Leading when you feel useless

John Walsh speaking to guests at a Men's Health Week
event at the Crypt

Many good leaders - even great leaders can sometimes feel useless or hopeless. The same has happened to me. I remember a while ago I did a leadership development talk and came back to York Street feeling all positive and inspirational. I had a client booked in to see me so I went into the one of the rooms at York Street to see her. After we sat down, she shared some awful news with me. She was devastated and not seeing any hope or way forward. I suddenly felt very useless, having no words or easy options to offer. The positivity and inspiration evaporated very quickly as the story unfolded and I saw in this woman's face and features deep grief. I listened and offered words of support that seemed so weak and ineffective when compared to the anguish this woman bore. We talked for a while and then she left. I left the room feeling of no use at all to a fellow human being in need. 

I have thought about this incident since. I have got to a place where I think feeling useless is actually OK. What isn't OK is not managing it and working to transform it. To feel negative emotions is part of being human - it's what we do with them that makes or breaks us. There are personal and organisational behaviours that facilitate the transformation of these negative states. If we practice these consistently and patiently we start to build good cultures and practice. We also end up better people as we are focused on the positive. The great thing about these things is they cost nothing and can change everything.  So what are these actions or approaches? I'll touch on a few.

The most wonderful thing we can offer someone is not our words or sentiments (although they can be really helpful and powerful). The greatest thing we can offer someone else is our presence, listening and attention. A friend of mine was a psychiatric social worker in Bradford. He's retired now. He told me the story of meeting a homeless man and sitting on a wall in Bradford talking and listening to this man. The man spoke of his story and life. After half an hour my friend explained he had to go and instinctively put his hand in his pocket to offer some change. The man looked at him with deep and sad eyes and said, 'Put your money away my friend. You've given me what I really needed. You gave me yourself'. When my friend described the man, I actually recognised him. I was inwardly surprised as there is no way this man would ordinarily have turned down a 'hand out' but he did. Probably because he found something better - something more healing and helpful. I'm not advising people to approach homeless men on their own in Bradford or any other city, it's always safer to do this work with others through an organisation. What I am saying is we bring to every conversation, meeting and consultation what we are. We can be like my friend - a presence that brought peace and connection or the opposite. That's the power we hold in our hands. It's actually an awesome responsibility. So reflecting on the sort of presence we will be today is no small thing.

Another thing is that we can be a mirror to people struggling. This mirror reflects back to them what they cannot see at the moment or are not hearing. A friend of mine who is a mental health chaplain in a hospital outside Leeds will often talk to the nurses on the wards. The nurses tell him of their work. He tells them they are doing a fantastic job and sometimes he thanks them for all their care for the patients. The nurses tend to light up and are clearly thrilled to hear these words. My friend usually then says, 'Doesn't your manager say these things to you?' The answer is always the same, 'Never.'  This is so sad. We need desperately to re-discover the beautiful art of affirming others. We need to speak truth to feelings of uselessness in ourselves or others. We need to help others see what we see in them. Negative emotional states blind us to what we have and are. We can see so easily the gnat and miss the elephant. I have been very fortunate to have had such great NHS colleagues as Yvonne Coghill at the NHS Leadership Academy, Catherine Hall at York Street and Andrea North at LCH Specialist Services speak to me of my own gifts and qualities in ways that nurture and develop. This really is transformational work. People start to see who they are and what that means. Accepting at times our own feelings of inner poverty is fine as long as we don't stay there. We have to own them to transform them. Own it but go through it. See it but then look up and onwards.

The woman at York Street I mentioned early on in this post got through the incident, we were able to offer support and she moved on to a life and place of recovery. York Street is somewhere where we see again and again people face the worst and somehow get through it. It's incredible how things can turn around and work out as we work it through.

If you are reading this and feeling not too great about yourself and your leadership skills and practice, take heart, good and even world class leaders go though the same. You're in good company! There's an Oscar Wilde quote that says, 'We are all in the gutter, but some of us are looking at the stars.' I hope no one reading this is in the gutter. I also hope next time you feel useless you also look at the stars too. 

