Enabling partnerships for change

We live in a simultaneously challenging and encouraging time. It is challenging as economic austerity impacts on public services and we are faced with growing social and health problems which cannot be simply diagnosed or easily solved. These problems have multiple causes and complex inter-relationships. It is encouraging as we see new energy, ideas, movements and initiatives emerging as innovative ways forward. In this era of constant challenge and change we must keep positively focused on seeing new possibilities and co-creating new futures. Fundamental to making this happen is the notion of effective partnerships. hence our reference to 'co-creation' of new futures. How can we bring together existing expertise and services in effective, authentic and supportive partnerships to make the difference?

This post is co-authored (partnership working in action!)  by Professor Ieuan Ellis, Dean and Pro-Vice Chancellor at Leeds Beckett University and John Walsh, Practice Manager at York Street Health practice, part of the Leeds Community Healthcare NHS Trust (LCH). In this post we outline some elements of partnerships established between York Street Practice and Leeds Beckett University, and reflect of how partnership working has happened and the dynamics that stimulate its work and life.

Leeds Beckett is a modern, professional regional university with a population over 2,900 staff, 28,000 students and with a firm commitment to be a catalyst for social and economic progress in and for the region as well as making its contribution and impact nationally and internationally. The university has been estimated to contribute over £450m to the local economy every year. The Faculty of Health and Social Sciences is one of the four university faculties and plays a key role in establishing and enabling partnership working 

Leeds Community Healthcare NHS Trust is a family of 65 community health services. This includes services  such as community dental, prison healthcare, district nursing and health visiting. Within the trust, York Street Health Practice is the health team for people who are homeless and in the asylum system.

The partnership between our two organisations has grown over the past two years. It embodies a number of different facets, themes and partnership links with other organisations which include the following examples;

  * A partnership between York Street and academics from social work, social care and youth and community studies to create best theory and practice in working with the marginalised, vulnerable and bringing street work perspectives. This is part of a wider international partnership with the universities of Amsterdam, Prague and Barcelona and involving Leeds Adult Social Care Services and so has an integrated care approach to the teaching and development of the work. Last year colleagues from Leeds Beckett, Leeds Adult Social Care and York Street attended a conference in Prague with students and colleagues from these universities and offered teaching and joint collaboration on academic perspectives. This partnership has resulted in funding for research into York Street Practice and its model of care and how adult social care works in addressing homelessness from a street perspective in Leeds.

* Funding has been acquired to hold an international conference in Leeds on new themes in inclusion. This conference will bring together managers, academics, organisational development specialists, practitioners and service users to look at how we create best culture for staff and best care for patients and carers. The conference will highlight international, national and local ideas and practice.

   * The development of a new undergraduate course at Leeds Beckett on youth, communities and society has York Street as key advisory partner. York Street is presently talking to key NHS figures and organisations about ensuring this course achieves recognition for best innovative practice and transformational change.

   * York Street is working with Alan White, Leeds Beckett Professor in Men's Health, looking at how we reach out to some of the most vulnerable people in the city. This partnership work was celebrated during Men's Health week last year in partnership with St George's Crypt. This brought wellbeing practice and health intervention to homeless men. It offered a move away from traditional model of health consultations to one of health conversations over food and dialogue. Health workers from LCH and other health services took part in this holistic and co-delivered event.

   * York Street is presently discussing some mental health and wellbeing research work with Professor White. York Street is also in discussions with Michelle Briggs, Professor of Nursing and Jane South, Professor of Healthy Communities at Leeds Beckett, to develop ideas and map out joint-working for the future

   * Paul Mackreth, a senior lecturer in community nursing at Leeds Beckett, is working with York Street. The team will be offering teaching on leadership this year for student district nurses.

The tripartite partnership of Leeds Beckett, York Street and St Georges Crypt has helped inform the work of CommUNity, a Leeds Beckett community campus partnership. This is an initiative that builds sustainable partnerships between voluntary/community organisations and Leeds Beckett with an emphasis on projects focused on health and wellbeing. The overarching goal is to find new, more effective ways to improve health and reduce health inequalities in communities. Combining the resources and knowledge of community organisations with those of the university creates benefits for both partners: it improves knowledge exchange and gives staff from both sectors access to different sources of expertise, widens participation and opens up opportunities for students and research.

