Inspiration and the way forward

The NHS and social care along with other services face major challenges. There are financial, economic and social issues affecting the care people need. In this difficult period we are faced with different views and options for the future. In this post, myself and Pria will reflect on two themes which seem to us so vital. They are our vision and the tools to help us make it real.

The future will be decided not only by what we do, it will be shaped by what we see now. Our vision will create what appears and generate the ideas to realize it. The author, Joel Barker, says it well: "Vision without action is merely a dream. Action without vision just passes the time. Vision with action can change the world." We need to elaborate a vision of how social care, health and other sectors can come together to create new ways of working. How silos can fall and new integrated solutions be created to meet need in the fastest and most effective caring manner. This vision would enthusiastically embrace co-learning and co-work with patients and carers. It could in alliance with people and communities work on a holistic approach to those in need. The Maori people speak of well being. This is a fascinating word as it is not well arm or well house or well mind but the whole person. The Maori vision sees well being as a house with four walls; the physical, the mental / emotional, the social and the spiritual ( in terms of meaning and purpose ). This holistic vision offers the possibility of circular care where all the four walls reverberate and work off each other. It is also circular as it can only be delivered by different people and services working together in a circle with and around the person. This vision could focus on the person first and foremost. The phrase 'person centred care' is used a great deal today and rightly so. However, we can only really have people centred care if we move away from seeing people as problems. The challenge is to look through the problem to the person and their gifts. This is a move to the person and their potential.

We live in a complex period. The words of Charles Dickens in 'Tale of Two Cities' about another historical period has an echo with us today. He writes, "It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness....it was the spring of hope, it was the winter of despair, we had everything before us, we had nothing before us." This period includes austerity but also great opportunities to really breakthrough old system thinking and make a shift to better more humane perspectives and practice. Today is not a time for despair but vision and action. The road will not be easy but we can build or rather grow cultures and care that offer best solutions for all. However we can only do this by thinking and doing what's needed in new innovative and potent ways.

There are many tools to support this journey. We will touch on two key skills that support the way forward. The first is to see that the future lies all about us in the present. It is found wherever people care and have passion. This folk represent what the future of our services could be. Recently I met an inspirational Doncaster GP who works in a poor area. He shared the work that he was doing. He said he shook hands with everyone who came into his surgery to welcome them and connect. He said one Saturday a month he would have clinics for carers to reach out and be there for them. The GP also shared that he visited the well as the sick. This was well being work. This GP was creating the forms of the future. These positive practices of really connecting with patients, making space and support for carers and promoting wellness in the community are a sign of what could be done and is being done. We need to capture these wonderful innovative works and share them and ask what they say to us.

The second help is the use of creative space and dialogue. This is where people come together and develop a safe space where trusting and listening discourse can occur. From these transformational hot spots come ideas, inspiration , actions and positive changes. Are the meetings we attend or set up creative dialogical spaces? If we are not learning in them or finding creative energy and visions there then probably not. We need to develop the art of dialogical exchange. Our good NHS colleague, Dr Maxine Craig, speaks of dialogic change. This is where change and creativity occurs in the locus of authentic and open sharing. It's amazing how fresh thinking and practice flow from deep dialogue and connection. When we experience it we feel inspired and caught up in possibility.

The future offers us many challenges and openings. We believe that the need of a vision that positively infects us all and calls forth clear and courageous actions is central to where we need to go. We also affirm that people of passion and vision and the power of dialogue are mechanisms for the vision to become visible. To us the choice seems pretty clear. We are will either be people of purpose and passion who make a great future that works or we won't. That's the crossroads we stand at.

John Walsh, York Street Health Practice, Leeds Community Healthcare NHS Trust  
Pria Bhabra, Leeds Adult Social Care Commissioning, Leeds City Council 

Stress Control - is it for me?

When I first saw the flyer I remember thinking what a great opportunity for staff to have that kind of support. Having worked in the NHS for over twenty years I am aware that the pressures staff are working under are unprecedented and I could think of a few friends and colleagues who might want to access the classes. I didn’t immediately think it was for me.

 As I reflected on the fact that I was experiencing a number of difficult things at work, namely increased work load and lacking the job security that I had always taken for granted I began to realise that a number of things on the flyer really did apply to me. I was feeling anxious, not sleeping and intermittently struggling to eat (not me at all!) and I was worrying about what the future held for me and my family. It struck me that I could possibly benefit from the stress control classes. It struck me again and again but for some reason I didn’t ring.

I am really fortunate that I have some great colleagues and friends that I can confide in and I was able to share with a trusted friend, that I felt I would benefit from going to the classes, but was worried about ringing. My friend is a very intuitive honest and caring person and she just asked, ‘what’s really stopping you?’. I became quite tearful which was a surprise and when I really thought about it there were two things; that I felt like I was saying I couldn’t cope and the ‘stigma’ of accessing a mental health service. I have been a nurse for over 20 years and to hear myself say that was quite something, a revelation. If I could think like that as someone who has been supporting patients and their families for many years, then how difficult might it be for someone without the insight and experience I have had to access the service? It really made me think.

And what I thought was, that the things that were causing me stress were not going away and the ways I normally managed difficulties didn’t seem to be helping, so I would have to do something different. I picked up the phone and made the call. It was lovely to speak to someone on the end of the line who was sensitive and explained that they needed to take some details before putting me through to someone else. I was treated with care and respect by both the people I spoke to and I was offered a place on a six week stress control course.

