Inspiration and the way forward

The NHS and social care along with other services face major challenges. There are financial, economic and social issues affecting the care people need. In this difficult period we are faced with different views and options for the future. In this post, myself and Pria will reflect on two themes which seem to us so vital. They are our vision and the tools to help us make it real.

The future will be decided not only by what we do, it will be shaped by what we see now. Our vision will create what appears and generate the ideas to realize it. The author, Joel Barker, says it well: "Vision without action is merely a dream. Action without vision just passes the time. Vision with action can change the world." We need to elaborate a vision of how social care, health and other sectors can come together to create new ways of working. How silos can fall and new integrated solutions be created to meet need in the fastest and most effective caring manner. This vision would enthusiastically embrace co-learning and co-work with patients and carers. It could in alliance with people and communities work on a holistic approach to those in need. The Maori people speak of well being. This is a fascinating word as it is not well arm or well house or well mind but the whole person. The Maori vision sees well being as a house with four walls; the physical, the mental / emotional, the social and the spiritual ( in terms of meaning and purpose ). This holistic vision offers the possibility of circular care where all the four walls reverberate and work off each other. It is also circular as it can only be delivered by different people and services working together in a circle with and around the person. This vision could focus on the person first and foremost. The phrase 'person centred care' is used a great deal today and rightly so. However, we can only really have people centred care if we move away from seeing people as problems. The challenge is to look through the problem to the person and their gifts. This is a move to the person and their potential.

We live in a complex period. The words of Charles Dickens in 'Tale of Two Cities' about another historical period has an echo with us today. He writes, "It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness....it was the spring of hope, it was the winter of despair, we had everything before us, we had nothing before us." This period includes austerity but also great opportunities to really breakthrough old system thinking and make a shift to better more humane perspectives and practice. Today is not a time for despair but vision and action. The road will not be easy but we can build or rather grow cultures and care that offer best solutions for all. However we can only do this by thinking and doing what's needed in new innovative and potent ways.

There are many tools to support this journey. We will touch on two key skills that support the way forward. The first is to see that the future lies all about us in the present. It is found wherever people care and have passion. This folk represent what the future of our services could be. Recently I met an inspirational Doncaster GP who works in a poor area. He shared the work that he was doing. He said he shook hands with everyone who came into his surgery to welcome them and connect. He said one Saturday a month he would have clinics for carers to reach out and be there for them. The GP also shared that he visited the well as the sick. This was well being work. This GP was creating the forms of the future. These positive practices of really connecting with patients, making space and support for carers and promoting wellness in the community are a sign of what could be done and is being done. We need to capture these wonderful innovative works and share them and ask what they say to us.

The second help is the use of creative space and dialogue. This is where people come together and develop a safe space where trusting and listening discourse can occur. From these transformational hot spots come ideas, inspiration , actions and positive changes. Are the meetings we attend or set up creative dialogical spaces? If we are not learning in them or finding creative energy and visions there then probably not. We need to develop the art of dialogical exchange. Our good NHS colleague, Dr Maxine Craig, speaks of dialogic change. This is where change and creativity occurs in the locus of authentic and open sharing. It's amazing how fresh thinking and practice flow from deep dialogue and connection. When we experience it we feel inspired and caught up in possibility.

The future offers us many challenges and openings. We believe that the need of a vision that positively infects us all and calls forth clear and courageous actions is central to where we need to go. We also affirm that people of passion and vision and the power of dialogue are mechanisms for the vision to become visible. To us the choice seems pretty clear. We are will either be people of purpose and passion who make a great future that works or we won't. That's the crossroads we stand at.

John Walsh, York Street Health Practice, Leeds Community Healthcare NHS Trust  
Pria Bhabra, Leeds Adult Social Care Commissioning, Leeds City Council 

Taking the power

A lot of people know I write blog posts. That's certainly true. However it's often other people - colleagues, twitter friends, work partners, the homeless and patients - who inspire them ( If I ever make any money from them I will owe a lot of royalties !) This post follows that pattern.

Roz Davies is the founder of WeLove Life and is committed to exploring the potential of citizenship and digital health to improve well-being. Roz inspired a post  on wellbeing by sharing a powerful quote with me. The post went live and was tweeted and re-tweeted. Then it happened again. Roz shared another quote that both caught my mind and challenged my imagination. That quote is the context and inspiration of this writing. Once again I am grateful to Roz for her wise sharing.

