The good we do

We have wanted to write a blog post about goodness for some time. We have also wanted to write a post about our identity, who and what we really are. Last week gave us the inspiration we needed to try to write. I (John) attended the leaving party of Dave Ashton, the Head of Practice at the NHS Leadership Academy. It was a real joy to join many good colleagues including Dave Thornton. The evening was a toast to Dave on his retirement and a recollection of his unique qualities and presence. I have met a number of people who work or who have worked with Dave. The constant appellation used by them in connection to Dave is the word "good." Phrases such a "such a good man" and 'good people like Dave' pepper the conversations. The same word is used unfailingly of Yvonne Coghill of the Academy too. There is clearly something about Dave and Yvonne that touches, connects and inspires others. The people who have used this appellation come from different levels of the NHS and some don't even know each other.  I sat at the event and heard tribute after tribute to a kind, warm and wise man who had made such an impression on so many.

Goodness is an incredible power. It lifts and lights us up when we are not in a good place. True goodness never makes us feel little, inferior or ashamed. It rather illumines what we are and can be at our best. It draws us to a dimension of being where we know that we are good and can be even better. A dazzling witness to the fragrance of goodness is Anne Frank the young Jewish girl arrested by the Nazis. 60 years ago this month she was arrested by the occupying Nazis in Amsterdam. She died the following year in the camp at Belsen.

Anne Frank in the midst of the darkness that Nazism was holds out a message of what we are all called to be. Anne was an ordinary girl who offers a voice for what really matters. She writes that, "In spite of everything, I still believe that people are really good at heart." This amazing statement should give us hope that all can change and that there is, in the darkest heart, a good spark. That flicker can become a flame and that flame, the light of possibility. Anne actually gives us a living guide in her words to life and a better world. They are a charter for goodness despite the darkness. We will share a selection here.

Anne speaks of "How wonderful it is that nobody need wait a single moment before starting to improve the world." Yes - we don't need a degree or permission. We can start right now where we are. One of the most beautiful services in Leeds is PAFRAS ( Positive Action for Refugees and Asylum Seekers ). It started when one generous person opened up her car boot to give our clothing, food and help to the most destitute. Today it is a thriving and caring service in the city. Right where we are is the place our positive passions and hopes can start to be realised. Anne describes this, "Parents can only give good advice or put them on the right paths, but the final forming of a person's character lies in their own hands."

Anne teaches us that in the darkness we mustn't give into its grip and power. She talks of how her own principles were challenged. She writes "It's really a wonder that I haven't dropped all my ideals, because they seem so absurd and impossible to carry out. Yet I keep them, because in spite of everything, I still believe that people are really good at heart." Her hope was grounded on the fact that good exists in all and who knows when that good will start to flow and happen. She wrote that "Human greatness does not lie in wealth or power, but in character and goodness. People are just people, and all people have faults and shortcomings, but all of us are born with a basic goodness.”

Anne also knew how this approach illumines the world. "Look at how a single candle can both defy and define the darkness." The single candle of a good human candle can shine and bring light to many. This light doesn't burn solely for itself but for others. She knew how goodness is infectious and once started is like a mighty wave. "Whoever is happy will make others happy" she writes in her diary.

Anne's focus on goodness was aligned to kindness. Her words are "In the long run, the sharpest weapon of all is a kind and gentle spirit.” This 14 year old girl going through such a nightmare was possessed no doubt of a deep wisdom. She found her joy in the beautiful things of life. "I don't think of all the misery, but of the beauty that still remains."  Anne mentions her death. "I don't want to have lived in vain like most people. I want to be useful or bring enjoyment to all people, even those I've never met. I want to go on living even after my death!'' And this has happened. A young girl living in an encroaching darkness speaks words of goodness, kindness and light - words that help us along on our daily path today. A child teaches us out of her wisdom what we should know but often don't.

Anne possessed a deep awareness of life, beauty and goodness. This was, we believe, her deep identity; her true self. Goodness is that heart that warms and cheers another. It's those words, actions and even looks actions that connect us and touch us. People like Dave and Yvonne shine with this.

Anne Franks' experience in Amsterdam seems a long time ago. Yet its message burns brightly whenever someone, despite the problems, reaches out to love, care and do good. Out of such actions the hope of a better tomorrow will come and it is those who do so who really make history. It tells us that goodness is our true identity. To fully live is to be fully good. That's the promise what Anne's message offers. It's a clear and bright message to a world that often seems so very lost. It's incredible that in the midst of a system that stood for destruction she pointed to goodness.

John Walsh. York Street Health Practice. Leeds Community Healthcare.

Lisa Falkingham. Service Improvement Team, Leeds Community Healthcare 

Philosophy and the workplace

We have a rich history of philosophy ranging from ancient writers like Plato and Aristole to modern day philosophers like Sartre. Can philosophy have any relevance to a workplace or service? Or is it something mainly for the academic books and university classrooms. In this post I will offer the words of Hegel, the 19th century philosopher, as an insight into some of the problems and challenges we face in our work and life. Philosophy should be something that has relevance in the streets and offices of the world. Indeed the likes of the ancient philosopher Socrates went into the streets to listen and engage on his ideas.

Georg Wilhelm Hegel was a philosopher who died in 1831. He has had a massive impact on philosophy and there are still people today who call themselves 'Hegelians' in honour of this eminent philosophers ideas. What I will present in this post is my understanding of Hegel and what he can teach us as we try to make the best cultures for staff and create the best care for patients. In doing so I offer what I understand the words to mean. It may be that eminent Hegelians may correct me on my understanding. That's fine, I accept that. It's all part of the process. So here we are and here we go.

 “Nothing great in the world was accomplished without passion.”

Passion is the engine and fire that drives work and development. A friend of mine who sometimes delivers talks and speeches often gets the kind compliments such as, 'We felt your passion coming through' and 'Your passion shone through.' This gives us an important clue. Passion connects us with others. It shares with them what matters to us. It is a fire burning brightly in our heart and mind and is capable of enkindling light and flame in others. Hegel tells us we need passion. Without it we will not accomplish anything great.

Passion is actually very common. It's just that we don't always recognise it. We see it when a young mum is battling to get the kids ready for school and gets them there day in day out. We observe it when perhaps after the bereavement of a loved one a person devotes themselves to raising money for a charity. They will offer their time, resources, voice and energy for this to occur. This is all passion and i'm sure we have all seen it and been touched by its presence. The sad thing is where someone has lost their passion. This is also the scary thing. Where did those high ideals, commitment to others and good intentions go? I suppose it's often not a sudden thing but a slow wearing away of vision, values and hope. Andrew Harvey, a writer, talks in one of his books about growing up in a house with his family. One day one of the walls fell in. Termites had been eating away at it for ages and no one know. It then fell. This eating away of our passion and principles takes place whenever we allow cynicism, negativity and nastiness to enter our work and thinking. Passion also need to be kept alive. The furnace needs constant fuel to keep it burning well. Positive and visionary people and networks, a big vision, good reading and the development of a deep and abiding hope are all wonderful helps that ensure the nurturing and sustaining of passion. Hegel's message is so needed because with passion we can do great things.

