COIN July 2025 workshop - London скачать в хорошем качестве

COIN July 2025 workshop - London

At a COIN Workshop on 29th July 2025, people of experience gathered to discuss the educational implications of Community-Oriented Integrated Practice (COIP), especially in the context of the UK policy of Neighbourhoods – geographic areas of about 50,000 population where people are expected to collaborate for health and care. Getting the Right Balance between Community Empowerment & Medicalisation Speaker: Matt Harris, Reader in Public Health Innovation The Brazilian Community Health & Wellbeing Worker role could help the UK to achieve a good balance between Empowerment & Medicalisation. The role is: 1. Comprehensive – helps to solve problems that any household has, with any aspect of health or care. 2. Hyper-local – recruited from local population of about 120 households to serve that population; they are paid fulltime. 3. Universal – they visit each of their 120 households at least once a month. 4. Integrated into statutory services – they can refer to GPs, Police, Fire Brigade, Social Care, Housing Departments, Local Authority. And vice versa. If the UK were to adopt the model, it is important to find ways to regulate, train and evaluate them that avoids them becoming overly bureaucratised – overly ‘NHS-ified’. Points expressed: • The NHS must be recruited to the ideas inside the CHWWs and see them as complementary - people to work with rather than to be told what to do, or ignored. • Health Visitors in the UK once had a very similar role – to great effect. • It is very powerful to have workers with lived experience of what life is really like. • Will they be seen as supporting the public, or as GP substitutes? Or both? • Need to learn the principles when still in training, and at school. • Communities need to decide who they want, rather than impose individuals. • Businesses must see them to be of value. • Need to be able to evaluate their impact on people’s lives, meaningful conversations, trust, relationships, learning. Integrating Primary Care and Public Health is Essential, but Difficult to Achieve Speakers: Tony Burch, Chair of Age UK London Salman Rawaf, Director of WHO Centre for Public Health Education & Training Junior doctors and medical students are in a poor state. Motivation is more likely to come from being community-embedded than simply being administrators of medical science. The 2008 WHO Report - Primary Care - Now More Than Ever - described a need for community-based primary care. But most healthcare systems in the world are about urgent, medical care; they do not care about Health. A school of thought now says that GPs should be focused only on medical treatments of diseases, and not be bothered about the Health of individuals and communities. What do you think? Points expressed: • Formal healthcare systems affect only 20% of health. Environmental, social and genetic issues are far more important determinants of health. • We need measures, like happiness, that give insight into health as well as disease. • GPs can become immune to suffering because we are overwhelmed with targets; we, and our patients, would benefit by being in closer ‘touch’. • GP job satisfaction comes from helping people to find health, of which medical treatment is only one part. Empowering people is a bigger part. Healthy Deaths and International Collaboration for COIP Speakers: Richard Smith, co-chair of Lancet Commission on the Value of Death. Laura Calamos. Clinical Assistant Professor/Advanced Practice Registered Nurse, University of Michigan. Advisor to Nepalese Government on Community-Oriented Integrated Practice We have an unhealthy relationship with death. Death is much too medicalised. There is a tendency in health professionals to see death as an enemy rather than as a friend. There is too much over-treatment. It is seen as a medical problem, rather than a family, community, relational, spiritual phenomenon. There is a paradox in life where many people at the end of life are being over-treated while there are billions of people who cannot get access to the most basic palliative care. We need to rebalance death and end-of-life care: bring death back into life. Move death from happening in hospitals, looked over by doctors and other health professionals, to be more of a community enterprise. We need to understand better how to change systems to achieve this. Points expressed: • We need to be able to talk about death – make it less taboo • Need a Living Will that your family is aware of • Normalise it in TV shows, death & grief cafés • Helping the family through death and after-death is important • Hospitals are institutions to take death out of our sight • We need to talk about ‘death control’ in the way we once talked about ‘birth control’ – ‘natural childbirth’… How do we help people to die with dignity? • An economic lens inhibits a good death – ‘you are not economically viable so we will put you in a care home because you are no longer useful’