Dying Matters Awareness

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

Jane and Dianne 

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

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

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

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

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

Jane Wilde and Dianne Fawcett, palliative care discharge facilitators

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

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

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

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

The Heart of Nursing

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

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

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

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

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

Find out more about the community cardiac service here. 

All part of an NHS PR person's day's work

Okay so you all think the world of public relations is glamorous right? Well, maybe... Even in the NHS it's that buzzy team in the office coming up with the vibrant ideas and always talking (or tweeting) very loudly about it - when we're not out to lunch that is!

Hannah and myself at the RCN stand

Well I would like to set the record straight here and now.  Firstly, yes I am very proud that myself and my brilliant team of Sarah, Mandy, Hannah and Andrew occupy the buzzy, vibrant area of Stockdale House in Headingley and yes we do have some great ideas - we may not share some of the wilder ones with the rest of the organisation - but I am proud of everything we do.  Yes we do bake a good cake to accompany our fresh coffee or Earl Grey tea and we do enjoy the odd lunch at Hyde Park Corner or in Headingley if we're celebrating something special - but I like to think we're known for turning work around and getting some brilliant results.

Above all else, we're focussed on the needs of our organisation, our services, our staff and the patients and their families we serve - we use our communications expertise to share messages and seek engagement with key individuals and groups.

This week's activities that fall within the remit of "all in a PR person's day's work" are possibly on the less glamorous side.  Our work has involved having lots of lovingly branded items made for our current recruitment campaign.  So count them: 1,000 hessian bags, 1,000 hand sanitisers, 1,000 trolley coins, 1,000 torches, 1,000 water bottles, 10,000 (yes 10,000) pens oh and before I forget (not that it is possible to), the 1,000 air freshener dangly things fragranced with jasmine - and yes, I do regret giving Mandy and Hannah free reign to choose the scent as it's all you can smell in our office right now!  I also regret the hessian bag choice, well I don't because it looks fabulous, but when you have eczema on your hands, handling hessian bags makes your eczema bleed - but it doesn't make me exempt from mucking in to help the team effort!

Before and after 

It's all focussed on how we attract new talent to our organisation to be the future of community healthcare in our brilliant city of Leeds. We have some challenges in terms of vacancies within some of our services so it's our job as comms people to get some great messages out about working for our organisation and to make this sound attractive as possible.

So we made the biggest production line in Stockdale House history (our Leeds head office) to put one of each branded item into each hessian bag, as we've been attending some jobs fairs in Leeds in the last week to attract new staff to our current vacancies in our organisation.  Attending the fairs means getting the 1,000 filled bags to each venue and setting up what is for us, a bit of an ambitious exhibition stand.  But we're taking it in our stride and doing quite well actually!

Today and tomorrow we're at the Royal College of Nursing Jobs Fair in New Dock Hall, Clarence Dock, Leeds. Myself and Hannah from the team have been lugging round said goodie bags and lots of other boxes and racks, as well as putting up our gargantuan display graphics that include our fab campaign strapline: "A passion for community services" - that's us in 5 words - at the venue yesterday so we can attract some lovely new staff to our organisation.  So if you're interested in nursing or indeed any other role in a community focussed organisation then do stop by any time from 10am - 5pm - we're on stand number 15.  

And we have some great goodie bags to give away...in case you hadn't guessed.  Here's hoping for a great event and some new staff to join our community based organsiation.

P.S. Before I go, I just wanted to add that it's Sarah's birthday this week, so if you need us, we're out to lunch on Friday trying to put a little glamour back into our week!

P.P.S. We do have a vacancy coming up in the team so if this post has attracted you to our heady world of hessian bags, glamorous exhibitions and the odd team lunch, keep an eye on NHS Jobs for the details.

Gillian Neild, Communications, PR and Marketing Manager, Leeds Community Healthcare NHS Trust

@GillianNeild

Helping people to live independently

Debbie Slater is currently a community nurse. She first worked for the trust whilst on placement and enjoyed it so much, she wanted to return...