“Only one man ever understood me, and he didn't understand me.”

This hits on a very true thing which is that we as human beings are or can be,  very complex people. We are not robots or computers ( although we are learning that modern technology sometimes seems to have a mind of its own and what worked well yesterday won't today but will tomorrow ). We may remember at school we would have those puzzles that said 'If it takes three men two days to dig a ditch how long will it take two?' There was a mathematical answer. However, in real life it really depends on the people. There may be two of the best and strongest people and will do it quickly or may be the opposite. Complexity is a feature of humanity. Humanity is actually a mystery. We have so many commonalities and yet such differences. We can sing like angels, paint things that take our breathe away and show world changing compassion. We can also as a race kill, hurt and betray. It seems we have in different human beings such variations of good and bad. Hegel points us to this. We can never really be understood in our depths. We may know lots about our self and others. We may know ourselves and others incredibly well. And yet there are parts of us we do not see or cannot fathom. This bears on work as while we have policies and processes to follow, we should also try always to see through to the human standing in front of us. We may not know, may never know, what the issues are in their life. They may not know fully either. This should lead us to be always polite and professional with all while following whatever process has to be followed. If a chink of light shines through and we see the problem or issue then we can offer help and support.

“The only thing we learn from history is that we learn nothing from history.”

Sometimes in a  work setting a person with an issue repeats the same behaviour again and again. Nothing seems to work. We need to balance this with the fact that people do change and 'we live and we learn.' Work Systems can also be like this. We keep going on with them even when they have stopped working. We even re-invent them and call them by new names! The truth I believe is that if we don't change the way we look at something we just get keep getting the results of the old thinking. Einstein once said that 'No problem can be solved from the same level of consciousness that created it.' This points us to the need to learn from history by transcending the mental boxes the old answers and problems come in. Fresh thinking on old problems will help us avoid that 'Groundhog Day' syndrome.

“The length of the journey has to be borne with, for every moment is necessary.”

Hegel is here telling us a vital truth. We are all on a journey. We walk along a life strewn with lessons and possibilities. To get to where we need to be we need each moment. I remember working with a homeless client at York Street who had so many awful issues going right back to childhood. The recovery and transformation of that man has been incredible. Yet his journey, long, difficult and unpicking so many things, could probably not have occurred in any other way. He could not jump over all the scaring issues and be whole and sorted all at once. That would have been a very nice event but the lessons probably would not be there. It was in the journey that he found himself and meaning and purpose in life.

The good news here is that even the winter seasons of life have purpose and promise. We can even find in these somewhere sometimes the first shoots of spring. Our life is really about discovering who we are and what we are. That is a deep and wonderful journey. We can't achieve it in a day. It takes days and nights and even the tough times can help us grow and live if we can accept and transform them. Sometimes life or others have really hurt us. We might feel cut, hurt and incredibly let down. In this state we actually stand at a precipice. We can either from this become either wounded healers or wounded hurters. Our pain can cause us to somehow become more empathic and caring or make us bitter and project it outwards onto others. The late Henri Nouwen wrote a book about wounded healers. These are the people who themselves bear wounds but don't transmit them. Somehow they have transformed them into service, kindness and vision.

So Georg Wilhelm Hegel tells us some home truths about the need for authentic passion, the complexity of ourselves and others, the need of fresh thinking and the  difficulty and glory of the life journey. If we look at this in terms of a manifesto for work and change we might find the following

        * Be passionate

        * If we have lost our passion we need to re-kindle it

        * Know humanity can be difficult to understand at times and be tolerant 

        * Follow processes but always see the person stood there in front of us

        * Old thinking will create what it already existing as the problem

        * Fresh thinking can bring creative solutions for the future

        * The challenge is to stop reading and own the story. To consciously own our life and make it the best for our self and others.

        * Life can be really tough but even from these dark places we can grow and deepen

I don't think this would be such a bad manifesto for us all. In fact it might even lead us to a re-energised and renewed service. We have much to learn from these giants of history like Hegel. And as someone once said if we stand on the shoulders of a giant we can see for miles and miles.

John Walsh. York Street Health Practice.                 

Stoptober

In the past couple of weeks the trust's Stoptober activities have ramped up a gear in preparation for the start of the campaign this Wednesday. Firstly we held Stoptober awareness raising sessions at Leeds General Infirmary and St James Hospital. People were able to stop by the stall, talk to one of the advisor's or attend a drop in session. 

Maree with Steven and Richard

On the weekend following this, a couple of colleagues and I plus my youngest son headed to Briggate to join in with the Stoptober roadshow. At the roadshow there was two guys (pictured), Steven and Richard, who were great at bringing the crowds over, something to do with their outfits perhaps. We had two big wheels which could be used to show how much money people could save and the health benefits of stopping smoking over different time periods. We have similar wheels ourselves that we show to clients, but not on the same scale.

We got the opportunity to talk to lots of people and let them know what Leeds NHS Stop Smoking Service do, how we can help and how they can access our services. We also signed lots of people up there and then to come to clinics. 

Lots of people had carbon monoxide tests done and the results for some people were quite eye opening. It led them to think about what they were doing to their bodies when they were smoking. Carbon monoxide (CO) is a poisonous gas, it is found in car exhausts and faulty heating systems (when heating systems breakdown), and has the potential to be fatal. CO is also found in cigarettes.

Dot takes a carbon monoxide
reading from Paul. 

It causes the blood to thicken, become sticky and hardens the arteries. It can contribute to strokes and heart attacks, so you can see why a lot of people were concerned after having a reading taken.

As a result of the roadshows and awareness event, I have seen an increase in clients at the Kirkgate Market clinic as a result, which I am delighted about. Most of my clinics are pretty busy at the moment as more and more people prepare to quit in Stoptober.  

Photos of our activities can be found on Leeds Community Healthcare NHS Trust Facebook page. 

Maree Diamond

Stop Smoking Advisor 

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 

The life of a Stop Smoking Advisor

Paul, who works at Leeds Teaching Hospital,
tests his carbon monoxide levels at a recent
Stoptober event the team held at the hospital. 

When I tell people I'm a Stop Smoking Advisor, they tend to react in one of three ways: firstly, surprise and interest; secondly 'So you're the sergeant major?'; thirdly, 'What a waste of time that is. People should just stop!'.  The first is very gratifying, the second slightly irritating and the third highly annoying.

People are often surprised. It is a different kind of job, helping smokers to disentangle themselves from a substance at least as addictive as heroin that they have unintentionally, and quite legally, woven into a poisonous web that affects the very fabric of their lives.

