Champions for health

This is the story of a project that we formally closed last week. It was an initiative called Health Champions and ran for two to three years in Leeds. It started when Jane Willliams, Strategic Development and Commissioning Manager (Mental Health) for NHS Leeds, brought the three of us, Isobel, Charlotte and myself together. We represented the third sector (St Anne's Resource Centre), NHS Leeds Integrated Commissioning Team and a service of Leeds Community Healthcare NHS Trust. Our brief was simple. To reach out to the 13 key non health homeless agencies in the city, bring them together and create a network of health champions. These agencies included St George's Crypt, St Anne's Resource Centre, Holdforth Court, Emmaus and the Street Outreach Team. These health champions would make strong the links with established health services, raise health and wellbeing as a key issue in their organisations and work with the NHS to co-create health solutions to their clients issues.

We had a very successful training session at the old Public Health Resource Centre in Armley. We followed this with seminars on subjects chosen by the health champions and also topical issues. These included dual diagnosis, personality disorder and TB. Some vibrant open days were also held. These were open to people using services and agencies and were all very well attended. In total there were three open days, the first two focusing on mental health and alcohol. The last was an event called 'Making the Links' and brought together housing, health, faith sector, food provision, law, probation, floating support, Public Health, sexual health services and many others. The aim was to have all these services concentrated in one place so services and clients could, as we entered a period of great challenge and change, be able to 'make the links to make the difference'.

The three of us worked hard for and with this project. What were the lessons? What did we see as we tried to build this from the ground up? There were many things we learned. We will try to pinpoint three that we think have real value not just for our personal learning but for the city. The first one was that there is no place where health stops. To explain this it's best to recall that Leeds has three health trusts (Leeds Community Healthcare NHS Trust, Leeds and York Partnership NHS Foundation Trust and Leeds Teaching Hospital NHS Trust) as well as Public Health which is part of the local council. When we did the training we did an exercise to see what health work these 'non health' workers were working with. We saw masses of health and wellbeing work across services and the city from these colleagues. We heard and saw how colleagues were dealing with everything from drug addiction to mental health to physical mobility problems. This shows us we cannot just put up a sign saying 'Not Health' as there is no place where healthcare stops or doesn't exist in the homeless sector. This has especial relevance for the city of Leeds. Its health and wellbeing vision is that we all create a caring and healthy city where the poorest receive healthcare the fastest. In the training we were seeing that this commitment to the poor and sick was something non-health services were already doing and working with. Health and wellbeing should be seen as the work of us all and we should all seek to align ourselves to work with the city and its vision.

The second lesson was how well the three of us worked together. Sometimes partnerships don't actually work together that well. Why did this one? We would venture the following answer. Two of us had already worked together (St Anne's and York Street) and there existed a very positive history of good work and respect.  There was also a real exchange of ideas and listening between the three of us as well as humour. We think the biggest help was that we all sought to give. We didn't focus on what we got but rather on what we could give (and interestingly got so much back from the project). Partnerships sometimes flounder because people may seek to control and not focus on the common good and goal. That didn't happen here. The common vision and this giving attitude made the project a real joy as well as hard work at times.

The last lesson is to use the common parlance - one size doesn't fit all. We could create the framework but we learnt we had to let it develop organically. Different services took the training and work and applied them in different ways in their services. There was something here about how we balanced management and autonomy. Again we would suggest that there is a wider lesson here. Often the best services have this balance and sometimes a tension resulting from this dual reality. Without the leadership and management there would be no steer or direction, Without the autonomy and room for growth there would be no creativity or new life. Sometimes holding this balance can be a challenge but in this tension lies the path of allowing possibility to emerge and making sure things stay on track.

This article has brought the three of us back together to remember and celebrate the Health Champions Programme. But we were not the stars of the show - just its organisers. The real stars were the workers and service users who worked in this programme. They were the people who worked in the centres, hostels and teams responding to need and linking in with health for the best outcomes. It's fitting to end by saying thank you to these good people who made the difference for the better and still do.
 