“I’m passionate about community services because
I help support people to live independently
in their own homes and live a fuller life as possible.”

"When I was a student nurse, I worked with the Intermediate Care Unit (ICT). It was one of the areas I enjoyed most and learnt a lot from. Once qualified, I wanted to return as a permanent part of a rehabilitation team. For the first two years after qualifying I worked at St James Hospital on an acute medical ward before joining the trust’s Intermediate Care Unit (ICT).

I wanted to work for ICT so I could experience a different type of nursing and for me, being in the community meant I could get to know patients better because they were in their own homes.

A typical day for me involves going to the office in the morning, where I will find out which patients need to be seen and what referrals have been sent in. I will then discuss and plan the day with my nursing colleagues and the Multi-Disciplinary Teams. The rest of the day I will be out in the community visiting patients. Sometimes I will have to rearrange visits through the depending on whether I get a call about new referrals or patients that need to be seen quickly. Being a community nurse allows me to work independently, however I know I can discuss any issues that have cropped up with the rest of the team, and normally have a debrief once I return to the office at the end of the day.  

For me there are many rewarding parts to my role including; preventing admission to hospital by picking up on a patient becoming unwell early, helping people recently discharged from hospital to stay at home or assisting people as they adjust from being dependant on staff to living independently.

I enjoy the variety the day brings, every patient and situation is different, I never know what I will find when I arrive to do a visit."  

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." 

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."

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 

 

Flying High

Humankind has been interested in flying for a long time. Leonardo Da Vinci in the 15th century drew pictures of what a flying machine might look like. He had studied the flight of birds for his work. In the early years of the 20th century the Wright brothers managed to get a plane they had built to fly a few hundred feet. Before the century was out we were not just flying planes in the air but space ships to the moon. The ancient literature of the world also speaks of flight in powerful engaging ways. In ancient Greece there is the story of Icarus who flew with wings made by his father. He ignored his father's instructions and flew too close to the sun and fell down into the sea. The Book of Psalms also speaks of  flying. It says, 'Oh, that I had the wings of a dove! I would fly away and be at rest.  I would flee far away and stay in the desert;  I would hurry to my place of shelter, far from the tempest and storm.' (Psalm. 55:6-8).

 What is this attraction to flying and rising up to the heavens? It marks the centuries and as a race we have dreamed about, written about and worked to fly. There are probably multiple reasons for this interest. One as the Psalmist records is to escape from problems and dangers and find a place of rest. Another is that we have an inborn ( it seems ) need to rise and reach out. To ascend and transcend. To fly a bird needs wings. If a wing is badly broken it may not be able to take flight or fly again. While we do not as humans have wings the analogy is an interesting one connected to work and work values. It is a useful framework in which to ask the perennial question of what is a good health worker. What does great nursing and GP work look like? What are its component parts? What makes the difference between the average and the exceptional?

Louise and myself met recently and talked about the themes of this post. Louise is a third year nurse student at Wolverhampton University and I, a manager at York Street Practice, part of Leeds Community Healthcare NHS Trust. We will try to point to the two wings of good health work. We reckon that there are also the wings of good social work, care work and every valuable human endeavor. We believe these two wings enable those who discover and exercise them wisely and well to soar and move forward. This post is a distillation of the words of the emails and tweets we have sent to each other. In them we were asking what makes us fly - what makes us do the incredible.

The first wing is compassion. Compassion means to care for another. It means that heart connection that moves us to help and support another. The word compassion is from the Latin words for 'with' and 'suffer' or 'suffering'. So we have the idea of suffering with or being alongside someone in pain or difficulty. Recently I attended the NHS England event on NHS Citizenship in London. This event was to support and develop the public voice in the NHS. We broke into small discussion groups and our first task was to draw what the NHS meant for us or what we wanted from it. In a group of 6 people (mostly public and patients) three of us drew a heart. Another person drew a picture of matchstick men and women all holding hands in a circle. We know instinctively our service is all about compassion and care. The NHS in its intent, constitution and purpose is founded on principles of compassion and care where need is the basis. 

