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.  

Elevators and services

We live in a world where most of us want to move away from what we call 'The Elevator Effect'. The Elevator Effect is where people get in a lift and look away from those in the lift with them. We will look at the ceiling. We will look at the lift numbers intently as if we expected them to go somewhere else. Where just two people are in a lift they will often stand as far away as possible from each other. We understand that this is an enclosed space and we want to give others as much as space as possible. But there is something else. When we speak of the Elevator Effect we means where people together will not speak or connect. We are often glad to get out of a lift. That might be to do with the enclosed space. It is also to do with a group of people together but not together. In the closed in elevator it is somewhat understandable. In life, work and business it is less so.

We have integrated care services and programmes across health and social care. We have partnerships between the third sector and the statutory services. There are also moves to involve patients and carers more fully.  We also have work with the faith communities. These are all initiatives we support as it brings us all together. It means new understanding, work and co-operation may occur. For patients and clients better, faster and more inclusive services are the planned outcome. This bringing together of all for the common good should be welcomed, nurtured and developed. All of us have so much to learn from each other. It gives us a great opportunity to hear and grow.

There is however a concern for us in this process. The worry has a name and that name is silo. It's easy to work in a silo. We work in our own space and never look up or out. We are like goldfish in a bowl going round and round. We may occasionally look outside the glass and see the world working and moving. We, however, keep on moving. Even in teams with different sections people will sometimes have not team work but section work. This focus on looking at our work but not around and beyond is not the way to create the best services for clients or the best cultures for the future. If the glass of the goldfish bowl breaks the poor fish dies. However if our glass breaks we have the opportunity to live in new and creative ways.

Silo work is a result of a silo consciousness. Silo consciousness always lives in a black and white world of separation. It is always us and them. Our concern is that unless we deal with this consciousness we will bring it over in our efforts to create new joined up approaches, partnerships and services. If we do this we will have elevator meetings where people are not connected or even talking in an engaged way. Silos leave their mark and moving on involves a transition. Silos also go two ways. They go across and up / down. They go across where different services work separately rather than together. This is where we see each other as units that can be called upon when needed but not core and essential partners and co-creators of best care. Silos work up and down where in the same organisation people work as if other sections did not exist. This can be fed by illusions and judgements some people hold of each other. This leads to non-contact and hence non-understanding of roles and struggles. It's so sad when we don't listen to the other. It should be so commonplace for the doctor and social worker to really listen and learn from his patient and for different agencies to meet and co-learn together. There may be some parts of an organisation where silo work is what is needed. That would be fine. It's the silo consciousness that we see as the problem.

The opposite of the silo consciousness is the relational approach. This is a fancy word for something very simple and rich. It means that relationships are what our work is all about. We are social beings and need each other. We live in communion and communication and it is this context that we flourish and grow. At York Street Health Practice we talk in our presentations of 'Circular Care' where all should work together with the client ( in our case homeless people and people in the asylum system ). The symbol of a circle is used as it co-joins us all. It can't be complete until we are all there. It also means that we can't do this alone, we don't want to to do this alone and we don't do this alone. This relational approach is also expressed as a circle where the circumference is the practical work we do - the GP writing the prescription, the nurse bandaging the wound, the support worker making the phone call. The centre of the circle is and has to be the call to rapport, connectivity and relationship. This relational cannot and should not stop at our service door. It needs to extend across services and cities. It is the dissolver of silo consciousness. This post is an example of where Leeds Adult Social Care and Leeds Community Healthcare NHS Trust meet to see what we can do and write to bring together people and communities for change and connection. The Migrant Access Project is another example. It is chaired by the Head of Adult Social Care Commissioning and has statutory and voluntary sector as its members. It exists to support networking across different communities.

Relationships are what will offer the most authentic integration,partnership work and patient engagement work. It is in relationship that we understand others and grow ourselves. It is here where we can jointly see solutions and create change. There is a price here too. That price is that relationships to be genuine need certain features. For the best relationships we have to be our best. Respect, kindness, equality, humour, giving as well as taking and mutual support are all needed. If we grow these seeds great things can happen. We see this in our own city where positive relationships are bringing forth positive results. We have so much to give and learn from each other. We can only receive this in lasting ways when our minds are set on the greater good and open to others. We know that Social Care and the NHS face major problems. Our words will not solve them. What the words point to may offer the best context and bond in which they can be addressed. This is our hope.

