A timely call

The Centre for Innovation in Healthcare Management has this year produced a manifesto with the wonderful title 'Giving Inspiration a Chance to Flourish' . The manifesto is a bright and colourful production. I don't think the brightness and clarity of the publication is accidental. It reflects the method and spirit of the manifesto's message.

The CIHM is a health innovation centre based at the University of Leeds. Its website describes its dynamic work well  as a 'network of doctors, public sector managers, organisational change consultants and academics, who are passionate about improving public services. We believe that CIHM is unique in that it is a ‘think and do tank’: not only do we undertake major pieces of academic research but we also work with health and social care organisations to help create the conditions in which change occurs.' The Centre is  led by Becky Malby, a deeply respected and inspirational figure in the world of innovation and health. Becky recently visited York Street Health Practice.  Becky, Catherine Hall and myself spent nearly two hours in discussion and dialogue. It was one of the most enlightening and inspiring talks I have ever had in nearly 20 years of working in the NHS.

 The manifesto is a challenging and positive road map of where we can go and what we can be. The heart of the manifesto is 'finding solutions with people that deliver and use services.' The manifesto has eight key parts.

 (1) Develop local solutions with local people.

 (2) Provide conditions that allow staff, patients and communities to adapt, innovate and improve together

 (3) Create space for communities to provide health and social care,prevent ill health and be well

 (4) Support regulation to stop unacceptable behaviour; not to improve the behaviour of the majority.

 (5) Choose co-operation as the expected and default behaviour

 (6) Understand what’s going on around here now, how things work now.

 (7) Give people the chance to talk about what matters to them and how they will act towards each other.

 (8) Create opportunities for patients, their families and carers to have a voice in all aspects of their health and social care.

 Each of these elements has a 'Why?'and 'How This Works' explanation. The important thing about this manifesto is that it is underpinned by a clearly stated set of core beliefs about us all. The manifesto terms them as 'self evidently true' ( perhaps borrowing from the US Declaration of Independance's self evident truths ). These are located in a view that we are not just individuals but part of communities, that we have great potential, possibilty and can organise ourselves and that systems should learn from each other and understand each other. It is these clear and liberating beliefs that underpin the manifesto.  

This manifesto seeks to ground itself on what is best in us and others. It offers a picture of how the NHS could develop. In the section 'What We See What Inspires Us' we find people going the extra mile, kindness and the spirit to keep asking difficult questions. The manifesto is not a theoretical construct living in the clouds neither is it a collection of practical recommendations. It is rather a call for us to link mind and heart in positive action for the future. It marries the need for clear thinking with rooted actions. It is space that starts that discussion of what the inner being and external expression of the NHS can be. I would ask all colleagues to read this manifesto and let its aspirations and power challenge us. By all means debate and question what the manifesto says but let's have that dialogue. From this discourse, great things can emerge. Without it, I am not so sure. I hope we can all commit ourselves to grow opportunities and spaces for this Manifesto and it's challenge to become living practice. 

John Walsh, York Street Practice

Little bit of peace and quiet

Danny, one of our public members

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

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

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

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

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

Daniel Lipzith, public member of LCH

John Walsh, York Street Health Practice

Stoptober starts in September

Maree at the Leeds Market drop in clinic

I’m Maree and I am a Smoking Cessation Practitioner with Leeds Stop Smoking Service. I joined the team in February. Our service is city wide and we provide 1 to 1 sessions, drop ins and groups. Most of my clinics are in West Leeds, namely Armley, Bramley, Pudsey and Wortley but I also do a drop in clinic in Kirkgate Market (Leeds city centre market) on a Friday morning. More details about the drop in here.

We provide help and support to those who want to stop smoking and we can help our clients to access the treatments they need to help them stop. Research has shown that using NRT (nicotine replacement therapy) or one of the pharmacological aids (champix or zyban) plus the help of the NHS, people are four times more likely to stop smoking than if they were to go alone.

The team supports the national stop smoking month long campaign, known as Stoptober. The campaign begins on the 1st October and runs for the whole month. Even though it’s only September, we’re already getting prepared. The team will be on the Jubilee Wing at Leeds General Infirmary between 1pm and 4pm on Monday 15 September and the Gledhow Wing at St James Hospital between 9.30am and 2.30pm on Friday 19 September. You might think we’re got our months confused but we want to get people interested and motivated in advance so that they are up and running for the start of Stoptober. We'll be there to give advice but people can also begin the course there and then and access the treatment. 
  
