The view of a student health visitor

We welcome many students on placements at LCH and aim to give them opportunities that will help them develop in their chosen field. Jenanne joined our Health Visiting team on a placement, and below she shares not only her experience of working in that service but also shadowing the senior management team...

"As a student health visitor who is soon to qualify, the opportunity to spend part of my training on Alternative Practice was attractive. This afforded me time to shadow other professionals and services to gain an insight into their practice and as such, I spent time with community midwives, school nurses, those who provide services for children with additional needs and shadowing health visitors in another NHS trust (amongst others). As illuminating as these experiences were, I couldn’t help but wonder what life was like at the top of the tree – and was very gratified when Thea, chief executive at LCH, agreed to have me shadow her for the day.

On the surface of it, spending the day in the Quality Committee and Senior Management Team meetings may not sound that interesting. But I was astonished at the breadth and scope of the services which LCH provides – and the commitment that those involved have towards providing quality care to all our service users. One guiding principle, it emerged, should underpin all care: would you want a loved one being cared for by this service?  If the answer is no, then concepts of ‘quality’ and ‘targets’ are irrelevant. We should all strive towards this gold standard, and not tolerate anything less no matter how challenging our clinical environment.

Another powerful message which I took away was that decision-making can be characterised by clarity and speed. It is appropriate to ask ‘why not?’ when others put up barriers to change; it is not enough to accept that things cannot be changed because they have always been done that way, or because there are personal politics at stake. Instead we must all ensure we are working as a team in both our locality and as part of the trust as a whole.

Far from being abstract and aloof, the fundamental message that I took away from the day was that those in senior management have an acute perception of what things are really like for staff ‘on the ground’ and that we are all working together towards the same goal: providing safe, transparent and top quality care for all who use our services."

Jenanne Fletcher, student health visitor

To find out more about the Health Visiting team, click here. 

Healthy Lifestyle Service Walk Leeds

On Sunday the Healthy Lifestyle Service were at the launch of Walk Leeds, a walking festival that is running until Sunday 7 June. Tasha, a healthy lifestyle practitioner from the team recaps the event... 

"Thankfully the weather held out for us and didn't rain, which was a good start. The event was well attended and we got the opportunity to speak to over 100 people, some of which we referred on to use the Healthy Lifestyle Service. 

The Mayoress of Leeds, joined by Janet Street Porter, opened the event and then took part in a two mile brisk walk returning to collect packs, information and advice from Janine, one of the dieticians from Weigh Ahead, and myself.

People we spoke to said the service sounded great, particularly because of what we offer which includes 12 weeks of support, Bodyline Gym membership cards and LLGS sessions plus lots of motivation which people do struggle with. 

If you are needing some extra support or advice to improve your lifestyle, you can get in touch with the team by calling 0113 843 4537. We're available on the phone Monday to Friday between 9am and 5pm but clinics run at various times. For example, we run an evening clinic at Armley Moor Health Centre, which you can drop in to." 

If you're interested in finding out more about Walk Leeds, visit www.walkleeds.com

All about that paste…

All about that paste…

Kathy (left) alongside her colleague, Dawn,
at a Mouth Cancer Awareness Event

For the past 25 years Kathy Fox has been ‘All about that paste’, working in the Community Dental team, educating people about good oral health.

“I have worked for LCH 25 years this year. My career began as a dental nurse before I studied post graduate qualifications that led me on to work in oral health, which I have done for the last 15 years. 

My role is to lead, deliver and evaluate preventative programmes for children, young people and vulnerable adults at risk of oral health inequalities. I enjoy the variety of work and the people I work with and meet in my role. There is such a rich diversity in the staff and members of the public. 

As part of my role, I train a wide variety of services, for example, teachers and Early Start teams; provide expert knowledge and up to date resources about oral health promotion; lead citywide public health campaigns; promote dental registration and attendance at general dental practices. I enjoy the belief I have helped someone and educated them on how to maintain good oral health and access oral health care. 

As well as all the role responsibilities things I’ve listed above, I continue to work as a dental nurse at the Out Of Hours service so I see the difficulties patients experience in trying to register and the bad experiences some patients have had.

I get to work on lots of new exciting projects as part of my role. Recently one of these projects was creating ‘All about the paste’, a parody pop video. We came up with the idea of creating the film as a fun way to engage with young people and we think we have achieved that. We’ve had lots of positive feedback – if you haven’t seen it yet, you can watch it here.

If anyone is thinking of joining LCH, whether as part of the dental team or another service, go for it. There are lots of new opportunities and challenges to enrich your career here.”

Dying Matters Awareness

Next week is Dying Matters Awareness Week. The aim of the week is to encourage people to talk about dying, death and bereavement and making plans for their end of life care. The trust's end of life team, part of District Nursing, works alongside other organisations in the city to support and care for people who are in the final stages of life. You can find out more about this collaborative care at www.leedspalliativecare.co.uk 

Jane and Dianne 

Jane and her colleague, Dianne, have written a post about what their roles as a palliative care discharge facilitators involves, and how they work with patients and their families. 