John Walsh. Support Manager. York Street Health Practice

 Pria Bhabra. Commissioning Officer (Migrant Access). Leeds Adult Social Care 

Staying safe and sane at work

This title may surprise some readers. The words 'safe' and 'sane' are probably not words we may use a lot to do with work. When we say 'safe' we mean a state of feeling good or at least OK - emotional wellbeing. Not feeling threatened or capsized. When we use the word 'sane' we likewise refer to being balanced, stable and established. We use these words as there are currents, dilemmas and events in the workplace that that really do challenge our sense of safety and sanity. When people use phrases like 'Work is driving me mad' you get an idea of where we are coming from. So how do we maintain our safety and sanity in a world and work that is constantly moving and changing? 

We would like to offer this article to look at three aspects of the problem.

Outside Work
There is a  symbiotic relationship between work and our life outside work. One affects the other. In fact what happens in one can overshadow and sour the other if we are not careful. Therefore, can we maintain our work sanity and safety by what we do outside? If people have positive activities outside work this gives an powerful resource to deal with work stresses and difficulties. Each will have our own practices to achieve this. The  list is long - walking, swimming, working out, meditation, reading, dancing and so on. What we think they all have in common is that they take us out of ourselves or maybe away from our problems and actually into our authentic selves. In getting this bit right we create a good 'work problem' detox programme as well as finding ways to grow and develop. If we can get side of life right we have somewhere to go and be re-energised and refreshed. The business world is building 'quiet rooms'into their offices and building mindfulness and meditation into their work programmes. They realise the need and are prepared to bring it into the office and service space. 

Inside Work
   In work we may face lots of things that can make us feel upset and stressed. If these continue and worsen it can start to impact us on different levels - sleep, patience, hope, certainty, physical, emotional and mental levels. There are work services to support staff such as HR, staff counselling, coaching and talking to one's trade union. Usually when we have a problem there are three things we can do. They are all simple and well known. The strange thing is that we often don't do them or only do one or two but not all three. We'll mention them now as ways to start resolving what may challenge our work sanity and safety. They are
(1) See the Source - think and reflect on what is causing the problem. Don't focus so much on the effects but what is the cause.
(2) Speak to another. We can get things wrong and most of us benefit from reality checking. It's easy to see  just through an emotional lense or a fear lense. Another perspective from a colleague with insight can really help.
(3) Act. Decide that you have a choice here. Decide what you need to appropriately do and take the first step.
 We realise fear, busyness, tiredness, etc all get in the way here. But if we don't act things won't change. This path can certainly demand courage, resolution and support but the only way to a resolution is through addressing the issue. In addressing it too it is good to think of how we might manage this. How we need to be polite, professional and clear and what support we will need. This road is often difficult. It is also a road through which much valuable self discovery and self worth can emerge.

Inside Ourselves
The third of our three areas is us - ourselves. It is an admission that we can contribute to a problem or an issue at work that causes work to be a place of threat and stress. It is where we stop blaming the economy, the manager or a work colleague and own our responses and approach. We may have a number of emotions or states that we don't like but which play a part. These may include feeling very vulnerable and scared, anger. wishing to undermine others, ego, jealousy, hopelessness and passive aggressive features. We are not equating these states as some come from different places. We note them to recognise that we all need to realise the stones or pebbles we are throwing into the work pond. We may not always recognise our behaviour patterns or how we play out situations. We may when confronted by another or by our own awareness say "Well that's me! That's the way I am wired. I can't change."

Looking at our inner states will mean us facing parts of us we don't like or even deny. Yet this is part of the journey. Facing ourselves as we are is the road. One of the most eminent psycho-analysts in history Carl Jung said, “Where we stumble and fall is where we find pure gold.” Seeing and naming the problem is the fundamental.  Putting this together we would respectfully suggest a programme for positive and real change begins when we 

(1) See the inner issue

(2) Accept it as part of us but recognise that we are not pieces of wood or stone. We have the freedom to change. Accept that we can be different

(3) recognise that change will make us better people and possibly our work life better for ourselves and others. 

From here we can start to look for what we need to do to change and grow. This might mean using counselling or other disciplines. What this adds up to is a new perspective. It is a recognition that none of us is perfect and that growth is a wonderful and tremendous possibility for us all. This is a transformation that can work good in other areas of our life other than work. John remembers many years ago visiting a client in prison outside of Leeds. He was there for a violent crime. In the visit he was angry about what had happened to him. John then visited a few weeks later. He was in a very different frame of mind and outlook. He had been visited in the interim by a nun who worked with homeless people in Leeds called Sister Eileen Carroll. Eileen, who died a few years ago, was such a positive force for good in the lives of homeless people in this city. She had spoken to him about the need to let go and how holding onto this was only really hurting him. The words must have sunk into our friend's heart and mind as when we visited him he accepted he was in prison for a crime he had committed, that he was to serve his time and wouldn't hold any grudge. And that's what he did. He's never been back to prison. He had faced his own inner feelings and state, listened to a wise person and then let a new pathway open us which he followed. Change is always possible and we hold in our hands the keys to open the door to change. Change should always be infused with wisdom and patience. We cannot change things or particularly ourselves overnight. We can however take the first step right now to a better life and us if we wish. Let's take it. 