That was 3 weeks ago and I have now just completed the first session of the course. I was a little apprehensive and I guess slightly anxious as I made my way to the West Yorkshire Playhouse but I was also looking forward to it. As I arrived I was greeted warmly by the two course facilitators who explained how the course would run. The clear informative delivery was interesting, engaging and inclusive. There was real acknowledgement that taking the steps to get to the session was achievement in itself particularly when you are feeling stressed. I think there were a few metaphorical pats on the back at that point!

What I saw and experienced was a group of people of different age’s genders and race sitting together and beginning to understand an ever present issue of life. It was good to know that I wasn’t on my own. We’ve only just started but I left with a real sense of anticipation (not anxiety!) and I am looking forward to relaxation in week 2. I know that the things I learn and refresh will help not only me, but my colleagues’ friends and family.

I feel fortunate to be able to access the group and while it doesn’t change the situation that may have precipitated my feeling stressed, I hope that this positive input will help me build my resilience to cope with what’s in front of me. I’ll keep you posted!

LCH Staff member December 2014

Change The Way You Think

Recently I went along to one of our Improving Access to Psychological Therapies (IAPT) service’s stress management classes to see for myself what they were about and see if I could change the way I think. After all, we have pre-conceived ideas about things especially if it is something unknown. The service said to me that people have misconceptions about the classes; that people will expect you to speak as though you’re at an Alcoholics Anonymous class i.e. ‘Hello my name is Andrew and I’m stressed’ – you don’t.  And nor do you have get on a sofa and talk about your childhood.

The session I went to took place during the evening at Leeds college of music. On arriving, there was a discrete sign by the front desk and a friendly receptionist directed me to the first floor room where the session was held.

The start of the class felt like any training I have been to in my professional life. The two facilitators, who led the session, greeted people as they arrived, checked them in and passed on an evaluation form. There was some nice gentle guitar music playing and jugs of water were available if you wanted to grab a drink.

With the session being the sixth course in the series there was a brief re-cap of what had been covered so far by Jake, one of the facilitators. The main theme for this session was sleep, and how to get a better night. There were lots of practical tips like not using laptops and phones just before bed to help you drop off (something I maybe need to remember).  We were also given advice on the things like the temperature of the bedroom and having blackout blinds. One of the interesting tips that the other facilitator, Alice, gave was setting aside worry time. This is the idea that if you are a worrier you stop yourself from doing it all the time and set aside 30 minutes to reflect on your problems and stop worry from dominating other things.

There are more details of who’d benefit from the courses and how to access them online at LeedsIAPT.com. The courses run on a regular basis so new ones are starting all the time.

Andrew Carver, Communications officer, Leeds Community Healthcare NHS Trust

Unfreezing the brain - recovering from post traumatic stress

Monday mornings are a morning of EMDR (Eye Movement, Desensitisation and Reprocessing), my favourite. As an EMDR therapist my job is to work with people who are struggling with PTSD (Post Traumatic Stress Disorder) – as a result of any kind of trauma: being in a war zone; rape; accidents; assaults; torture; really any kind of trauma that can happen to you as an adult. 1 in 3 people after a traumatic event can develop PTSD, it’s a horrible thing to have to live with – flashbacks to the events, nightmares about the trauma, feeling constantly anxious and like you’re under attack. Like a walking, talking burglar alarm, always on alert for danger. And sometimes not being able to face certain things related to the trauma e.g. can’t go to the place where it happened, and then this escalates and can stop you getting out of the house, can’t stay in your house… You get my drift. 

The clients I am seeing this morning don’t really fit the norm for our bread and butter EMDR work. The first lady I’ve been seeing for a couple of months and she’s doing really well, we’re almost done. As a result of a number of traumas through childhood and adulthood, she has a phobia of choking and hasn’t eaten solid food for six months, living off Complans, you know liquid food drinks. We’ve been working through a long list of ‘small’ traumas (these don’t feel small to her of course) and now cheesy chips and bacon are featuring prominently in her recovery.

Because life is never straight forward, this client also has checking behaviours (Obsessive Compulsive Disorder) and if I thought about it hard, would also fit the diagnostic criteria for GAD (Generalised Anxiety Disorder) and as we treat the traumas / phobia these other issues are also getting better. Working with this case has been an absolute joy for me, the client is so lovely, we have a good laugh although we are dealing with some difficult stuff and I get the pleasure of watching someone recover, enjoy eating again (what’s not to like about that) and also make other positive changes in her life.

So to EMDR. Eye Movement, Desensitisation and Reprocessing, it’s a bad title I know and it’s hard to spell. Let me try and explain what it is us EMDR therapists do. Most of the time your body copes with new information and experiences without you being aware of it. It is believed that this happens whilst we are asleep, particularly during rapid eye movement sleep. When something out of the ordinary occurs you can become traumatised by the event or by being repeatedly subjected to distress.

These experiences then become frozen in the brain and are stored in the limbic system, which is the primitive bit of our brain that deals with senses, emotions and it’s all raw. It’s the caveman / cavewoman bit of our brain – fight, flight, freeze. And when information gets stuck here – it gets re-triggered all the time usually with the symptoms of PTSD. I think of this bit of our brain as our downstairs brain (above the back of your neck). Your ‘upstairs brain’ is where we process information and experiences so they become a memory or part of our past, also known as the pre frontal lobe, (front / top of your head) which deals with reasoning, problem solving, emotional intelligence, all that kind of thing.