John Walsh, York Street Health Practice

Charlotte Hanson, Public Health, Leeds City Council
Isobel Worswick, Former Manager, St Anne's Resource Centre

Hearing the homeless - working for best services

We all favour client participation, joint working with key partners, having a strategic vision and making a difference. But how do we do it? How do we make sure one of the key elements is not lost or ignored? Some may say there isn't always an easy answer to this. Some recent work between Healthwatch Leeds and Leeds Community Healthcare / York Street Health Practice offer a good model of how this can happen. In this blog two of the participants describe the work and its lessons.

Healthwatch Leeds is committed to a great vision - 'Healthwatch Leeds gives people a powerful voice on health and social care services in Leeds and beyond. Healthwatch Leeds helps the people of Leeds to get the best out of their local health and social care services, whether it's improving them today or helping to shape them for tomorrow. Healthwatch Leeds is all about local voices being able to influence the delivery and design of local services. Not just people who use them, but anyone who might need to in future'. Healthwatch is the official body that represents patient voice and concerns in the field of health and social care. Its work is vital and everybody in health and social care should actively and positively welcome it. 

Healthwatch Leeds contacted York Street Practice as it needed to produce a report on homeless people and health in Leeds for the Health and Wellbeing Board. The two agencies had already met and were both committed to the provision of the best patient care and experience possible in the city. In the conversation about the report, York Street decided not to host the event for the voice of the homeless to be heard. The reason was we wanted a neutral place where our patients could speak and be as open and honest as possible. We discussed with two key partners in the city - St Anne's Resource Centre and St George's Crypt. They agreed to host the event where Parveen Ayub, Community Project Worker, and volunteers at Healthwatch could meet homeless people and talk to them about health issues and services in Leeds. This work was supported by the agencies involved. It was written into a report that was presented to the Leeds Health and Wellbeing Board. The report looked at difficulties homeless people encounter when accessing health and social care services and the impact it has on their health and well-being. The report supported outcome 5 of the Leeds Joint Health and Well-Being Strategy 2013-15. In this way the voices of those who have few to speak for them was presented to the key strategic health and social care body in Leeds. The homeless were heard! 

To us this linked together many key needs. These include; positive partnerships between health and patient groups, allowing the patient to be heard in neutral but supportive environments that they trust, for patient groups to reach out to where people are, for those without power and a voice to be supported so their voice and needs are heard and for the leading authorities in the city to have this presented to them so they can feature it into their work for the whole city. This circle approach - from patients to strategy - from patient groups to health services - from the creation of positive space where dialogue can occur to changes in the system - all offer great hope and models of how we can work. 

This is how we can make Leeds the best city for health and wellbeing. It's a tremendous thing that we can work to make sure that not only the poorest receive healthcare the fastest but that their voice can be heard quickly through initiatives such as this. This might be the first time in the UK that Healthwatch and a health service have written a joint article celebrating joint great work and offering a key model of how we can work for the vulnerable. If it isn't the first time that's good. If it is, that's something good too. We see what we have tried to describe as best practice for those most in need now and a promise what future work can look like. Hearing the homeless and vulnerable is how we work for best services.

Parveen Ayub -  Healthwatch Leeds

John Walsh - York Street Health Practice

National report

On Wednesday 16 July I represented Leeds Community Healthcare NHS Trust at the National Confidential Inquiry into suicide and homicide by people with mental illness. The event took place at the Manchester Conference Centre and was opened by Niall Boyce, editor of The Lancet Psychiatry.

The first speaker was Stephen Habgood from Papyrus This was the sharing of the story of Stephens' son's death. It was titled ' All the Kings Horses'. When this gentleman spoke there was a total silence in the room as we heard the pain and loss suicide brings. Words from me to describe this story would be a very poor thing. The power of it struck me like lightning. What I can say it is that it was so right to start this event with these powerful and heart touching words. It set the centre and heart of what we were about to hear. I would like to use this space to thank Mr Habgood for his words and sharing. 

The second speaker was Professor Dame Sue Bailey, Consultant Child and Adolescent Forensic Psychiatrist at Greater Manchester West NHS Foundation Trust. This was an impacting speech. Professor Bailey drew from the Francis and Berwick reports to share her thoughts.  What I found so valuable were sentences which really struck and resonated with me. These statements don't need my commentary so I will record them as I scribbled them down. These are my summaries

          - one death - a ripple effect of thousands 
          - the need to listen to parents and families
          - the need for continual learning - all teach, all learn
          - prefix quality with safety. The two go together. If we get safety right quality will follow
         -  the need for intelligent kindness in healthcare
         -  quoting Bill Gates - 'It's fine to celebrate success but it is more important to heed the lessons of failure.'- the duty of candour

These may seem like truisms and obvious value statements. If however we all really lived and sourced them in our practice and services a real transformation could occur. 