In response to the question of why she was wanted to be a nurse, Louise offers three reasons: 

 (1) "To care for patients and their families in time of need. no matter what their social background,ethnicity or choice in life. I believe we all need someone to care and who cares."

 (2) "To make a difference. I am keen to become a change maker, in that I really want to help and guide others, not just stand for the norm, be proactive in the face of adversity. I really want to make that difference, and inspire many who doubt that they can. If I can they they can! We can all be change makers. To stick our heads above the parapet is an immense feeling; one that at times I would love to hide from. But I myself am out there now, and I will make a difference, somewhere, somehow."

 (3) "Because this is all I have ever wanted to do! If I can help then it would really make me happy
  These sentiments are not rare. We find them across the NHS and in many places. Compassion is the heart we bring to a world in pain and worry. We really can be that difference. Healthcare without compassion has no values, focus or future."

The second wing is true leadership. We say true as there is unfortunately some confusion around leadership. People think leadership is management. We would rather say that the difference is management deals with systems and leadership works with people. One can be a good manager and poor leader and vice versa. To place an equals sign between manager and leader is a mistake. Leadership is a presence which we bring. Leadership is about people. It's seeing the best and bringing out the best in others and also seeing the best in ourselves. The best leaders are people of vision, values, care and compassion. It's what we learn and give that makes good leadership. Some leaders are quiet, some are not. Leadership is a possibility to us all. Like the cosmos with its stars, meteorites, suns , planets and galaxies it takes a myriad of forms and expressions. The trick is to see the possibility of leadership and keep our minds open to this and see what happens. We may find doors open today, tomorrow or in the future. We may not sometimes be the first to see it. People (usually fellow leaders who instinctively know it when they see it) may see in us what we may not at that moment see in ourselves. Leadership like life is all about us seeing, owning and releasing our gifts.

When people start to see our leadership emerging they will often say very nice and affirming things. We may find this difficult to see and accept. We may struggle with their compliments and affirmations. This is understandable. It is a sign however that our gifts and identity are starting to express themselves in visible and effective ways. We need to listen to the praise and compliments others give. We are always greater than we think ( much much greater, despite all our faults and flaws ) but we need to remain modest and humble when we start to see it too. So authentic leadership is the other wing. These wings fly together. Great leadership is compassionate and to inspire others is a truly compassionate act. Compassion feeds good leadership as fuel a fire.

Compassion and true leadership offer a vision of what the NHS is and can be. It offers the greatest perspective of all. That is transformation. The spiritual writer Richard Rohr talks of how it is transformed people who transform others. It's those who are themselves transformed that transform situations and support others to make that journey also. When we find our wings we find energy, meaning and direction. When compassion and good leadership are our wings we fly and fly high.

John Walsh. York Street Health Practice. 

Louise Goodyear, Student Nurse at Wolverhampton University

Culture Change in the NHS

Leeds Community Healthcare is currently working in partnership with NHS Employers and Southampton University on a project to understand and support culture changes in the NHS. The project will run until November 2014 with specific outputs on tools for development of new cultural paradigms across the health economy.

The project team comprises of Catherine Hall (Service Manager for Specialist Services), Caroline McNamara (Senior Clinical Lead), Julie Mountain (Head of Adult Neighbourhood Services),  Julie Thornton (Development Lead) and myself.

Much emphasis has been placed on 'culture change' over the past couple of years in the NHS and we have seen forensic examination of system failures across the NHS. The outcome of this has immediate impact on patients and their families and the importance of putting these terrible events right is critical. One of the more astonishing and distressing facts to emerge from the Francis Report for example was the number of instances of not only poor care, but inhumane care. Patients were left lying in their own urine, or were left for hours without food or drink. Psychological studies have helped to shed light on the mechanisms underlying inhumane behaviour, such as ignoring distress and harm to an individual, although it is worth bearing in mind that none of them were caring for vulnerable patients.