In reflecting how and why this work happens, a number of key elements come through, three of them described here.

To start with there is a shared purpose and vision. The key people involved have moved beyond 'silo' thinking and working to what Kate Cowie, the social change specialist, would term 'a world centric view'. This view is panoramic. This vision is one that respects different disciplines and seeks to create a meeting point for them to develop and learn together. It is an explicit recognition that we work better together and can only deeply learn from and each other in listening dialogue. It looks outward and is open to the new. This provides the framework and field for the work and ideas to appear. The focus has always been on something bigger than ourselves. It has been what can support best health and care interventions with homeless and vulnerable people.

The second key to this successful partnership is that it is capable of creating positive and creative space. We may all have attended meetings where there is no freshness or innovation or inspiration. The joint meetings between Leeds Beckett and York Street have been places of trust, openness and clarity. They have been where it is possible to test and sift ideas and options. We would venture that one key ingredient here has been that the participants haven't seen partnerships as what we can get but more about what we can all contribute to the common good.

A third key aspect of this fruitful partnership has been the human element. Support, kindness, humour and respect have marked the work and tell us that partnerships are fundamentally not just about what we do but who we are. They offer the possibility to bring our best gifts to the present.

As this new year of 2015 starts we will continue on this road of trying to create a health and education partnership that makes the difference in our city and beyond. This post is a sign and witness to that commitment. We believe we are only at the start of a journey that offers potent and engaging models of how we can all work and learn together. This offers something for all of us. It also offers a future. 

John Walsh, Practice Manager, York Street Health Practice

john.walsh@nhs.net @johnwalsh88

Professor Ieuan Ellis,  Dean Faculty of Health and Social Sciences & Pro-Vice Chancellor, Leeds Beckett University

i.ellis@leedsbeckett.ac.uk  @Prof_IeuanEllis

Building therapeutic relationships

We have a team of health visitors that work with babies, young mums and families across Leeds. Sam Taylor is a recent member of the team...

“I'm passionate about community services because
working in the community allows me to see
clients in their own homes and environments,
which allow me to build the therapeutic
relationships that are key to my role.”

"I have been working in health visiting for just over one year. I recently completed the post graduate diploma, which included a year-long placement with one of the Leeds Community Healthcare NHS Trust's (LCH) health visiting teams.

My background is in adult nursing and I previously worked in a hospital, which gave me valuable experience in healthcare and with the public. I trained to be a health visitor as I wanted to make a difference to outcomes for children and families, as well as trying to improve their experiences of childhood and parenting through caring support and guidance.

I received a lot of support whilst on placement at LCH and was made to feel part of the team from day one, this made me want to return once I was qualified.  

The role of a health visitor includes a variety of things, such as delivering the core Healthy Child Programme, running well baby clinics and the antenatal programme for first time parents, assessing families and children who require additional packages of care and planning these as well as attending multi-professional meetings for families.

In health visiting it is really important to form empowering relationships with families that support them in making changes to improve the outcomes of their children. It is extremely rewarding when you see these changes happen."

Meet Our Team: Sarah Holbrey

1

     Sarah Holbrey is one of our Stop Smoking Advisor's. We interviewed her about her role in the community with the Leeds Stop Smoking Service.

How long have you been doing the role?

I started working for the trust in May 2014 and was new to the role of a Smoking Cessation Practitioner.

   

   Tell me a bit about your background

     I studied psychology and health psychology at university which ties in nicely with the health promotion and behaviour change aspects of my current role. I previously worked as a healthcare assistant in a low-secure mental health unit for Bradford District Care Trust and more recently as a researcher in dementia care research at the University of Bradford.

     What brought you to work at the Stop Smoking Service?

     I realised I did not want a career purely in research, but instead wanted to work in a more applied way, working closely with clients and being at the heart of an intervention where I can see the direct benefit an intervention has on a person’s well-being.

   Why did you want to work in the community?

I liked the idea of working across different settings and thought it would give me more opportunities to work with a broader range of client groups too.  

   Describe a typical day

     A typical day is usually a mix of clinical work and admin. If I have a clinic that involves setting up any equipment and resources needed for the session and welcoming both new and ongoing clients where I will discuss options with them, measure their Carbon Monoxide levels and support them to plan coping strategies in their quit journey. The admin side involves restocking my resource bag with things like record sheets, leaflets and booklets, answering emails, ensuring electronic records are up-to-date and other bits and bobs like faxing treatment requests.