The last speaker was Professor Louis Appleby, National Director for Health and Criminal Justice and Professor of Psychiatry at the University of Manchester.  Professor Appleby is Director of the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. He presented the findings of the report. The findings can be found here. The presentation ended with recommendations. These included: 

       * suicide three days after hospital discharge should be regarded as a 'never event'
       * care planning needs to be careful and effective including for those who self-discharge 
       * adverse situations / events that precede admission should be addressed before discharge
       * the benefits of reducing length of stay in in patient stay should be balanced with risks and should not be an aim in itself
       * in intimate partner homicides, mental health services should play a full role in multi- agency work and case reviews. 
       * Crisis Resolution and Home Treatment might not be suitable for patients with too high risk or who do not have good family and other service support
       * economic factors should be recognised with patient suicides and support offered with housing, debt and employment.
       
There is here a real challenge for our mental health services and other care services. I would suggest it is even a bigger call than that. Three months ago I received a call at work that a friend of mine hadn't shown up at work. A visit by the police and his father to his flat the next day found him there. He had taken his life. This was someone who had a job he liked, lots of friends, a great career future and who did a lot of good to others. I and others still have no real answers as to why our friend took his life. He never had any contact with mental health services and as far as we know showed no signs to any of us of mental illness. The answer to this is bigger than any service. I think it lies in how we create cities, conversations and cultures where people can talk about their feelings and thoughts and where we can support people to find hope in the darkness they may be encountering. This report raises vital questions and recommendations for all us to work with.

John Walsh, York Street Practice

Meet our staff...

Sharon Underwood, a Health Visitor with the Early Start Team has been awarded the Deans Prize by Leeds Metropolitan University following the completion of her Master’s in Public Health. 

“After a break from studying after my first degree in health visiting, I decided to start a new course and discovered the MSc in Public Health: Health Promotion at Leeds Metropolitan University. Completing the course was as much about doing something for my own personal achievement as well as knowing it would assist with my everyday role as a Health Visitor.

There have been many elements to the course that I have found interesting, one of which was my research project for my 12,000 word dissertation. I decided to look in to the attitudes parents have towards supplying alcohol to their underage teenagers.

Alcohol consumption in adolescence is a source of increasing concern. In England, it is illegal for persons under the age of 18 years to purchase alcohol, and the reduction or prevention of under-age alcohol consumption is a government priority, with supply of and access to alcohol being key aims in the national strategy. The Department of Health’s Chief Medical Officer advocates that an alcohol-free childhood is the healthiest and best option for children. However, research implies that the consumption of alcohol by young people frequently ignores these recommendations.

Parental supply has been identified within a number of studies as a significant point of access to alcohol by teenagers. They may do this for many reasons; to demystify drinking alcohol, be in control of how much they consume or some see it as a rite of passage. A recent Drinkaware study identified a correlation between parental drinking habits, and influences upon children. I specifically chose to recruit and interview parents, aged between 44 and 64 years, from middleclass families as research shows there is an increase in the weekly drinking habits of this group. 

Of the seven parents I spoke with there was a varying degree of attitudes, awareness and lack of knowledge. One mum even took away with her some prompt cards describing different scenarios where her children may her approach her for alcohol to use during discussions with her children.

It was evident through the interviews that parents aren’t given much advice and support on what they should do if their teenage son or daughter comes to them to ask for alcohol to take to a party, etc. As a nurse by background and working in the healthcare profession for 30 years, I have seen the short and long term health impacts for people and their families who have been affected by excessive drinking of alcohol and as health care professionals we should get better at having these conversations early.”

Congratulations to Sharon on her degree and well deserved prize.