The fact is - it's a fascinating job.  I meet people of every age, educational background and culture.  I see some of them struggle against enormous odds to get rid of the habit that is literally trying to kill them.  There are individuals who find it incredibly easy to stop smoking and wish they'd done it two decades sooner, and those who simply can't imagine a life without cigarettes.  It never ceases to amaze me is the sheer guts and determination of so many people to set themselves free from their addiction.  Not everyone succeeds, but many do.  And when they turn the corner, perhaps after numerous attempts, their pride in their achievement is a joy to see.  For some, even people in their 50s and 60s, the simple congratulatory document that we present to them is the first certificate of any kind that they have ever received.

In future blog posts,  I hope to give a flavour of what our day-to-day work entails.  No two days are ever the same.

Smokers who come to sessions run by the Stop Smoking Service are 4 times more likely to quit cigarettes for good than if they try to do it on their own.  We also help people to stop using other forms of tobacco such as smokeless (chewing) tobacco like paan and gutkha, and shisha (waterpipe).

We are a team of friendly, experienced proffessionals who are here to help people give up tobacco.  Together with the Healthy Lifestyle Service, we currently run 46 weekly Stop Smoking sessions around Leeds.

To access support, or for more information, ring Leeds NHS Stop Smoking Service on 0800 169 4219 or check out  your nearest clinic here.  At some clinics no apointment is needed, you can just come along.

Dot Read
Stop Smoking Advisor

Connecting, catching and celebrating

This post is about something we should do all the time but don't. It's interesting that fantastic organisations and services ( both statutory and third sector ) do great work yet don't seem to have an impact in proportion to their work. There are probably many reasons for this. In this post I will suggest one is that we do not connect, catch and celebrate. If we do not do this, we miss so much. If we learn the joy of connecting, catching and celebrating I can assure you you will see everything change - well a lot of things change. Perhaps the most important is how we see our work and indeed our world. So what is connecting, catching and celebrating?

Connecting is seeing with panoramic vision. This means seeing the whole picture and its attendant possibilities. To illustrate this a story may help. I went to a national event last year. In it we talked about partnership work. One service miles away from Leeds which I believe has existed for a number of years and is working with vulnerable people made an astonishing statement. They said that they would need to start to speak to third sector organisations about the work they do. It was good that they were thinking of doing this but struck me that such connecting could have happened from the early days of this service. I wonder why it didn't. My guess ( and I may be wrong ) is that the service did not then have a connecting consciousness. They didn't see connecting as the essence of their work. Connecting means that we can't do our work alone, we do not want to do our work alone and that we don't do our work alone. Deep partnerships where all teach and all learn and all grow together is what connecting is all about. The writer, Malcolm Gladwell, in his best seller 'The Tipping Point' makes the point about Paul Revere. Paul Revere was a hero of the American Revolution who did a famous ride warning the British were coming in 1775. He is revered as a great figure in American history. Malcolm Gladwell makes the point that Paul could only do what he did because he was a 'connector'. He knew the people in the towns he was riding to so his connections made a difference. If he didn't have the connections then they may not have listened to him and American history then may have taken a different turn. If you're reading this and you are not connecting and do not have vibrant effective partnerships then there is some very good news for you. They are only an email, phone call or even tweet away. We can become connectors by taking that step today.

Catching is an interesting word. We often talk about 'catching a cold.' That's the same idea here. This is about catching an idea and unpacking it. Many of the posts I have co-authored have been because over coffee ( coffee features heavily in my life! ) with colleagues from the statutory, faith, business and third sector, they have said something amazing and it has had ricochet effect across my mind. We have then 'caught' the idea and looked at it. This discussion has led onto other ideas and thoughts. These co-creative moments are what inspires us and lift up to us new vistas and openings. The Leeds Food Homeless Map for homeless people started when two people met at York Street Health Practice and talked about food in the city a few years ago. Neither of them had the idea of a map when they entered the room to meet. That arose in the talk and started to take shape. It now is an established system with a paid worker, many organisations taking part and making a difference to food poverty in the city. Meetings with fresh coffee and fresh ideas can produce the incredible.

Celebrating is what we do with the connecting and catching. From the meetings and ideas where do we go? The simple answer is everywhere. We should speak it, write it, blog it and tweet it. If we miss this bit, we miss a key part. Celebrating is actually starting the circle all over again. By celebrating we connect our idea with others and from that other ideas come which need celebrating. So the whole dance goes on and on generating networks, inspiration and positive outcomes. An example from my own life is when I met Steve Keyes, Head of OD at Leeds Community Healthcare NHS Trust. Steve later kindly invited me to speak at the NHS Do OD conference in London with him. This created some great innovative work and dialogue between Steve and me which is still going on. At the conference Steve introduced me to Dr Maxine Craig from South Tees Hospital Trust. The  meeting with Maxine led to emails, great discussion and two articles on service and staff dynamics. It has also led to the start of some of the most exciting and transformative work I have ever known. Maxine linked me to Anne Cooper, Lead Nurse for Informatics at NHS England. I met Anne for coffee and in a very short space she converted me to going onto Twitter. Since then I have linked with some great people through this channel. These include Louise Goodyear, a third year nurse student at Wolverhampton University, who is an real inspiration. Louise and I are just finishing off a blog on what matters in healthcare. I don't usually talk about myself this much and do so only in this post to point out what the possibility, goodness and magic of connecting, catching and celebrating can do. I hope you give it a try.

John Walsh, York Street Health Practice  

Three Easy Traps

Lisa and I recently had a deep discussion about how we create the best cultures for staff and how services become best spaces for staff and personal development. As we thought over what we had written a number of key themes came to mind. One area we covered was how we easily fall into 'traps'. Traps are mental and practical illusions that hold us in a place of no power while taking all our energy and vision away. Traps are pretty awful things. They are workplace vampires and yet we can walk into one tomorrow as easily as walking through a door. In this post we look at three work traps and how we might escape and even avoid them.

The first is the not accepting responsibility trap. This is easily enough to do yet its effects are deadly. We may not be able to control our workplace or economic factors but there is one area where we can exercise dominion and that's with ourselves. Whatever the issue or challenge ( and we have many ) we can be responsible for ourselves. We can make the commitment to be the best we can be; the best nurse, doctor, support worker and manager. It may not be easy but it can be done. People who are bullied often feel there is nothing they can do about it. This is one of bullying's great triumphs - to make us believe we have no power or choice to change things. The giving up of power and refusing to accept responsibility for one's self and our responses is a trap that can bring misery for us and others. Once we accept the power to be or in the words of the theologian, Paul Tillich, 'the courage to be' we enter a new dimension of living. That is the dimension we call integrity. It's where we own our behaviour and are open to change, criticism and growth.  It's where the blaming others stops and the work for self development starts . We grow when we are honest about ourselves and seek to own our process of becoming. Paul Tillich also warned that, 'Neurosis is the way of avoiding nonbeing by avoiding being' . By refusing to be what we are and can be we open up the possibility of becoming ill.

