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.  

Being mindful of your mental health

Stress, depression, anxiety can affect anyone. One in three of us regularly feel stressed. One in four of us feel anxious One in five of us feel depressed.* 

Sabina, Dave and Berni all recognised they were struggling to control their stress. Signs of stress can vary by person but common signs include feeling on edge, angry, unable to switch off, tearful, having poor concentration. 

Each of them reached out to Leeds IAPT, either through their GP or by referring themselves by calling 0113 843 4388. To help manage their stress, anxiety or depression, it was recommended they attended the 'Stress Control' course. This runs for six weeks  at venues across Leeds, at times in the day or evening. Each session has a different focus, from learning to control your thoughts to controlling your body to helping you get a good night's sleep.

In these short films, they have described how the course has helped them:

If you feel like you need help with managing stress, you can get in touch with our Leeds IAPT team on 0113 843 4388. Find out more about Leeds IAPT - www.leedscommunityhealthcare.nhs.uk/our_services_az/leeds_iapt/

*Mental Health Foundation

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.  

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

I get by with a little help from my friends

Recently I became a Dementia Friend.

Su McAlpin, Dementia Friends Champion at
LCH with 'Gina'  

I have a personal interest in the Dementia Friends campaign but in my role of Communications officer at Leeds Community Healthcare NHS Trust, I went along to one of the trust's training sessions to see what it involves and how we could help promote the campaign internally to colleagues.

On arriving at the session, I explained to the leaders I was there from a ‘comms perspective’ and said I would sit to one side so not to disrupt the session. I was encouraged to take part; I didn’t realise anyone could become a Dementia Friend, you don’t need to be a healthcare professional. The awareness is useful, regardless of whether you’re at work or doing the weekly shop.

The training session is just an hour long but gives you a really good insight in to what things we can do to make our community dementia friendly. There are lots of great analogies that help you to understand what it can be like for a person with dementia. For example, you’re walking in to a health centre and there is a black mat at the entrance. You would cross the mat, enter the building and go on to attend your appointment. To a person with dementia, they may see the mat as a black hole and don’t want to step on to it for fear of falling in to it. This could make them scared to access the building and prevent them from going to their appointment.

After talking to the trust’s Dementia Friends Champion, Su McAlpin, I found out that around 100 of the trust’s front of house staff have been trained as Dementia Friends recently with more to follow. They’re the first people that greet patients so it’s important they recognise the signs and know how to support someone. Su is running a number of training sessions internally and also externally - recently, she spoke to a local Beavers group. We’re also looking at all our buildings to make sure they are dementia friendly too.

The campaign is aiming to create 1 million dementia friends by 2015. You don’t need to go along to a session, you can also sign up to be a dementia friend online at www.dementiafriends.org.uk 

Let’s all help to make Leeds a dementia friendly community!

Sarah Elwell, Communications officer

@LCHNHSTrust 

#DementiaFriends

Privileged to work in the community

"I’m passionate about community services because
I work with children with neurological conditions
and long term conditions to assist them in
activities and participation in their own environment."

Lauren Haworth is a Community Children's Neurological Physiotherapist and tells us a little about her role with the trust...

"Initially I decided to join the trust as I wanted to be associated with such a large organisation with such a good reputation. After joining on a six month temporary contract, I never left and have been here seven years now. I love my job!

I trained in the North East at the University of Teesside and completed a previous rotational physiotherapy role in another West Yorkshire NHS trust. I specialised in Musculoskeletal Physiotherapy, but felt that Children's Physiotherapy was an opportunity and an experience I had to try. It is very rewarding working with children.  

Every day is different in my role. I am very privileged to have my treatment area in a school, or health centre, or patients home, or swimming pool or trampoline! I treat and assess children in environments appropriate to the goals we are working on and negotiate family orientated treatment plans to accommodate the child and family as much as possible.

By working in the community, I think we are able to see the real challenges and difficulties affecting our patients in their own homes and environments and I'm proud to be able to assist with this."

A passion for community services

Our staff are passionate about providing community services. Andrea is a nursing sister at HMP Leeds and tell us about her career to date...

Andrea Copeland 

"I qualified as a nurse in 1995 and started my carer in offender health six months later. I have worked in a variety of prison settings high secure, YOI female and currently local category B.