You can access information and support from your local Health Centre or GP surgery or your child’s school/college pastoral services. In addition, you may find the following websites a useful source of information:

• Drinkaware: Alcohol and your child
• Drinkaware: What do other parents
• NHS Choices

Celebrating Positive Pathways

Positive Pathways celebrated their first year of existence yesterday at St George's Centre in Leeds. Positive Pathways 'supports people who need to find suitable housing or are having difficulty managingwhere they live due to issues connected to their mental health'. The service is led by Community Links and is a partnership with Touchstone, Leeds Mind, Leeds Irish Health and Homes, St Anne’s Community Services and Leeds Federated Housing Association.

The event was opened by Catherine Donnelly, Service Manager at Community Links, who I first met 20 years ago when we both worked for Leeds Shaftesbury Project, the forerunner of Community Links. Catherine epitomizes everything that is good about the work we all try to do -  compassion, professionalism, vision, values, hope and commitment. Catherine introduced the event and the speakers. Chris Dickinson, Head of Commissioning at Leeds City Council spoke first about the work of Positive Pathways and the support of the local council for the scheme to deliver this valuable service to vulnerable people in Leeds. The next speaker was Councillor Bill Urry. Cllr Urry is the new lead for homelessness in Leeds and has already started to go out and meet services and clients. He visited York Street last week and the previous week had been out on the streets with services working with those rough sleeping. Cllr Urry gave a humble and gentle speech. He celebrated the event and asked what he could do for the agencies and service users there. He mentioned his predecessor Cllr John Hardy who worked so hard and so passionately for the homeless. It's a great thing that Leeds has a lead for homelessness and we commit ourselves to work with Cllr Urry to develop the best we can for our people who are homeless.

The third speaker was myself. I spoke about how Leeds can become best city. The day before I had meet with two good colleagues who work with the Health and Wellbeing Board - Peter Roderick and Rob Newton. We had talked about York Street, the passion we all have that Leeds is the best city for health and wellbeing and how we can proceed with this compassionate dynamic vision. I think I was still filled with the hope that meeting gave me as I decided to focus on that theme. I said that we become the best city by creating the best services for clients and the best cultures for staff. The two are not separate - it's all about caring for people. The need and hour for 'Integral Inclusion ' is now. I tried to map out ways for us to make those services that truly care for staff and service users.        

In attending the event and reflecting afterwards many things enter my mind. To pick three key things would not be easy but I'll try. The first was that it was so appropriate that Chris, Bill and myself spoke about what out third sector colleagues were doing. It was so right for the local authority and NHS to publicly acclaim and honour Positive Pathways and by implication third sector work. These three forces - the local authority, health and third sector working together and learning together offer a real hope to this city. This partnership triangle offers a sign and possibility for the future. This work can offer the most potent and supportive options for Leeds and it's people. The event was a microcosm of what we are and where we can go.

This brings me to the second key feature. We heard the voice of the service users. This was so key. That partnership triangle always needs to have that voice at its very centre. If we don't have patient- centred care then we are not offering the best models and practice. To hear the service users and volunteers was so powerful. Their stories, hopes and optimism touched, I think, everyone in the room. Anthony de Mello, the spiritual writer, once said that the shortest distance between a human being and truth is a story. The stories we heard connected us to people's lives and the work of the partners in Positive Pathways - work that helps people change their lives. The great health and wellbeing vision of Leeds mentions as an outcome 'People will be involved in decisions made about them'. This has to be key to our work. We have to make sure service users aren't just consulted but at the heart of what we do and are involved in what affects them.

 

The last thing that touched me was where we are in services locally and nationally. I think we are at a moment where we can do great things but to do this we have to think and act differently. As the events at Mid Staffs unfolded I remember wanting to know more. One Friday night I started to read and watch about what had happened. It was a heartbreaking experience. The next day a strange thing occurred. As I worked around the city centre I was still thinking about what had happened at Mid Staffs. Unbidden into my mind came a quote I had read a long time ago. The quote was, 'The darker the night the brighter the stars'. I didn't know who is was who said this but I knew what it meant. I looked the author up when I went home and it was the Russian novelist Dostoevsky who wrote this. Not that I have read him. I had not and still haven't. The quote however appeared as a real answer. The stars, despite the darkness, were the opportunity for something new and authentic. Not just the opportunity but that this was actually happening in different places. Those of us who want and work for new inclusive cultures for staff and great services for clients - this is our hour. The old cultures and  systems have shown in graphic deadly detail where they can lead. I believe those of us who have new visions, dream brighter pictures and work to make them come true that this is our time. Of course history and life will not automatically deliver these best services and cultures to us. We have to work for them and we have to fight for them. There are many of us in the third and statutory sectors who are sowing the seeds for this future and even seeing it happen before our eyes. If you are part of this work, thank you for what you do. If not, then why not join us? 