Particularly pertinent is the ‘bystander effect’, in which individuals stand by and fail to help a victim in distress. Relevant variables (see Fischer et al, 2011) include the number of bystanders present (more means it is less likely that a victim will be helped); the ambiguity of the situation (more ambiguity leads to less help); and the similarity of the victim to the bystander (the greater the similarity, the more likely that help will be offered). Research has also shown that pressing situational factors may readily override explicitly enounced value systems and beliefs, such that a person in great distress is ignored (Darley & Batson, 1973), something that could find parallels in busy clinical settings.

Also relevant is Philip Zimbardo’s Stanford Prison Experiment (Haney & Zimbardo, 1998) where those who were put in charge of prisoners subjected them to inhumane treatment that seemed to transcend all moral boundaries. Relevant issues are discussed by Miller (2011) and by Haslam and Reicher (2012). The latter’s findings indicate that a positive hospital culture of strong leadership in human values and appropriate peer support should help to counteract any negative tendencies.

The vast majority of NHS organisations run perfectly smoothly and cope extremely well under the pressures that are currently being experienced by staff.  When we hear talk 'in the system' of culture change what do they or we precisely mean? It’s useful to nail down a definition here:

"Culture is a set of shared, taken-for-granted implicit assumptions that members of an organisation hold and that determines how they perceive, think about and react to things (Schein 1992)." In other words it’s 'The way we do things around here'. 

In a recent accompanied visit with a District Nurse to one of the poorer districts within Leeds we visited an elderly couple. The patient we had gone to visit had the start of small ulcer around his bottom and the Nurse had visited to offer treatment and reassurance. We had gone only to see the man for treatment but it quickly became apparent that both needed some form of care. Whilst Elaine was attending to the 'real' patient I chatted to his wife. A large portion of what we both did that morning was not only attending to the patient’s clinical needs but also a whole range of social and psychological support. Most of that was through being interested, curious and listening to stories about their journey through life; where they grew up, which school they went to, what their parents did and noticing the pictures on the wall.  Each photograph telling a story about their lives, the histories of their families and how they had grown up in Leeds. 

Often with huge pressure on their time, nurses (and other care professionals) do this day in day out with care, compassion and attention. This is clearly technical clinical competence done with kindness. We could say that kindness is something, which is generated by an intellectual and emotional understanding that self-interest and the interests of others are bound together, and by acting upon that understanding. Human beings have enormous capacity for kindness. It is this essence that is at the core of our change work in LCH.

If we are to support the changes that are necessary and needed within the NHS we also have to be mindful and supportive about the millions of positive interactions that take place every day across the country. The danger is that we become embroiled in negativity regarding the terrible events such as Mid Staffs without paying attention to the amazing work that takes place. There are things that we are doing and can do provided they make sense to staff and patients and also connect to our values and behaviours.

Culture change is happening all the time and as a reminder of this we only have to look back to how things used to be.  The essence of what we stand for in the NHS will never change, this is the greatest of all platforms with which we can truly 'stand on the shoulders of giants'.

‘We are living in a world of change - the tempo of life has quickened considerably. The wheels of “possibility” in our world of nursing would appear to be turning more swiftly. Many hospitals have been enlarged and new departments have sprung up within them. There is a new look in many of the Wards and Nurses' Homes. Revolution is in progress, and like every transitional condition, it has an upsetting and almost bewildering effect on the various members of our profession. Is it not all the more necessary, therefore, that everything possible should be done to ensure stability and continuity? But one of the main foundations is a sense of community, and all efforts should be made to foster and strengthen the feeling that we are all part of a whole, with a common centre and mutual purpose.’ (The British Nursing Journal September 1951)

Steve Keyes, Head of Organisational Development

 

References  

Darley, J. & Batson, C. (1973). ‘From Jerusalem to Jericho’: A study of situational and dispositional variables in helping behaviour. Journal of Personality and Social Psychology, 27, 100–108.

Fischer, P., Krueger, J., Greitemeyer, T. et al. (2011). The bystander-effect: A meta-analytic review on bystander intervention in dangerous and nondangerous emergencies. Psychological Bulletin, 137, 517–537.