EMDRs job is to help move the information from a trauma from downstairs to upstairs in your brain, which given we normally do this whilst asleep, is a natural healing process. There’s some controversy at times in the world of psychology / research about how EMDR actually does work. I really don’t care, it just does and I get to see it happen.

We start off with a thorough assessment, then prepare for treatment. Then we ask specific questions about a particular disturbing memory and use either eye movements or theratappers (which buzz alternately in either hand) to replicate what happens whilst we are asleep. With repeated sets of this, the memory tends to change so it loses the distress associated with it and becomes a neutral past memory. Sometimes this can happen in one session, other times it takes longer but what is great is seeing people not only get rid of those negative symptoms of PTSD but also seeing positive benefits for clients in other areas of their lives as well. It’s a real privilege. 

Enough theory, my next client is struggling with Obsessive Compulsive Disorder (OCD) and I am seeing her as part of a research trial. She is doing well, although she has had OCD for years and years and years, not been able to work, and has been stuck in her flat, not seeing many people. She struggles to see sometimes how well she is doing and today was one of them days. I was (hopefully) top cheerleader today and she managed to achieve something in the session today, that in our first session she told me she could never even contemplate doing. Go Girl! 

Afternoon is being on duty for the service. Psychological Wellbeing Practitioners (PWPs) are on the phones taking self-referrals as they come in. My job is to be on call to give advice and support them in making decisions about treatment options etc., deal with any other new referrals coming into the service from other professionals, crisis calls, whatever. I think there’s a bit of snobbery sometimes from other professionals about PWPs, but I’ll tell you they do a really hard job really well and I’m always impressed by how good they all are on the phones.

Zoe Marsden – Senior Mental Health Practitioner and EMDR Therapist, Leeds Community Healthcare NHS Trust

 

Takeover Day

We are year 6 pupils from Gledhow Primary School and we are dementia friends.

 

We have had the amazing opportunity to be part of the NHS Takeover day at the Shine Centre in Harehills. Takeover day is where children get to take over the world of work and this has been an amazing opportunity to learn about Dementia  and how it affects the sufferer we learned how to approach and talk to someone with dementia.

Today was a special day because there was some new staff for the NHS here for induction .we made a display board about dementia friends and showed it in a market stall for takeover day. New NHS staff were looking at the different stalls. Bunting and drawings were used to attract their attention, sometimes they came to ours, so we asked them a question ‘If someone reacted to you in a strange way, how would you deal with it?’   Also we had the opportunity to browse the stalls ourselves finding out about other parts of the NHS. We were able to go around and ask people in the NHS about what their favourite bit in their job. I have learnt a lot about what peoples jobs are in the NHS such as; library services, weight management, safe guarding, trade union and a lot more.

We think it was really fun and informative and think that it should definitely happen again!

Written by:

Marley, Hussein, Evie, Charlotte, Ewan, Lucy, Aimee and Mohsin

I get by with a little help from my friends

Recently I became a Dementia Friend.

Su McAlpin, Dementia Friends Champion at
LCH with 'Gina'  

I have a personal interest in the Dementia Friends campaign but in my role of Communications officer at Leeds Community Healthcare NHS Trust, I went along to one of the trust's training sessions to see what it involves and how we could help promote the campaign internally to colleagues.

On arriving at the session, I explained to the leaders I was there from a ‘comms perspective’ and said I would sit to one side so not to disrupt the session. I was encouraged to take part; I didn’t realise anyone could become a Dementia Friend, you don’t need to be a healthcare professional. The awareness is useful, regardless of whether you’re at work or doing the weekly shop.

The training session is just an hour long but gives you a really good insight in to what things we can do to make our community dementia friendly. There are lots of great analogies that help you to understand what it can be like for a person with dementia. For example, you’re walking in to a health centre and there is a black mat at the entrance. You would cross the mat, enter the building and go on to attend your appointment. To a person with dementia, they may see the mat as a black hole and don’t want to step on to it for fear of falling in to it. This could make them scared to access the building and prevent them from going to their appointment.

After talking to the trust’s Dementia Friends Champion, Su McAlpin, I found out that around 100 of the trust’s front of house staff have been trained as Dementia Friends recently with more to follow. They’re the first people that greet patients so it’s important they recognise the signs and know how to support someone. Su is running a number of training sessions internally and also externally - recently, she spoke to a local Beavers group. We’re also looking at all our buildings to make sure they are dementia friendly too.

The campaign is aiming to create 1 million dementia friends by 2015. You don’t need to go along to a session, you can also sign up to be a dementia friend online at www.dementiafriends.org.uk 

Let’s all help to make Leeds a dementia friendly community!

Sarah Elwell, Communications officer

@LCHNHSTrust 

#DementiaFriends

Helping peple feel less alone

Alice Curling, who facilities our stress control classes, blogs about her work as part of the Leeds IAPT service.

"

"I have been interested in mental health ever since studying psychology at A-level about 10 years ago and since then I have studied, worked or volunteered in or around the field of mental health.

I have worked for the Leeds IAPT service for just over a year now and am really enjoying my job. Of course there are difficult days when things haven’t gone as well as you would hope or when sessions are difficult, but the good days; when you can see people improving, really make up for it.