As well as these events, we’ll be putting up displays across our clinic sites. The very helpful lady on the community reception at Thornton Medical Practice, has kindly said she would like to arrange a display on one of her notice boards, solely to promote stop smoking and Stoptopber. So I am really excited about that and I am going to rustle up some resources for her to get her notice board all swanky. When she has done it, we’ll post some photo’s on the trust’s facebook page.  

Maree Diamond, Stop Smoking Practitioner

Stammer School

Laura Gibson, is a Specialist Speech and Language Therapist at the trust's Stammering Support Centre. After watching 'Stammer School' on Thursday, she has offered her thoughts on the programme and compared the advice shown with what the support centre in Leeds do.   

"As soon as I saw the Channel 4 programme, ‘Stammer School’ advertised I quickly added it to my planner. I work as a Specialist Speech and Language Therapist at the Stammering Support Centre based in Leeds where we see children and adults from the Yorkshire and Humber area and beyond and I was really interested to learn about how the therapy approaches differed from those used at my place of work.

It was great to hear everyone’s stories and the different reasons why people had come to the ‘Stammer School.’ Everyone’s stammer or stutter, was different both in its nature and also the impact that it had on each individual’s life. I was struck by how Musharaf had wanted to do some teaching work experience whilst Vicky had wanted to speak out at a charity ball.

There were a couple of things which would be different from the “Stammer School” at the Stammering Support Centre:

1. We tailor our therapy packages to the individual: we believe in an eclectic approach to stammering therapy at Stammering Support Centre. We always tailor our assessments and therapy approaches to the individual and we have different assessments[1] and therapy for different age ranges. So for example, one person may attend 1:1 sessions whilst another may benefit more from our ‘Talking Out’ outdoor pursuits group program.

2. We focus on long term outcomes. Whilst independent programs can make massive improvements over a short period of time, it can be hard to maintain specific strategies. Our aim would be facilitate the development of skills and strategies which would enable the individual to independently manage their stammer in the longer term.

3. Holistic management. Often with therapy it is not just about the stammer but also the environment as talking may be more difficult in certain contexts or with certain people. We would be interested in identifying those variables and also working with the individual, the family, friends, teachers, employers – indeed anyone who could make a significant impact on the environment of the person who stammered.

4. Evidence based approaches. At the centre we always base our work on the latest research and clinical evidence. We would not advocate or trust any approach that had not been through rigorous evaluation. That is why we evaluate everything we do with clients to make sure that it is as effective and efficient as it could be. We are also concerned with researching innovative ways of working and developing new strategies[2].

If you are interested in hearing more about our work at the Stammering Support Centre, email ‘Getting the Word Out’ to stammeringsupportcentre@nhs.net and we will add you to our distribution list for our monthly newsletter."

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[1]Our assessments for children and young people are free due to charitable funding from Action for Stammering Children.

[2] Development of app for young people and adults who stammer.

No.

On a bus in 1955 in Montgomery, Alabama a bus driver ordered a black woman to stand up and give her seat to a white passenger. This was the rule of bus segregation introduced in 1900. The woman, a seamstress called Rosa Parks, looked at the driver and said 'No'. As a result she was arrested and the civil rights movement in the United States developed to a new level. It resulted into a bus boycott that lasted a year. Rosa explained her word, 'I had given up my seat before, but this day, I was especially tired. Tired from my work as a seamstress, and tired from the ache in my heart.' She also said, 'All I was doing was trying to get home from work'.

Rosa's 'No' changed the world. It played a pivotal role in the movement led by Martin Luther King for racial equality and respect. Today where she boarded the bus there is a plaque to Rosa. Her statue is in the US Capitol Building in Washington DC. She received countless awards, met American presidents and had streets named after her. What Rosa symbolises is an ordinary person doing an extraordinary thing. Here was a black woman who said 'No' because her conscience wouldn't allow her to go along any longer with a system that discriminated against people on the basis of their skin colour. Rosa is a call to integrity. Her name is a byword for having principles and holding them when the going gets tough.