The second trap is rescuing. This is a trap good and kind people fall into. We meet a client and want to 'fix' them. We want on some level to be their rescuer. The problem with this is that it doesn't work usually as people don't dance to our agendas. If it happens to work it still isn't the best way as it means us sorting people like models rather than people finding their own power and possibility. People caught in this trap can often end up in one of two states. The first is self defeat and blaming themselves. 'I can't do this. I've tried but I have failed.' The other is where the blame gets projected outwards to the client. 'They don't want to change. I have tried and tried and these people aren't interested.' What both states have in common is that they view clients as problems to be fixed rather than people with real choices. The journey model is a richer and more respectful picture of work. The journey model is where we walk alongside others as a positive and supportive presence not necessarily agreeing with their choices but still walking with them. This model rather than the 'fixing' rescuing one respects choice and offers the possibility of real change and healing.

The last trap is resigning. By this we do not mean resigning from work. We mean resigning from working for better cultures and approaches. Resigning from hope. It's easy to give up. It's also easy to slide into a 'It's only  a job' viewpoint. When we go down this road we lose our passion, our vision and our hope. It's a terribly depressing thought to think of someone who has lost their soul for the work they do. That their work is just 'doing the job' rather than building and supporting a service that heals and cares.  Everyday we have a hundred and one opportunities to be a wonderful difference for the better. To be the kind ward sister. To be the compassionate doctor whose presence and words bring calm to a patient. To be the service development worker who listens to staff and supports them through a difficult time. These are not extras. They are fundamental to good compassionate care and service. They are transformation and workplace wellbeing.

A part of any solution is awareness. For us to see and change our own attitudes and conditioning. To become aware of when we are not taking the power, when we are trying to rescue others ( rather than support them ) and when we are resigning to just be another worker rather than a person who can make a difference and contribution. As we write this the need for a  clear vision, firm values, good support and a willingness to honestly see the need for change and work towards it become apparent. This is a work that can take time, commitment and focus. It's also an escape from the prison these three traps represent and that can only be real freedom. These words may sound very dramatic. But then again they describe us moving away from giving away our power, boundaries and hope so they are, in our opinion, deeply true.

John Walsh. York Street Health Practice. Leeds Community Healthcare

Lisa Falkingham. Service Improvement Team. Leeds Community Healthcare 

Creating Community Partnerships

Recently Karl and I met to discuss the exciting growth in collaborations and the developing partnership between Leeds Metropolitan University (Leeds Beckett University from 22 September) and York Street Health Practice. These collaborations reflect a new and innovative way of working in, and for the community between the NHS and education.

Karl works on the CommUNIty Initiative which is based in the Faculty of Health and Social Sciences at Leeds Met University. CommUNIty has an overarching goal of finding new more effective ways to improve health and reduce health inequalities in the region. It aims to achieve this through supporting the development of meaningful, sustainable and mutually beneficial relationships between Leeds Met. and community/voluntary organisations. Practically, this means scoping out current partnership work within the university, building rapport with university staff and community partners, seeking ways to share knowledge and resources, and proactively seeking out opportunities for future collaboration. Formally established in 2013, CommUNIty has developed from the collaborative work of Prof. Jane South and colleagues in the Faculty, particularly the strategic partnership work with Hamara healthy living centre in Beeston. What the collaboration with Hamara has and continues to demonstrate, is that investment in a sharing and open relationship with community organisations has benefits not only for the academic institution and the community partner, but also the broader community in which the work is situated.

Community partnerships, supported by the CommUNIty initiative with the likes of Leeds Community Healthcare Trust and St. George’s Crypt offer universities a multitude of benefits. They offer opportunities for research and teaching, allowing academics and students to access knowledge from people who are delivering practices being taught in the classroom, and experiential knowledge from people who are receiving services. Conversely these partnerships enable the academic community to share knowledge garnered through research, with community partners and promotes joint working to ensure findings are presented and disseminated in a ways which meet the needs of the target audience. Partnership working also offers opportunities for staff and students to share and develop their skills in the community through volunteering and placements and provides opportunities for widening participation in teaching and research.

As we sat drinking coffee talking about how our services were working together we ended up talking about the essence of what good partnership means and looks like. We often presume good partnership work exists. But what does it look like? What are its component parts? Three things came to mind in the discussion, of course many other key aspects could have been mentioned too. The three things were service, strengths and steer. These three are the glue and life to what make compassionate and successful partnerships. They are glue because they hold partnerships together. They are life as they breathe creativity, energy and vision into partnerships.

Service has to be at the heart of all good partnership work. The day we forget people is the day the rot starts. People and their service have to be at the centre of all we try to do and accomplish. Every circle has and needs a centre. Nature abhors a vacuum and if people aren't the substance of our work other things will rush in to fill the absence. We miss the point if we miss the people. One of the authors remembers years ago hearing a tape by a business sales trainer. In it he asked his audience 'What is the purpose of a business? 'To make a profit' they called back. 'No' he said, 'You're wrong.'   It's to make and keep a customer. If you do this the profit will follow as night follows day. And to keep a customer we have to treat people well and with honesty and respect.' The trainer knew the truth. It's all about people and service.

Partnerships are places where we offer our strengths and gifts to make things happen. We found ourselves in our conversation using the analogy of partnerships being people who bring different strengths to the table to share and create something new. These strengths are usually what our work roles are. They are also what life and loved ones have taught us. Steve Jobs, founder of Apple, talked about how as a child he got electronic kits which as well as giving him electronic know how gave him a real level of self-confidence. Our gifts make and sustain partnerships, so does our lack. What we don't have teaches us the value of the other. What other colleagues bring enriches and shapes our experience and practice. Partnerships are spaces for our gifts to contribute. They are also arenas to discover our latent talents and possibilities. Partnerships teach us to be humble too. We don't know it all, we need each other.

The last aspect is steer, or steering. In business and leadership circles this means to lead and give direction. The book by Jean Philippe Deschamps sums it up.  It's called 'Innovation Leaders: How Senior Executives Stimulate, Steer and Sustain Innovation.' Partnerships without good leadership are like a car without a steering wheel or a ship without a rudder. The leadership steers the partnership onward and forward looking. What is good leadership? There are many answers to this. One answer is that good leadership - in fact great leadership - isn't about what we've got - it's about what we give. Think about great leaders such as Martin Luther King and Nelson Mandela. They gave all to the cause they committed themselves to. Dr King paid the ultimate price with his assassination. Nelson Mandela spent over 20 years in prison. Thankfully, we will probably not be asked to make these sacrifices. But, we can learn the lesson that great leadership often means great giving. There's a secret here, giving has a boomerang effect. We may give but it often comes back to us in different ways and forms. Some of the best partnerships in the city happen because those involved give and give to make it work, and yet the returns on this investment are often much greater than the sum of what has been put in.