 

John Walsh, York Street Practice

Nursing and what really matters

John Walsh at Men's Health Week event at the Crypt
alongside Councillor Mulherin

On Monday 9 June I attended the Nursing Times Leaders event in London. This was an award ceremony for the top 50 nursing leaders in the UK. It was to honour nurses and midwives who are "pioneers, entrepreneurs and inspirational role models in their profession...practitioners who have changed practice for the better, shown visionary thinking, had a major positive impact." (Jenni Middleton, editor of the Nursing Times, official brochure). The awards were decided by a very esteemed panel including Dame Christine Beasley. The night was a wonderful celebration of people who have made the NHS what it is at its best. It was a great privilege to be there. I was there as the guest of my dear friend, colleague and mentor, Yvonne Coghill, the national lead for inclusion at the NHS Leadership Academy. Yvonne herself won one of the awards.

I met many good people that evening. It was great to meet NHS leaders such as Jane Cummings, chief nursing officer and Caroline Alexander, chief nurse for the London region. It was a special moment to join senior colleagues from the NHS Leadership Academy to support and celebrate our Yvonne winning this award. Meeting Dr Dave Ashton and Karen Lynas from the Academy was a real joy too. They are two fabulous people and we had some great discussions about how the Leadership Academy and York Street/Leeds Community Healthcare (LCH) can work together to develop the best patient care models, staff and leadership development and work for and in the city of Leeds.  I hope these exchanges can continue as they hold tremendous promise and possibility.

 

So what really matters for nursing and all health professions in the NHS? To answer this I think we have to answer why, despite all the current problems, the NHS is still popular with the mass of British people. Why it still holds such a special place in the minds and hearts of a nation? I think the answer is that the NHS is special because it makes us feel special. And it makes us feel special because it promotes and incarnates the most powerful of human virtues - goodness. It connects us with this in a very real way. It is a commitment to care, to heal, to do good. It represents this a social body and daily practice. That's why Mid Staffs was so appalling and shocking to us. The very spirit and heart of the NHS was denied and subverted by awful practice and culture. A healing service ended up it's opposite. When people see the NHS in it's real form, they remember the fantastic nursing team that looked after their mum. They think of the kind doctor who was so helpful to them when they had a medical problem. After nearly twenty years working with homeless people on the streets of Leeds, it's exactly the same. It's the goodness and kindness that breaks through. It's goodness that starts to transform us. I've seen big tough men, no strangers to the police and prison system, crying at some act of genuine goodness that has affected their lives. I have also seen where homeless people have been lit up with happiness as they have shared what little they had with others. There's an immense energy and power in goodness. Yet I think goodness isn't an easy thing to define. It's more felt than spelt out. Most of us will know when we encounter it. It lifts us up and makes us open to hope and engagement. Goodness is a mirror that shows us what we can be. I believe goodness is what all of us in the NHS need. It is what makes everything else tick. From the 6 C's through to vision and values to good patient care, goodness has to be the core and life.

This bring me to Yvonne. Yvonne is someone with many gifts and qualities. The list of these would be a very long one. Intelligence, courage, integrity, compassion, wisdom ,strength, gentleness, energy, panoramic vision, deep psychological insight (she's the best psychologist I know), fairness, understanding and so on. For me the one defining quality one sees shining in Yvonne - the jewel in the crown so to speak -is goodness. I don't find it a surprise that what makes the NHS an incredible service at its best is what makes Yvonne such a wonderful human being. Yvonne is a very special person in a very special service. It's people like Yvonne who show us the best in ourselves and encourage its manifestation.  I feel very blessed to know Yvonne as mentor and friend. I'll finish this posting sending Yvonne from all her friends at LCH a big well done for the award and an even bigger thank you for what she is and does for this service of ours. 

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

 

 

 

Healthcare Assistants - Our Unsung Heroes

I am so pleased we were able to celebrate International Nursing Assistants' Day on the 12^th June 2014 in Leeds. 

Nationally therapy assistants and nursing assistants are an essential part of our workforce and are often the unsung heroes. In LCH, care assistants are trained, hardworking and professional.  In my experience as a health professional and as a recipient of healthcare, an experienced care assistant can turn a traumatic experience into a positive caring interaction. They can diffuse anxiety with friendly, confident and competent care.

Thank you to all of our healthcare support workers.