   What area of your work do you find most rewarding? 

I love the clinical aspect of my role. It’s wonderful to see the changes in clients as they progress along their quit journey. Quite often people are nervous at first or unsure of what to expect from the service, or are feeling a bit low in confidence if they have relapsed. It’s so rewarding to see them grow in confidence once they achieve their quit day and I can see them changing in front of me, for the better, both physically and emotionally. And of course, knowing that I just might have saved someone’s life, as sadly, one in two people who smoke will die from a smoking related illness.

How would you like your career to progress?

I want to pursue a career in public health and health psychology so I can have a more direct influence on developing effective and evidence-based interventions. This of course means more studying, but I'm always keen for a challenge!  

Autumn is in the air

In my travels around the health centres, doctor’s surgeries and leisure centres across West Leeds last week, I noticed there is a definite autumnal feel in the air, with lots of brown crisp leaves getting blown into the health centre corridors.

I keep telling my clients that it’s a great time to stop smoking because the weather is on the turn and it is getting chillier so who wants to be stood outside smoking and shivering when they could be inside all cosy and warm. If that's not enough of an incentive, the money they could save could help them pay for Christmas. A 20 a day smoker could save over £500 over the weeks between now and Christmas. 

As well as quitting smoking to help improve lifestyle, our Healthy Lifestyle Service is on hand to support with other areas ( The Healthy Living Service is a city-wide service, you can find out more here ). At the start of October, we, the Stop Smoking Service, opened our first joint clinic with the Health Lifestyle Service. For the first time, people can come along to Armley Moor Health Centre on a Wednesday and get help with stopping smoking, advice on healthy lifestyle changes like diet, exercise and reducing alcohol consumption in one location. People can see our Stop Smoking Advisors, Emily and Emma, or our Healthy Lifestyle Practitioner, Tash. This is a truly is a holistic approach and one stop shop to a healthier lifestyle for the West Leeds community. New people are invited to come along at 6:50 pm and returning clients sessions run between 5:30pm and 6:45pm.

If you want to find out more about where the nearest clinic is for you, please get in touch, call 0113 843 4537.

Maree Diamond

Stop Smoking Advisor

The Wellbeing Compass

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

  

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

  

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

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

  

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

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

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

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

John Walsh, Support Manager, York Street Health Practice

Gill Trevor, Director, Phoenix Health and Wellbeing 

The I of Illness and the We of Wellness

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

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

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

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

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

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

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

John Walsh. York Street Health Practice       

World Homeless Day

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

Client visiting the GP at York Street

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

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

                                             * educate people about homeless issues

                                             * celebrate and support local good works

                                             * highlight local issues  

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

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

John Walsh. York Street Health Practice

Dancing in Winter

Leeds Beckett University and York Street Health Practice are just starting to plan research on the work, model and care the practice tries to provide to people in Leeds who are homeless or in the asylum system. I met the other day with my good friend and Leeds Beckett colleague Dr Erika Laredo. Erika teaches Youth and Community Studies and has been a key element in the work between York Street, the university and Adult Social Care in working to create the academic and practical space where best practice and theory can emerge. We met for coffee to discuss York Street and I tried to explain how we work, what we do and the model of care we use. In the context of this dialogical exchange I realised more fully and deeply then ever that Erika could not properly understand York Street and neither could I without seeing it in terms of what was happening in the NHS nationally. It was only in the bigger picture that York Street makes so much sense and offers so much possibility. The metanarrative here was this. This bigger theme was the real story of which York Street was both product and response.

 At the end of the day I thought of the people I had spoken to or had contact with that day. The answer was both surprising and charming. There was my great and true colleagues from Leeds Community Healthcare like Steve Keyes, Catherine Hall, Eleanor Wilman, Anne McGee, Jo Speight and Lisa Falkingham. There was Anne Cooper the Lead Nurse For Informatics at NHS England. There was Alicia Ridout from the Health Innovation Services at The University of Leeds, Maxine Craig, OD Lead at South Tees NHS Trust, Becky Malby from the Centre for Innovation in Healthcare Management and the Leeds LAMSOC ( medical students championing quality and caring leadership ). There was Dave Ashton and the inestimable Yvonne Coghill. There was of course my good colleagues at York Street working for the homeless. And there was an inspirational student nurse called Louise Goodyear who is at Wolverhampton University. What struck me was all these people connected with the NHS represented a movement - a force might be a better word that represents what the future of our service could be. Feeling both humbled and proud at the same time I saw how York Street was part of this energy that was working to create new ways of thinking and being a health service. In fact I believe the connections were precisely because people were moved and held by the same visions and hopes.

