources, or by re-negotiating and questioning which version of Welshness is more valuable, ‘the removed and authentic’ (as seen at the Welsh school) or the ‘new and hybrid’ as seen at the Youth-Club.