"Dianne and myself are both district nurses. We began our role as palliative care discharge facilitators in 2011 after it was recognised improvements could be made to discharging patients who wish to die at home. Improvements included speeding up referrals to the District Nursing teams and cutting down on the delays in care planning meetings and care packages. Transfer of care at end of life needs to be organised safely and often within hours to ensure people can get home or to their care home quickly, if that is their wish and families feel well supported.

We support district nursing teams to deliver high quality end of life care by ensuring everything is well organised and the transfer of care is seamless e.g. completing the community nursing documentation, ensuring medications are available. This enables district nurses to spend more time with the patient and their family when they arrive home. Also as part of our role, we support district nursing teams by attending discharge care planning meetings on their behalf, often on the day of referral. If patients have a Leeds GP we will attend care planning meetings at Leeds or neighbouring hospitals and hospices. Care planning meetings are arranged either by a joint care manager or a medical social worker. The meeting gives the patient and relatives / carers the opportunity to express any concerns or anxieties regarding the discharge home and explore all options. Following  the  meeting, we co-ordinate equipment / care with the other healthcare professionals involved. The ward staff handover the patient's care and the home circumstances and environment are taken into consideration. The hospital occupational therapist and physiotherapist work closely with us to identify equipment required for discharge.

We both spent many years as part of the district nursing team looking after palliative patients at the end of their life and have developed advanced communication skills enabling us to have sensitive conversations at this difficult time. We have also built strong relationships with ward and community staff, acting as a link between the staff and patients / families when their care is transferred.

We are both passionate about what we do and endeavour to deliver a quality service. The most fulfilling part of our role is enabling patients to die in their place of choice and families feeling well supported at such a difficult time." 

Jane Wilde and Dianne Fawcett, palliative care discharge facilitators

Here is one example showing how the district nursing and end of life care staff recently worked together to ensure a patient's wishes were respected and the patient and family were well supported and cared for in the final stages of the patients life. 

On hearing the devastating news that his cancer had spread, there were no further treatment options left and his life expectancy was only weeks left, the patient felt very numb and fearful of what was ahead. His only thought was to return home to spend time with his wife and dog.

A discharge planning meeting was quickly organised. He and his wife said they were relieved to hear about the services and equipment available at home and to know funding was available to ensure they had adequate support. He commented it was good to hear he had choices and could change his mind about the decisions he had made if he wanted too. Also, knowing who would be involved in his care before they went home and that they could contact a nurse at any time day and night really reassured them and made them less fearful about returning home. 

The patient was impressed by how quickly everything happened to get him home and said his dog was happy to see him. A few weeks later he died peacefully at home.  

The business of delivering specialist services

Meet Dan, he’s the Business Manager for our specialist services which are healthcare services for specialist communities (such as prisoners, detainees in custody, the homeless and asylum seekers), or specialist conditions (such as dental, podiatry, MSK, healthy living, mental health).

Dan has shared with us what his role as a business manager entails…

Dan collecting an award at the
LCH Achievement Awards in 2014.

Tell us, what does your job involve?

I am a key link for our services with commissioners. I ensure we have fair contracts that are value for money, that are well specified and that have effective and realistic performance measures. I help services compete for new business or compete to retain their existing business when it goes out to tender. I manage the innovation and business change functions so that services are supported to innovate, improve and embed any changes.

What attracted you to this role?

I've always worked in healthcare and had got into quite strategic roles which felt detached from services and real people. I saw this role advertised and had worked with York Street Practice in a past life and had enjoyed it so I thought I would give it a go. It's a very busy and challenging role, I've never worked so hard in my life! However, it is extremely rewarding as I can see how I am impacting on healthcare for real people despite not being a clinician myself.

What is the best bit about doing your job?

No day is the same. I get to go all over the city, meeting all sorts of people. I'm often working with services that have problems but this doesn't get me down as I feel that I am helping them overcome issues or barriers.

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

I think it was when we won the very first NHSE 'Excellence in Public Participation' award last year. It was for a piece of work where we collaborated with homeless and asylum seeker clients at York Street Practice to improve how they access services and as part of this we won some funding so that patients could use digital technology to manage their own healthcare. When we went to collect the award for this innovation we got to take service users with us. It was extremely powerful and so rewarding to have national acclaim for what was essentially a very simple project. Also when we won the police custody bids it was so exciting - it was hard to believe that months of hard work and late nights had paid off and it made me extremely proud to work for LCH and to have been part of that team.

How has your past experience helped with your role?

I did a Communications degree back in the day so people often think it's weird I've ended up with the job that I do in the NHS. However, the key competency I need for my day to day working is communication skills and the ability to form effective relationships, so perhaps it wasn't such a waste of time after all! I also did a lot of voluntary caring roles at university which made me realise early on that I wanted a career in the NHS and not in the cut throat media industry!