So what is this movement? What does it mean? What does it seek? What happened at Mid Staffs Hospital is the clue and key here. It  shows us the old system at its worst. Hence the need for fresh thinking and ideas about where we go. Across this service people and movements are working to ask the questions, have the dialogue and seek the solutions we all need. Creative innovative thinking and practice are mushrooming all over the system.

What are the signs of this movement and its people? There are probably many. The following come to mind.

    * Innovation

    * Openness to others and new ideas.

    * Effective and learning / teaching partnerships with the third sector and faith communities

    * Compassion and goodness as central values

    * The use of digital technology to enhance the speed and quality of access to healthcare

    * A move away from 'We know' to 'We offer - let's work together'

    * A real commitment to dialogue

    * A listening to needs and hopes

    * Positive risk taking

    * Seeing gaps and issues and raising them

    * The use of intuition. Einstein's point about the intuitive mind rings so true here. 'The intuitive mind is a sacred gift and the rational mind is a faithful servant. We have created a society that honours the servant and has forgotten the gift.' This movement celebrates the gift.

    * This movement values systems but sees beyond to people and communities as central and as living and vibrant assets.

When I think in images of the old and new, I see two things. When I think of the old system I think of a great mechanical machine that works to produce something. To be fair much good was done through and in the old system. Yet the image of machine echoes true to me. And this new movement? The image that comes to mind is a dance where the dynamic interchange goes on and on in different forms and shapes. The Hindu faith tradition has a wonderful way of describing the cosmos and life itself. It calls it a  dance - a dance of energy, power, being and opportunity. The symbol of   dance helps understand this move across Health. There may be disagreements and debate but there is a direction. There may be different voices and ideas but there is real vision,potency and participation. 

Mid Staffs probably represented the worst point in the history of the NHS. It was a dark night for our service. The shock, scandal and heartbreak we all saw and felt expressed our devotion and commitment to the NHS. Health had entered a winter season. These new movements, services and people are a counter sign to that. They are the signs of a better and new tomorrow for the NHS. They are the signs of hope and renewal. They are the signs of spring.

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 

Little bit of peace and quiet

Danny, one of our public members

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

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

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

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

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

Daniel Lipzith, public member of LCH

John Walsh, York Street Health Practice

Meet our staff - Rehan Majid

The trust has a wide variety of services and employs over 3,500  people, many of which carry out different roles. Through these blog posts, we aim to offer a snapshot of some of these roles by talking to people that either care, treatment and support.

Rehan speaking to a client at York Street Health Practice

Rehan Majid, a Client Support Worker at York Street Health Practice, has kindly shared with us an insight in to his role. 

Tell us what your role as a Client Support Worker involves...

The CSW role is very varied and diverse. I work with and across all client groups here at YSHP, helping, supporting, signposting and advocating in whichever support matter is raised with me, with the exception of Immigration. In this role, it is vital to be able to think and work on my feet and be able to be very resourceful and to be able to work under pressure.

Working with various clients across the practice is wonderfully diverse, and brings the best out of me as I have to be able to switch from one set of issues to another often in a very short space of time. In my professional opinion, it is imperative to have a basic understanding of various systems whether health, welfare or the Asylum Process.

Moreover, the role entails being able to go out and deliver presentations on issues that I care about very passionately and share information with whichever audience I have been requested to speak to. The teaching aspect is for me is equally wonderfully satisfying for me, as I am able to utilise and demonstrate skills that lay dormant within me.  

                                                                                                                                                                  

Why did you want to do this role?  