Lisa Falkingham. Service Improvement Team. Leeds Community Healthcare
John Walsh. York Street Health Practice. Leeds Community Healthcare

Holding it all together

This post starts with the story of a friend of ours. She works in a large global business and her name is Pat. Pat has worked there for seven years and is presently in an office which works with staff counselling. She loves her job and finds it deeply rewarding. She says, "I am so lucky to be in a place where I can spend time with people who make a difference every day and I really believe my added value comes in supporting others." The concern for Pat is that she may be moved back to her old department. This wouldn't be a disaster but will take Pat away from where she has found such growth and life. Her current post is described by her as a ground for exploring and discovering for herself and others what she can offer. Her words express this powerfully, "My role has enabled me to flourish and pursue my passions...using my skills to support others to reach their potential, recognise their strengths and skills and also to identify needs...Honesty, difference, challenge, enthusiasm, resistance have become my food, my motivation. Where there is energy there is hope and potential." Pat faces three challenges here. The first is what happens if they move her. The second is how does she manage the process until the decision comes through. The last concern is are these thoughts wants or needs? These are deep questions. In this post we will offer a possible answer to our friend. In it we will try to touch on what is essential here. We hope there might be life lessons here for us all.

The first worry is the big 'What if'' question. In Pat's case it is a 'may well happen' statement. A number of things are interesting here. It's amazing how we often we can go to the worst possible place when a change is a possible outcome. We can worry and think the very worst will happen. Why do we think the worst? Why are so many of us more likely to think the worst than the best? We think a possible answer is that we haven't reached that place yet of holding our life and it's determination in our hands yet. A place called inner freedom. In history we often hear about the right of countries to self determination. It was one of the big arguments against the large Empires. Countries must have the right to govern their own destinies and futures. It's not always the case that we exercise this right with ourselves. We either deny we have any power or give it away. When we worry in such a way we are really saying 'I have no power. I can't control anything here. I have no choices.' The truth is that worry is very common and a paralyzer of our life and energies.

The problem is that it is a mental prison and we need freedom. We need to be someone who owns their life and destiny. Not easy. Maybe big tough decisions but that is what freedom entails and gives. It gives the possibility of living in a new, fresh and abundant way. Pat realised this and sought places and strategies to not walk in to these dark domains of worry and fear. She accepted what might happen and that if it did she would have choices to make. She would make them and take the next step by placing one foot in front of the other. If what she didn't wished happened she would work with it. She might decide to leave or stay. The decision actually became secondary in her life. What mattered was how she got there. It had to be in a way that she owned her dignity and life. The journey became the key focus.

The second thing was how was she to manage her process during these tough months of not knowing. Her words are revealing here. Pat talks about "I can chose to enjoy today; I can see what I want and I can strive and do what I can to work toward that. I've talked to people in the organisation. I realise is that I get strength, not from the talking but from the doing." Pat knew she couldn't control or predict the future. She knew to live in the future was only possible in her head. What she did have - concretely and really right in front of her - was today. She could take the day and make it into the best possible. Pat was actually a difference maker because she focused on the present and made it the best.  It's not always easy but is the way. Of course we have to plan and make decisions. However we always do that in the present for the future. We are not mean't to live in the future. Paradoxically by owning herself and the present Pat was making the future. What she also saw was that to let go of the fears is freedom but feels like awfulness to start with. Pat believes all will probably be well. She does this because she has seen it work out well a thousand times before. She also knows that her worry often tells her untruths. If we thread these strands together we find a self ownership of herself in the process, a focus on the present and a belief that things would somehow come around. She lived in what might be called a state of hopeful tension. There were moments of worry and unrest but also hope and a look to a future while being anchored in the now.