Angie Clegg, Executive (Nurse) Director of Quality 




 

Celebrating Nursing Assistants' Day

On Thursday 12 June, we decided to recognise the hard work of nursing assistants with a celebratory day.  

Working across the city, both day and night, nursing assistants are essential to ensure the trust continues to provide a high standard of community nursing care.  

Five community nursing assistants took time out of their busy schedule to give us an insight in to the role of a nursing assistant at LCH. Huge thanks to Julie, Karen, Adele, Maggie and Janet for their time, here’s a few snippets from our chat:

What made you want to become a community nursing assistant?    

Karen: “It was my friend that is also a nursing assistant that encouraged me to consider becoming one. I first started with a one month contract as an agency nursing assistant at Meanwood Health Centre but I ended up working there for seven months, during which I fell in love with the job. As soon as a permanent band 3 post came up, I applied and was successful.”

What attracted you to join LCH as a community nursing assistant?

Maggie: “As I don’t drive, this was the first nursing assistant role I had seen where I could walk, rather than being required to have a car to get around and see patients. I really enjoy getting out and about in the community, I find it is much more relaxing than being on a ward. Plus I feel empowered to make decisions yet know I have a supportive team to contact should I need to.”

What do you enjoy about being a community nursing assistant?

Karen: “I enjoy working with some of our more challenging patients, especially when I can bring out their sparkle and find a common interest to chat to them about and bring them out of themselves.”

Adele: “I have been with the trust for four years now and enjoy every aspect of my job. Daily, it offers me the chance to meet new people, be challenged and take on responsibility.”

What would a typical day involved for a community nursing assistant?

Janet: “I work on the day shift so the first part of my day generally involves being in the community, providing treatments such as doing leg dressings, taking pressure measurements, assisting with bowel care, giving insulin and eye drops, etc. The nursing assistants and myself then head back to base (there is 12 bases across the city) at lunchtime to regroup, discuss patient care and get work schedules for the next day. After this we will all head back out, either to a patients home, day centre or residential home. No two patients are ever the same so my day is always varied.”

What has been a highlight during your time as a nursing assistant at LCH?

Adele: “In my previously role at a residential home, I only did personal care but becoming a nursing assistant has allowed me to learn more and offer the next level of healthcare to patients. The training opportunities at LCH are really good.”

Janet: “One of my personal achievements is getting my NVQ level 3, which I did through the trust.” 

What would you say to someone thinking of becoming a nursing assistant?

Julie: “Other members of my team and myself work a lot with students, taking them out in the community with us, mentoring them. For anyone thinking of a career in nursing, being a nursing assistant is a great way to start and give people insight in to healthcare.”

 

Sarah Elwell, Communications Team

A local partnership with global impact

John Walsh, of York Street Health Practice, discusses his recent trip to Prague as part of a learning programme on street work...
 

In May I joined a group of students and academics from Leeds Metropolitan University (LMU) to travel to Prague to take part in and work to develop a powerful and innovative learning experience. This was the intensive learning programme on street work between four universities, LMU, Barcelona, Amsterdam and Prague, to which the project forms part of a three-year Erasmus-funded Intensive Programme (IP), which initially began in 2013.

 

The Leeds teaching programme, which is led by Darren Hill and Dr Erika Laredo from LMU, creates the space for 40 students from across the four universities to work with academics and practitioners on street work, research, theory and practice. The students come from a range of backgrounds including social work and youth work and had all done preparatory work on issues of homelessness, addiction and social theory. 

This was a great example of how Leeds, in all it's rich complexities of academics, practitioners, students and former service users, could come together to learn and debate options and approaches across countries. Darren Hill, senior lecturer in social work at LMU and co-organiser of the programme, summed up well what this meant: "The students and staff will be studying international street work, visiting homeless projects in Prague, designing research proposals and sharing their skills and experiences. We hope that it will encourage the students to go into masters degree level study and move into street work practice. By drawing together a range of academics and professionals across a variety of disciplines, we aim to address the new knowledge and skills that professionals working within a street context will require over the next decade." More details about this can be found on the LMU website.