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

Regardless of whether a role in LCH is clinical or managerial we need people who have the right values and who have good people skills - if this is you then do come and work for us. We can train people in all manner of skills and knowledge areas but we cannot train you in the values - this has to be core to you. If you have our values then get in touch!

If you would like to join our team, click here for our latest roles being advertised. 

The Heart of Nursing

Caroline is a cardiac nurse specialist and as part of her role cares for heart failure patients, monitors their symptoms and helps them to plan their long-term care. She is one of 17 community cardiac nurses providing long-term care to patients within the trust.

Heart failure patients require ongoing monitoring because their symptoms, which include shortness of breath, fluid retention and fatigue. It can vary greatly from patient to patient, and also day to day.

“Often we see patients who are really uncomfortable but because of the intervention that we do and the adjustments we make to their medication, their symptoms improve dramatically. Often, within a week or two, patients say they can breathe easier again,” she explains.

Many of these interventions are carried out in Caroline’s heart failure clinic. Caroline spends time with the patients discussing their symptoms and taking blood tests. Based on this information, she can adjust doses of medication accordingly and give lifestyle advice, which can help people to manage heart failure.

Caroline also sees patients in their own home when they are too unwell to attend the clinic. If a patient who is retaining fluid doesn’t respond to an increase in water tablets, they often find that they benefit from having it delivered intravenously via a drip. In the past, dealing with this would mean admitting the patient to hospital. A few years ago, our community cardiac team in Leeds received a grant from the British Heart Foundation’s ground breaking scheme to pilot delivery of intravenous diuretics at home. The trial was a great success, and since, the service has been able to improve the lives of many patients that have been able to receive treatment in their own homes. 

Find out more about the community cardiac service here. 

1001 Critical Days

1001 critical days 

Sue Ranger, consultant clinical psychologist, within our Infants Mental Health team was invited to help develop the  1001 Critical Days Report, which was launched recently. Here she shares details of her experience...

  

"Tim Loughton, MP and former Children’s Minister, said that tackling child mental health issues and maltreatment in the first two years of life should be no less of a priority for politicians as defending the realm.

He made the comments ahead of the launch of an Inquiry conducted by the All Party Parliamentary Groups for Conception to Age 2- first 1001 days into perinatal mental health and child maltreatment. It suggests that the cost of failing to deal with these issues is estimated to be £23 billion, half of annual defence spending of £43billion, and that poor parental / child attachment can be passed down from one generation to the next, creating a vicious cycle and damaging environment in which to grow up.

The report is the culmination of months of inquiry sessions, which took evidence from a committee panels of experts and parliamentarians, to investigate the various factors that affect the emotional and social development of children from conception to age 2. The report was launched on Wednesday 25 February at the Speaker’s House in Parliament where a number of leading academics, clinicians and policy makers in the field were in attendance.

The over-arching inquiry pulls together previous research in the area to offer two main conclusions:

One is that to deliver socially and emotionally capable children at age 2, local policies need to be based on a commitment to primary prevention. The evidence presented in the Inquiry strongly indicates that identification of need should take place before the child is harmed, not after. Therefore, inspection should look closely at primary prevention measures which would deliver this result.

The second conclusion is that, without intervention, there will be in the future, as there has been in the past, high intergenerational transmission of disadvantage, inequality, dysfunction and child maltreatment and the economic value of breaking these cycles will be enormous. In addition, the report offers nine recommendations, which it says are practical, achievable but, above all, the minimum essential if society is to tackle these issues. 

I was lucky enough to be one of those invited to contribute to the process of gathering evidence and opinion to inform the new ‘Building Great Britons’ report on the vital importance of supporting infants and their families in the period from conception to the child’s second birthday. My involvement meant attending a series of several meetings in the beautiful wood panelled meeting rooms in the Houses of Parliament over a period of five months from September 2014 to February 2015 and providing verbal and written comments on the importance of early attachment relationships and support for infants and their families in the earliest days of a child’s life.

A significant and rapidly growing body of research now exists to support the clinical evidence that tells us that an infant’s environment and experiences in utero and in the care they receive in the first months of life will dramatically influence outcomes throughout their lives. If babies have positive and loving care before and after birth from parents who are physically and emotionally healthy then they will grow healthy brains and become secure and resilient children who make good progress and do well in school and beyond. Relationships are a key part of this process and that includes the relationships that parents have with professionals and services to support them in caring for their babies and young children. Proactive and preventative services are less costly in the long term than reactive services to address established difficulties so the policy makes good economic sense too.

I was formally invited to attend the launch of the 1001 Critical Days Report on Wednesday 25 February, along with various others including our local CCG Children’s Commissioner, Jane Mischenko,  by the Rt Hon Frank Field MP and Tim Loughton MP who chaired the APPG meetings. Speakers at the launch included Mr Speaker, The Rt Hon John Bercow MP, The Rt Hon Paul Burstow MP as well as MPs Tim Loughton, Sharon Hodgson and George Hosking OBE, CEO and Research Director of the WAVE Trust. It was quite a line up! The surroundings of the state rooms at Speaker’s House at the House of Commons were equally grand and impressive. Even gaining access to the event required airport style security checks and an escort to the Speaker’s House!