The quote is, "Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it's the only thing that ever has." It comes form Margaret Mead. Roz asked on the basis of the quote, "how we create the conditions where we feel we have agency to act together for shared purpose?" A great question. In this post I will attempt an answer. I will not look at group dynamics, how small groups can 'seize the moment and the market' or how small groups can create 'tipping points'. I want to look at something else. Something much more simple, difficult and transforming. It's how we find and hold our power. For it is when we own our power and potency that the world starts to change. That's when the magic happens! It is so tragic when we doubt our own power or give it away. I am not saying we can't do anything until we consciously own our power. It's in the doing that a lot of this will start to emerge and function.

Several months ago three things happened to me over three days. The first was that I met a well known national NHS figure in Leeds for coffee. As we sat in a coffee shop and talked the subject moved to identity. Knowing who and what we are. By this we meant really becoming aware of ourselves, our power, gifts and possibility. This wise man then said that it is only when we know ourselves that everything starts to fit. It's only when we see and own ourselves that life flows freely and beautifully ( though not without pain and difficulty). In the next two days I had discussions with two different friends who both said in effect that they didn't know who they were and were searching to try to find their true self - their authentic identity. By this these good people meant that were trying to find a life rather than an existence. They wished and were moving from existing as human doings to becoming human beings. The search for who we are is the quest for who we are at our best. This is not a new 'fangled' thing. All the great faiths talk about and use meditation. Meditation is about transformation. This transformation is becoming what we already are in the depths of our being. It is by accessing this potential and power that we become people who can make the difference in lasting and meaningful ways. It's transformed people who transform others. Its transformed people who transform situations and support others discover their power and space. It is this that ignites and fires small groups. It is when people see a vision and possibility and move to make it real that they start to challenge the status quo with a new approach. It involves a potential and energy which is both infectious and illuminating.

So how do we tap this energy? How do we become what we actually are? That's a great and deep question. I will offer here three things that can start or support the journey. They are not the destination but will certainly help us travel there. They are calls to

                                     

* Catch the Fire

* Create the Space

* Clear the Ground  

Catching the Fire means glimpsing the possibility. It means believing this is possible. It involves us internalizing a vision. We may need to read, talk to others and dream for this to happen. We have a wonderful faculty to support us in this endeavor. It's the imagination. Einstein noted that, "Imagination is more important than knowledge. For knowledge is limited to all we now know and understand, while imagination embraces the entire world, and all there ever will be to know and understand.” We can dream about what it would be like to be empowered for service to others and ourselves. Dreaming is not meant to be only for sleep. When we try to catch the fire we may soon find it has caught us.

Creating the Space is all about realism and support. It is a realisation that this usually takes time and we will need support and sustenance for the journey. We need liminal space. The writer Richard Rohr speaks about liminal space. He writes that a liminal space is "the crucial in-between time - when everything actually happens and yet nothing appears to be happening. It is the waiting period when the cake bakes, the movement is made, the transformation takes place. One cannot just jump from Friday to Sunday in this case, there must be Saturday......Greatness does not just happen unprepared. It must be waited for, needed, desired and an inner space must be created." This means making space for the true us to appear and grow. It means waiting and not giving up. This space needs to be supported by good influences or we will give up.

Clearing the Ground is caning the rubbish. By this I mean the mental rubbish that fills our heads and aspirations so often. Lakoff and Johnson in their book on metaphors make the point that our mental and life concepts "govern our everyday functioning, down to the most mundane details. Our concepts structure what we perceive, how we get around in the world, and how we relate to other people " It's fine if we have a positive supportive conceptual system. Many of us will have to do some clearing. Thoughts of negativity, self doubt, self hatred, jealousy, etc will need to be cleared away. The ground needs to be cleared for the emergence of the true us. We should seek good and wise advice as how best this process should be done.