Partnerships are the future of this city. We are happy and feel honoured to be involved in the building of them. The 6th President of the United States, John Quincy Adams, said, 'If your actions inspire others to dream more, learn more, do more and become more, you are a leader.'  Dreaming, learning, doing, leading and becoming more - these are the charter and content of the partnership we are working to bring about. In difficult days for so many these are signs of hope and new ways of working.

John Walsh, York Street Health Practice

Karl Witty, Team Lead for CommUNIty Partnerships, Faculty of Health and Social Sciences, Leeds Metropolitan University 

Sexual Health Week 15 - 21 September

Providing first class sexual and reproductive health care for young people in Leeds

Contraception and Sexual Health (CASH) of Leeds Community Healthcare flag ship young people under 25 clinics based in city centre, looking after the sexual and reproductive Health of Young people in Leeds. We are in the city centre and operate a drop in service and everyone who walks in is seen.

We have been working since 2006 to build awareness of sexual Health and reproductive issues facing young people of Leeds including reducing the stigma behind emergency contraception. We actively promote and campaign for safe sexual practices and prevention of unintended, unplanned pregnancies.

We feel that more and more people understand emergency contraception and where to get it from. At Citywise (our under 25s clinic) and CASH, we are the largest provider of emergency contraception in Leeds. Anyone can come in and request emergency contraception and we provide it free of charge. In a typical Emergency contraception consultation, we will discuss confidentiality, safe sex practices, counselling and testing for common sexually transmitted infection like chlamydia and gonorrhoea. We also teach how to put on condoms, discuss future contraception and can carry out pregnancy tests. We work to educate young people and actively champion safe sex and condom use, providing demonstrations to new young people attending our clinic for first time. By presenting all options to young people, they can make informed decisions about the contraception methods best for them.

 

We are also the largest providers of both types of emergency contraceptive pills in Leeds and this is something we feel very proud of. As well as this, our doctors have inserted the highest number of emergency coils in Leeds last year. Our feedback from young people who have coils inserted as emergency contraception usually comment that that the doctors make a frightening experience "reassuring and pleasant." This is something we are always striving to achieve and I believe we are a dynamic and vibrant place that welcomes young people and provides a friendly service. We will always endeavour to not only give them excellent medical care but build awareness to enable them to be young responsible mature young men and women.

Staff at Citywise and CASH clinics has worked incredibly hard and effectively to dispel myths and taboos regarding sexual health and practices, especially around emergency contraception and sexual transmitted infections including HIV. We treat young people attending our service like we all want to be treated with respect, tolerance, compassion and empathy.

 Citywise and CASH is proud to celebrate Sexual Health week 2014.

 

 Blog by Dr Farah Haider MBBS, MFSRH

A house of cards

It's not unusual to hear people say about themselves 'I'm useless' or about others, 'You're useless.' I guess the thought that we are pretty useless at times haunts many of us. The problems with these thoughts and statements is that they are not usually true and if believed build mental prisons. In this post I will try to explore what I see the real truth about us really is. 

Recently I was at a half day conference in Manchester and met up with my friend, Laura Neilson afterwards. Laura expresses what is best in the medical profession - the care, compassion, kindness and sense of peace that a good medic brings to a sick person. We met through work on health inclusion led by Professor Aidan Halligan. Aidan is developing some amazing and innovative ideas at the moment. Over coffee, Laura and I talked about a number of things. She mentioned how a friend of hers says that we all are like a pack of cards and we all have a few cards missing. None of us has the full deck - the full 52. I found this an intriguing thought and hence this blog. This first thought led to more reflection.

The first thought was that we all have nearly all the cards. If we have 46, 48 or 50 of them that's not bad. If we can focus on them we are focusing on our strengths and what we can contribute. Focusing on the cards we have gives us a good base to move and live from. It also allows the possibility of other cards to possibly appear. Not looking at the cards we have and looking for the cards we haven't is often a disaster. Some of us have sat with people who couldn't see all the good they had - they couldn't see the wood for the trees. All they could see was the negative issue in their lives. I remember a friend going through painful relationship issues. Working on the hospital wards always brought him around. Seeing the suffering of others shifted his mental picture to what he had and could offer. We shouldn't allow the two or three cards we don't have to cancel out the other 50.

The second thought was the two or four cards we don't have may not matter so we don't need to worry too much about them. If they do matter, we have two roads that open up before us. The first is to find them. This is a path of learning, growth and development. The other road is to accept that we don't have them and won't get them. The lesson here can be deep one. It teaches us that we are not the chain but just a link. We are confronted by our lack. We see the need for others to enrich and complete us. We need their gifts and responses to be and do what have to. We are also taught to be humble. We have to admit and accept our limitation and lack. There are Kings and Queens in a deck of cards - there shouldn't be any in the National Health Service. We are as the word in the name says part of a service. We are here to serve and support each other and help each other grow. It's not always easy to say 'I can't do this' or 'I need someone to help me with this.' I sat today with a good colleague and talked exactly about this. Actually it isn't weakness to say this but strength and wisdom. The real weakness is not to be able to say this and confess our need.

So we are a House of Cards. Not in the usual sense of the term - some unstable arrangement that can topple so easily. We have cards made of the best and brightest human gifts. Cards that reflect and shimmer with potential. Cards that echo greatness and possibility. Life and work can be tough at times. We can't always change that. We can avoid making things worse. We can also recognise more and more our gifts and become more resilient and focused. Tough times can knock us off focus. Like all powerful emotions and experiences tough times can distort reality. We really need the cards we have and to play them wisely and kindly. When we think of it those 50 cards to play with - all those Aces, Kings, Jacks and Queens  - we may see new ideas and vistas.  

John Walsh, York Street Health Practice.

The case for care navigation

Health and social inclusion is a priority. Inclusion work around health and social inequalities usually takes two forms. The first is that we attempt to support people and communities access services. We open new clinics, change times and offer new aspects of the service to support this. The second form is to take services to people and communities - to have outreach clinics and workers. Both forms are valuable and powerful options that can make a real difference. The authors of this article believe that there is a third way which builds on the previous two forms but offers a radical orientation for genuine involvement and change. 

Leeds GATE (Gypsy and Traveller Exchange) is a member led organisation which exists to improve quality of life for its members and the wider Gypsy and Traveller communities. It describes itself as ‘value-based’ and these values include such things as ‘helping people to help themselves’ and ‘keeping people safe’. Leeds GATE has developed a reputation for community led approaches to improving health and well-being. Mutual understanding of the impact of social determinants of health, including structural inclusion makes natural bed-fellows of Leeds GATE and the York Street Practice.  This blog post arises from discussion between our organisations in which the proposed role of ‘Care Navigators’ has played a central part.