My job is also really varied; I do face to face and telephone assessments, one to one treatment sessions and have recently begun to facilitate a stress control class. The class was definitely outside of my comfort zone, but I’m really pleased that I put myself forward for it. The classes cover very similar material to what we would usually use in one to one sessions but you are able to reach more people in a shorter space of time. We also get to cover a range of interventions which we sometimes don’t have the time to do in the one to one sessions. The course material has also taught me new things and techniques which I have incorporated into my one to one sessions.

Facilitating the class has definitely improved my understanding of stress and has improved my one to one practise at the same time. I would certainly encourage other workers to facilitate the groups. Although you don’t get the same immediate feedback from people that you get from one to one sessions, you can see the improvement in many people. I would also definitely encourage people who think they would benefit from attending the class to contact the service. Many people fear a group or class situation but once you come you will see it’s not as bad as you think! People are also surprised at just how many people are going through similar difficulties as them which can help people feel less alone.

I am learning all the time, not only from my colleagues but from people accessing the service as well. No day is ever the same, and I hope I can continue to learn and grow so that I am constantly improving my practise."

Alice Curling - Stress control class facilitator

Desperately seeking patients...the NHS, really?

The idea of 'marketing' services and seeking out patients for some in the NHS is seen as a bit of a taboo, even for experienced communicators, like myself, who have worked in NHS communications and public relations for over 11 years (and for over 18 years in total).

'Change the way you think' campaign poster

Very often we have great service and staff stories to tell and this can be done very easily through local media and increasingly, through social media.  Sometimes we have an even bigger message that we must tell as many people as possible and we need to turn to marketing tactics to help spread the word.

However when spreading that word is also about a subject such as mental health, it gets trickier again.  For some this is a taboo, something we can't even chat about with mates at the pub.  In fact it's just those people our current mental health campaign is aiming to reach.

Improving Access to Psychological Therapies (IAPT for short in the NHS filled world of jargon and acronyms) exist to help people find ways to cope with emotional stresses and strains, depression and anxiety that just won't go away and the overwhelming feelings some of us can be faced with at one point or another in our lives.

Across the country these services get a poor reputation as they're really hard to access due to waiting times being up to a year in some places. We have great commissioners who have ensured these services have good resources so anyone who needs to can get help the same day - you can even join one of our stress management seminars the following week.

But we just don't think enough people know about this service. So we have enlisted the help of the creative types at DS.Emotion and we've been working together on ideas for a campaign to make people think again about mental health services and to think if they could actually benefit from the help and support of our skilled team.

Put simply ,our campaign says to people with emotional problems, those feeling stressed or anxious, "Time to change the way you think" - and for those who access our service, that's just what we aim to do.

It's been no mean feat; in just around a month we've discussed ideas and concepts to really try and help to change the way people think, reviewed and tested messages, designed and tweaked creative visuals and launched the campaign.  In about a month! We're really proud of the work we've created with DS.Emotion and the support we've had from the experts at Boutique Media and from our colleagues in the IAPT team and others across our organisation.  

As you read this, our really important messages are on local radio in Leeds, on buses around the city, at railway stations and on social media - they'll be dropping through thousands of letter boxes around Leeds in the next couple of weeks too.

Awareness of mental health issues has changed radically in recent years, we have a great service in Leeds to help you or someone you may know, so let's all change the way we think about mental health.  

www.iaptleeds.com

Gillian Neild, Communications, PR and Marketing Manager, Leeds Community Healthcare NHS Trust

@GillianNeild

All part of an NHS PR person's day's work

Okay so you all think the world of public relations is glamorous right? Well, maybe... Even in the NHS it's that buzzy team in the office coming up with the vibrant ideas and always talking (or tweeting) very loudly about it - when we're not out to lunch that is!

Hannah and myself at the RCN stand

Well I would like to set the record straight here and now.  Firstly, yes I am very proud that myself and my brilliant team of Sarah, Mandy, Hannah and Andrew occupy the buzzy, vibrant area of Stockdale House in Headingley and yes we do have some great ideas - we may not share some of the wilder ones with the rest of the organisation - but I am proud of everything we do.  Yes we do bake a good cake to accompany our fresh coffee or Earl Grey tea and we do enjoy the odd lunch at Hyde Park Corner or in Headingley if we're celebrating something special - but I like to think we're known for turning work around and getting some brilliant results.

Above all else, we're focussed on the needs of our organisation, our services, our staff and the patients and their families we serve - we use our communications expertise to share messages and seek engagement with key individuals and groups.

This week's activities that fall within the remit of "all in a PR person's day's work" are possibly on the less glamorous side.  Our work has involved having lots of lovingly branded items made for our current recruitment campaign.  So count them: 1,000 hessian bags, 1,000 hand sanitisers, 1,000 trolley coins, 1,000 torches, 1,000 water bottles, 10,000 (yes 10,000) pens oh and before I forget (not that it is possible to), the 1,000 air freshener dangly things fragranced with jasmine - and yes, I do regret giving Mandy and Hannah free reign to choose the scent as it's all you can smell in our office right now!  I also regret the hessian bag choice, well I don't because it looks fabulous, but when you have eczema on your hands, handling hessian bags makes your eczema bleed - but it doesn't make me exempt from mucking in to help the team effort!

Before and after 

It's all focussed on how we attract new talent to our organisation to be the future of community healthcare in our brilliant city of Leeds. We have some challenges in terms of vacancies within some of our services so it's our job as comms people to get some great messages out about working for our organisation and to make this sound attractive as possible.