The last thing was Pat's questioning of her motives and reasons. Was this needs or wants? It's a good question. Sometimes what we call need is actually just what we want. How do we tell the difference? One suggestion might be that a need is a thing we require at this moment for our deep development and growth. It's something which is essential to our becoming who and what we are. It may not be essential tomorrow but it is today. Without it our authentic growth would come to a halt. Or perhaps key aspects of it would. Pat described her role as "a role which has enabled me to flourish and pursue my passions ...using my skills to support others to reach their potential". It sounds like Pat needs this role as it helps her see and release her skills and gifts. The big challenge to Pat will be that if she is moved will she have the same space to grow and flow? Kate Cowie in her amazing book 'Finding Merlin. A Handbook For The Human Development Journey In Our New Organisational World' makes a key point on this. She writes that, "if our working environment is not providing us with the stimulation we need - our responsibility to ourselves is to seek an alternative place of work, one which will foster ( rather than hold in abeyance or,worse, stymie) our ongoing growth." We can confuse our needs with our wants usually due to powerful emotions dominating the picture. We can also fail to note our needs. This brings us back to where we started - the giving away of our power. Our needs are important. They call and grow us. We shouldn't ignore them. In a busy 24-7 world where everything is go this may sound like luxury. It's actually life itself.

 Living with uncertainty isn't easy. Holding it together can be real challenge. Pat shows us not only that it can be done but one way how it can be done. Some of the best wisdom is that found in the market place and there where the Pat's of this world live and teach the rest of us if only we will stop and listen.

 Lisa Falkingham. Service Improvement Team.Leeds Service Improvement Team

 John Walsh. Support Manager. York Street Health Practice. Leeds Community Healthcare NHS Trust      

A tale of two mentors

We don't know anyone who is a great health professional who has not had some form of mentoring. Mentoring can come in different shapes and sizes. It may be near or remote. It may be long term or for a short period. We seem to be made for mentoring. We need that 'other' to challenge, shape and support our journey. They often see what we don't. They bring out what is hidden. They are living mirrors reflecting back to us our values and qualities. They can somehow unearth what lies buried in the depths of our personalities and hopes. We would like to share a story of mentoring where a bright and caring young woman found her light in a difficult situation.

This is a true story. It is the story of a person known to us. The person is a a young woman called Paula who was aged 16 years old when this story begins. She lived with her parents and found a Saturday job in the South of England where she lived. The job was in a shop that sold all sorts. She described it as selling everything "from Anadin to kits for brewing your own beer."  The owner was a gentle man in his late years. He was kind to Paula and she loved the job. He retired and the business was sold to a man who became the new proprietor and manager.

While the new manager was supportive to other staff he seemed to take an instance dislike to Paula. He would always find fault. "Everything I did was wrong!" she recounts. She was accused of talking to the customers too much. Paula didn't earn a fortune in the shop yet the new boss started docking her wages when things were not to his satisfaction. These are her words of how it affected her.

"He constantly picked away at my confidence."

"I was faced with shifting expectations that I could never meet. Most hurtful of all, it was obvious that I was one of a few special targets, while he was satisfied with a  similar level  of work or effort from others."

"So, how did I survive in the shop.. as things got worse and worse? Not particularly well... After my shift finished I would often cry on the bus back home."

Things came to a head when Paula was talking to and helping a customer. After the customer left the boss attacked her verbally saying, "Who do you think you are girl! This is my shop and you will do as I tell you." Paula was afraid and left the next week. It was a real heartbreak as Paula had connected with the customers and cared for them. She says, "I was so sad as I missed all the regulars who came in... missed the stories, hearing about their families , their lives. I missed being part of that community. It made me realize  though, how much I enjoyed contact with general public & perhaps my calling was nursing." Paula went on to train as a nurse.

Years later when Paula was newly qualified as a nurse the door opened at her first clinic. Her first patient was an old face from the past. It was her old manager. Paula froze and a long talk took place. Paula explained how she was made to feel in the shop. The man broke down in tears and said how sorry he was. He went on to explain his domestic problems at the time. He also talked about how his health had deteriorated. Paula felt compassion for him and found  it in her heart to forgive him.

This story has a number of life lessons in it. The first is that should never treat others badly because we feel bad. The man was suffering and as result was projecting his pain onto others. This is never right. The answer is always to seek ways to hold and deal with it not transmit it. The second is that the saying "every cloud has a silver lining" is true in many cases. The awful situation for Paula turned out to the place where she found out her life vocation. Sometimes it is in the darkness that we find the light. At the little shop where Paula loved her job and suffered so much was where she found her path. The next life lesson is that the person who is meant to mentor or lead us might not be the one we actually get our help and support from. Paula did not get supportive and caring mentoring from her boss. Sometimes the spaces that are meant to nourish and develop us don't. We shouldn't always be surprised. We just need to look elsewhere to receive what we need. The last lesson is that Paula found the support and help she needed in the customers who visited the little shop. They were her help and support. These everyday people were her true mentors. There is a real lesson here. Everyday wisdom is everywhere. All we need is an open heart and mind to access it. Paula did and because of those true mentors - those ordinary folk going into the shop - she has served the sick and infirmed in her role as a nurse for years. Powerful stuff this everyday wisdom!