I remember seeing an advert in the Nursing Times for nurses working in a prison in London. I had never thought of nursing in a prison, my morbid curiosity led me to apply. When considering my career path I always considered police, probation or social work so it's no surprise I ended up working in the arena of offender health

My friends and family were quite shocked when I told them I wanted to work in prison healthcare, particularly the male side of my family. Of course, their impression of prison was influenced by what they'd seen on the TV or read in the news, and they were worried about my safety and the possibility of prisoners behaving inappropriately towards me. In fact, I'd say you're safer in prison than you are on the streets. Sometimes you get prisoners making gestures or being suggestive, but I'm a female in a male prison and you get the same on hospital wards.

Our role here means we can not only make a difference to individual’s lives but the extended family and even society itself by hopefully assisting in the reduction of offending. We have close partnership working with the prison and play a key role in the resettlement and rehabilitation agenda. Assisting changes to someone’s health plays a key part in enabling offenders to leave prison having addressed their health needs and enter society in a stable and less chaotic state. We ensure systems and support are in place.

We have the difficult task of looking after some of the most damaged and vulnerable people in society. People for whom trust is difficult to do as, they have often been let down by the people that should matter the most in their lives. Engaging our clients takes excellent communication skills, patience and empathy.

I have worked for Leeds Community Healthcare NHS Trust for three years; it is currently a very exciting time to be part of the trust. Our offender health pathway is expanding, we currently care for prisoners at HMP Leeds ,HMP Wealstun and HMYOI Wetherby. And we have recently secured the contract for police custody in West and South Yorkshire. There are a number of challenges in my role. One of the biggest is finding a way to provide our services in an environment driven by security and discipline. We have to abide by prison timetables and we can't always see a patient we might want to have access to immediately

If asked to describe a typical day I couldn't as no day is the same! I have stayed in this arena of nursing for 19 years so it can’t be that bad! Everyday is different, within the routine of clinics, screening, triage, chronic health conditions and health promotion is the unpredictability that working in this environment brings. We are required to attend emergency situations such as serious assaults, injuries, self harm and sadly major life threatening conditions which we have to manage until emergency services can enter the prison

The skill set required in this environment is important however as it so generic you cannot possibly know everything, this is where our close teamwork comes into play. Sharing knowledge and skills is vital and teamwork and supporting each other underpins. Despite the challenges, the work is so rewarding and I really like my job. Prison healthcare staff are sometimes perceived as being inferior to those who work in hospitals or clinics, but this couldn't be further from the truth. I actively chose a career in prison healthcare and my professional experience has grown substantially since I've been working here. You need resilience, patience, a sense of humour, stamina and the ability to be team player is fundamental." 

Building therapeutic relationships

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

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

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

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

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

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

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

No two days are the same

Emma Ross is Senior Healthcare Support Worker at Hannah House, she tells us why she loves her role...

“I'm passionate about community services
because no two days are the same.”

"I have worked for the NHS for around six years, four of those have been spent working at Hannah House, where I provide planned or emergency short-break care for children with complex needs. The house is a ‘home from home’ where we provide care for children up to the ages of 19 years. 

Before Hannah House I worked for a community team in Wakefield where I would deliver respite for children with disabilities and complex health care needs within their own home.

I applied for my role at Hannah House as a Senior Healthcare Support Worker because I wanted to work with children in a relaxed home from home setting as I find this type of environment is more comforting for the children and less daunting than the hospital. Also I wanted to work in a team rather than on my own.   

No two days are the same at Hannah House. A typical day will generally involve getting the children who have stayed overnight up and ready for the day, which includes helping them wash and dress and with meals. Through the day, I take care of their personal needs and assist with meeting their healthcare needs as well as spending the day doing various activities and having fun.

I love working at Hannah House. I enjoy spending time interacting with the children and doing activities with them. Every aspect of my role is rewarding but I especially enjoy making the children happy."

Treating patients as individuals

Gemma Crabtree is one of our community podiatrists who looks after the people of Leeds feet! She tells us what here role involves...

“I'm passionate about community services
because we provide quality evidence
based treatment and treat patients as individuals.”

"I work as a Community Podiatrist and have been with the trust for nine years. At present I am acting up in my role and working as a clinical lead.