So we made the biggest production line in Stockdale House history (our Leeds head office) to put one of each branded item into each hessian bag, as we've been attending some jobs fairs in Leeds in the last week to attract new staff to our current vacancies in our organisation.  Attending the fairs means getting the 1,000 filled bags to each venue and setting up what is for us, a bit of an ambitious exhibition stand.  But we're taking it in our stride and doing quite well actually!

Today and tomorrow we're at the Royal College of Nursing Jobs Fair in New Dock Hall, Clarence Dock, Leeds. Myself and Hannah from the team have been lugging round said goodie bags and lots of other boxes and racks, as well as putting up our gargantuan display graphics that include our fab campaign strapline: "A passion for community services" - that's us in 5 words - at the venue yesterday so we can attract some lovely new staff to our organisation.  So if you're interested in nursing or indeed any other role in a community focussed organisation then do stop by any time from 10am - 5pm - we're on stand number 15.  

And we have some great goodie bags to give away...in case you hadn't guessed.  Here's hoping for a great event and some new staff to join our community based organsiation.

P.S. Before I go, I just wanted to add that it's Sarah's birthday this week, so if you need us, we're out to lunch on Friday trying to put a little glamour back into our week!

P.P.S. We do have a vacancy coming up in the team so if this post has attracted you to our heady world of hessian bags, glamorous exhibitions and the odd team lunch, keep an eye on NHS Jobs for the details.

Gillian Neild, Communications, PR and Marketing Manager, Leeds Community Healthcare NHS Trust

@GillianNeild

Helping people to live independently

Debbie Slater is currently a community nurse. She first worked for the trust whilst on placement and enjoyed it so much, she wanted to return...

“I’m passionate about community services because
I help support people to live independently
in their own homes and live a fuller life as possible.”

"When I was a student nurse, I worked with the Intermediate Care Unit (ICT). It was one of the areas I enjoyed most and learnt a lot from. Once qualified, I wanted to return as a permanent part of a rehabilitation team. For the first two years after qualifying I worked at St James Hospital on an acute medical ward before joining the trust’s Intermediate Care Unit (ICT).

I wanted to work for ICT so I could experience a different type of nursing and for me, being in the community meant I could get to know patients better because they were in their own homes.

A typical day for me involves going to the office in the morning, where I will find out which patients need to be seen and what referrals have been sent in. I will then discuss and plan the day with my nursing colleagues and the Multi-Disciplinary Teams. The rest of the day I will be out in the community visiting patients. Sometimes I will have to rearrange visits through the depending on whether I get a call about new referrals or patients that need to be seen quickly. Being a community nurse allows me to work independently, however I know I can discuss any issues that have cropped up with the rest of the team, and normally have a debrief once I return to the office at the end of the day.  

For me there are many rewarding parts to my role including; preventing admission to hospital by picking up on a patient becoming unwell early, helping people recently discharged from hospital to stay at home or assisting people as they adjust from being dependant on staff to living independently.

I enjoy the variety the day brings, every patient and situation is different, I never know what I will find when I arrive to do a visit."  

Privileged to work in the community

"I’m passionate about community services because
I work with children with neurological conditions
and long term conditions to assist them in
activities and participation in their own environment."

Lauren Haworth is a Community Children's Neurological Physiotherapist and tells us a little about her role with the trust...

"Initially I decided to join the trust as I wanted to be associated with such a large organisation with such a good reputation. After joining on a six month temporary contract, I never left and have been here seven years now. I love my job!

I trained in the North East at the University of Teesside and completed a previous rotational physiotherapy role in another West Yorkshire NHS trust. I specialised in Musculoskeletal Physiotherapy, but felt that Children's Physiotherapy was an opportunity and an experience I had to try. It is very rewarding working with children.  

Every day is different in my role. I am very privileged to have my treatment area in a school, or health centre, or patients home, or swimming pool or trampoline! I treat and assess children in environments appropriate to the goals we are working on and negotiate family orientated treatment plans to accommodate the child and family as much as possible.

By working in the community, I think we are able to see the real challenges and difficulties affecting our patients in their own homes and environments and I'm proud to be able to assist with this."

A passion for community services

Our staff are passionate about providing community services. Andrea is a nursing sister at HMP Leeds and tell us about her career to date...

Andrea Copeland 

"I qualified as a nurse in 1995 and started my carer in offender health six months later. I have worked in a variety of prison settings high secure, YOI female and currently local category B.

I remember seeing an advert in the Nursing Times for nurses working in a prison in London. I had never thought of nursing in a prison, my morbid curiosity led me to apply. When considering my career path I always considered police, probation or social work so it's no surprise I ended up working in the arena of offender health

My friends and family were quite shocked when I told them I wanted to work in prison healthcare, particularly the male side of my family. Of course, their impression of prison was influenced by what they'd seen on the TV or read in the news, and they were worried about my safety and the possibility of prisoners behaving inappropriately towards me. In fact, I'd say you're safer in prison than you are on the streets. Sometimes you get prisoners making gestures or being suggestive, but I'm a female in a male prison and you get the same on hospital wards.

Our role here means we can not only make a difference to individual’s lives but the extended family and even society itself by hopefully assisting in the reduction of offending. We have close partnership working with the prison and play a key role in the resettlement and rehabilitation agenda. Assisting changes to someone’s health plays a key part in enabling offenders to leave prison having addressed their health needs and enter society in a stable and less chaotic state. We ensure systems and support are in place.

We have the difficult task of looking after some of the most damaged and vulnerable people in society. People for whom trust is difficult to do as, they have often been let down by the people that should matter the most in their lives. Engaging our clients takes excellent communication skills, patience and empathy.