What is a ‘Care Navigator’? When we speak of care navigators we are proposing a new role which sees trained members of communities acting as a bridge between individuals with health needs and providers of healthcare. This could include services as wide ranging as dentistry, diabetes, maternity, or end of life care, to name but a few.  Our model of navigators is not intended to replace any clinical role, nor to gate-keep direct access to services. The role is better understood as providing a fast track to understanding and increased, effective dialogue between isolated community members and the professional healthcare support they need. A navigator would be the ‘go to’ person for community members needing additional support to understand and work their way through what is often a very complex care system, and for professionals seeking to ensure that their services are effective and don’t exclude groups of people traditionally regarded as ‘hard to reach’.

We imagine navigators spending time in their own communities, generating conversations and sharing information, and in clinical settings doing the same.  It’s not that navigators need to be ‘the expert’ but they would know who ‘the expert’ on any given topic is and would be able to effectively link patients and experts together whilst supporting developing trust and good communication. This care navigation approach, which has been successfully adopted to ensure that homeless people leaving hospital are navigated into services which assist in avoiding rapid re-admission, places people  at the heart  and action of services.  Care navigators can make significant impact on service access inequalities and can work with care providers to create viable, caring and realistic services that people actually need.

The vision of NHS England aims for people to have greater control of their health and wellbeing, supported to live longer, healthier lives by high quality health and care services that are compassionate, inclusive and constantly improving. The Health and Social Care Act 2012 introduced significant amendments to the NHS Act 2006. The Act introduces two legal duties, requiring clinical commissioning groups and commissioners in NHS England to enable:

• Patients and carers to participate in planning, managing and making decisions about their care and treatment through the services they commission
• The effective participation of the public in the commissioning process itself, so that services reflect the needs of local people.

The Marmot Review (Fair Society, Healthy lives) drew attention to the financial and social costs of health inequalities. It might be fair to suggest that many busy service providers and the infrastructure behind those services can find including marginalised people in commissioning, design and delivery of their services difficult to achieve. There is credible evidence available that proper inclusion significantly reduces cost and delivers real health improvement but for service providers making change happen, even just knowing where to start, can be easy to say but hard to achieve.

Care navigators could play a vital role in supporting community involvement and ensuring that the high values and vision of the NHS, and the social and financial savings associated with good care outcomes, are available and meaningful to all groups. Their position at the heart of their communities but, importantly, located as colleagues within professional care settings would enable effective dialogue to address outstanding healthcare inequalities. We believe there is potential to improve health of current and future generations via focus on developing community wide initiatives and individualised care plans on issues as mortality rates, long term conditions, mental wellbeing, etc. Navigators would look at prevention and early spotting of illness and conditions, promoting confidence in early intervention, raising awareness on key issues and, critically, advising clinicians on programmes of follow up action.

Care navigation represents person centred care in which the person and community are at the centre of the care provided. It supports best care in recovery after illness capitalising on tremendous care and support which already operates within communities. The care navigators can explore with the community how people can best manage their own conditions. They could look to develop 'health cell' groups in the community - small groups of community members - each devoted to a different health aspects such as men's health, depression and suicide, etc - the care navigator would help these groups learn, share and link to professional expertise - these cells would be centres of knowledge, accurate information, good signposting and support.

Another benefit, especially in light of the Francis Report findings, is that care navigators could act as barometers for measuring clinical effectiveness and safety, catching and reporting community and individual experiences of health care. The need for health and other services to be transparent and honest with patients would be enabled by care navigators supporting clinicians and providers to find appropriate language and methods to share information.

Care navigation offers a real innovation as it is a new paradigm for working with people from the different marginalised communities which will place the community at the centre of health and wellbeing. The care navigators would be co-located - in the community (understanding the community and relating to its gifts, issues and hopes) and within services. Co-location alongside professionals, as well as within community settings, would assist in linking to other relevant service sectors such as housing, social care, aiding awareness and practical responses to social determinants of health.

There is tremendous potential social and health value and impact present here. Care navigators would promote the dissolution of health inequalities, promote a culture of health inclusion, address in a practical and living way the stereotypes that people from communities face on a daily basis, promoting local community involvement and building potent links between services and people. Critically, it presents the possibility of a real culture of trust and hope to emerge, creating real access for the community to health and celebrating successful good practice and good service models.

We believe that this navigator model is based on a fundamental truth - communities and people have answers and assets. A meeting between these gifts and existing services is needed and holds tremendous promise. Inclusion from, with and for the community may be the greatest hope for health and wellbeing of communities. Health and social work would be based on and flow into communities and become enriched by the assets of the community. We hope this option can be seriously discussed, examined and tried. Care Navigation potentially offers a powerful key to dissolving some of the worst health and social inequalities people in this country face. We believe it is an idea whose time has come. We commend it to you.

John Walsh, Support Manager, York Street
Helen Jones, Chief Executive Officer, Leeds GATE  Health Practice

Hope in Gipton, hope in Leeds

I recently met with Jane Stageman, who represents Leeds City Council and Becky Malby, director at the Centre for Innovation in Health Management (CIHM) at the University of Leeds. Our aim was to discuss leadership work in the city. The meeting flowed with ideas and visions for the future. I've written this post as a way to recall the discussions and offer them as ways forward to a better, brighter city for all.

Becky shared the work of project called Action for Gipton Elderly which she had recently visited. 

This project seeks to offer support and care for the elderly who live in the Gipton area. It works to make sure elderly people have food in cold icy weather when they cannot venture out. It coordinates a team of volunteers who visit the elderly and it has an arrangement with local fish and chip shops to provide some free meals. The link to health and wellbeing is clear. Elderly people are offered contact and support and loneliness is challenged by community action. Elderly people will have fewer falls and possibly fewer hospital admissions as they won't have to venture outdoors in ice and snow to buy food and milk. They will also have local people to call if they have issues and difficulties. This is real community action in practice. It tells us that people and communities have answers and assets that we need to hear and support. Local answers from local people are a powerful health and wellbeing force. These projects also tell us something about what we human beings can do and be at our best - that we can care, organise and change things. The greatest enemy of human development is the attitude and spirit that says it can't be done or won't work. Projects like this say that it can and is being done, and the effect is the improved health and wellbeing of our elderly people.

The vision we talked of was around the concept of Leeds as an international centre of culture. This discussion led us to ask what 'good culture' or 'best culture' looks like. Is it nice statues or beautiful buildings? Is it well kept parks or first rate arts productions? Of course it is. Yet it has to be something more - something much more. In its last days, Ancient Rome had fine temples, buildings and sports, yet it was collapsing from within. No one was or is suggesting that Leeds is collapsing from within but what we did see in the discussion was that good culture was that which values and inspires people. The best culture is one where people can dream, hope and have compassion.