The grandeur of the setting only served to emphasise the importance of the agenda and the significance of this report for me as an Infant Mental Health practitioner in Leeds. Our city is one of few in the UK to have already acknowledged the importance of the first 1001 Critical Days and to already have in place a Best Start Strategy that prioritises proactive and preventative services to support families through pregnancy and the first two years of a child’s life.  Indeed, we held an excellent conference in October 2013 on this very subject at which I was able to present a paper on the ways that Leeds is delivering services for infants and their families to promote infant well-being and outcomes.  We were lucky enough to have several brilliant national speakers on the podium at the conference including George Hosking from the WAVE Trust.

A number of services and initiatives are already in place in Leeds doing sterling work in supporting these families and the infants who are the most vulnerable of our citizens. These include Early Start teams, Family Nurse Partnership Team, Preparation for Birth and Beyond, BabySteps, and the Infant Mental Health Service, to name but a few. An ambitious programme of training and consultation to support practitioners to support families is well underway.

The ‘Building Great Britons’ report is an inspiring and exciting publication that very much endorses the Best Start Strategy in Leeds and the commitment we have made to the first 1001 Critical Days. It has been a privilege to be part of the process of making a little bit of history happen in such an important area of policy. Getting things right for infants produces positive outcomes for them and for society. Truly an investment in the future!"

Sue Ranger

Consultant Clinical Psychologist 

More information can be found at www.1001criticaldays.co.uk

Positive about Change?

'Learning is the discovery that something is possible.' 

Fritz Perls

'The problems of the world cannot possibly be solved by skeptics or cynics whose horizons are limited by the obvious realities. We need men who can dream of things that never were' 

John Keats

Dr Martin Seligman is a Professor of Psychology at the University of Pennsylvania. He is famous for his work in the field of Positive Psychology. This school of psychological thought doesn't seek to replace mainstream psychology but complement it through the study of what gives life meaning and what makes it worth living. It asks how we can extend and amplify the good that is already working in our lives and shining the light on our creative assets and seeking their growth and unfolding.

One of the authors at the beginning of his academic career attended a presentation where Dr Seligman outlined his early ideas about the need for Positive Psychology. Dr Seligman received a series of challenging questions around 'why bother with all this positive stuff?', Dr Seligman replied that he had to because he was a born pessimist. He said he needed a practice that helped him see through problems to positive options and be more optimistic about outcomes. His natural temperament would lead him to be locked in the problem. He needed a key to unlock this process and move to another place to address the issue. This echoes well the comments of Einstein and Jung that we often cannot solve problems on the same level of consciousness that generated them. We need new spaces and thinking to break the code of the problem.

This positive, more optimistic approach echoes much of what we see crossing our services and on forums like Twitter. People and networks are sharing fresh, kind and affirming ways of being and doing as the future framework for change. These new movements offer such promise, potency and energy. Yet it is not always an easy walk although a much needed one, especially if we are talking about the deep, sustainable change that so many of us see as possible and work so hard to achieve. All too often we have experienced changes in services that only touch surface structures, policies and procedures rather than going to the heart of the issues. And sometimes people propose a ‘be positive approach’ as part of these initiatives, failing to really appreciate the complexity of issues, acknowledge the scale of the challenges or engage the difficulties that the people involved deal with on a day to day basis when they see the potential of what could be possible in the face of a reality that seems intractable.

The kind of positivity Seligman is promoting has nothing to do with creating false positive-ness that can only ever skim along the surface of change. Rather, a Positive Psychology approach invites us to name the problems and the pains and see how we can learn from them to work them through in constructive and compassionate ways. Positive Psychology offers much for us to learn. It is not just about being positive, its about engaging with the complexity of a challenge and bringing positive approaches to working with it. Authentic listening, mutual support, empathy, knowing we don't have all the answers, a commitment to deep and open dialogue and the creation of new ways to think and do health and care is the DNA of these new movements. At it’s heart is the belief that all of us have tremendous goodness, gifts and potential. We believe that is from the activation of these wellsprings that the solutions and new forms of service will emerge.

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

- Dr Andrew McDowell  http://www.theperformancecoach.com

(The authors of this met recently at an initiative of the NHS Health Trusts and Public Health in Leeds. They have brought Health Coaching into the city so we can look at and change the quality of our health conversations with patients. The old model is where the patient is the passive recipient and the clinician the expert. This is a move to a new terrain where both are experts and co-create health plans and solutions together. At the heart of this approach lies a view of people as not problems but as people with assets, gifts and potency. This more humanistic and positive model offers great promise to people and the city.)