I have worked for Leeds Community Healthcare NHS Trust for three years; it is currently a very exciting time to be part of the trust. Our offender health pathway is expanding, we currently care for prisoners at HMP Leeds ,HMP Wealstun and HMYOI Wetherby. And we have recently secured the contract for police custody in West and South Yorkshire. There are a number of challenges in my role. One of the biggest is finding a way to provide our services in an environment driven by security and discipline. We have to abide by prison timetables and we can't always see a patient we might want to have access to immediately

If asked to describe a typical day I couldn't as no day is the same! I have stayed in this arena of nursing for 19 years so it can’t be that bad! Everyday is different, within the routine of clinics, screening, triage, chronic health conditions and health promotion is the unpredictability that working in this environment brings. We are required to attend emergency situations such as serious assaults, injuries, self harm and sadly major life threatening conditions which we have to manage until emergency services can enter the prison

The skill set required in this environment is important however as it so generic you cannot possibly know everything, this is where our close teamwork comes into play. Sharing knowledge and skills is vital and teamwork and supporting each other underpins. Despite the challenges, the work is so rewarding and I really like my job. Prison healthcare staff are sometimes perceived as being inferior to those who work in hospitals or clinics, but this couldn't be further from the truth. I actively chose a career in prison healthcare and my professional experience has grown substantially since I've been working here. You need resilience, patience, a sense of humour, stamina and the ability to be team player is fundamental." 

Building therapeutic relationships

We have a team of health visitors that work with babies, young mums and families across Leeds. Sam Taylor is a recent member of the team...

“I'm passionate about community services because
working in the community allows me to see
clients in their own homes and environments,
which allow me to build the therapeutic
relationships that are key to my role.”

"I have been working in health visiting for just over one year. I recently completed the post graduate diploma, which included a year-long placement with one of the Leeds Community Healthcare NHS Trust's (LCH) health visiting teams.

My background is in adult nursing and I previously worked in a hospital, which gave me valuable experience in healthcare and with the public. I trained to be a health visitor as I wanted to make a difference to outcomes for children and families, as well as trying to improve their experiences of childhood and parenting through caring support and guidance.

I received a lot of support whilst on placement at LCH and was made to feel part of the team from day one, this made me want to return once I was qualified.  

The role of a health visitor includes a variety of things, such as delivering the core Healthy Child Programme, running well baby clinics and the antenatal programme for first time parents, assessing families and children who require additional packages of care and planning these as well as attending multi-professional meetings for families.

In health visiting it is really important to form empowering relationships with families that support them in making changes to improve the outcomes of their children. It is extremely rewarding when you see these changes happen."

No two days are the same

Emma Ross is Senior Healthcare Support Worker at Hannah House, she tells us why she loves her role...

“I'm passionate about community services
because no two days are the same.”

"I have worked for the NHS for around six years, four of those have been spent working at Hannah House, where I provide planned or emergency short-break care for children with complex needs. The house is a ‘home from home’ where we provide care for children up to the ages of 19 years. 

Before Hannah House I worked for a community team in Wakefield where I would deliver respite for children with disabilities and complex health care needs within their own home.

I applied for my role at Hannah House as a Senior Healthcare Support Worker because I wanted to work with children in a relaxed home from home setting as I find this type of environment is more comforting for the children and less daunting than the hospital. Also I wanted to work in a team rather than on my own.   

No two days are the same at Hannah House. A typical day will generally involve getting the children who have stayed overnight up and ready for the day, which includes helping them wash and dress and with meals. Through the day, I take care of their personal needs and assist with meeting their healthcare needs as well as spending the day doing various activities and having fun.

I love working at Hannah House. I enjoy spending time interacting with the children and doing activities with them. Every aspect of my role is rewarding but I especially enjoy making the children happy."

Treating patients as individuals

Gemma Crabtree is one of our community podiatrists who looks after the people of Leeds feet! She tells us what here role involves...

“I'm passionate about community services
because we provide quality evidence
based treatment and treat patients as individuals.”

"I work as a Community Podiatrist and have been with the trust for nine years. At present I am acting up in my role and working as a clinical lead.

After qualifying as a podiatrist, I applied for a job with the trust and was successful in this. Although I live in Harrogate, I much preferred to work in Leeds.

Like with most community services, there is no typical day. Although I am based at Kirkstall Health Centre, where I deliver a clinic daily, my colleagues work across Leeds, providing treatment in a number of locations that is as close to home as possible for the patient.

Each day is very busy, seeing clients for 20 minutes at a time. Within this time it is important to find out if there have been any problems since the last appointment and see if any further actions need to be taken i.e. referrals or requests for insoles. I will then provide treatment if necessary and update their records.

Through the Community Podiatry Service, we deliver core podiatry, management of high risk feet and nail surgery as well as specialised clinics that for example, people with high risk diabetics, high risk feet and chronic painful skin lesions would attend. We also work with vulnerable people such as those with mental ill-health or those receiving healthcare in prison. To meet the individual treatment needs of patients, care is personalised and planned.

Although I provide treatment for both adults and children, I work with children quite a lot and find this area very satisfying. The service offers special support for children include flat foot, curly toe, growing pain, hypermobility and toe walking. Each child tends to attend and present different problems which makes the day more interesting when I have to find a solution."  

Care in the community

Jade Griffiths is one of our nurses who provides care to people in their own home. 