The top four myths about great leaders

Myths are funny things. We can believe things about ourselves or others which are just not true. Not only can we believe them but we can keep on holding them year after year. There are myths about all sorts of things including what great leaders and great leadership looks like. Here is my list of the top four myths about great leaders. I do not pretend this is the best list or the most comprehensive one. If you've got your own list that's great, it shows you are at least thinking about leadership and what it means. So hold onto your hats as we go into the land of make believe - a land that can seem so real that we believe it is. I'll leave the most fatal and deadly myth of all until the very end.

Myth Number One: Great leaders always get it right.

That's not true. Good and great leaders get it wrong and fail at things. Great leadership is not the absence of failure. It is the presence of effort, commitment and overcoming difficulties. Abraham Lincoln, one of the most celebrated American presidents lost his job, failed in business, had a breakdown, was defeated for nomination to congress, defeated at least twice for the US Senate and was defeated for nomination as Vice President. Alongside these failures were great successes too and eventually the Presidency. If we think great leadership is about never getting it wrong I think we are describing perfection rather than leadership.

Myth Number Two: Great Leaders always get results. They inspire everyone and win everybody over.

Again not true. Great Leaders often get into trouble because of their honesty and integrity. Their leadership challenges the existing set ups and people don't like that. If you think of Jesus, Gandhi and Martin Luther King, we see some interesting commonalities. They were all great leaders - men of inspiration, vision and care. All three changed the world. All three were also killed by those who opposed them. In Buddhism, there are the tales of the cousin of the Buddha who tried to split the community, turn people against Buddha and tried to have him killed three times. Leadership that shapes and changes things for the better will always have those who oppose it. Great leadership does not escape opposition. It works and goes ahead despite it.  

Myth Number Three: Great Leaders always have the answers. They are the ones in the know.

Don't think so. If great leaders had all the answers they would have stopped growing and learning and that never happens. It would be quite frightening if a leader had all the answers. It would mean they were cut off from the riches and depths of other people. The opposite is actually true here. Great leaders know they don't have all the answers. That's why they are always open and listening to what others say and do. Great leaders are perpetual learners and in that learning their great leadership lies. 

Myth Number Four: You will never be a great leader

This is the real 'serpent in the Garden of Eden' falsehood. It often births the others and is fed by them. Whatever you do, don't believe it. Leadership is when a person sees, owns and releases their own gifts. As we all have gifts we can all be great leaders. It isn't the lack of qualities and gifts - it's that we don't realize them and know how to let them manifest. I can honestly say I have worked with hundreds of homeless people over the years (people with the poorest backgrounds and worst odds against them usually from early years) and have never met one who did not have great gifts when you really got to know them. Great leadership is the point where the gifts come to the surface and start functioning. It's the shining of what is within.

We may not be like Napoleon who when he escaped from Elba in 1815 was met by an army regiment sent to stop him. He spoke to them, inspired them and won them all over. Napoleon then marched on Paris with this army whereupon the King fled. We may not be the unique special witness to justice and equality that Nelson Mandela was. However, if we can activate our gifts and make our contribution to making the world a better and brighter place and we can do this day in day out then something amazing will happen. We won't be great leaders - we will be the best.  

John Walsh, York Street Practice

Culture Change in the NHS

Leeds Community Healthcare is currently working in partnership with NHS Employers and Southampton University on a project to understand and support culture changes in the NHS. The project will run until November 2014 with specific outputs on tools for development of new cultural paradigms across the health economy.

The project team comprises of Catherine Hall (Service Manager for Specialist Services), Caroline McNamara (Senior Clinical Lead), Julie Mountain (Head of Adult Neighbourhood Services),  Julie Thornton (Development Lead) and myself.