The Stress Umbrella

'Change the way you think'

After my anxiety stepped up to a new notch of feeling shaky every day and wanting to avoid going to work I knew I needed a little bit more help. I went to the GP and told her how bad I was feeling. She referred me to a service in my area run by Leeds Community Healthcare Trust. Completely free on the NHS, the service offers an indispensable six week course which focuses on the stress umbrella. This features depression, anxiety, overcoming fears, sleep, medication, coping mechanisms and more. I was a little sceptical I have to say – an avid reader with two science degrees and a lot of self help books, I wondered what this course could give me that was new information.

However I cannot praise the course enough. It is divided into different modules and each come with fantastic booklets full of advice and activities to last a life time, and useful homework to apply what you have learned to your week. Every week you complete a questionnaire on how your feeling, confidentially, and this is used to assess the improvements or changes in your mood so that you can get further help where necessary and monitor yourself. This course ended with many people hanging round at the end just to sing and shout their praises. I did not know things like this existed on the NHS, but it motivated me to take hold of life by the horns again. Not only am I feeling over the moon now, but the useful pack and CD are for life, I feel I can refer back to it whenever I need!

Here I break down the course with some of my opinions about it and try to answer your potential questions as a service user.

But when could I even attend?

Leading a very busy work and life schedule I was sceptical about when I would even be able to attend. The course organisers are understanding and exceptionally flexible. There are day-time or evening sessions. When I couldn’t attend one of my Thursday night sessions due to work, they easily swapped me on to a Wednesday session who were up to the module I was up to, and there were a variety of convenient locations in Leeds, including the Cosmopolitan hotel in the heart of the city centre and West Yorkshire Playhouse, opposite the bus station with abundant transport options. If you did miss a session there was opportunity to swap, or catch up via the course booklets. However, it is best you do attend all the sessions for your own benefit. As I said, the course was invaluable to me; it gave me a magnificent boost!

Who else was going, will I have to talk?

The course is not like going to group therapy. In fact, I’d liken it most to attending a lecture or classroom lesson. Each session is around 90 minutes to two hours and always features a brain/drink/toilet/chat break of five minutes or so in the middle. There are usually two speakers so as to engage your listening further (we all know focus is near impossible for two hours of just listening!). You can further prepare for each session with the booklets given out in advance of that session, so you can get a good over-view before you attend. But you absolutely do not have to talk at any point if you don’t want to. The shy and anxious among you, please be reassured, there are barely any verbal questions asked that aren’t rhetorical, and no one has any pressure to answer anything. What you do find however is some members start to recognise each other and even make friends through the course. You also have the opportunity at any time to talk to the speakers in private about further questions. There is absolutely nothing intimidating in turning up and you are always greeted to sign in and grab a drink and weekly questionnaire then sit wherever is most comfortable by very friendly experienced faces.

Now I have to be honest, I thought in the original state I was in, “right, I need CBT, I need one-on-one therapy, it’ll cost loads, and I’ll probably need it for the rest of my life, I’m such a mess”. And so I was sceptical about attending a ‘group session’. I realise now, one of the biggest boosts was attending a group session. For a start, it shows that actually there are so many in the same boat. In fact, I could not believe how helpful that was to me or how many people kept attending. The age range was phenomenal, a perfect cross section of age, race and gender in fact. And there were no qualms in me bringing along my partner or a friend (subject to space on the week’s course). This was most helpful in fact, when I couldn’t relax at 3 am in the morning and my boyfriend would wake up and talk me through the relaxation techniques leant like a prize yoga teacher!

I must say, my problems were quite specific, relating to a couple of things that happened to me in my work life that had made me very anxious in work. I was convinced the course would be far too generic to help. How wrong I was! And, it is a tribute ironically to that old proverb ‘your problems are no worse than anyone else’s. Because while I was thinking my problems were worse, or too specific – actually the thinking cycles involved in depression, stress and anxiety are highly generic. By breaking the way I perceived past situations and upcoming problems I have successfully overcome the pessimistic and over-paranoid thinking patterns.

Course Breakdown

As I mentioned, the course is split across six weeks, and each week also comes with a matching booklet in advance with more information and activities. I have taken here the official module descriptions outlined in the invitation letter and added footnotes about my experiences from the course:

Week One: Information about stress

You will find out what stress is and what it is not, the main signs, the vicious circles that keep it alive and how Stress Control works. We will show you a video of people talking about how stress affects them. We will give you a pack to keep future course materials in and encourage you to start to apply the learning between classes.
An introduction to the stress cycle. Here you will realise how low self esteem, depression, anxiety, panic, poor sleep, anger, addictions and phobias can all be linked and feed each other in a powerful cycle. You will learn how to assess your own personal stress cycle and where the points are you can cut it! I left this class feeling so proud of myself for taking a step myself to self-recovery and also feeling so normal surrounded by so many others. You will see the cold hard facts about how many people are suffering, as well as the full room around you. You will also realise, therefore, it is not you, and you are not stuck like this, and you will learn to remove yourself from the stress so it cannot feed itself.