We have a real need to dream. Albert Einstein, probably the greatest scientist of the 20th century once said 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.' This is so important as it calls us to use our imagination to forge our future and plans. It's not without significance that the great Martin Luther King didn't say 'I have a policy' or 'I have a document', but rather 'I have a dream.' Hope is key too, but what is hope? We venture the answer that hope is the belief that we can work things through and make things better, despite whatever might block us or stand in our way. In the ancient world and in works like Aesop's fables, hope was represented by the swallow. This is because the swallow was seen as one of the first birds that appeared at the end of winter and the start of spring. Lastly is compassion, hearing the call of another and respond from the heart to them in their need. For us to be a centre of culture is to be a city that engenders and inspires these qualities. If we create a city of hope, compassion and imagination, that would be a city where the best in humankind will be at the centre of all we try to do and great culture will be second nature.

We so often hear that a society and humankind can be measured by how it treats its elderly. All across the city, people and communities are committing to projects that place elderly people at their centre. In Beeston, Nicola Dumphy has embarked on a project that supports the people with dementia (and their carers), and aims to build a supportive and connected dementia friendly city. This project will change the experience of living with dementia in Leeds for many by inspiring co-produced services that meet the needs of the city. Projects like these are conceived and thrive on hope, compassion and imagination. In embracing these as a city we can hold our heads high when others, as well as ourselves, look to measure our society and our culture.

The community initiative in Gipton, the commitment to build a dementia friendly city and the vision of good culture for Leeds are part of what this city offers to its people. Leeds is changing all around us. Great people are doing amazing things. This is both a sign and a source of our future. If we can do this now, what else can we achieve in the future? What would our city, a centre of culture look like? We hope this article can be a contribution to why and how we can create those cultures, conversations and communities where people care, hope and dream.

John Walsh, York Street Health Practice

Natalie Leach, Centre For Innovation In Health Management

Jane Stageman, Leeds City Council

The power of forgiveness

This post is about the F word. 

It's about a word we struggle to use. It's about forgiveness. It's a strange thing that we probably find it hard to advise someone to forgive another. We may find it an affront if someone suggests we should forgive someone who has hurt us too. In this writing we will try to look at what forgiveness is and isn't, why we need it and how to take a first step towards it. Like everything we have written and hopefully will write we offer this as a possible way to healthier and happier workplaces and everyday life.

Forgiveness often brings out our defenses. 'Why should we?', 'He started it' and 'After what she's done - you must be joking.' It might be best to start with what forgiveness is not. It is not saying that bad is good. It's not saying that negative and hurtful things said and done to us are acceptable. Forgiveness isn't agreement with wrong doing. Neither is an agreement to meet with or associate with those who have hurt us. It might well be best that they are not in our life. Lastly forgiveness is not a weak option - something for the timid and those lacking in backbone.

Forgiveness is letting go of whatever is hurting us. It is a process of not holding onto what has struck us. It takes real strength to do this and brings real freedom. Mahatma Gandhi helped change the world. He also had to deal with ongoing conflict. He reflected that 'The weak can never forgive. Forgiveness is the attribute of the strong.'

Forgiveness has nothing to do with offering an alibi for wrong doing but everything to do with keeping our own hearts and minds free of what can only poison them. Anger, bitterness, harshness and revenge are the children of a unforgiving spirit. A refusal to forgive and really let go can lead to or exacerbate physical and psychological problems. Forgiving is good for us. It's not surprising that Dr Frederic Luskin, Director of the Stanford University Forgiveness Project entitled his book 'Forgive For Good: A Proven Prescription for Health and Happiness.'

One of York Street's client's was someone who was a victim of tremendous violence. It marked his life and outlook. Through a series of people, experiences and his own choices he moved more and more into recovery and healing. After a meeting with one day, the client informed his worker that he had made a deep but clear decision. He had decided to forgive those who had hurt him so much. This didn't mean that what they had done was right or that he wanted contact with the people concerned. Rather he had let go of the hurt and anger. He compared it to carrying nettles. He couldn't and wouldn't put the stinging nettles down but they cut his hands. That day this man got his freedom and he has kept it up to this day. He put the nettles down. That's what real forgiveness gives - it gives authentic liberation. When we can do this we cease to be victims. The events and people who have had such an awful power over us no longer do so.

  

There is a real need to forgive ourselves. We all fail and some of us even do things we are ashamed of. The answer is not to be full of guilt and to 'beat ourselves up' continually. We have to honestly own our failures and issues. We also have to let go of them. This should also teach us not to be too judgmental of others. As the writer G. K. Chesterton put it, ' We are all in the same boat and we are all seasick.' Seeing our own failings should make us less likely to throw stones at others. Forgiveness of ourselves helps breed a deep acceptance of ourselves. If we can accept ourselves as we are - warts and all - day in & day out - we are on the way to health and wellbeing. Accepting ourselves opens up the road to change and growth. It also opens the way of accepting and forgiving others.

So how do we start to forgive? Forgiveness is sometimes an incredibly difficult thing. C. S. Lewis the writer of the Narnia stories said 'Everyone says forgiveness is a lovely idea until they have something to forgive.' Some people might need therapy or spiritual counselling to move forward. We will offer what hopefully will be a first step for everyday hurts and pains. We will probably find we won't be able to just turn on forgiveness like a tap. It is a process not a one off event. We can't force forgiveness. It is something we have to work through and grow in and through us. The thing we will need is to find is a relaxed state where the emotions are not running all over the place. That place can be obtained in a number of ways. The important thing is that we deeply relax. This needs to be a safe space where we feel at peace. We may benefit to have another person - someone we trust and like - present. This provides the space where a discussion can start about feelings and possible wishes for a different approach. Having the right space and place will nurture rational and forward looking approaches and hopes. To be a people of forgiveness is to be a people of freedom and peace. We all would like to be free and at peace with ourselves and others. Forgiveness is one of the keys that opens that door.

 Lisa Falkingham, Service Improvement Team, LCH  

John Walsh, York Street Health Practice, LCH

A movement for a city

On Friday 5 September, York Street Health Practice had a very special visit. Two members of the Australian Parliament visited the practice. Our visitors were Steven Marshall, State Liberal Leader and Leader of the Opposition in the House of Assembly in the Parliament of South Australia and Stephen Wade, Shadow Minister for Health, Mental health and Substance Abuse, for Ageing, Suicide Prevention and the Arts. Sandy Biar the advisor to Mr Wade was also part of the visit.

The event was part of the work organised by Leeds and Partners. Leeds and Partners were represented by Tim Straughan, the L&P Director of Health and Innovation. Tim is a good friend of York Street. He supported the practice obtain funding for digital technology to support vulnerable people access healthcare in a faster more effective way. Leeds and Partners is based on the delivery of three strategic objectives. These are - promoting and raising awareness of the city of Leeds locally, nationally and internationally, work with partners to promote the city as a great visitor destination and work with partners to drive up the volume and value of inward investment in the city. 

