What is an empowered city?

Recently Tom Riordan, Chief Executive of Leeds City Council, quoted the following words: "The 19th Century was a century of empires. The 20th Century was nation states. The 21st Century will be a century of cities." This is both a fascinating insight and a clarion call. It reflects the discussion in the city of what Leeds can be and should be. In everything from theatres to places to eat, Leeds has so much to offer.

Pria and myself recently met and part of our conversation was on the theme of empowerment. Empowerment is a word that gets used a great deal. But what is empowerment? And is it really possible? Empowerment in our view is where a person discovers their own power and possibility. It is that paradigm shift where a person sees their gifts and starts to own and release them. This certainly happens. The problem we see with empowerment is not that it doesn't exist ( it does! ) but that we get the picture of how it happens all wrong. We have certainly heard good colleagues talking about 'empowering people' or 'We need to empower him or her' The problem with this is that it portrays us as the ones with the power and the others as not having power. Our task is then seen as somehow giving of our power to the other. We would suggest the real picture is that we cannot empower anybody as empowerment is not a magical power we can give to another. Each person has to discover their own power and potency. What we can do and this is really significant is provide the space, relationships, approach and support for this to occur. I (John) have worked with homeless people for 20 years on the streets of Leeds and have seen people empowered in incredible healing ways as they found their identity, skills and options. It was the clients who did the work and made and lived the changes. Hopefully I supported that process and didn't act too much as an obstacle. The great strength of this understanding is that we recognise that all of us already have great gifts and power but there is a need for this to come alive and flow.

This theme led to a discussion of how Leeds is and can be an empowered city. Where the culture, programmes and partnerships tap into potential of people and support its activation. One example of where this occurs is MAP. MAP is the the Migrant Access Project. It is chaired by Mick Ward, Head of Commissioning at Adult Social Care. A number of leading agencies in the city are part of the board including LASSN, Touchstone, York Street Health Practice and Leeds Refugee Forum.  The project trains people from different communities ( such as the Eritrean, Sudanese, South Asian and East European communities ) to act as networkers. A networker is a bridge  builder between communities and services. These networkers receive training in how benefit, housing, health and other systems work and act as a conduit for accurate and clear information for communities to access services. The Migrant Access Project has completed a fifth round of training to networkers which ended in May of this year. Since then a weekly drop in has been set up to support the networkers. This is proving successful in gaining an insight into community issues and how best to resolve these. The emphasis here is on creating awareness, improving access to services and involving partners to meet with communities. One example is a networker who has a desk at a One Stop Centre and offers support, advice and signposting to members of different communities. She does not take people to services but supports them access them.

There is in this work important themes that can be seen in terms of empowerment. The first is that the networkers are given support, training and ongoing assistance. This allows this work of finding confidence, knowledge and networks to occur. This inner work of growing and becoming a networker is not only for oneself but for service to the wider community. The networker is constantly going out to create conversations and connections. They are continually creating bridges everywhere they go. This tremendously supports services to understand and deliver services in the most understanding and effective way. It also supports communities understand and access services. These links make a real difference as people access the housing, health and social care they need. This model also helps people make that transition to become great citizens of a city. By this we mean people who make the commitment to invest in and contribute to the city.

This is empowerment in practice. People seeing and offering their gifts so our city can be the best for health and wellbeing where the poorest improve their healthcare the fastest. This vision of statutory, third sector, networkers and communities working together for the city and each other offers a picture of what we are doing and can be. It is a present reality and a future promise. The good news is MAP is not alone. Across the city agencies, people and communities are working together for the future. These projects - from St George's Crypt to Genesis to Pafras - all show what we can do together. An empowered city is a city of hope which values people, shares skills, celebrates gifts and serves communities. It's a wonderful thing, that with so much bad news in the world, this work is going on in Leeds.

John Walsh, Support Manager, York Street Health Practice

Pria Bhabra, Migration Partnership, Adult Social Care, Leeds City Council 

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

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? 

Men, Health and Hope

 

Last week saw International Men's Health Week celebrated at St George's Crypt in Leeds (from Monday 9 June to Friday 13 June). The aim was for homeless men in Leeds to receive a week of wellbeing and health actions and events, an idea formed by Kim Parkinson at the Crypt. Kim is the training and housekeeping mentor and a great force for good among homeless people. This idea led to an initial meeting with Andrea North and myself from Leeds Community Healthcare NHS Trust (LCH), Alan White, Professor of Men's Health Studies at Leeds Metropolitan University, Jade, a social work student at Big Issue in the north, and Kim to plan and design the format and spirit of the week. Rob Newton from the Institute of Health and Wellbeing and the Health and Wellbeing Board at Leeds City Council and Karl Whitty, research officer in the Centre of Men's Health at Leeds Met joined us shortly afterwards.