Week Two: Controlling your body

We get down to tackling stress in this session. You will learn how your body signs feed stress. We look at why we get stressed and how the body reacts to it. You will learn three skills – breathing, retraining, exercise and progressive relaxation and look at caffeine. There is a relaxation CD to take away and we would like you to try to start to use this regularly.

I really enjoyed this session; we learnt not only breathing strategies but physical muscle exercises for instant relaxation. We had a go at doing them as a class and also received the invaluable relaxation CD which takes about 30 minutes to complete. The tracks from the CD are also available to download as MP3 online for those who would rather play through their phones or tablets. The strategies to controlling caffeine were very useful to me as it made me aware of my intake, I’m a bit of a coca-cola and tea addict but working out what time to drink it and how to count it is beyond helpful if your prone to sleep issues, nervousness or palpitations. 

Week Three: Controlling your thoughts

You will learn how your thinking feeds stress. We will teach you ways to ‘think your way out of stress’ – first of all by ‘building the foundation– ‘Wait a minute’. Then you will learn ‘The Big 5 Challenges’ and, finally, you will learn a way to nip stress in the bud – ‘Breaking stress up’.

This is quite possible the best feature of the course. Learning to challenge thoughts. You will learn to be able to strip back nervous and sad impulses and begin to think in a clear, logical way. This will vastly improve your ability to make effective decisions, think with a clear head, and remove “tunnel vision”. The key is not to avoid difficult thoughts, but rather to acknowledge them, and challenge them with the cold hard facts. Thus you will overcome self destruction and insecurity. This aids much more than your happiness, it aids your self-esteem and self-belief. 

Week Four: Controlling your actions

This session looks at how the way we act feeds stress. You’ll learn ways to face your fears and a great skill called ‘Problem Solving’. Also we will look at why some people, who seem to be doing all the right things, still don’t get over their stress. We will then teach you how to overcome this (‘Getting out of the Safety Zone’). These skills are really useful for building up self-confidence. You might start to see the big picture in this session – seeing how all the skills you have learned so far fit together.

Again, a great thing about this session is it actually builds on your confidence to go for things. It teaches you behaviours such as avoidance, why it happens, and how to avoid it. Realising this is natural and part of the ‘fight or flight’ response will help you to realise that you are actually well evolved to avoid things. You will realise therefore the behaviour is not strange but instead how to remove yourself from it – you can overcome these feelings. You will also learn about when you’re avoiding things without realising and thus how to combat oncoming factors. This means you can nip a bout of depression in the bud before it spirals out of control.

 Week Five: Controlling your panic, using your breathing to control stress, prevention skills and Medication

Panicky feelings are part and parcel of stress. This session teaches you ways to control them. We will teach you about using your breathing to calm your body and, hence, your mind. We will also look at some great ways to prevent stress. We will look at tablets used for stress and, if you feel these may help you, how to get the best out of them.

Some really useful information here about panic attacks, how to prevent them through both breathing and productive thinking. Various medications are discussed for anxiety and depression, as well as a review of the famous herbal remedy ‘St John’s Wart’, and you can discuss what drugs are incompatible with each other or suit your other problems best.

 Week Six: Controlling your sleep, Wellbeing and Controlling your future

Poor sleep is often a result of stress. It also keeps stress going as you don’t recharge your batteries. So, in this session, we will look at skills to help you get a good night’s sleep. Wellbeing starts the final set of skills as we look at ways of staying on top of stress.

Learning to completely re-set your sleep patterns is invaluable. I used to have every issue; bad dreams, waking at all hours, restlessness, oversleeping, messed up patterns. When I went into shift work this was even more compounded by my ongoing anxiety. The most useful tips in this session are those that teach you how to make your bed a haven for sleep and how to re-set your cycle so you can get back on track. However by this point, you may have found your problems significantly diffused! And to finish there is an overall summary of everything covered, further advice for moving forwards and a plan for further actions with the service and beyond. 

What happens after?

So what happens to you after you complete this course? Well, there is absolutely the option to re-attend any session if you need. But further to that there is the option to go on to one-to –one help if required, and you will have built up a collection of useful information, numbers and websites through the course. If your questionnaires still rate you as at any risk to yourself or your scores are still quite high for depression or your life is being affected you will be automatically rung for a further discussion.

How do I get on to this service?

This service is run by Leeds IAPT. The service is part of the national Improving Access to Psychological Therapies (IAPT) programme – see www.iapt.nhs.uk for more details.

You will need to initially give your details over the phone (number at the end of this blog). You will then be emailed your initial questionnaire. Complete this in your own time and then you ring the service and go through it with them in a bit of detail. This initial screening can take up to an hour but there is an option to visit face to face if you would prefer. This will assess if the course is suitable and fully register you to the service. You can then discuss which sessions you can attend. The service also sends you useful text messages before each session to remind you of the time and location.