Haney, C. & Zimbardo, P. (1998). The past and the future of U.S. prison policy. Twenty-five years after the Stanford Prison Experiment. American Psychologist, 53, 709–727.

Haslam, S.A. & Reicher, S. (2012). Contesting the ‘nature’ of conformity: what Milgram and Zimbardo’s studies really show. PLoS Biology, 10, e1001426.

Miller, G. (1969). Psychology as a means of promoting human welfare. American Psychologist, 24, 1063–1075.

Schein E (1992). Organizational culture and leadership. San Francisco: Jossey Bass

The British Nursing Journal, September, 1951.

Happy birthday NHS

Margaret Thatcher retired from the House of Commons at age 66. Many people used to retire at 65. The NHS is 66 on July 4. Rather than retirement, a recent study by a prestigious American health body suggests the opposite is the case. The report actually points to vitality, life and plenty of work to do yet. The Commonwealth Fund is a non partisan and private health foundation based in New York. Its mission is 'to promote a high-performing health care system that achieves better access, improved quality, and greater efficiency, particularly for society's most vulnerable, including low-income people, the uninsured, minority Americans, young children, and elderly adults.' Its board includes key health experts such as James R Tallon. A report called 'Mirror, Mirror on the Wall, 2014 Update: How the U.S. Health Care System Compares Internationally' makes some interesting points. It compares the USA health system with 10 other health systems including our own. The other countries are Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden and Switzerland. The really key point is that the study looked at what really matters. Key elements such as access, health care quality, equity, efficiency and key indicators of healthy lives (e.g. infant mortality) were used. The result was that the best overall health ranking was......the NHS. Switzerland and Sweden were second and third respectively. (http://www.commonwealthfund.org/publications/fund-reports/2014/jun/mirror-mirror).

When we often hear how bad things are in the NHS, this health specialist study says something else. So how do we square the bad news we hear and the scholarly study done by this Foundation? One doesn't have to be a genius to see that bad things happen in good services. That things in a service may be wrong yet a service can be right and good. This leads to the need for renewal and reform not ditching the service. I hope if we found a dirty plate at home we would wash it, not smash it. The study also suggests that there are powerful energies and practices in the NHS that are working well. If there wasn't, how could it be rated the best in overall health ranking?

The NHS is where ordinary people do extraordinary things everyday. The NHS is a sign of what a civilized nation looks like. It embodies the highest principles - social care, social justice and social equality. It says that health should be based on our need not our bank account. The NHS is ours - it belongs to the people. This report says she is still delivering 66 years on. We know that she is what her best practice and foundation express - great vision, values, care and compassion. That's why so many of us are so proud of the NHS and so many of us are humbled to be part of her service.

 

Happy birthday NHS - thanks for all you do and have done for people. 

 

John Walsh, York Street Practice

Men, Health and Hope

 

Last week saw International Men's Health Week celebrated at St George's Crypt in Leeds (from Monday 9 June to Friday 13 June). The aim was for homeless men in Leeds to receive a week of wellbeing and health actions and events, an idea formed by Kim Parkinson at the Crypt. Kim is the training and housekeeping mentor and a great force for good among homeless people. This idea led to an initial meeting with Andrea North and myself from Leeds Community Healthcare NHS Trust (LCH), Alan White, Professor of Men's Health Studies at Leeds Metropolitan University, Jade, a social work student at Big Issue in the north, and Kim to plan and design the format and spirit of the week. Rob Newton from the Institute of Health and Wellbeing and the Health and Wellbeing Board at Leeds City Council and Karl Whitty, research officer in the Centre of Men's Health at Leeds Met joined us shortly afterwards.

 

We, as a meeting of forces, representing the local authority, health, third sector, faith sector and education, were able to create an amazing week of events. The week included massage, meditation, podiatry, theatre, physical fitness, haircuts, song and pamper bags for the men. Running throughout were a series of positive and yet serious health messages. Health professionals from a variety of LCH services (including Tuberculosis service, Community Dental, York Street, Healthy Lifestyles Service) attended, offering connection and conversation. We deliberately moved away from a model of formal structured consultations to conversations over food and coffee - to share, engage and listen. Age UK Leeds joined the week as did Leeds and York Partnership NHS Foundation Trust. Our Primary Mental Healthcare Service provided information leaflets.