John Walsh. Support Manager. York Street Health Practice
Louise Brady. Clinical & Strategic Development Lead Practice Nursing. NHS Manchester CCG's North, Central & South 

 

The bad sister

There is a film many of us have watched. It's called 'Whatever Happened To Baby Jane?' and it was released in 1962. It featured two of the foremost actresses of the time, Joan Crawford and Bette Davis. It's a powerful and gripping movie. It's also pretty disturbing. As a film it was very popular at the time. It was nominated for five Academy Awards and won one. It's the story of two sisters who live together. One was a child film star - Baby Jane. The other watched on from the sidelines but late became a film star herself. This sister ends up paralysed. In the mansion where they live Baby Jane psychologically tortures her sister. Isolation, abuse and hatred spew forth from Jane. As you can see this is not a film for the light hearted.

We hope that this doesn't happen between any sisters in our society. We do know however that something similar does happen in one place to a lot of people. That place is our own mind. In these inner spaces thoughts of self doubt can invade, occupy and abuse us. They can live with us and the abuse can go on for years. A friend of ours suffers from self doubt. This is someone who is one of the most wonderful human beings you could meet. She is kind, caring and helpful. The sort of person who makes the world a better and brighter place. She shared with the writers how these self doubts affect her. This expresses too her courage and strength in being prepared to share. The following are her words.

"Self doubt to me is something that I would describe as a negative feeling."

"It makes me question everything that I am doing in a short period of time, why am I doing it, am I any good at what I do, can I change anything I am doing to make this horrible sickly feeling go away?"

"I feel very worthless at the moment, I feel like I am underachieving, and I am cross with myself for this."

"I feel worthless, out of my depth and very very lost!"

This friend suffers from thoughts which undermine her confidence and blind her to all the good she is and does. This is the iniquitous nature of self doubt. It is never a friend and always an enemy. We are not talking here about deciding whether we can do something or should. We mean an unwanted sense of unworthiness that paralyzes us and makes us feel and think the worst. It's something most human beings probably have at some times in their life.

In mythology we find some fascinating figures. There was the figure of Medusa in Greek mythology. She was a female creature with snakes as her hair. If you looked at her and she gazed at you, you would be turned to stone. In European myths there was also the creature called the basilisk. If the basilisk gazed at you it would bring death. To look at Medusa or the basilisk wasn't something we would advise. These thoughts of self doubt are the mental equivalent of Medusa and the basilisk. They freeze us and psychologically slay us. They rob us of life, energy and hope. In the film the one who should have cared for her sister became her tormentor. These thoughts of self doubt are our bad sisters. And we need to find ways to deal with them.

Some people need counselling or therapeutic help with this. Others may be able to create their own strategies on the ground to work through this. We would like to recommend two practices that may help. They are based on our friends experience. They may not be for you so maybe talk them through with a GP or professional first. The first one is to go easy. It's very easy to get into a battle with these awful thoughts. To fight them and try to beat them back. This approach while understandable can easily backfire. The more fire we aim at them the stronger they get. It's as if these thoughts absorb whatever is aimed at them. They get more ingrained and deep seated that way. Our friend records this phenomena, "the more I fight it the harder it becomes to control." So to step back, try to relax, let go and find a place of being at ease will put one in a good place to address the problem. A parallel might be if we have to face a person we are in dispute with and have a discussion with them about the conflict. It's much worse if we approach the meeting full of anger, resentment and thoughts of lashing out. Being calm, collected and in control is best from all points of view. Likewise to go calm puts us in the best position.

The other practice is to look towards the sun not the shadows. We don't mean this literally. We mean focus not on the negative self doubts but rather on positives either within or outside us. Rather than allow the shadows to surround and engulf us we look to where the light is. Our friend spoke of "lots of happy thoughts always do me the world of good." Exactly. This is creating new inner hardware for the mind. It is creating new patterns and connections. It links us to the good and the best. It gives us hope and ideas for the future. Focusing on the good and happy can be a good way to sow seeds to undermine the weeds of self doubt. It's like a dark room. We din't have to push out the darkness. We have to rather turn on a light and the darkness goes.