These three are not exhaustive as transformational tools but can be very potent. These three - vision, space and  dislodging the destructive mind concepts - offer a way forward. We may need other supports. Twelve step groups, professional therapy, medication, meditation,relationships and other things may all have a role to play. Each journey is different. Yet each journey is also paradoxically the same for we discover that behind the mess and mistakes stands someone who is amazing, beautiful and good. We sense and feel this when we are at best. Becoming who and what we are is living that permanently as a condition. This is the most wondrous experience a human being can have. Then we do really feel connected not just to others but to ourselves. We then do not have to pretend or hide. And the great news is that we are already this. The challenge is to become aware in a deep way of this reality.

The most important thing we can do today is to take the next step on this path. Not the 20th step but the next. If we do that we are going in the direction of the sun away from the shadows. So to answer Roz's question. It is when we tap and release the immense good and power within and become who we are that we as individuals and in small groups can start to shake and move the world. I hope - I really hope - you take the next step today. We have nothing to lose but our chains.    

John Walsh. York Street Health Practice

The Wellbeing Compass

Paul worked in a statutory body. He had worked there a long time. Over the years he had become slowly depressed at work. Getting up and facing work every day became an awful experience. While at work he would go through the motions a lot of time. He knew this. He was running on empty. Any passion, commitment or emotional connection to work had gone. Paul knew things were not right. He had started to drink after work but always turned up the next day. He reported that his managers did not develop him and his potential and gifts. They were happy as long as he did the business which he did. Paul didn't feel valued. He was not alone. Other work colleagues felt the same and would make 'black humour' comments throughout the week about work. Paul's office space was not attractive. Cluttered desks, messy offices and untidy environments were the reality. Paul's friend's noticed  at times the quiet despair but didn't know what to say. His world and day from porch to work and back again was one long stressful run. Arriving home he would often breathe a sigh of relief. Paul eventually had a form of breakdown. He took time off work and now works elsewhere. This move has meant a recovery of happiness, energy and passion for Paul.

  

Wellbeing is like a compass. A compass has four points - North, South, East and West. They are called the four cardinal points. In this post we will look at the four cardinal points of wellbeing. We need ultimately all four to have the healthiest and best for all in our society.

  

We can see all four of them in Paul's story. The first is our own responsibility to self care. This is the duty of self wellness. Paul knew something was very wrong. He went on for years in this state yet he didn't seek a plan of recovery and self nurture. He looked to alcohol for solace. This is admittedly the first and most difficult step. The usual excuses fly up as defenses. "I'm just tired." "I just need a holiday" and "Work's tough for everybody". With this we have to start at home. We have to look inside first. Only then can we look out. There can be no real wellness without inner wellness. There's an old maxim that says "First within then without." It's so true. It's when we start to change inside that the outer world can start to move from grey to beautiful colours.

The second point of wellbeing is our circle of friends and family. Paul's friends and family were and are good people. However they either didn't see what was taking place before them or didn't know how to respond. Sometimes a person is lost in a state of unwellness. It takes a loved one to share their concern and open the possibility of a different quality of life. Finding the words may be difficult and we may stammer with the words but they are so needed. We must speak with kindness and sensitivity but also strength. This challenges us all. We can all be sources and signs of wellness to others.

  

The third point is the work place. We often make workplaces for work not for people. Staff wellness isn't factored in. We think if we allow a toaster or kettle we have ticked this box. The call is much greater. I (John) recently attended an event on leadership organised by the Centre For Innovation In Healthcare Management (CIHM) at the University of Leeds. The room was beautiful. There were lovely table clothes and flowers on the table. There was good lighting, windows, nice food and a great ambience. When we entered this space there was a real sense of welcome and wellbeing. This was a master class in valuing people and creating 'good space'. The result was we all felt more included and the event was a tremendous success. Compare this with someone years ago who told me that his team away day was in.....the busy grey office where he worked everyday. We realise budgets can be tight but if we don't value and cherish staff and colleagues, teams will inevitably suffer and even collapse. Creating environments where we can grow and be well is what our staff need and deserve. The American writer, Peter Maurin, spoke of a society where it would be easy to be good. How would we design work and office space where it would be easy for staff to be well, hope and be inspired? The outer always feeds the inner.