 

The event was opened by Cllr Roger Harrington, Chris Fields, CEO at the Crypt and Professor White. On Thursday, Cllr Lisa Mulherin, the chair of the Health and Wellbeing Board visited the event in support. Lisa has consistently supported these events and we are grateful for her support and voice for the poor and vulnerable of our city. Andrea North and Catherine Hall, two other great supports of these initiatives at LCH also, in their busy work lives, attended to support. A big thank you too to Sarah Elwell, the new communications officer at LCH who did an incredible job managing the photography, press release, partnership agreements, Twitter, Facebook and other media actions in such a professional and helpful manner.

I was in London for the first two days at health events so missed the start of the week. I did attend the last three days and was touched by many things. Three themes shine through. The first was the theme of 'space and place'. The Crypt is an incredible centre of welcome and wellbeing. They are one of York Street's best partners and we always try to support their good work. This brings home to me one of the key aspects we use at York Street as part of our model of work.  The people who come to the Crypt and York Street are those who often have no positive space or place in their lives. From the asylum world, they may be people who have been tortured, imprisoned or raped. In the indigenous homeless world, the vast majority of those we have the honour to try to support have problems going back to childhood. We work to create what the theorists call 'psychologically informed environments', places and spaces where people can feel welcome and accepted. The Crypt and York Street are such places as are many places in this city. The creation and development of these spaces is crucial to the human development and recovery of the homeless and vulnerable.

The second theme was that of the homeless people themselves. On Wednesday when I arrived, I sat down and  looked out at a sea of faces, each etched with stories and I'd guess, in most cases, pain and loss. It was at that moment that a former client of mine came up and gave me a big hug. I had worked with her a number of years ago. As I sat with her and listened to her present story I heard of  the struggles and setbacks as she was trying to build a more positive and healthier life. In the centre of the difficulties and pain there was also hope. This was not someone giving up but keeping on to try to get to where she needed to be. In this woman, there was the courage, the hope and belief that things, including her own life, could get better. This is what inclusion and wellbeing work is all about. It's when people can find their hope and strength that changes can really start to happen. Talking to men over the three days I had the same experience. Sensing the heavy issues people carried yet a not giving up spirit - a hopefulness against so many odds. If we ever lose sight that is what our work is really about, then that will be a really sad day. If we forget the people, we lose our way. Isn't that what the tragedy of Mid Staffs teaches us? On the Monday evening I was at an event in London with the top 50 nurse leaders in the UK, truly amazing people. I was there as guest of my good friend and mentor, Yvonne Coghill, the national lead for inclusion at the NHS Leadership Academy. Yvonne walks the national stage in the NHS. She is one of the leaders in this great service of ours. Although she never mentions it, she also makes time, again and again, to reach out and support people in the most vulnerable positions. If we ever wish to know what 'best leadership' looks like, this is it. Concern for people has to be at the heart of what we do.

The third aspect was how we all working together made a difference. Apart we are little. Together we make a powerful impact. Sometimes people see effective partnership work as some arcane art that 'business gurus' can teach us to generate. The truth is much simpler. Good partnerships happen when people who care connect. This is what happened at Men's Health Week at the Crypt. People who cared enough to put aside time to meet and act came together to do something. My mind fills, as I try to write this, with images of this in practice. Professor White sat with homeless men at a table talking about their health. Alex Hammond and his team from Healthy Lifestyles Service going straight into action connecting with men about how they can make positive changes. Dawn and Gill from the Community Dental Team at Armley smiling and talking about dental care to the men. Urban Spawl and Opera North offering arts, drama and theatre. Dr Phil Commons from Leeds Met with physical fitness. LYPFT were represented by my friend and colleague, Ken Cattle. Ken is a former mental health service user and now has dedicated his life to working with people in the community with mental health problems. Ken was an amazing presence talking to and connecting with the men there. Talking about mental health is not always easy but Ken did it again and again. The week made me proud of what we can do together, what we can be together. We have in Leeds 12 integrated care teams bringing together health and social care. These teams work to provide the best, quickest and most effective responses to those in the community. I saw at the Men' Health Week the same spirit, promise and potency. This city has a great health and wellbeing vision - 'that Leeds will be a caring and healthy city where the poorest receive healthcare the fastest'. I saw that happen at Men's Health Week. It really shows we can do it. If we can build on these experiences we can realise the vision and then Leeds may end up as, not just best city for health and wellbeing in the UK, but in Europe too.