My memories of the two weeks are positive and plentiful, with particular things standing out. One was that the Prague conference on the ground was run and overseen by just one person - Barbara Janikova. Barbara is lecturer in the Department of Addictology, First Faculty of Medicine at Charles University in Prague. I was amazed at how one person supported us all and organised the operation on the ground, day after day. She was always there helping students and staff and we were all inspired by her. On the last day at the final meal, we were able to celebrate her and all she had done for us. While it is true that Barbara is an extraordinary person, it showed me again how one person can make a massive difference. It is a lesson I see often in the NHS and elsewhere, that it is really the people that matter. If we get the right people, people of care and vision, all the rest can follow. Without this, I think we run into real problems.

During the two week teaching experience, Jo Smith, my colleague from Leeds Adult Social Care, and I took part in different sessions. Jo is a mental health social worker for the homeless and works in the Mental Health Homeless Team, which is part of Leeds City Council, as well as in the CRI Street Outreach Team. Each day we ran sessions to encourage the students to meet and take part in interactive work; this was to support cross national discourse, discussion and work.

We worked with tutor groups looking at different aspects of teaching and research. My group looked at drug issues and visited an inspirational project, which works with those with drug problems in the city of Prague. It was interesting to hear about their challenges and work and it struck me how in Leeds, we are very fortunate to have built and continue to build strategic alliances for the poor and the vulnerable. These alliances see inclusion as not just including marginalised groups but address how a whole city can and should develop positive health and wellbeing agendas, vision and practice. This allows the generation of work from the bottom up and top down to occur and really start to change things. Two examples of this are the Leeds Health and Wellbeing Board Vision and the innovative work around homeless hospital discharge work (Homeless Accommodation Leeds Pathway (HALP), which Leeds Community Healthcare NHS Trust and York Street Practice have been key workers in). One person (who has extensive experience in services and service development) and attended the HALP launch in January commented to me recently how, when they attended the launch event, they were impacted by the incredible positive energy in the room and how everything was joined together, from the streets to strategic levels.

We used a variety of forms to teach and share in the two weeks. One interesting format was a staged debate between myself and my friend and colleague, Dr Asun Llene Berne, professor of Theory and History of Education at the University of Barcelona. I was asked to take the proposition that in times of austerity research should not be funded and the funding should go into practice and services. Asun argued that practice without research is lost, hence funding was necessary. The debate took place and we both presented our cases. I was struck by the high level of discussion, reflection and co-learning that the debate and the overall teaching experience created.  I believe with Darren, Erika, Asun, Barbara, Jo and other good colleagues such as Sue Lindsay, we already see international and innovative ways of learning and practice emerging. This offers new possibilities of health and education working in positive partnership to generate quality research, an improved discourse on the needs of our most vulnerable people and the evolution of the most compassionate and effective care possible.

Colleagues at LMU have written an article on York Street Health Practice (click here to read). In it they have a fantastic quote that this a is local partnership with a global impact. I hope we can build this into a living ongoing experience, which can generate a new international dynamic model  of collaborative work, research and practice. I'm proud that Leeds Community Healthcare NHS Trust are involved in something so potent and promising.

 

John Walsh

York Street Health Practice

Can't beat those revision blues? Help is available...

Leeds Child and Adolescent Mental Health Service (CAMHS) offers assessment, support and evidence-based interventions to children and young people with significant emotional and behavioural difficulties (e.g. anxiety, depression, eating disorders) and their families.

This month saw the annual Mental Health Awareness Week; a nationwide event that encourages people from all walks of life to learn, talk, reflect and engage with others on all issues relating to mental health. According to the charity Anxiety UK, as many as 1 in 6 young people will experience an anxiety problem at some point in their lives. If you think about Leeds alone, that is a huge number of young people and families affected. This is particularly pertinent at present, as it is exam season and thousands of young people are feeling the pressure to achieve their potential. You can find some useful tips on managing exam stress on the Anxiety UK website.

As well as offering assessment, support and intervention to service users, the Leeds CAMHS Training Unit offers highly valued training workshops to professionals working with young people with a variety of mental health issues, including anxiety. Research carried out into the impact of our workshops on practice shows benefits at personal, organisational and inter professional levels. To find out more about CAMHS and the services they offer for service users and professional, visit our website.

For more general information such as practical advice, resources and a parent helpline take a look at the Young Minds website.