The last cardinal point is the outer world and its demands. The spiritual writer Richard Rohr speaks of how we can often be human doings rather than human beings. This relates to how our lives can be all about doing, doing, doing. Not really living from deep places. Not being who and what we are. He writes how 'mostly what we do is reprocess the past and worry about tomorrow.' These wise words make us ask how we can navigate society in a wellbeing spirit as well as create possibilities of doing the old things in new ways. The world and its stress affects us in a daily and hourly fashion. Finding the best tools and resources for navigation, direction and creation are vital.

The four cardinal points of the compass are interesting. While seperate they are connected. Wherever one starts one can get to the other points. The compass also gives us direction. The word 'cardinal' comes form the Latin 'cardo' meaning hinge. Hinge in the sense of 'that on which something turns or depends'  So these points are important hinges for wellbeing.

Paul suffered so much for so long because he either didn't realise or neglected the duty of self care, his friends didn't speak, his work management and environment didn't value and inspire and the world itself offered lots of stress and pressure too. We would argue that we all have a duty to dream. To ask what do I and my world need to make it a place of peace, development and inner refreshment. If we allow ourselves to be dreamers we may be very surprised where our dreams take us  and what our dreams make us.

John Walsh, Support Manager, York Street Health Practice

Gill Trevor, Director, Phoenix Health and Wellbeing 

The I of Illness and the We of Wellness

Recently I spoke with Roz Davies, who is the founder of WeLove Life and is committed to exploring the potential of citizenship and digital health to improve well-being. We had a discussion about how the inner aspect of health and holistic approaches to support wellbeing. I noticed a quote Roz uses - ''When 'I' is replaced with 'We' even illness becomes wellness!" 

This saying really struck a chord with me and I mentioned it to a colleague a few days later. As I was talking about it I realised that I didn't know it's meaning. The following day in a coffee shop I tried with the rational mind to unravel the sentence. It wasn't easy. Ten words meant so much! It's an enigma really that one set of words can be so simple and yet so deep. There was something here that was a door leading to other doors. Not in a sense of never understanding but rather of deep gazing. Deep gazing is where we see things as they are - in their deepest meaning. I suppose the poet Gerard Manley Hopkins meant this when he wrote, "There lives the dearest freshness deep down things."

So what did the mysterious sentence mean? I can only offer my own glimpse of its meaning so that is what I shall try. There are two points in the sentence - the 'I' and the 'We'. There are also two results or conditions - illness or wellness. What I see is that the 'I' ( i.e.you and me) is a paradox. The 'I' is both a glorious possibility and a terrible threat. The 'I' is a glory if we mean the wonderful gifts and potential we all have. Think through your day. The smiles, kind emails, laughter of children, support of friends, the amazing technology that links us together and the hearts that open when nature or humankind hurts us or others. This is that energy and power released and the good news is that it is everywhere and everyone. Even in the darkest heart and place it is present like a seed in the soil waiting for the opportunity to burst into visible life and shape. This 'I' we must nurture and cultivate. Our life and future demands and needs it.

Yet there is another 'I'. This 'I' is the ego. It's the part of us that grasps and wants to control, possess and get all it can. It can be prepared to push others aside and get angry, jealous and resentful when it doesn't get its own way.When we see this in others we are repelled. It's a human trait we don't like and yet most of us have elements of it. We sometimes use words to deny and justify it. Bullies may say they are just being assertive. When we are greedy we might say we are just enjoying life. This is the paradox - the amazing and the appalling.

To have an 'I' which focuses on self alone will bring us a lot of misery, suffering and isolation. We have to turn out to community and the other. We have to find ways to use our gifts for service and not just self. There is a powerful story in Dostoevsky. It is called 'The Parable of the Onion'. The story is that the old lady lives a life of awful selfishness. She dies and goes to Hell. She complains to the Devil there has been a mistake as she shouldn't be there. The Devil says,"You've been a greedy, selfish woman all your life. Surely, this is where you belong." The woman then remembers that she once gave an onion to a beggar. At that point God intervenes and sends the onion down and the woman is raised up out of Hell to Heaven. At that point those also in Hell start grabbing her ankles and are caught up too. More and more grab and hold on. The onion holds. They are all being lifted up to Heaven. At a point the woman begins to get angry and resentful. She starts to kick at the others and as they fell the onion frays more and more. Every kick brings a fray. As she kicks more and more people back into Hell the onion get smaller and smaller. Eventually there is only one person left holding onto to the woman. She kicks them away too. At that point the onion breaks and she falls back into Hell.