Much emphasis has been placed on 'culture change' over the past couple of years in the NHS and we have seen forensic examination of system failures across the NHS. The outcome of this has immediate impact on patients and their families and the importance of putting these terrible events right is critical. One of the more astonishing and distressing facts to emerge from the Francis Report for example was the number of instances of not only poor care, but inhumane care. Patients were left lying in their own urine, or were left for hours without food or drink. Psychological studies have helped to shed light on the mechanisms underlying inhumane behaviour, such as ignoring distress and harm to an individual, although it is worth bearing in mind that none of them were caring for vulnerable patients.

Particularly pertinent is the ‘bystander effect’, in which individuals stand by and fail to help a victim in distress. Relevant variables (see Fischer et al, 2011) include the number of bystanders present (more means it is less likely that a victim will be helped); the ambiguity of the situation (more ambiguity leads to less help); and the similarity of the victim to the bystander (the greater the similarity, the more likely that help will be offered). Research has also shown that pressing situational factors may readily override explicitly enounced value systems and beliefs, such that a person in great distress is ignored (Darley & Batson, 1973), something that could find parallels in busy clinical settings.

Also relevant is Philip Zimbardo’s Stanford Prison Experiment (Haney & Zimbardo, 1998) where those who were put in charge of prisoners subjected them to inhumane treatment that seemed to transcend all moral boundaries. Relevant issues are discussed by Miller (2011) and by Haslam and Reicher (2012). The latter’s findings indicate that a positive hospital culture of strong leadership in human values and appropriate peer support should help to counteract any negative tendencies.

The vast majority of NHS organisations run perfectly smoothly and cope extremely well under the pressures that are currently being experienced by staff.  When we hear talk 'in the system' of culture change what do they or we precisely mean? It’s useful to nail down a definition here:

"Culture is a set of shared, taken-for-granted implicit assumptions that members of an organisation hold and that determines how they perceive, think about and react to things (Schein 1992)." In other words it’s 'The way we do things around here'. 

In a recent accompanied visit with a District Nurse to one of the poorer districts within Leeds we visited an elderly couple. The patient we had gone to visit had the start of small ulcer around his bottom and the Nurse had visited to offer treatment and reassurance. We had gone only to see the man for treatment but it quickly became apparent that both needed some form of care. Whilst Elaine was attending to the 'real' patient I chatted to his wife. A large portion of what we both did that morning was not only attending to the patient’s clinical needs but also a whole range of social and psychological support. Most of that was through being interested, curious and listening to stories about their journey through life; where they grew up, which school they went to, what their parents did and noticing the pictures on the wall.  Each photograph telling a story about their lives, the histories of their families and how they had grown up in Leeds. 

Often with huge pressure on their time, nurses (and other care professionals) do this day in day out with care, compassion and attention. This is clearly technical clinical competence done with kindness. We could say that kindness is something, which is generated by an intellectual and emotional understanding that self-interest and the interests of others are bound together, and by acting upon that understanding. Human beings have enormous capacity for kindness. It is this essence that is at the core of our change work in LCH.

If we are to support the changes that are necessary and needed within the NHS we also have to be mindful and supportive about the millions of positive interactions that take place every day across the country. The danger is that we become embroiled in negativity regarding the terrible events such as Mid Staffs without paying attention to the amazing work that takes place. There are things that we are doing and can do provided they make sense to staff and patients and also connect to our values and behaviours.

Culture change is happening all the time and as a reminder of this we only have to look back to how things used to be.  The essence of what we stand for in the NHS will never change, this is the greatest of all platforms with which we can truly 'stand on the shoulders of giants'.

‘We are living in a world of change - the tempo of life has quickened considerably. The wheels of “possibility” in our world of nursing would appear to be turning more swiftly. Many hospitals have been enlarged and new departments have sprung up within them. There is a new look in many of the Wards and Nurses' Homes. Revolution is in progress, and like every transitional condition, it has an upsetting and almost bewildering effect on the various members of our profession. Is it not all the more necessary, therefore, that everything possible should be done to ensure stability and continuity? But one of the main foundations is a sense of community, and all efforts should be made to foster and strengthen the feeling that we are all part of a whole, with a common centre and mutual purpose.’ (The British Nursing Journal September 1951)

Steve Keyes, Head of Organisational Development

 

References  

Darley, J. & Batson, C. (1973). ‘From Jerusalem to Jericho’: A study of situational and dispositional variables in helping behaviour. Journal of Personality and Social Psychology, 27, 100–108.