Summary

An absolutely fantastic course which is perhaps deserves more promotion. I hope it will successfully undergo re-tender and grow. I wish that people were more aware this time of thing existed. When I first went to my GP I thought I was going to be fighting on my own for a very long time. The course as successfully inspired me to continue to pursue my goals of becoming a teacher, beating past bad experiences and difficulties. I know where ever I go in my life or career this course is invaluable and in fact I would teach it to my staff/ students/ pupils if I was ever in the position to do so. I think if you’ve ever been stressed, you could benefit ten-fold from this course.

References

http://www.leedscommunityhealthcare.nhs.uk/our_services_az/leeds_iapt/

Please visit the official Leeds IAPT site for more information. Or call directly to self-refer:0113 843 4388

I encourage you if you are not from Leeds to discuss with your GP for equivalent services.

Seeds for the Future

I believe there is a real need for dreamers, poets and writers. These people – men, women and children – draw the pictures of what tomorrow can be. They offer maps and landmarks to the future. While some may see them as hopeless utopians they are actually the midwives of new possibilities. This article is about a book that helped changed the landscape.

The book is ‘The Citadel’ by A J Cronin. Cronin was a doctor and a very popular and respected author. The book written in 1937 tells the story of a young caring doctor Andrew Manson who works in Wales.  He works among the people and helps them. Later he moves to London and is tempted by money. He starts to seek money from the wealthy and this starts to corrupt him. He re-finds himself and despite major challenges walks ahead in his old values and commitment. The book was seen as a damning indictment on the old health system. Cronin stated that, “I have written in The Citadel all I feel about the medical profession, its injustices, its hide-bound unscientific stubbornness, its humbug … The horrors and inequities detailed in the story I have personally witnessed. This is not an attack against individuals, but against a system.”

The book was a bestseller and sold over 150, 000 copies in the first three months in Britain. It was also a hit in the USA and Europe. The book was made into a Oscar winning film in 1938. A Gallup poll in 1938 revealed that those polled said the book impressed them more than any other book apart from the Bible. Many people have argued that the book laid the foundations for the National Health Service in the United Kingdom. Both Cronin and Aneurin Bevan ( the Minister of Health from 1945 to 1951 ) had worked at Tredegar Cottage Hospital though at different times. Tredegar was used as a model for the NHS. The book showed the grave problems with the old system and pointed to something better. The foundation of the NHS was due to a number of factors including people after a World War wishing for and expecting something better. Cronin’s work filled the air with a critique and question that supported the foundation of the NHS. It was part of a movement, people and energy that birthed this service for the people.

There are a number of things that face us here. There is the power of ideas and the written word. Cronin’s book gave voice to the feelings and experiences of many. He became a voice for change. This teaches us that our words and what we share can shape the future. We may never achieve the effect of an A J Cronin but our voice and dreams can be part of a movement for the best care and culture for all. Ours may be a small cry and impact but together we can move mountains. Vincent Van Gogh the artist noted how ‘Great things are done by a series of small things brought together.’  The impact of ‘The Citadel’ tells us also that we will never know what our good actions and honest words will achieve. Cronin when writing his book would not have realised how his book would help a shift for the good and health of so many. To step forward and speak the truth, seek the best and create the vision is what we must do. Cronin’s work was a key element in a diverse movement hungry and visionary about change. This also tells us we need each other and diverse alliances around common themes.

When A J Cronin wrote patients would have had no voice. Things are changing and we have – thankfully – a growing patients movement. Carers also would have had no real voice and today carers are often overlooked. We hope the voice of carers can feature more and more in the future and services. Today we have many voices on social media and elsewhere pointing out the faults and flaws in the systems we have. Do all these words connect? Do they generate change? My guess is that some do. The reasons why some words fall and some reach is an interesting one.

Healthcare is all about humans.  It will never be as perfect as we all would like.  Each generation needs someone or something for it to maintain it’s moral compass. The 19th century writer John Henry Newman spoke of ‘ to live is to change and to change often is to become more perfect.’ This is a good charter of how we must always seek change and innovation. We never reach Nirvana but we can improve things and help more people.

The message of A J Cronin is that one person can make a difference, that words and ideas when linked to wider forces can change the picture before us and that we need to keep on speaking the truth and seeking authentic renewal of our services. If we do this we will contribute to the dreams, poetry and writing of tomorrow. And not only contribute - we will help write and author them.

John Walsh, York Street Practice

This post arose through transatlantic dialogue and reflection. Sometime work with others brings  a freshness, wisdom and vision. This collaboration was and is one of those times. I would like to dedicate this blog to the three good people involved.The first is Marie Ennis O’Connor (@JBBC ) who connected people together for this to happen. The second is Dr Brian Stork an American  physician (@StorkBrian) who is writing on this subject in an American context for his blog. The third participant is @HealthIsCool who offered such kind and helpful advice about format, content and presentation. It is a joy to be connected to these friends. The blog is all about a message which linked to a movement changed history for the better. I hope that we all find our messages and movements and do likewise.  