These bad sister thoughts can plague many but there is recovery and hope. Self doubt is an old problem for our race. Shakespeare wrote about it, "Our doubts are traitors, and make us lose the good we oft might win, by fearing to attempt.”

We hope you take from this post that these 'Baby Jane' thoughts can be dispelled although it might take time. We conclude by dedicating this post article to our friend. We thank her for courage and sharing with us. She later let us know she was feeling somewhat better. We believe her words here will touch and help many. And that's what human life and goodness are all about.

John Walsh. Support Manager. York Street Health Practice  

Louise Goodyear. Student Nurse. Wolverhampton University 

The oyster and the pearl

We all recognise the value and necessity of good self esteem. We all can see how low self worth can stop us believing, acting and changing. Beliefs about 'I can't' or 'I won't be able to' are mental shackles that bind us to the present limitations and close off possibility and the future. Lack of self worth can lead to illness, tiredness and always thinking the worst of ourselves. In this post we will look  at self worth and ask what it consists of and how we can focus it on. We will offer some thoughts. We know that not all will agree. That's fine. This is an area where we need dialogue and exchange. We don't claim to hold absolute answers but hope there is something of value in what we write.  

We will take as our starting point the words of the Sufi writer, Rumi, "What strikes the oyster shell does not damage the pearl". This is a deep and wise saying. What does it means? The oyster is our surface life. This means our likes and dislikes, our emotions, body, mind and preferences. It also could include what we connect with externally and our possessions. These are part and parcel of our life. They are important and need to be nurtured and nourished. Yet Rumi tells us there is something else. There is a pearl. In history people have called this by different names: the real or true self, the soul, the deep or intuitive mind,the spirit, the heart and many more. It refers to that central essence of us that might call our life or being. There is in us a deep source and this is the place where our deepest gifts and existence seem to rise from. Rumi's message is that while the oyster may be struck by illness, pain, self doubt or life experience the inner essence remains. The pearl shines and remains unharmed. To us this offers a wonderful picture of authentic self worth.

The outer may change. We may even sadly lose some things we love and depend on. Our feelings may go up and down but the centre of our being which is life, wonder and creativity remains. Self worth then is all about celebrating the oyster and holding it but fundamentally more. It is a call to see and value the pearl. The strength of this position is that it means our self worth is not based on what we do or who we know but on who and what we are. It also means that we are all amazing wonderful beings born of a universe which is too marvellous to fathom . Werner Heisenberg, the Nobel Prize winner for physics notes, "Not only is the universe stranger than we think, it is stranger than we can think." It's sometimes the case that wonderful people can't see their wonder. Instead an illusion of low self worth lives and moves in their minds. This is a real conundrum. It may be explained by negative conditioning and experiences. The difficulty is in how the good comments and reflections of friends and loved ones seem to bounce off. Perhaps this shows how the deep the lack of self worth is. It may also reflect something else. We may be looking in the wrong place for self worth. Focusing on the oyster for our self worth rather than the pearl. If we focus on the passing and temporary we may soon get disappointed. For example if we focus on feelings we may end up on a sea saw - one day feeling good and the next not. If our self worth is based on money or fame what happens if we don't have them or lose them? Our self worth will disappear too. If we base it on the oyster shell we may end up with a self worth that either isn't there or can easily disappear. If we focus on the pearl we may find we have a centre for self worth and self well-being based on being itself - who we are in the depths.

The famous existentialist philosopher Jean Paul Sartre spoke about being, having and doing. We would see being as the base of self worth and having and doing as its handmaids. The error in our opinion is that often make having and doing the base and foundation rather than the pure expressions they are mean't to be. Having and doing won't provide deep self worth. They will support it and express it. So being - our centre and life is the principle of real self worth.

We realise we are walking into philosophical territory here so perhaps a story might help our words. The story is a real one and is about a man called Peter. Peter suffered from chronic lack of self worth. He doubted himself and saw himself deep down as useless, worthless and less than all. He held a series of beliefs that confirmed this for him. When things went wrong he would beat himself up mercilessly. Peter was a man of great kindness and compassion but not to himself. When things went good and people said nice things he always batted them away, never accepting the compliment. It's a sad story. Peter today is a person who values his self worth. His friends and colleagues would never think the above description was ever him. And in a sense it wasn't. For Peter's discovery of his worth and glory has remade him into a new person. What supported Peter on this journey was to become aware of the pearl. He knew that his self esteem could not depend fundamentally on money, status, success or feelings. He saw over a period that deep down he was amazing and good. And not only him but everyone was the same. That was really good transforming news. When people say to him 'You're amazing Peter!' He now says, 'Thank you. We all are amazing  - it's just that we don't see it' Peter built his self worth on the pearl not the shell. This building led him to value and appreciate the shell in new and fresh ways.

