The business of delivering specialist services

Meet Dan, he’s the Business Manager for our specialist services which are healthcare services for specialist communities (such as prisoners, detainees in custody, the homeless and asylum seekers), or specialist conditions (such as dental, podiatry, MSK, healthy living, mental health).

Dan has shared with us what his role as a business manager entails…

Dan collecting an award at the
LCH Achievement Awards in 2014.

Tell us, what does your job involve?

I am a key link for our services with commissioners. I ensure we have fair contracts that are value for money, that are well specified and that have effective and realistic performance measures. I help services compete for new business or compete to retain their existing business when it goes out to tender. I manage the innovation and business change functions so that services are supported to innovate, improve and embed any changes.

What attracted you to this role?

I've always worked in healthcare and had got into quite strategic roles which felt detached from services and real people. I saw this role advertised and had worked with York Street Practice in a past life and had enjoyed it so I thought I would give it a go. It's a very busy and challenging role, I've never worked so hard in my life! However, it is extremely rewarding as I can see how I am impacting on healthcare for real people despite not being a clinician myself.

What is the best bit about doing your job?

No day is the same. I get to go all over the city, meeting all sorts of people. I'm often working with services that have problems but this doesn't get me down as I feel that I am helping them overcome issues or barriers.

Do you have a particular highlight from your career to date?

I think it was when we won the very first NHSE 'Excellence in Public Participation' award last year. It was for a piece of work where we collaborated with homeless and asylum seeker clients at York Street Practice to improve how they access services and as part of this we won some funding so that patients could use digital technology to manage their own healthcare. When we went to collect the award for this innovation we got to take service users with us. It was extremely powerful and so rewarding to have national acclaim for what was essentially a very simple project. Also when we won the police custody bids it was so exciting - it was hard to believe that months of hard work and late nights had paid off and it made me extremely proud to work for LCH and to have been part of that team.

How has your past experience helped with your role?

I did a Communications degree back in the day so people often think it's weird I've ended up with the job that I do in the NHS. However, the key competency I need for my day to day working is communication skills and the ability to form effective relationships, so perhaps it wasn't such a waste of time after all! I also did a lot of voluntary caring roles at university which made me realise early on that I wanted a career in the NHS and not in the cut throat media industry!

If someone was thinking of joining the trust in a similar role, what advice would you give them?

Regardless of whether a role in LCH is clinical or managerial we need people who have the right values and who have good people skills - if this is you then do come and work for us. We can train people in all manner of skills and knowledge areas but we cannot train you in the values - this has to be core to you. If you have our values then get in touch!

If you would like to join our team, click here for our latest roles being advertised. 

The Heart of Nursing

Caroline is a cardiac nurse specialist and as part of her role cares for heart failure patients, monitors their symptoms and helps them to plan their long-term care. She is one of 17 community cardiac nurses providing long-term care to patients within the trust.

Heart failure patients require ongoing monitoring because their symptoms, which include shortness of breath, fluid retention and fatigue. It can vary greatly from patient to patient, and also day to day.

“Often we see patients who are really uncomfortable but because of the intervention that we do and the adjustments we make to their medication, their symptoms improve dramatically. Often, within a week or two, patients say they can breathe easier again,” she explains.

Many of these interventions are carried out in Caroline’s heart failure clinic. Caroline spends time with the patients discussing their symptoms and taking blood tests. Based on this information, she can adjust doses of medication accordingly and give lifestyle advice, which can help people to manage heart failure.

Caroline also sees patients in their own home when they are too unwell to attend the clinic. If a patient who is retaining fluid doesn’t respond to an increase in water tablets, they often find that they benefit from having it delivered intravenously via a drip. In the past, dealing with this would mean admitting the patient to hospital. A few years ago, our community cardiac team in Leeds received a grant from the British Heart Foundation’s ground breaking scheme to pilot delivery of intravenous diuretics at home. The trial was a great success, and since, the service has been able to improve the lives of many patients that have been able to receive treatment in their own homes. 