Fischer, P., Krueger, J., Greitemeyer, T. et al. (2011). The bystander-effect: A meta-analytic review on bystander intervention in dangerous and nondangerous emergencies. Psychological Bulletin, 137, 517–537.

Haney, C. & Zimbardo, P. (1998). The past and the future of U.S. prison policy. Twenty-five years after the Stanford Prison Experiment. American Psychologist, 53, 709–727.

Haslam, S.A. & Reicher, S. (2012). Contesting the ‘nature’ of conformity: what Milgram and Zimbardo’s studies really show. PLoS Biology, 10, e1001426.

Miller, G. (1969). Psychology as a means of promoting human welfare. American Psychologist, 24, 1063–1075.

Schein E (1992). Organizational culture and leadership. San Francisco: Jossey Bass

The British Nursing Journal, September, 1951.

Feeding our people

John Walsh speaking to attendees of the
Homeless and Food Aid meeting at St George's Crypt

I was asked to speak at St George's Crypt in Leeds at a Homeless and Food Aid meeting and training evening. This brought together services, faith communities and concerned individuals to work to make sure that people who struggle in Leeds can access food. A year and half ago the Yorkshire Evening Post pointed out how malnutrition cases seeking hospital admission has trebled in five years. Our good colleague, Councillor Lisa Mulherin, the chair of the Health and Wellbeing Board, said: "The numbers being admitted to hospital are shocking and potentially the tip of the iceberg. It’s an absolute disgrace that in a wealthy, modern nation we are seeing anybody turning up in hospital in that condition." Dr Ian Cameron, the director of Public Health in Leeds, said this increase in hospital admissions was a national not just local issue. 

This meeting was part of a response of a city to this issue. And it's not just homeless people or people on benefits but the low paid affected. We seek to draw together services and people to make sure malnutrition doesn't occur in our city and the hungry can be fed. Councillor John Hardy has played a central and leading role in this work. Services like York Street Health Practice and faith initiatives such as Unity in Poverty Action were involved from the beginning. These networks seek to draw together services and people to make sure malnutrition doesn't occur in our city and the hungry can be fed. See a piece in the Yorkshire Evening Post here. There is also now an All Parliamentary Inquiry into Hunger and Food Poverty, which is presently taking evidence under the chairmanship of Frank Field MP and the Bishop of Truro. 

The meeting had three speakers. It was a series which brought together people to look at needs which emerged alongside food. The topic this evening was mental health. I spoke about the Health and Wellbeing Vision of the city and need for a manifesto of good mental health work. This is not just what we do but also how we do it. The call focused on what we try to do at York Street - creating a positive space for the vulnerable, build kind and effective relationships and support people to identify and engage with hope. If we miss these things we end up working superficially. Emma Strachan from Public Health gave a great presentation about the positive work Public Health is doing in Leeds and how she will act as a link between the network and Public Health. The last speaker was Philip Bramson from Volition who spoke eloquently about mental health services in the city.

The meeting was attended by about 45 people - from churches, Adult Social Care, the Welfare Rights Unit, MIND, the food banks. Skyline, Archway and other organisations. Special mention must be made of Unity in Poverty Action who have done such amazing work in bringing together and supporting this network. The sense in the room was one of care and commitment to be with and support those in this city who find life hard. If we could bottle the energy, compassion and goodness of those present we would have a very potent power to move towards making Leeds the best city for health and wellbeing. This meeting showed me what makes great partnerships. Great partnerships are like a three legged stool. The legs are great vision, great work and great relationships. Pull one leg away and something essential is missing. Without vision we flounder. Without the work there is no change and without the relationships we don't connect.   

This blog is called 'Feeding our people' and it's true. The vulnerable, hungry and sick are not people - they are our people. They belong to our city and we are linked to them. We either work together to create comprehensive cohesion or struggle alone as isolated individuals. The first path is all about making a caring and supportive city. The latter is its opposite - it's negation. If we take the first way and really work together for this one thing will certainly happen, we will be the best we can be in the best city we can make. And that really is something worth working for isn't it?

