Tuesday, 26 August 2014

A vision of care

Representatives from CaSH ( Contraception and Sexual Health service ) and York Street Health Practice met over coffee to talk and listen. Both are Leeds Community Healthcare NHS Trust services. CaSH  provides effective, accessible and non-discriminatory contraception and sexual health services to improve the sexual health and wellbeing of both young people and those who are vulnerable in Leeds. CaSH includes a consultant, doctors, nurses, clinical support workers and a youth worker. York Street is the medical team for people who are homeless, vulnerably housed and in the asylum system in the Leeds area. Both teams operate across the city.

The meeting had three great outcomes. The first was a commitment to find new ways to work together and support the Leeds Health and Wellbeing Board vision for the poor and vulnerable in our city. We recognised the potency that our services together working for best health outcomes and care offers. Two are better than one and the specialisms of both services working alongside each other offers much. The second thing is that both services have the quality mark for working in domestic violence. We discussed how we can work together to obtain level two of this quality mark. The third aspect of the discussion was what we might call 'the deep stuff' - how we work and support not just good housing, medication and services but how we help support people find identity, focus and purpose.

In this last aspect we touched on three elements - responsibility, respect and relationships. These '3 R's' offer a possibility of what can happen. The first was responsibility. This is the moment when we really make that commitment to be adult and act as adults. To stop blaming and undermining others. To accept ourselves and life as it is and work from there for the best. It's amazing how we as adults can act as children. The call to be an adult and responsibly act is rarely a once and for all reality. It must be something we do and renew each day and week - sometimes against great stress and challenges. To move away from behaviour that is not adult and responsible to be honest and authentic people is a journey. Our good friend, Anne Cooper, the Lead Nurse for Informatics for NHS England, wrote a very powerful blog about this road to being authentic.  Anne ends it with these wonderful words, 'So authentic leadership is, I believe critical; the ability to be myself and be human, not to be a robotic corporate being, to help others to understand the whole me, flawed as I am.' To be responsible is to own ourselves and take responsibility for one's self. It's actually to love ourselves just as we are but also to love ourselves enough to want to change and develop too.

Respect. What does respect look like? Perhaps it can be defined by what it does, not look like. The subject of domestic violence and abuse we discussed offers a contrary opposite picture of what respect isn't. Those words, attitudes, actions, undermining, bullying, nastiness and hate are what we find at the heart of domestic violence and abuse. The opposite of these may be deemed acceptance, developing, affirming, kindness, love, gentleness and goodness. This to us is respect and whenever humans find these values they usually start to warm up themselves and open up like new flowers to the sun. These things - kindness, respect, gentleness - are infectious and can change so much.

What about relationships? Any one who has worked in care for a while and who has really been listening and learning knows that relationships are the heart of all that good care work is all about. We can do the work it's true but we can't do work that connects and changes people without positive therapeutic relationships. At York Street one of the theoretical images of the work we use is that of the circle. The circumference is the doctor giving the prescription, the nurse bandaging the wound and the support worker filling in the form. Yet the centre of the circle is and has to the rapport, the connectivity, the relationship. All good health work has to focus on creating and sustaining this relationship. It's the relationship that makes the difference. After the tragedy of Mid Staffs we have a real call to ensure person centred dominate all our work.

So how do we become conduits for responsibility, respect and positive relationships? There are a number of ways. In fact each of us receive dozens of opportunities every day for this to happen. A story might help here. Last year at a conference outside Leeds one of the authors was approached by a student studying health asking to visit their service. A few weeks later the student arrived and had a tour and talk about the service. After this the young student started to talk about an issue she was facing in her placement. She saw a clash between what she was learning in her classes and what she saw in her present health placement. We were able to say two things. The first is that what she saw in her placement was culture. She mustn't think the great things she learnt in class - the patient centred approach, great team work, vision and values - were just ideas that couldn't work in the real world. What she was looking at in the placement was culture and that culture had been made by human beings. And it could be unmade or remade by human beings too. The second thing was that in the NHS that there is an army of us - thousands and thousands working for better cultures and care. She was part of this movement and she could be - indeed was - the change needed. The call was to light a candle rather than curse the darkness. That young student - with no power and authority - went back to her placement and course to be that difference. That's not good leadership - that's really great leadership. What we see in this young woman is how to be a transmitter of the responsibility, respect and relational approach that we are talking about in this blog. Great leadership isn't about where we are - it's about what we are. We can be people who own their own being and potency to serve and care for others. If we can do this we don't have many worries that the '3 R's' - responsibility, respect and empowering relationships - will quickly start to appear. 

Dr Farah Haider, CaSH,

John Walsh, York Street Health Practice

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