Find out more about the community cardiac service here. 

1001 Critical Days

1001 critical days 

Sue Ranger, consultant clinical psychologist, within our Infants Mental Health team was invited to help develop the  1001 Critical Days Report, which was launched recently. Here she shares details of her experience...

  

"Tim Loughton, MP and former Children’s Minister, said that tackling child mental health issues and maltreatment in the first two years of life should be no less of a priority for politicians as defending the realm.

He made the comments ahead of the launch of an Inquiry conducted by the All Party Parliamentary Groups for Conception to Age 2- first 1001 days into perinatal mental health and child maltreatment. It suggests that the cost of failing to deal with these issues is estimated to be £23 billion, half of annual defence spending of £43billion, and that poor parental / child attachment can be passed down from one generation to the next, creating a vicious cycle and damaging environment in which to grow up.

The report is the culmination of months of inquiry sessions, which took evidence from a committee panels of experts and parliamentarians, to investigate the various factors that affect the emotional and social development of children from conception to age 2. The report was launched on Wednesday 25 February at the Speaker’s House in Parliament where a number of leading academics, clinicians and policy makers in the field were in attendance.

The over-arching inquiry pulls together previous research in the area to offer two main conclusions:

One is that to deliver socially and emotionally capable children at age 2, local policies need to be based on a commitment to primary prevention. The evidence presented in the Inquiry strongly indicates that identification of need should take place before the child is harmed, not after. Therefore, inspection should look closely at primary prevention measures which would deliver this result.

The second conclusion is that, without intervention, there will be in the future, as there has been in the past, high intergenerational transmission of disadvantage, inequality, dysfunction and child maltreatment and the economic value of breaking these cycles will be enormous. In addition, the report offers nine recommendations, which it says are practical, achievable but, above all, the minimum essential if society is to tackle these issues. 

I was lucky enough to be one of those invited to contribute to the process of gathering evidence and opinion to inform the new ‘Building Great Britons’ report on the vital importance of supporting infants and their families in the period from conception to the child’s second birthday. My involvement meant attending a series of several meetings in the beautiful wood panelled meeting rooms in the Houses of Parliament over a period of five months from September 2014 to February 2015 and providing verbal and written comments on the importance of early attachment relationships and support for infants and their families in the earliest days of a child’s life.

A significant and rapidly growing body of research now exists to support the clinical evidence that tells us that an infant’s environment and experiences in utero and in the care they receive in the first months of life will dramatically influence outcomes throughout their lives. If babies have positive and loving care before and after birth from parents who are physically and emotionally healthy then they will grow healthy brains and become secure and resilient children who make good progress and do well in school and beyond. Relationships are a key part of this process and that includes the relationships that parents have with professionals and services to support them in caring for their babies and young children. Proactive and preventative services are less costly in the long term than reactive services to address established difficulties so the policy makes good economic sense too.

I was formally invited to attend the launch of the 1001 Critical Days Report on Wednesday 25 February, along with various others including our local CCG Children’s Commissioner, Jane Mischenko,  by the Rt Hon Frank Field MP and Tim Loughton MP who chaired the APPG meetings. Speakers at the launch included Mr Speaker, The Rt Hon John Bercow MP, The Rt Hon Paul Burstow MP as well as MPs Tim Loughton, Sharon Hodgson and George Hosking OBE, CEO and Research Director of the WAVE Trust. It was quite a line up! The surroundings of the state rooms at Speaker’s House at the House of Commons were equally grand and impressive. Even gaining access to the event required airport style security checks and an escort to the Speaker’s House!

The grandeur of the setting only served to emphasise the importance of the agenda and the significance of this report for me as an Infant Mental Health practitioner in Leeds. Our city is one of few in the UK to have already acknowledged the importance of the first 1001 Critical Days and to already have in place a Best Start Strategy that prioritises proactive and preventative services to support families through pregnancy and the first two years of a child’s life.  Indeed, we held an excellent conference in October 2013 on this very subject at which I was able to present a paper on the ways that Leeds is delivering services for infants and their families to promote infant well-being and outcomes.  We were lucky enough to have several brilliant national speakers on the podium at the conference including George Hosking from the WAVE Trust.