“I'm passionate about community services
because I can care for people in their
own homes and help them get back
on track with their own lives.”

"It was during the 2^nd year of university whilst on my nursing placement that I fell in love with working with people in the community. I found working in hospital quite impersonal so much prefer working in people’s homes where you get to know them, their families and their home circumstances so much more.

Working in the community as a nurse means no two days are ever the same, whether I’m helping a person manage their diabetes or supporting a person at the end of their life. Generally my day will start with going to the office, seeing what appointments I have, catching up with the team before setting off on the road. I could either be seeing a patient that receives regular care or a new patient. Last minute changes can happen too if an urgent appointment crops up. Although I work on my own whilst on the road, I always feel supported, whether it is by my community nursing colleagues or the Multi-Disciplinary Teams.  

What encourages me to get out of bed in the morning? Simply knowing that I can make a different to a person’s life."

A positive impact

Siobhan Jones joined the team at Hannah House at the start of 2014 and has been enjoying it ever since. She explains what led her to work for a community trust... 

"I'm passionate about community services as you
get to see the children in lots of different settings
and work with the families to help build relationships."

"Prior to working at Hannah House I spent 16 years working for Leeds and York Partnership NHS Foundation Trust. I worked on several units predominately supporting adults with a learning disability who also display challenging behaviour. This included working on the assessment and treatment unit, respite unit and working with people during their transition back to the community. I also worked on the respite unit for adults who also have complex health needs.

I applied to work at Hannah House for several reasons, the main one being the opportunity to work with children. Prior to and during my nurse training I worked with children in a variety of settings all of which I found extremely rewarding. Since becoming a mum I have been reminded how enjoyable it is to spend time with children and to help them through the various stages of development. 

Each day at Hannah House is different. Overall a typical day can be broken down into three main areas. The first being the direct contact you have with the child; meeting their needs whether this be personal care, medication, nutrition, in relation to play and stimulation or supporting their method of communication and assessing their health needs and responding appropriately. 

The second concerns communication with others. This may be the family, school, community nurses. It may be carried out on the telephone; obtaining information regarding changes since their last stay or providing others with updates and information e.g. their school. 

The third is looking how things can be done better. This can be reviewing practices and identifying how care can be delivered better at Hannah House. It may involve looking at how we can improve communication between ourselves, the child and others who are involved in the child’s care. It may have a wider scope involving how the services can work better together to provide the most effective and efficient service possible.

Working in a community trust allows me to work with other teams and in different locations, such as in the child's home. This enables me not just to see how the child spends their time at home but helps with building a relationship between myself and the family.

The most rewarding aspect of my role is knowing that something you have done today, however small, has had a positive impact upon the child you are caring for."

Meet Our Team: Sarah Holbrey

1

     Sarah Holbrey is one of our Stop Smoking Advisor's. We interviewed her about her role in the community with the Leeds Stop Smoking Service.

How long have you been doing the role?

I started working for the trust in May 2014 and was new to the role of a Smoking Cessation Practitioner.

   

   Tell me a bit about your background

     I studied psychology and health psychology at university which ties in nicely with the health promotion and behaviour change aspects of my current role. I previously worked as a healthcare assistant in a low-secure mental health unit for Bradford District Care Trust and more recently as a researcher in dementia care research at the University of Bradford.

     What brought you to work at the Stop Smoking Service?

     I realised I did not want a career purely in research, but instead wanted to work in a more applied way, working closely with clients and being at the heart of an intervention where I can see the direct benefit an intervention has on a person’s well-being.

   Why did you want to work in the community?

I liked the idea of working across different settings and thought it would give me more opportunities to work with a broader range of client groups too.  

   Describe a typical day

     A typical day is usually a mix of clinical work and admin. If I have a clinic that involves setting up any equipment and resources needed for the session and welcoming both new and ongoing clients where I will discuss options with them, measure their Carbon Monoxide levels and support them to plan coping strategies in their quit journey. The admin side involves restocking my resource bag with things like record sheets, leaflets and booklets, answering emails, ensuring electronic records are up-to-date and other bits and bobs like faxing treatment requests.

   What area of your work do you find most rewarding? 

I love the clinical aspect of my role. It’s wonderful to see the changes in clients as they progress along their quit journey. Quite often people are nervous at first or unsure of what to expect from the service, or are feeling a bit low in confidence if they have relapsed. It’s so rewarding to see them grow in confidence once they achieve their quit day and I can see them changing in front of me, for the better, both physically and emotionally. And of course, knowing that I just might have saved someone’s life, as sadly, one in two people who smoke will die from a smoking related illness.

How would you like your career to progress?

I want to pursue a career in public health and health psychology so I can have a more direct influence on developing effective and evidence-based interventions. This of course means more studying, but I'm always keen for a challenge!  

Elevators and services

We live in a world where most of us want to move away from what we call 'The Elevator Effect'. The Elevator Effect is where people get in a lift and look away from those in the lift with them. We will look at the ceiling. We will look at the lift numbers intently as if we expected them to go somewhere else. Where just two people are in a lift they will often stand as far away as possible from each other. We understand that this is an enclosed space and we want to give others as much as space as possible. But there is something else. When we speak of the Elevator Effect we means where people together will not speak or connect. We are often glad to get out of a lift. That might be to do with the enclosed space. It is also to do with a group of people together but not together. In the closed in elevator it is somewhat understandable. In life, work and business it is less so.