 

We, as a meeting of forces, representing the local authority, health, third sector, faith sector and education, were able to create an amazing week of events. The week included massage, meditation, podiatry, theatre, physical fitness, haircuts, song and pamper bags for the men. Running throughout were a series of positive and yet serious health messages. Health professionals from a variety of LCH services (including Tuberculosis service, Community Dental, York Street, Healthy Lifestyles Service) attended, offering connection and conversation. We deliberately moved away from a model of formal structured consultations to conversations over food and coffee - to share, engage and listen. Age UK Leeds joined the week as did Leeds and York Partnership NHS Foundation Trust. Our Primary Mental Healthcare Service provided information leaflets.

 

The event was opened by Cllr Roger Harrington, Chris Fields, CEO at the Crypt and Professor White. On Thursday, Cllr Lisa Mulherin, the chair of the Health and Wellbeing Board visited the event in support. Lisa has consistently supported these events and we are grateful for her support and voice for the poor and vulnerable of our city. Andrea North and Catherine Hall, two other great supports of these initiatives at LCH also, in their busy work lives, attended to support. A big thank you too to Sarah Elwell, the new communications officer at LCH who did an incredible job managing the photography, press release, partnership agreements, Twitter, Facebook and other media actions in such a professional and helpful manner.

I was in London for the first two days at health events so missed the start of the week. I did attend the last three days and was touched by many things. Three themes shine through. The first was the theme of 'space and place'. The Crypt is an incredible centre of welcome and wellbeing. They are one of York Street's best partners and we always try to support their good work. This brings home to me one of the key aspects we use at York Street as part of our model of work.  The people who come to the Crypt and York Street are those who often have no positive space or place in their lives. From the asylum world, they may be people who have been tortured, imprisoned or raped. In the indigenous homeless world, the vast majority of those we have the honour to try to support have problems going back to childhood. We work to create what the theorists call 'psychologically informed environments', places and spaces where people can feel welcome and accepted. The Crypt and York Street are such places as are many places in this city. The creation and development of these spaces is crucial to the human development and recovery of the homeless and vulnerable.

The second theme was that of the homeless people themselves. On Wednesday when I arrived, I sat down and  looked out at a sea of faces, each etched with stories and I'd guess, in most cases, pain and loss. It was at that moment that a former client of mine came up and gave me a big hug. I had worked with her a number of years ago. As I sat with her and listened to her present story I heard of  the struggles and setbacks as she was trying to build a more positive and healthier life. In the centre of the difficulties and pain there was also hope. This was not someone giving up but keeping on to try to get to where she needed to be. In this woman, there was the courage, the hope and belief that things, including her own life, could get better. This is what inclusion and wellbeing work is all about. It's when people can find their hope and strength that changes can really start to happen. Talking to men over the three days I had the same experience. Sensing the heavy issues people carried yet a not giving up spirit - a hopefulness against so many odds. If we ever lose sight that is what our work is really about, then that will be a really sad day. If we forget the people, we lose our way. Isn't that what the tragedy of Mid Staffs teaches us? On the Monday evening I was at an event in London with the top 50 nurse leaders in the UK, truly amazing people. I was there as guest of my good friend and mentor, Yvonne Coghill, the national lead for inclusion at the NHS Leadership Academy. Yvonne walks the national stage in the NHS. She is one of the leaders in this great service of ours. Although she never mentions it, she also makes time, again and again, to reach out and support people in the most vulnerable positions. If we ever wish to know what 'best leadership' looks like, this is it. Concern for people has to be at the heart of what we do.

The third aspect was how we all working together made a difference. Apart we are little. Together we make a powerful impact. Sometimes people see effective partnership work as some arcane art that 'business gurus' can teach us to generate. The truth is much simpler. Good partnerships happen when people who care connect. This is what happened at Men's Health Week at the Crypt. People who cared enough to put aside time to meet and act came together to do something. My mind fills, as I try to write this, with images of this in practice. Professor White sat with homeless men at a table talking about their health. Alex Hammond and his team from Healthy Lifestyles Service going straight into action connecting with men about how they can make positive changes. Dawn and Gill from the Community Dental Team at Armley smiling and talking about dental care to the men. Urban Spawl and Opera North offering arts, drama and theatre. Dr Phil Commons from Leeds Met with physical fitness. LYPFT were represented by my friend and colleague, Ken Cattle. Ken is a former mental health service user and now has dedicated his life to working with people in the community with mental health problems. Ken was an amazing presence talking to and connecting with the men there. Talking about mental health is not always easy but Ken did it again and again. The week made me proud of what we can do together, what we can be together. We have in Leeds 12 integrated care teams bringing together health and social care. These teams work to provide the best, quickest and most effective responses to those in the community. I saw at the Men' Health Week the same spirit, promise and potency. This city has a great health and wellbeing vision - 'that Leeds will be a caring and healthy city where the poorest receive healthcare the fastest'. I saw that happen at Men's Health Week. It really shows we can do it. If we can build on these experiences we can realise the vision and then Leeds may end up as, not just best city for health and wellbeing in the UK, but in Europe too.

The late Maya Angelou once wrote that, "I've learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel." I doubt any of us who participated in the week will forget how we felt in trying to make a difference. I also don't think we'll forget those faces looking to us for support and help.

 

John Walsh, York Street Practice