A number of services and initiatives are already in place in Leeds doing sterling work in supporting these families and the infants who are the most vulnerable of our citizens. These include Early Start teams, Family Nurse Partnership Team, Preparation for Birth and Beyond, BabySteps, and the Infant Mental Health Service, to name but a few. An ambitious programme of training and consultation to support practitioners to support families is well underway.

The ‘Building Great Britons’ report is an inspiring and exciting publication that very much endorses the Best Start Strategy in Leeds and the commitment we have made to the first 1001 Critical Days. It has been a privilege to be part of the process of making a little bit of history happen in such an important area of policy. Getting things right for infants produces positive outcomes for them and for society. Truly an investment in the future!"

Sue Ranger

Consultant Clinical Psychologist 

More information can be found at www.1001criticaldays.co.uk

What are the 'communities of practice'?

"Without leaps of imagination or dreaming, we lose the excitement of possibilities. Dreaming, after all is a form of planning." Gloria Steinem 


We live in an evolving and unfolding universe. We see change at tremendous rates. The early 20th century started with the Wright Brothers flying a plane a short distance. Before the end of that century we were not only flying to the moon but landing on it. We live in a world of paradoxes. She is dynamic and at the same time fragile The world is interconnected and yet divided. The world is technologically accelerating and yet poverty, disease and war remain. Wall Street and poor neighbourhoods exist in the same state. This is our world with all its mess, marvels and mystery. It is beautiful, frightening and engaging. And it's all interconnected in some way with ourselves. As Carl Sagan, the astronomer, said: "The nitrogen in our DNA, the calcium in our teeth, the iron in our blood, the carbon in our apple pies were made in the interiors of collapsing stars. We are all made of starstuff."

Our organisations and services reflect a similar paradox. We see great service, innovation and kindness on wards and in communities. Yet there are financial worries and the awful episodes that inhabit our systems and cultures. In this complicated and complex setting there is an interesting phenomena to be sensed and seen. Across the NHS and other services new movements are arising. New energies are flowing across our systems. These networks and alliances are creating new ways of seeing and doing health and care like new seeds. They are focussed on people and putting people first. They embrace digital technology, are values driven and work intuitively as well as rationally. In a wintery time for the services we love there are signs and sources of hope and renewal. They are the summoning of spring.

These new movements take many forms and shapes. One of the most promising and fresh forms are the 'Communities of Practice'. What are 'Communities of Practice'? They are many things and no one definition exhausts their mission, role and possibility. One way to see the communities is as centres. They are centres of sharing. People who both work in and use services come together to share stories, experience and practice to develop deep dialogue and learning. From these encounters and co-learning arises a new form of shared wisdom and meaning.

They are centres of energy. They are spaces where we meet to explore issues and support each other. They are a terrain where freedom, connection and respect must be central. We hope these communities will be wellsprings for all who seek kind, better and effective cultures and practice. They are centres of life. Life and work should not be competitors or opponents. Through 'Communities of Practice' we can grow as people and workers. We seek personal and corporate development through the communities. In this way we seek to model how systems and services can be and indeed should be. In this way the communities are both dream and gift.

We invite you to join these communities, alliances and networks. Explore with us and work with the communities. Together we can make a difference. If we wish to learn and grow together we have great potential within us to create, despite everything, a future that works and cares for everyone.

Visit the Co-Creation Network website for information or watch an animation about the network here. 

John Walsh. York Street Health Practice. Leeds Community Healthcare NHS Trust
Angela Green, Improvement Academy.
Jane Pightling, Yorkshire &Humber Leadership Academy
Lucy Scarisbrick, Yorkshire &Humber Leadership Academy