I wanted to do this role for several reasons – primarily to try and help make a difference to people’s lives, to do my best to be a strong advocate as possible for the most vulnerable client groups in today’s society. To be able to care for people and support as much as feasibly possible the most vulnerable client groups in our society. I already had some previous experience within the voluntary sector and prior to that in a College of Further Education as a Street Life Support Worker. Having being grounded and brought up with a very strong sense of social justice, it was a natural step in a sense to be able to contribute in a positive sense, and be able to put back into the local community after having fulfilled my academic responsibilities. To be able to care for and work with the various clients groups is an ultimate privilege and an honour, and is a very humbling experience.

  

What is the best bit about doing your job?

The best bit about doing my job is being able to help our service users, even if it just means being there to listen, as often clients are in crisis, immense distress and feeling very alone. Hence, being able to listen to and support, providing empathy and a listening ear is often very powerful and can give people the lifeline that is required. 

Being able to help in the process of change is a critical aspect and most rewarding aspect, particularly when I am able to witness at first hand the progress of a client is a tremendously profound feeling, as there is some sense of achievement in those particular scenarios.

Have you seen York Street change during your time in role?

I have been very honoured and privileged to be able to witness the journey of the York Street Health Practice since its inception four years ago. York Street has gone from strength to strength, working exceptionally hard to try and meet the needs of our most vulnerable service users. Recently, the practise achieved the GOLD LEVEL of Involvement Standards, as well as being praised by local, regional and national agencies and above all by Dr Stephen Field from NHS England.

There are many changes that occur on a very frequent basis; however one critical aspect is that the levels of high quality care are not affected. YSHP prides itself on very high levels of quality holistic care, a welcoming and non threatening atmosphere. 

Do you have a particular highlight from your career to date?

Working at York Street has been a pleasure and a privilege, there have been some very touching and heart warming moments where some of our clients have been able to say thank you in very profound expressions, to listen just for a few seconds and hear what it means to have someone to sit, listen and care for that individual at that time.

If someone was thinking of joining the trust in a similar role, what advice would you give them?

I would encourage that particular person to be non judgemental, caring and compassionate, and to be ready to be open minded for the journey of a lifetime ahead. Moreover, it is important to have an understanding and empathy and be able to demonstrate plenty of compassion. It takes a special kind of person to be able to undertake a role of this nature, and to have very strong interpersonal skills and high levels of cultural awareness.

Thanks to Rehan for taking the time to share this.  

What happens at an NHS AGM?

On Thursday 18 September, we will be hosting our Annual General Meeting (AGM) as well as a Health Fair and Achievement Awards. This is a chance for us to reflect on the past year, highlight the work our services have done whilst looking to the future for the trust.

For those who have never attended an NHS AGM, we thought we would give you a rundown of what to expect on the day.

The event, which is taking place at Elland Road, home of the mighty Leeds United, welcomes everyone to attend. There will be a mix of people that work for the NHS or third sector organisations alongside members and the general public.

Opening at 4.30pm, the official AGM will start at 5.30pm and run until 6pm. During this time, Chief Executive, Bryan Machin, will provide a summary of the past year and then the financial accounts will be delivered by Cherrine Hawkins, Interim Executive Director of Finance and Resources. Guests will then be invited to ask the Board of Directors questions, these may touch on changes we’re making to our services or how money is spent across the trust.

Throughout the event, there will be lots of stalls for people to visit as part of the Health Fair. Many of our services will be there to showcase the care, support and treatment they provide to the people of Leeds and beyond. From 7pm to 8pm, we shall be celebrating achievements over the past year. Starting in July, staff began nominating their colleagues, teams and volunteers, for the awards, of which there are ten categories. Prior to the awards the nominations applications were narrowed down by a panel of judges. Dr Dawn Harper of Embarrassing Bodies on Channel 4 will be on hand to present our winners with their awards.     

We look forward to seeing you on the 18^th but if you can’t make it, we’ll be live tweeting from @LCHNHSTrust and posting updates to our Facebook page – Leeds Community Healthcare NHS Trust to keep you in the loop.

If you have any questions, please get in touch, email us at lch.comms@nhs.net or call 0113 220 8512.

Sarah Elwell, Communications team

The space to be vulnerable

Sean had a problem. He knew he was drinking too much. As a result his work, marriage and life were in trouble. What had started as a 'weekend relaxer' was now a weekday, sometimes daily, activity. Sean had made all the just excuses...

'Work is very stressful at the moment. I'll cut back when things get calmer'.
'I don't have a problem. It just helps me relax.'
'I probably drink too much but I can stop anytime.' 

