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 

Little bit of peace and quiet

Danny, one of our public members

For the first time, a staff member and a public member have come together to write a joint blog post. It promotes the concept of joint blogging where people come together to share and speak on a key theme. LCH has hosted blogs recently written with colleagues from the local authority, hospital chaplaincy, the University of Leeds, third sector and other NHS Trusts.

"The theme of this blog is the visit that Danny made to York Street Health Practice. Danny is one of the public members of LCH and also volunteers for the Expert Patients Programme, but most of all he is also a service user of a number of services provided by Leeds NHS. Danny visited and spent time with staff discussing homeless and asylum issues and models of care for the vulnerable. We also did a visit to St George's Crypt. The Crypt are a key partner of the Health in Leeds and have cared for homeless people since the 1930's. Kim Parkinson, Training and Housekeeping Mentor, showed us around and explained the vital work they do in Leeds. Kim is someone who does incredible work in this city for the most vulnerable and never seeks any limelight. York Street knows Kim as she has helped the practice build a presence at the Crypt. She expresses what good compassionate care is all about.

We started off the tour of the Crypt by seeing the amazing services and work they provide. We got an insight into the busy environment, vital work and fast pace of the work they do. We ended the tour by finding a place within the busyness that was different, the Chapel, and that's where this story starts. When Danny entered the Chapel he felt what many other visitors have felt. Here was a place of peace, stillness and quiet. The three of us sat down and talked about this. I (John) asked Kim if any staff use the Chapel and she answered, "All the time. So do clients. They just come in to sit down and enjoy the peace." The Chapel, although small, had a calming, passive atmosphere with an amazing theme throughout. On the walls there was a number of pieces of artwork all themed around the Last Supper. They featured services users from the Crypt to represent the Apostles. The artist had used his own face to represent Judas. There was circular seating and a cross in the corner. The Crypt's allocation and use of this space expressed their commitment to staff and service users. Although there was more to see at the Crypt we couldn’t help taking time to just sit there. We talked about the need for more places like this. Outside was a world of rush, push and stress. As we sat there, there was an atmosphere of calmness and tranquility. What was it that made us feel this way? We would venture the following as possible answers · Here was a space cut off from noise and hustle and bustle. There was a natural coolness that supplemented the calmness of the room.     Somewhere anyone can feel at ease. The lighting and furniture supported this calmness. We were seated – not rushing around. We were consciously open to the sense of calmness and quiet and it became where we were. 

This raises for us two needs. The first is the need for all of us to find some peace in our busy and noisy days no matter what we are doing or where we are. How can we find a little bit of peace and quiet in the turmoil and stress of work and life. It's a big question yet in its answer lies the welfare and wellbeing of our healthcare staff. If we can't find these places of peace and calm somewhere in our daily life then we would suggest that we have a real problem. There is a pressing need for us all to locate and utilise means of nurturing peace in the day. The famous French philosopher, Pascal, wrote that ‘All man’s miseries derive from not being able to sit in a quiet room alone.’ This appears on the surface to be a strange and even way out statement. Actually it isn't. We think that Pascal is talking about how when we don't have peace in our lives and especially peace with ourselves we can't sit in a room alone. This sense of unrest and inner distress touches all that we do. The need for peace is universal. We all need it and we should all seek it. Health should lead the way in supporting colleagues to good wellbeing actions and plans. We cannot have wellbeing without peace. This brings us to our other need.

For most of us we won't be able to turn on a sense of calm and peace like a light switch. It needs work, practice and external supports. The little chapel at the Crypt challenges us here. How do we design our buildings? We factor in desks, meeting rooms and kitchens. Do we feature in quiet rooms? Do we feature in places where people can feel peace and calm? And if not, maybe we should. Wellbeing means the creation of well places and spaces. We need to have a dialogue about what a wellbeing office or building looks like. We hope wherever in this city of ours buildings are built for statutory or third sector services in the future this can be figured into the discussions. What a thing it would be if we could create services where staff had these places of peace and inner refreshment and the effects permeated the rest of the building, environment and most importantly its care for patients. We could renew services and care in a radical and effective way."

Daniel Lipzith, public member of LCH

John Walsh, York Street Health Practice

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

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