We have integrated care services and programmes across health and social care. We have partnerships between the third sector and the statutory services. There are also moves to involve patients and carers more fully.  We also have work with the faith communities. These are all initiatives we support as it brings us all together. It means new understanding, work and co-operation may occur. For patients and clients better, faster and more inclusive services are the planned outcome. This bringing together of all for the common good should be welcomed, nurtured and developed. All of us have so much to learn from each other. It gives us a great opportunity to hear and grow.

There is however a concern for us in this process. The worry has a name and that name is silo. It's easy to work in a silo. We work in our own space and never look up or out. We are like goldfish in a bowl going round and round. We may occasionally look outside the glass and see the world working and moving. We, however, keep on moving. Even in teams with different sections people will sometimes have not team work but section work. This focus on looking at our work but not around and beyond is not the way to create the best services for clients or the best cultures for the future. If the glass of the goldfish bowl breaks the poor fish dies. However if our glass breaks we have the opportunity to live in new and creative ways.

Silo work is a result of a silo consciousness. Silo consciousness always lives in a black and white world of separation. It is always us and them. Our concern is that unless we deal with this consciousness we will bring it over in our efforts to create new joined up approaches, partnerships and services. If we do this we will have elevator meetings where people are not connected or even talking in an engaged way. Silos leave their mark and moving on involves a transition. Silos also go two ways. They go across and up / down. They go across where different services work separately rather than together. This is where we see each other as units that can be called upon when needed but not core and essential partners and co-creators of best care. Silos work up and down where in the same organisation people work as if other sections did not exist. This can be fed by illusions and judgements some people hold of each other. This leads to non-contact and hence non-understanding of roles and struggles. It's so sad when we don't listen to the other. It should be so commonplace for the doctor and social worker to really listen and learn from his patient and for different agencies to meet and co-learn together. There may be some parts of an organisation where silo work is what is needed. That would be fine. It's the silo consciousness that we see as the problem.

The opposite of the silo consciousness is the relational approach. This is a fancy word for something very simple and rich. It means that relationships are what our work is all about. We are social beings and need each other. We live in communion and communication and it is this context that we flourish and grow. At York Street Health Practice we talk in our presentations of 'Circular Care' where all should work together with the client ( in our case homeless people and people in the asylum system ). The symbol of a circle is used as it co-joins us all. It can't be complete until we are all there. It also means that we can't do this alone, we don't want to to do this alone and we don't do this alone. This relational approach is also expressed as a circle where the circumference is the practical work we do - the GP writing the prescription, the nurse bandaging the wound, the support worker making the phone call. The centre of the circle is and has to be the call to rapport, connectivity and relationship. This relational cannot and should not stop at our service door. It needs to extend across services and cities. It is the dissolver of silo consciousness. This post is an example of where Leeds Adult Social Care and Leeds Community Healthcare NHS Trust meet to see what we can do and write to bring together people and communities for change and connection. The Migrant Access Project is another example. It is chaired by the Head of Adult Social Care Commissioning and has statutory and voluntary sector as its members. It exists to support networking across different communities.

Relationships are what will offer the most authentic integration,partnership work and patient engagement work. It is in relationship that we understand others and grow ourselves. It is here where we can jointly see solutions and create change. There is a price here too. That price is that relationships to be genuine need certain features. For the best relationships we have to be our best. Respect, kindness, equality, humour, giving as well as taking and mutual support are all needed. If we grow these seeds great things can happen. We see this in our own city where positive relationships are bringing forth positive results. We have so much to give and learn from each other. We can only receive this in lasting ways when our minds are set on the greater good and open to others. We know that Social Care and the NHS face major problems. Our words will not solve them. What the words point to may offer the best context and bond in which they can be addressed. This is our hope.

John Walsh. Support Manager. York Street Health Practice

 Pria Bhabra. Commissioning Officer (Migrant Access). Leeds Adult Social Care 

5 Tips to manage stress

Sally Poyser is a Psychological Wellbeing Practitioner at Touchstone one of the partner organisations in the Leeds IAPT service. To mark stress awareness day Sally gives five easy tips to help manage stress.

Stress affects everybody, but high levels of stress can affect our ability to cope with the demands that come up in life.

So, it’s important that we try to look after ourselves by taking steps to manage our stress levels.

1) It can be easy to feel overwhelmed if we have a lot of things happening in our lives. We naturally focus on the negative things in life such as the things we can't do. Try to focus on the things that you can do something about. This will help you feel more in control.

2) It can be easy to only do the things that we need to do in life and we forget about the pleasurable things. Don't let stress get in the way of the things that you enjoy, arrange to see that friend that you have not seen for a while; pick that hobby back up that you have neglected or do something that you have always wanted to do.

3) We all need help from time to time, talk to a friend about what you are going through so you can get some support from others. 

4) It is a natural human response to avoid things that are uncomfortable, but we know that avoidance makes stress worse in the long term so look at the things in your life that you are avoiding and start to tackle them by facing your fears.

5) Exercise is a natural ‘antidepressant’, try to make small changes to be more active such as taking the stairs rather than the lift or go for a brisk walk.

If you feel that you need further help in managing stress our Leeds IAPT Partnership offers courses which run once a week over a six week period. These courses help learn coping strategies and techniques to help manage stress more effectively. You can call 0113 843 4388 to have an assessment the same day or see our service webpage for more details.

Sally Poyser. Psychological Wellbeing Practitioner. Touchstone.