We should focus on the visible and external aspects of life as well as the inner centre. The question is how we can live on the surface from the depths of our being. Often we live on the surface from the surface. It is the depths  - the deep - where we find the creativity, energies and potency that can make all things new. Peter found it. We hope we all can.

John Walsh. Support Manager. York Street Health Practice 

Louise Goodyear. Student Nurse. Wolverhampton University 

Taking the power

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

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

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

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

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

                                     

* Catch the Fire

* Create the Space

* Clear the Ground  

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

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

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

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

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

John Walsh. York Street Health Practice

Finding the inner treasure

This post is all about integration. Not so much service integration as personal integration although what affects the individual can affect the service. It comes from myself and Denis meeting for lunch one day in Bradford. Two particular stories were shared in that conversation, one was a very sad tale, the other was a beautiful and inspiring one.

They both point to the need for what Carl Jung called 'individuation'. This is where the innate elements of a person come together and become a working integrated whole. This is the path to psychological wellness and wholeness. Jung saw this as a journey and a deep work. He referred to the 'cure of souls'. Some have suggested that a film like 'Star Wars' is all about individuation. The Jungian analyst Stephen Galipeau wrote a whole book on the subject. Star Wars is all about a young man, Luke Skywalker, who leaves his family as he feels pulled away from the familiar and towards an unknown adventure. This journey becomes a search for the truth - the truth about himself. It is a quest for his true self. He encounters the good and the bad. He has the face the shadow aspects of an Evil Empire and Darth Vader (who turns out to be his own father). In the journey he discovers his own power ('the Force') and has to learn to use it. In this passage Luke finds the truth and becomes who he is. He becomes actualised. This is a journey we all can take. Jung speaks of those who hear the call of the inner person to grow and develop. 'They are called' Jung remarks.

The first story was someone who we know who has taken time off work with stress. He works for a non NHS organisation. Where he works can be very rigid and some people there can struggle with all the rules and control. We wondered how much a culture (that doesn't always support but controls) had been a factor in this good man's struggles. His job is with people and is often a lonely one. We were both struck by the need for structures that nurture and develop us. We see this as the need for wellness practice and wellness structures. We should all have a wellness practice. Something that keeps us connected to our true self and nourishes us with inner food. Along with this, the emergence of workplace structures that nurture wellness and health should be welcomed. We need to move away from 'institutional' templates to templates that think of what help staff to work and be healthy.

The second story was about a good friend of ours who is on the individuation journey. This offers great hope and scope to us. This person is undergoing what we can only transformation. Jung compared the process to alchemy where base metals were transmuted into gold. Our friend is turning the base metals of his life into the gold of a real and free personality. Words like harmonious, peaceful, calm, responsible, free and open come immediately to mind and experience in knowing him.  He has worked on dropping certain things from his life - things which acted as chains. He now projects a wisdom, presence and compassion. This transformation enables him to transform situations and help others on their transformation journey. Jung referred to the undiscovered self. This friend is on the road which will lead to the discovery of the True Beautiful Self we all are and have. To not take this journey can lead in Jung's words to a 'painful fragmentariness' in life.

The good news is that this transformation is both possible and is happening. In the story of Humpty Dumpty he fell from a wall and no one could put the pieces back together again. The great thing is we can. We can re-integrate the pieces and become whole again in a new and brighter way than before. Often we don't know our gifts, power and sheer amazingness. There has to be a process of discovery. This means seeing, owning and manifesting who and what we are. When we do that that's when the magic starts to appear. When we think of great services like the NHS we wonder if this shouldn't play a key role in staff development. Work can often be on a surface level. This is depth work supporting us all find our own inner treasure. The staff and patients of the NHS and other services (in fact every human being) have incredible gifts and energies. The question is how we support each other release them. It is our view that unless we touch the deep we won't receive it.

John Walsh. Support Manager. York Street Health Practice 

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

    

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       

Deep dialogue

Dialogue is probably a word like inclusion which we all use and may never unpack and seek it's authentic meaning. It is also something we all are in favour of. Yet this doesn't prove we know what it is or even practice it! So what is dialogue? Is it discussion? Is it listening? Or something more?

I attended the first session of the Leeds Indaba Programme last week. This is a leadership, ideas and innovation fellowship in Leeds based at the Centre for Innovation inHealthcare Management. Based at  the University of Leeds, CIHM is a centre of inspiration, idea generation and testing, community outreach and teaching in innovative and creative forms. To my mind, CIHM is both an assett of and gift to the city of Leeds.