Yet Sean did have a problem and a recent conflict with his family and time off work due to the alcohol had confronted him with his need for help. He was now on his way to his first meeting of AA ( Alcoholics Anonymous ). Sean arrived at the meeting and sat down with a few minutes to spare before the meeting opened. His mind reeled with a flurry of thoughts and a strong wish to bolt and get away through the door. Things got even worse when people stated to share with the famous words 'Hi. My name is X and I'm an alcoholic.' Sean was confronted by the vulnerability and deep honesty of those there. This struck him and confronted him. Sean got though the meeting and came back for more. Today he is many months sober.

Sensing our vulnerability is both a great challenge and a great possibility of growth. We often, like Sean, don't want to admit our vulnerability to ourselves or any one else. It's no accident that the 12 step movements such as AA start with this radical self honesty. The person admits to themselves and others that they have a problem and are there to learn how to deal with it. We do not need to have a gambling or alcohol problem to be vulnerable. Many things can make us feel this way. The news, work issues, relationships and people can bring to the surface the sense of not being OK - of feeling shaky and at our weakest point. This is a natural thing. It's human to feel vulnerable.

One thing some people find very helpful is to have the space to be vulnerable somewhere in their lives. This is where they meet with a person they trust. There is the positive centre where they can talk about how they feel and seek the path forward. These spaces where it is safe to be vulnerable we would contend are vital for good mental and emotional health and wellbeing. They can only exist where there is a positive connection, real trust and a non- judgemental framework. They are not spaces or place to beat oneself up or be ultra negative or throw accusations at others. More than anything they are places of affirmation and reality checking. They can exist in workplaces and in other life environments. They have three core elements which make them work - context, connection and consciousness. They offer a context where we see things in a larger way. We see our weakness but also our strengths and lights. This allows us to see our struggles in convergence with our qualities and this meeting offers possibilities of resolution, hope and coping. They offer connection. Firstly to another person and through this other to the wider human experience. It's easy to believe when we have a problem that we are on our own. These spaces, in a sense, bring us back to the human family. Through context and connection the third element can take place.  Our consciousness can change. Our views of ourselves and the issues can start to alter and new ideas and visions can start to grow. These spaces then can be truly transformative, albeit, in a gentle and quiet way.

These spaces allow us to be our authentic self. The real us is a mixed bag of things wonderful and things not so great. That's the same for all us. The challenge is how we learn to accept this and work to make the good better and either make the less good what it should be or learn to accept it. This work of inner integration leads to what might be called wholeness, completeness or true self acceptance. Dr Brene Brown, a research professor at the University of Houston Graduate College of Social Work, wrote a book with a fascinating title,  'The Gifts of Imperfection: Let Go of Who You Think You're Supposed to be and Embrace Who You are'. If we let others define who we really are we will lose our real self. In these spaces the real us can start to live and breathe.

Sean had to touch his own vulnerability to see who he really was. Yet the vulnerability was not the final destination but a road to discover a new life and self. In work we can help create these spaces to be vulnerable but only if we become people of care and trust. An interesting paradox really - it's when we start to be what we really are that we can help others find themselves. There's  an old Latin phrase and legal rule - 'Nemodat quod non habet'. It means 'No one gives what he doesn't have'. We cannot give what we haven't got. It's only when we start to become what we want to see in others that we can be truly forces of transformation. Ultimately its transformed people who transform others and its only inspirational visionary people who give vision and inspiration to others. The great news is that we can all do this. We can all in very different ways and shapes be people of inspiration, vision and catalysts of change and recovery. The reason is simple. Just as we all have  vulnerabilities, we all have tremendous potential and gifts. It's the tapping and release of these that can change our world. 

Denis Jackson, Mental Health Chaplain, South West Yorkshire Partnership NHS Foundation Trust

John Walsh, York Street Health Practice

The Power of Listening

Wouldn't it be great to be a really good listener?
 
Someone  once described Sigmund Freud, the 'Father of psychoanalysis', as such, "He struck me so forcibly that I shall never forget him. His eyes were mild and genial. His voice was low and kind. His gestures were few. But the attention he gave me, his appreciation of what I said, even when I said it badly, was extraordinary. You've no idea what it meant to be listened to like that." Wow! What an incredible listener and power of listening.