Always look on the bright side of life – and yourself!

Do you remember that Monty Python song about looking on the bright side of life?

Here’s a bit of it..

‘Some things in life are bad,
They can really make you mad.
Other things just make you swear and curse.
When you're chewing on life's gristle,
Don't grumble, give a whistle,
And this'll help things turn out for the best, and...’

If you've remembered how the tune goes good luck getting that out of your head for the rest of today! It’s certainly a catchy one. Alternatively if you've never heard the song might be one to YouTube. I think looking on the bright side of life is a useful idea to keep in mind. Let’s face it there’s always plenty of bad stuff going on at any point in time such the state of the economy, Ebola, plight of the elderly, wealth inequalities, etc. It sure is easy to be negative about and focus on many things going wrong in life. If you had to think about five things you don’t like about work how easy would this be? On the other hand, it can be helpful to think how useful it is to focus on all of these realities too much. This is to say whether it helps anyone to feel better, or if you would just worse. Or in fact whether focusing too much on such events can change any of the unpleasantness of these situations.  

Indeed the same can be true for the habits people can sometimes get into of focusing on themselves and on the mistakes they have made at the expense of everyday ‘mini-successes’. This would be considered a thinking bias in cognitive-behavioural therapy (CBT). Let’s have a think about the impact this can have for people. If done often and in all parts of people’s lives, it can easily lower people’s confidence and leave people more vulnerable to depression. After all it’s hard for anyone to feel good about life if they are caught up with seeing the worst in what they have done all the time. This is the sort of problem that we see in CBT here at Leeds IAPT.

One example of this can be seen from a woman who shared this thinking bias and had difficulties with depression. As part of her job she completed a teaching session and evaluated this afterwards in her therapy session as being a ‘disaster’. On discussion of what had happened there was one issue she had not been able to deal with as fully as she would have liked. However, with further exploration many aspects of her performance had gone well. Overlooking the more positive aspects of her behaviour had been a typical thinking bias for her and contributed to a belief of being a failure. This can be the sort of difficulty we deal with through CBT.

Anyone can slip into this habit. Who can really say they have never slipped into this thinking bias to some extent? You know, overlooked the things you have done well in place of some small possibly irrelevant mistake. If we put thinking biases on a scale for everyone, at one end have people who do these less often, and at the other people who make these biases more often. People who make them more often are more likely to develop negative beliefs about themselves and be more vulnerable to depression or stress. Perhaps people who are half way up the scale could find themselves doubting themselves more, and having less energy and motivation to do their job. Where do you think you’d be on the scale?

The way I see it more or less everyone could do with being further towards the ‘good’ end of the scale. Here’s an idea for doing that. How about once a day taking some time to think about something you have done and what has gone well from your actions. Preferably something you wouldn’t normally recognise. Maybe it would be useful for someone you know to try this out. In any case, I hope we can agree there is some value in looking on the bright side of yourself.

Matt Garner, CBT therapist, Leeds IAPT

  

Meet our members: Lynda Cooper

Lynda is one of our members who has been volunteering at the tea parties at both South Leeds Independence Centre (SLIC) and the Community Intermediate Care Unit (CICU). Lynda wrote this post as she has been particularly struck by her involvement and the work that those at the centres do.  

Andrew and Lynda

"I can remember my first visit to SLIC so clearly.  I was welcomed by Chloe, membership and involvement officer, who introduced me to Andrew, the centre manager.  Andrew chatted about the set up of the building and very kindly took us on a tour.  The facilities were excellent and very much aimed at making the patients stay as comfortable as possible, whilst also maintaining a positive environment to enable improvement in their physical wellbeing.

 The staff are amazing, they are very busy individuals but they never let it get in the way of keeping a cheerful persona.  The patience and care given is beyond anything I have seen in hospital wards for the elderly in the city.

I personally find it very enjoyable talking to the patients at the tea parties and it gives us all the  chance to chat to someone new, even if only for a short while.  I feel we are being given an opportunity to make a difference to the patients stay by introducing new interests.  The Steering Group is soon to meet at the centre to discuss what initiatives might be welcomed by both staff and patients to improve their stay.

I think there is an opportunity to involve members of LCH and the community to spend some time visiting the centre.  There are surely a lot of people out there who would enjoy and indeed benefit from visiting the patients.  I also think the time is right to give the local community encouragement to become involved.  Perhaps children at the local schools could in agreement with the Head of the school be asked to visit the centre, both age groups could benefit from the visits and it would ensure that the young ones realise how valuable, knowledgeable and entertaining elderly people can be. 

Maybe there is a need for climate change in the way the elderly are perceived, people now go on about how people are living longer and therefore increasing the cost to the NHS. Perhaps people need to start talking about our elderly who have worked hard all their lives in much less lugubrious surroundings and circumstances, with far less opportunities, and yet seem to be ignored and undervalued by the younger generations."

Lynda Cooper

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