After qualifying as a podiatrist, I applied for a job with the trust and was successful in this. Although I live in Harrogate, I much preferred to work in Leeds.

Like with most community services, there is no typical day. Although I am based at Kirkstall Health Centre, where I deliver a clinic daily, my colleagues work across Leeds, providing treatment in a number of locations that is as close to home as possible for the patient.

Each day is very busy, seeing clients for 20 minutes at a time. Within this time it is important to find out if there have been any problems since the last appointment and see if any further actions need to be taken i.e. referrals or requests for insoles. I will then provide treatment if necessary and update their records.

Through the Community Podiatry Service, we deliver core podiatry, management of high risk feet and nail surgery as well as specialised clinics that for example, people with high risk diabetics, high risk feet and chronic painful skin lesions would attend. We also work with vulnerable people such as those with mental ill-health or those receiving healthcare in prison. To meet the individual treatment needs of patients, care is personalised and planned.

Although I provide treatment for both adults and children, I work with children quite a lot and find this area very satisfying. The service offers special support for children include flat foot, curly toe, growing pain, hypermobility and toe walking. Each child tends to attend and present different problems which makes the day more interesting when I have to find a solution."  

Care in the community

Jade Griffiths is one of our nurses who provides care to people in their own home. 

“I'm passionate about community services
because I can care for people in their
own homes and help them get back
on track with their own lives.”

"It was during the 2^nd year of university whilst on my nursing placement that I fell in love with working with people in the community. I found working in hospital quite impersonal so much prefer working in people’s homes where you get to know them, their families and their home circumstances so much more.

Working in the community as a nurse means no two days are ever the same, whether I’m helping a person manage their diabetes or supporting a person at the end of their life. Generally my day will start with going to the office, seeing what appointments I have, catching up with the team before setting off on the road. I could either be seeing a patient that receives regular care or a new patient. Last minute changes can happen too if an urgent appointment crops up. Although I work on my own whilst on the road, I always feel supported, whether it is by my community nursing colleagues or the Multi-Disciplinary Teams.  

What encourages me to get out of bed in the morning? Simply knowing that I can make a different to a person’s life."

A positive impact

Siobhan Jones joined the team at Hannah House at the start of 2014 and has been enjoying it ever since. She explains what led her to work for a community trust... 

"I'm passionate about community services as you
get to see the children in lots of different settings
and work with the families to help build relationships."

"Prior to working at Hannah House I spent 16 years working for Leeds and York Partnership NHS Foundation Trust. I worked on several units predominately supporting adults with a learning disability who also display challenging behaviour. This included working on the assessment and treatment unit, respite unit and working with people during their transition back to the community. I also worked on the respite unit for adults who also have complex health needs.

I applied to work at Hannah House for several reasons, the main one being the opportunity to work with children. Prior to and during my nurse training I worked with children in a variety of settings all of which I found extremely rewarding. Since becoming a mum I have been reminded how enjoyable it is to spend time with children and to help them through the various stages of development. 

Each day at Hannah House is different. Overall a typical day can be broken down into three main areas. The first being the direct contact you have with the child; meeting their needs whether this be personal care, medication, nutrition, in relation to play and stimulation or supporting their method of communication and assessing their health needs and responding appropriately. 

The second concerns communication with others. This may be the family, school, community nurses. It may be carried out on the telephone; obtaining information regarding changes since their last stay or providing others with updates and information e.g. their school. 

The third is looking how things can be done better. This can be reviewing practices and identifying how care can be delivered better at Hannah House. It may involve looking at how we can improve communication between ourselves, the child and others who are involved in the child’s care. It may have a wider scope involving how the services can work better together to provide the most effective and efficient service possible.

Working in a community trust allows me to work with other teams and in different locations, such as in the child's home. This enables me not just to see how the child spends their time at home but helps with building a relationship between myself and the family.

The most rewarding aspect of my role is knowing that something you have done today, however small, has had a positive impact upon the child you are caring for."

Meet Our Team: Sarah Holbrey

1

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

How long have you been doing the role?

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

   

   Tell me a bit about your background

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

     What brought you to work at the Stop Smoking Service?

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

   Why did you want to work in the community?

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

   Describe a typical day

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

   What area of your work do you find most rewarding? 

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

How would you like your career to progress?

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

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