 

John Walsh, York Street Practice

Happy birthday NHS

Margaret Thatcher retired from the House of Commons at age 66. Many people used to retire at 65. The NHS is 66 on July 4. Rather than retirement, a recent study by a prestigious American health body suggests the opposite is the case. The report actually points to vitality, life and plenty of work to do yet. The Commonwealth Fund is a non partisan and private health foundation based in New York. Its mission is 'to promote a high-performing health care system that achieves better access, improved quality, and greater efficiency, particularly for society's most vulnerable, including low-income people, the uninsured, minority Americans, young children, and elderly adults.' Its board includes key health experts such as James R Tallon. A report called 'Mirror, Mirror on the Wall, 2014 Update: How the U.S. Health Care System Compares Internationally' makes some interesting points. It compares the USA health system with 10 other health systems including our own. The other countries are Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden and Switzerland. The really key point is that the study looked at what really matters. Key elements such as access, health care quality, equity, efficiency and key indicators of healthy lives (e.g. infant mortality) were used. The result was that the best overall health ranking was......the NHS. Switzerland and Sweden were second and third respectively. (http://www.commonwealthfund.org/publications/fund-reports/2014/jun/mirror-mirror).

When we often hear how bad things are in the NHS, this health specialist study says something else. So how do we square the bad news we hear and the scholarly study done by this Foundation? One doesn't have to be a genius to see that bad things happen in good services. That things in a service may be wrong yet a service can be right and good. This leads to the need for renewal and reform not ditching the service. I hope if we found a dirty plate at home we would wash it, not smash it. The study also suggests that there are powerful energies and practices in the NHS that are working well. If there wasn't, how could it be rated the best in overall health ranking?

The NHS is where ordinary people do extraordinary things everyday. The NHS is a sign of what a civilized nation looks like. It embodies the highest principles - social care, social justice and social equality. It says that health should be based on our need not our bank account. The NHS is ours - it belongs to the people. This report says she is still delivering 66 years on. We know that she is what her best practice and foundation express - great vision, values, care and compassion. That's why so many of us are so proud of the NHS and so many of us are humbled to be part of her service.

 

Happy birthday NHS - thanks for all you do and have done for people. 

 

John Walsh, York Street Practice

Meet our staff...

Lisa, Rosie and Deanna are three Occupational Therapy students from Leeds Metropolitan University, working with Integrated Services. During their three month placement, they have been undertaking a project, which they explain below.

We are a group of three students studying Occupational Therapy at Leeds Metropolitan University, currently on a role emerging placement with Integrated Services until the 11th July. 

For role emerging placements, students enter into a non-traditional placement setting and introduce or expand the role of occupational therapy within the service and develop a project around this. Occupational therapists (OTs) enable people to overcome obstacles which prevent them from participating in the occupations that matter to them. This may be a result of the aging process, illness, disability or other circumstances.

Our project is to promote occupational therapy to the other professionals working within Integrated Services in Beeston (where we are mainly based) who are predominantly District Nurses and Community Matrons.

During the beginning stages of the placement we gathered information to help us devise our project by shadowing nurses and OTs on client visits, conducting a focus group with OTs and surveying the nurses based at Beeston. Our rationale for the project was that most OT referrals are for equipment or adaptation provision and the OTs in Integrated Services are aiming to work more holistically. This includes enabling clients to engage in occupations that are important to them, such as being able to socialise with friends at a weekly coffee morning, being able to take their dog for a walk, or knitting a scarf for a grandchild.

As part of the project, we have created several posters which will be displayed at Beeston Health Centre, as well as leaflets which will be distributed to staff and patients, explaining the role of Occupational Therapy. During the last week of our placement, we are holding an interactive session with the nurses based at Beeston to explore the meaning of occupation and how beneficial engaging in meaningful occupations is to a person’s health and wellbeing. We will then discuss potential interventions OTs can provide, using case studies to illustrate the role of OT with several different clients.  

Our placement mentors believe there is an unmet need where occupational therapy could improve clients overall health and wellbeing (e.g. clients experiencing social isolation, disruption in roles and routines) however due to the perception of OT within the service these clients are not getting referred. Integrated working requires professionals to understand one another’s roles so we believe promoting OT to other professionals will serve this purpose while also addressing the unmet need of clients. We hope that when the placement is finished our mentors will continue to use the resources we have produced to promote OT across Leeds. 

Lisa Downing,  Rosie Longshaw and Deanna Stephens