Facilitating the visit were John Farenden and Tim Keenan from the health team of professional services firm Ernst & Young here in Leeds. John worked on the original development of the Leeds Innovation Health Hub and it was through him telling his international colleagues what wonderful work is going on across the city that the Australian politicians heard about it and specifically asked to come and learn more as part of their fact-finding mission. The meeting was joined by the Councillor Bill Urry, the Lead for Homeless issues on Leeds City Council, Helen Kemp, the new Chief Executive of Leeds MIND and our own, Neil Franklin, Chair of LCH. Anna Green, one of the new innovation leads at LCH, and Lynne Jones, our senior admin / medical secretary at York Street, hosted the visit.

The visit started with a short tour around the practice. We then met to discuss our work and the work of the city. We shared what we try to do. We spoke of the five areas of work we do. These are what we do as a health team, the services that come into York Street to make a difference such as benefit and legal support, where we go out to reach out to homeless people via outreach clinics and street work, our work strategically across the city and lastly our digital work using modern informatics as a tool to help people access good care. 

We also spoke about the model of care we use. This is not so much what we do as how we do it. It embodies three elements - the creation of positive space, therapeutic relationships and supporting people make the inner change to a more empowering vision. This was followed by a good and helpful discussion of health and social care, reaching the vulnerable and how to be build best possible care. Councillor Urry spoke of his work as an elected representative of Leeds going out into the streets with homeless workers and being deeply impressed by the passion he sees in those agencies working to engage with the homeless. Neil Franklin shared on how integration, inclusion and innovation were at the heart of what Leeds services do and how it was making a real difference as well as offering much opportunity for the future. The visit was  a special event and this blog expresses our thanks to Stephen, Steven and Sandy for visiting us. We would also like to express our thanks to Tim, John and Tim for including us on their visit.

The visit pointed to something bigger and much more important than York Street. What the visit expressed is something that is taking place across this city. Leeds like all cities has its strengths and challenges. There is in Leeds a consciousness emerging and moving in many places. It covers academia, health, the council, business, the third sector, the faith sector and a 101 other places. This consciousness is based on people seeing something bigger than themselves and their sector. This consciousness is with the city and for it. There are several aspects to this vision and movement across the city. It is an alliance of talents. It brings together people from all walks of life who bring their gifts to create something new and fresh. An analogy would be people all bringing different skills and ingredients and meeting to create a meal. Daily across Leeds services and people are meeting and working in innovative ways to make a difference for the better. We see it everywhere across the city. This coalition of care and development is real and meaningful. It is a learning community where no one claims to have all the answers. There is a humility and openness about it that is both inspiring and attractive. Although none of us claims to have all the knowledge we know that together we can create solutions and support each other to make Leeds the best city we can imagine. There is a vision and focus in this movement which is for the greater and common good. People come together to construct answers and projects to tap into the gifts and energies Leeds has.

What lies at the heart of this movement and consciousness are people who care and seek the good of others. There is also, in the most difficult of times, a sense of hope. What is amazing about this movement is that no one controls or even co-ordinates it. That is why we use the term 'consciousness' as this is an invisible network which visibly expresses itself and engages in the life of the city. Many of the people do not know each other and may never even meet. What is certain is that when they do there is a common vision, commitment and connection. This offers a potency, promise and possibility that means a great future for Leeds. We are proud, humbled and honoured to be able to play a part in this vital work. In this citywide movement which has no name is a model of what a city can do and be. It tells of what each and every person and each and every business and service can offer. In this energy and work together we co-create the future.

Anna Green, Innovation Lead, Specialist Services, Leeds Community Healthcare NHS Trust 

John Walsh, York Street Health Practice, Leeds Community Healthcare NHS Trust  

What should we offer?

Recently I met with Julia Hayes, Director of Inclusion Creativa. Julia is an educational psychologist and has worked around the world. She is passionate about finding creative ways to include marginalised children and adults in their local services and community, and supporting the staff and parents/carers who make this challenging task possible. The discussion turned around to the subject of what our beloved services and institutions should really be all about, and examples they had seen of those at their best.

What are Universities for? What is the NHS all about? What should schools provide for children? 

Our usual answers to these questions can be easily guessed. 'Universities are there to provide higher education and degrees as a step to a career.' 'The NHS is a service to care for and help the sick.' 'Schools are about children learning a good education.' There is truth in these answers - but is there something else? Is there a vital and vitalizing energy and mission these noble bodies could hold and transmit? And could this power enhance and support the day to day work of the services? We think so.

Most people, be they parents, professionals or customers, have had the experience of walking into a service and you know, straightaway, that they care about the people they work for. You might not be able to say why you know, but you just feel it. In the same way, one of us went to visit a school and as they sat there waiting for the teacher they were struck by the positive atmosphere and real kindness pervading the atmosphere. When this was noted in conversation with the Headteacher, she smiled and said 'Well here we focus on confidence and positive affirmation. That's how we work with the young people and prepare them for life.' This raises for us again the question of what is our core work. This school and many other services have it right. Services that focus on the person, their dreams and hopes and their personal path are the ones that make a difference. 

We started to wonder how all our services and organisations could promote two of the most needed values - hope and peace.  Institutions, such as schools and universities, are well placed to promote and nurture these sister values, despite what may be going on in the wider society. Helping people to see that despite all the bad things are have happened or are happening right now, keeping hope within themselves will help them survive those times. Hope is all about life. It is the centre and light that keeps us going in the worst of times. The American novelist Barbara Kingsolver  in one of her books says, 'The very least you can do in your life is figure out what you hope for. And the most you can do is live inside that hope. Not admire it from a distance but live right in it, under its roof.'

Peace is about people and also ourselves. Peace is not just the absence of conflict and trouble. Jewish people have the great word 'Shalom' to describe peace. Shalom means completeness, welfare, health and wholeness. It is obviously referring to a state of being - a way of being to oneself and one's neighbour. It is also used as a greeting and a way to say good bye. This understanding of peace is very rich. It embodies the highest aspirations and yet is earthed in everyday expressions of greeting. This is a wonderful picture of what true peace is. It has its heart in the highest and its feet firmly on the ground. 

Years ago I worked with a client who had a long and serious criminal record who had spent considerable time in prison. Today and for several years he has lived a normal respectable life in a normal respectable house. There are a number of reasons for this transformation. One is that he found some peace in himself and that spread out into all the aspects of his life. Just like a stone thrown into a pond the ripple effects are still going on. Peace changed this man and it can change us too. We accept that each of us has to find our own hope and peace. This is a part of our own journey of self discovery and worth. We started with questions and we will end with one. How can we make ourselves and our services real centres where hope and peace can flourish and shine? In our answer lies tomorrow's future.

Julia Hayes, Director of Inclusion Creativa 

John Walsh, York Street Health Practice