The late Maya Angelou once wrote that, "I've learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel." I doubt any of us who participated in the week will forget how we felt in trying to make a difference. I also don't think we'll forget those faces looking to us for support and help.

 

John Walsh, York Street Practice

 

 

 

Healthcare Assistants - Our Unsung Heroes

I am so pleased we were able to celebrate International Nursing Assistants' Day on the 12^th June 2014 in Leeds. 

Nationally therapy assistants and nursing assistants are an essential part of our workforce and are often the unsung heroes. In LCH, care assistants are trained, hardworking and professional.  In my experience as a health professional and as a recipient of healthcare, an experienced care assistant can turn a traumatic experience into a positive caring interaction. They can diffuse anxiety with friendly, confident and competent care.

Thank you to all of our healthcare support workers.

Angie Clegg, Executive (Nurse) Director of Quality 




 

Celebrating Nursing Assistants' Day

On Thursday 12 June, we decided to recognise the hard work of nursing assistants with a celebratory day.  

Working across the city, both day and night, nursing assistants are essential to ensure the trust continues to provide a high standard of community nursing care.  

Five community nursing assistants took time out of their busy schedule to give us an insight in to the role of a nursing assistant at LCH. Huge thanks to Julie, Karen, Adele, Maggie and Janet for their time, here’s a few snippets from our chat:

What made you want to become a community nursing assistant?    

Karen: “It was my friend that is also a nursing assistant that encouraged me to consider becoming one. I first started with a one month contract as an agency nursing assistant at Meanwood Health Centre but I ended up working there for seven months, during which I fell in love with the job. As soon as a permanent band 3 post came up, I applied and was successful.”

What attracted you to join LCH as a community nursing assistant?

Maggie: “As I don’t drive, this was the first nursing assistant role I had seen where I could walk, rather than being required to have a car to get around and see patients. I really enjoy getting out and about in the community, I find it is much more relaxing than being on a ward. Plus I feel empowered to make decisions yet know I have a supportive team to contact should I need to.”

What do you enjoy about being a community nursing assistant?

Karen: “I enjoy working with some of our more challenging patients, especially when I can bring out their sparkle and find a common interest to chat to them about and bring them out of themselves.”

Adele: “I have been with the trust for four years now and enjoy every aspect of my job. Daily, it offers me the chance to meet new people, be challenged and take on responsibility.”

What would a typical day involved for a community nursing assistant?

Janet: “I work on the day shift so the first part of my day generally involves being in the community, providing treatments such as doing leg dressings, taking pressure measurements, assisting with bowel care, giving insulin and eye drops, etc. The nursing assistants and myself then head back to base (there is 12 bases across the city) at lunchtime to regroup, discuss patient care and get work schedules for the next day. After this we will all head back out, either to a patients home, day centre or residential home. No two patients are ever the same so my day is always varied.”

What has been a highlight during your time as a nursing assistant at LCH?

Adele: “In my previously role at a residential home, I only did personal care but becoming a nursing assistant has allowed me to learn more and offer the next level of healthcare to patients. The training opportunities at LCH are really good.”

Janet: “One of my personal achievements is getting my NVQ level 3, which I did through the trust.” 

What would you say to someone thinking of becoming a nursing assistant?

Julie: “Other members of my team and myself work a lot with students, taking them out in the community with us, mentoring them. For anyone thinking of a career in nursing, being a nursing assistant is a great way to start and give people insight in to healthcare.”

 

Sarah Elwell, Communications Team