The Indaba programme is a joint partnership between the Centre, the University of Stellenbosch University in South Africa and the VU University in Amsterdam. Becky Malby, director of CIHM, Professor Erwin Schwella and Professor Goos Minderman were the facilitators. Indaba is a word meaning an important conference held by members of the Zulu or Xhosa people of South Africa. The Leeds Indaba was a meeting of a number of leaders from across the country from business, the NHS and the Third Sector. Its aim was to allow a discussion about leadership, positive passions, the NHS and its future and new fresh thinking.

I learnt many things. There was a large number of times when my mind lit up at comments made as they made sense of other things or connected them. In this post I will focus on the concept of dialogue. At the beginning of the session we each went around and spoke of who we were and our roles and interests. This was very different from when this is usually done. Usually people say their name, role and place of work. This was deeper. Those who attended spent some time talking about themselves and their journey. Throughout the day the honesty, depth and openness of the sharing was stimulating.  At the beginning of the day, Becky spoke of dialogue, she said, "It's only when we really know each that we can really have dialogue." This was one of those statements that illuminated my thought. In trying to unpack it the following things seem to come to view as learning points.

Perhaps to define dialogue we can look to a place where it holds a central place in everyday practice. This common place the word is used is in the religious world where different faiths will meet to work together and have dialogue. This is interesting as the world faiths have different views of the world and each other. Dialogue is the language or road they use to meet, listen and engage respectively with each other. The World Council of Churches has some wonderful words on the definition of dialogue. It states, "All dialogue involves an exchange, an interplay between speaking and suggesting on the one hand and listening and receiving on the other. Dialogue is, therefore, the opposite of monologue. It requires reciprocity and a certain equality...Dialogue is not merely 'discourse'". It is primarily a way of being together in charity, which gradually changes and renews the atmosphere.....where profound exchanges of thought and expression can achieve something which goes beyond clarity of conversation or individual conviction. ' ( WCC, Joint Working Group, 1967, 1). This definition embodies a rich message and offers a powerful praxis. It says to me that dialogue is about

          * being with the other

          * listening to the other

          * trying to understand the other's place - this doesn't mean necessarily agreeing with it

          * allowing the possibility of changing by exchange with the other.

Dialogue can only be deep when we know the other. Yet to know the other we have to dialogue with him or her. So there is a circle of connectivity and conversation which leads from dialogue to knowing and then to further and deeper dialogue. This circle of dialogue can keep going on and on. To be committed to deep dialogue means to be committed to deep listening, deep respect and deep sharing. It points to what the famous novelist Charles Williams called 'co-inherence.' This word gives us a clue to deep dialogue. It suggests connecting and in a sense dwelling in the other. To share in the hopes, struggles and life of another. This mutual indwelling while remaining ourselves would be the deepest dialogue. I have no doubt such dialogue has a power and connection that can cause real change and newness of vision.

Yet this deep dialogue seems to demands something else. A deeper dialogue seems to assume  a deeper commitment and conversation than we often have. I would suggest it demands an inner freedom in ourselves. The late British theologian Charles Davis spoke of "the openness and love that derive from inner freedom." This is a powerful insight. It's when we have authentic inner freedom that we can really love and be open. Our closed minds, fear and lack of real freedom within all make the most important things we both need and can offer very difficult. Charles Davis spoke of the need to find 'self-appropriation.'  He explained this by writing the following, "Happiness isn't not a quiescence gained by a narrowing of consciousness; it demands that a man accept the autonomy proper to him as a free person. A man has to take in hand his own becoming, decide what he is to make of himself, and then carry out his decision. Just to follow what others do or say and wait passively upon events is to live a diminished personal existence......to be fully a person does mean freely to take the decisions that determine the direction and growth of one's existence."

Deep dialogue flows from deep freedom and deep living. Perhaps this brings us to the fundamental lesson of leadership. Leadership is not something primarily we do - it's something we are. And that something we have to seek as we seek the freedom of self appropriation. I enjoyed the first Indaba meeting and look forward to the next. It was great to meet such good colleagues from different sectors and sit with them trying to listen and engage. It struck me that the Leeds Indaba was not just a space to learn but a school for deep dialogue. In that deep dialogue lies the possibility of some really invigorating and stimulating offerings. It's good to be on board the Indaba.

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                      

The good we do

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

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

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

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

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

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

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

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

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

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

Lisa Falkingham. Service Improvement Team, Leeds Community Healthcare