I am not writing this to make a religious point at all. The moral of the story is that it was her anger and selfishness that destroyed it for herself and so many others. The story is about harmony, wholeness and wellness demands our communion, care and concern with others. It expresses our own gifts but always in service. It's about always going out from oneself to others. When we do we are enriched and the connection enriches others. In this process - this mutual indwelling and enriching - we return to ourselves and the whole process starts all over again. The Medieval scholars called it egressus and regressus. It was the return and going out that marked and shaped all reality. In the seasons, tides and so many other things this dynamism operated. It helps us see how the 'I' is to go out to the ''We' to work and live. At the same time it returns to be sourced and refreshed. The 'I' goes out with it's gifts and riches - it is a container not a ruler of these. It brings to others in need and connection. It is itself enriched as well as enriching. It returns with new riches and possibilities. It's one of the most amazing things about life. If we hoard our knowledge, experiences and gifts we become miserable. When we give them to others we grow and find that we have more than when we started.

I'm very grateful to Roz for sharing this sentence. This sentence offers us a deep reflection on where individuality and community meet. It points out to me the dangers of self-centredness but also the value of each self - we all make up the 'We'. So what is the call and message of the words that I heard but couldn't see? It's simple really. We must self care but not self obsess. We always become ourselves most fully in connection and community. We can bring all we have to those we meet and who surround us. They can also bring all their qualities and light too. This creates authentic conversations, collaboration and culture. This quote is really a prescription. It is an action call and plan for how we can live for wellness - individual, community and world wellness. It's pretty incredible how ten words can offer such a transformative promise but they do. It is often in the small things that we find the big meanings and treasure we so need.

John Walsh. York Street Health Practice       

World Homeless Day

The other day I was returning to York Street Health Practice from a meeting. On the wall nearby I

Client visiting the GP at York Street

saw a homeless man I know very well. He was sat by himself and waved over. I went over to the man and we started to talk. It was good to just be there. I tried to listen and help. I have often thought many times clients often give us far more than we give them. I looked at this man. His body was under nourished. His clothes poor and not well kept. His face was much older than his years and his beard and hair were not well cut or combed. Yet when he smiled his face lit up and his eyes shone like a child's at Christmas. We talked for a while and then I had to go. I have thought about the man over the last few days. He is the reason why places like York Street exist and he is not alone in this world.

Today is World Homeless Day. It is a day when we remember homeless people everywhere. The aims of the day are

                                             * educate people about homeless issues

                                             * celebrate and support local good works

                                             * highlight local issues  

York Street is the medical team for people who are homeless and in the asylum system. It is part of Leeds Community Healthcare NHS Trust which is 65 services working with people and communities. Leeds as a city has a very dynamic health and wellbeing vision where Leeds will be a healthy and caring city where the poorest improve their healthcare the fastest. This is a vision which we enthusiastically embrace and seek to embed in our work. This vision is lived out by people and services across the city. It is also powerfully and wonderfully supported by Cllr Lisa Mulherim, chair of the Health and Wellbeing Board and Cllr Bill Urry, the lead for homeless issues. York Street receives visits and strong support from the directors of Leeds Community Healthcare and national NHS figures such as Yvonne Coghill, Steve Field, Rob Webster and Aidan Halligan. This illustrates a real coalition of care across our city and country to work for and with the most vulnerable. This is something to really celebrate and spread. So on World Homeless Day we express to all these friends and allies our deep thanks. We also thank our good partners across the city - the Crypt, Simon on the Streets, the Street Outreach Team, the hostels, Housing Options, the faith communities and so many many more. Thanks to you all. We can only do what we do because you do what you do. And that's the way it should be. Partnership is the today, tomorrow and future of our city. Together we make the difference.   

The sign of a civilised society it is often said is how it treats its most vulnerable people. We have in Leeds some great practice, innovation, compassion and vision. We have much to rejoice over and much to do. We owe it to ourselves to create the most humane and caring society we can. We owe it too to our fellow human beings who have fallen on hard times. We also owe it to the man sat on a wall with the shining eyes.

John Walsh. York Street Health Practice

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

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? 

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

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