Most of us think we are good listeners but are we? We probably often go into situations with minds full of ideas, hearts full of emotions and actions full of agendas and what we want from the meeting. Doesn't this block real deep listening? Is it is possible to deeply listen if we are full of all this stuff? Perhaps it's when we put to one side all our drives and wants and really become present to the other or others that the real gold standard listening really walks on stage. What is certain is that people usually pick up when they are not listened to. The refrain of 'He's not listening' is usually connected to ' He doesn't care'. This is a real issue as listening really is connected to caring for someone.

We recently heard a moving story about listening that we would like to share. Someone known to both of us had to go to a meeting where a team was going through a tough time. This person started to feel the trepidation and anxiety most of us would feel. What to say ? What to do? The friend concerned spoke to a wise colleague. The idea that came through was that the person should go to the meeting but not to offer solutions and 'magic answers' but rather themselves in presence and listening. They would go and listen and be there with people even if it was difficult. This just 'being there' and 'just listening' was what our friend did. Our friend describes the effect of this approach. 'I have to say that this was one of the most invigorating and humbling days of my career. All I did was listen and be with those individuals. They achieved what they wanted to achieve, but more importantly for me, they had the space to be themselves.'

There are three fundamental lessons here for us all. The first is that when our friend had a problem she spoke freely about her feelings to someone she trusted. That person listened and supported the emergence of possible approaches. Here we see the therapeutic process in a nutshell. Honesty, feelings, trust , listening and answers emerging from the encounter. Here we have a framework to create solutions and possibilities. We would guess that this is bit like a wizards spell in a fairy story book. If one of the ingredients is missing, it doesn't work or doesn't work fully. However, when all the components are there that's when the magic of options opening up starts. The second thing that we see is our friend decided to be part of the process rather than a 'fixer' or 'outsider'. She decided to go to the meeting to be present, to be alongside, to listen. A psychiatric social worker known to one of the writers used to do what he called 'the practice of presence'. He would visit patients on wards who had serious mental health problems and just be with them. He didn't seek to offer forms or solutions but himself as positive and listening presence. We are sure his presence was a healing and helpful one. This sort of listening and being present can only come from the depths of who we are. It really does mean putting aside our robe of importance and talking and 'just being there...just listening'. The third life lesson is what the result of this approach was. Our friend had an experience which was invigorating and humbling. The team did what they needed to do and were able to be themselves. This isn't a guaranteed result every time but there is something about humility, listening and openness to others that can help clear a way through difficult times.

Can we develop fantastic listening skills? Can we really move away from being people who are desperately waiting for the pause in another words to jump in with our words and statements? The good news is that we can. There are probably many things that can help this. We will pinpoint two. We will call them the direct and indirect approaches. The direct approach is to try to do what our friend actually did. To sit and listen and be open to the other person. To try to avoid the distractions - the looking at our watches, checking our phones and thinking about something else. If we try this again and again we will probably find out how difficult it is to really listen and be present. This practice will however start to sow the seeds that makes us great listeners. From these small acorns great trees can grow.

The indirect approach is that if we focus on developing ourselves in an authentic way we will become skilled listeners because to develop ourselves we have to listen to ourselves. Those on this journey will find their listening faculty developing as they progress. Not because they work on it but because they work on themselves. It reminds us a bit of students coming to York Street. They were totally focused on ticking certain competency boxes. We would tell them not to worry about this. They would tell us they had to get these competences passed. We would say 'Do the work and the boxes will get ticked. Focus on the work and you'll display the competences' and they always did. If we work on ourselves we will have to do a lot of humble listening and just being there with ourselves and others.

Is it worth walking this path of developing ourselves? Yes it is. Abraham Maslow, the eminent psychologist, did his studies not so much with the mentally unwell but rather those who had good mental health and stability. He spoke about the greatest of these people as those who were 'self actualized'. He went on to describe this state of self actualization - ' What a man can be, he must be. This need we may call self-actualization...It refers to the desire for self-fulfillment, namely, to the tendency for him to become actualized in what he is potentially. This tendency might be phrased as the desire to become more and more what one is, to become everything that one is capable of becoming.'  This promise and possibility is what will make us not just the best listeners possible but the best people possible too. And surely that's worth it.   

Lisa Falkingham, LCH Service Improvement Team

John Walsh, York Street Health Practice