Principles and values are what make us what we are. They shape and hold us. There is a saying that says, 'To betray oneself in order not to betray another is the greatest betrayal of all’. This is a very insightful comment. It tells us that there has to be some space or line written within us that is inviolable. This line says that we may compromise on some or even many things but not on this. We all need this line. Without it we have no deep identity. The word integrity comes from the word integer meaning whole or complete. Without integrity we cannot have completeness or wholeness. Without a core set of values or principles we cannot have what we all seek in so many different ways- that sense of oneness, wholeness and completion.

At work and life we can be challenged to go along with things that may conflict with our centre. There is a point when we have to make a stand for what we are. There is a time to say 'No.' Without this possibility we are not really free. We are not of course advocating that people fight everyone and everything. What we do assert is that principles are key and without them and standing for them we find something fundamentally missing in our life and what we can bring to work.

So how do we keep our principles? Rosa's life and words gives us some clues. She didn't go looking for trouble or fights with authority. 'All I was doing was trying to get home from work.'  She had given up her seat before but now knew she couldn't to be true to herself and her values of justice and fairness if she did. A moment may come for us all when we have to make a stand or lose our integrity. Rosa was filled with a sense of what was right. 'You must never be fearful about what you are doing when it is right',   She also said,  'I have learned over the years that when one's mind is made up, this diminishes fear; knowing what must be done does away with fear.' This to us adds us to the following. We need to have our core values and know them deeply - not just on an intellectual level but on a intuitional one also. There is nothing wrong with avoiding trouble and confrontation. However if we are faced with a situation where we need to make a stand then we need to do that  - trying to have sensitivity,grace and dignity. There is a moment when the issue that faces us is a values question and our answer is about whether we are true to ourselves or not.

This article is all about Rosa but it's also about you and us. It's about the sort of people we will choose to be. And the sort of people we decide to be is the sort of world we will create for ourselves and others.We started with Rosa and we will finish with Rosa. In doing so we dedicate this piece of writing to her and all the other Rosa's who say 'No' to whatever is wrong in our world. They are the real heroes and heroines. Rosa expresses this better then we ever can. 'Stand for something or you will fall for anything. Today's mighty oak is yesterday's nut that held its ground.'

Lisa Falkingham, Service Improvement Team, Leeds Community Healthcare

John Walsh, York Street Health Practice, Leeds Community Healthcare

Meet our staff - Rehan Majid

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

Rehan speaking to a client at York Street Health Practice

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

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

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

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

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

                                                                                                                                                                  

Why did you want to do this role?  

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

  

What is the best bit about doing your job?

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

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

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

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

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

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

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

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

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

Thanks to Rehan for taking the time to share this.  

A vision of care

Representatives from CaSH ( Contraception and Sexual Health service ) and York Street Health Practice met over coffee to talk and listen. Both are Leeds Community Healthcare NHS Trust services. CaSH  provides effective, accessible and non-discriminatory contraception and sexual health services to improve the sexual health and wellbeing of both young people and those who are vulnerable in Leeds. CaSH includes a consultant, doctors, nurses, clinical support workers and a youth worker. York Street is the medical team for people who are homeless, vulnerably housed and in the asylum system in the Leeds area. Both teams operate across the city.

The meeting had three great outcomes. The first was a commitment to find new ways to work together and support the Leeds Health and Wellbeing Board vision for the poor and vulnerable in our city. We recognised the potency that our services together working for best health outcomes and care offers. Two are better than one and the specialisms of both services working alongside each other offers much. The second thing is that both services have the quality mark for working in domestic violence. We discussed how we can work together to obtain level two of this quality mark. The third aspect of the discussion was what we might call 'the deep stuff' - how we work and support not just good housing, medication and services but how we help support people find identity, focus and purpose.

In this last aspect we touched on three elements - responsibility, respect and relationships. These '3 R's' offer a possibility of what can happen. The first was responsibility. This is the moment when we really make that commitment to be adult and act as adults. To stop blaming and undermining others. To accept ourselves and life as it is and work from there for the best. It's amazing how we as adults can act as children. The call to be an adult and responsibly act is rarely a once and for all reality. It must be something we do and renew each day and week - sometimes against great stress and challenges. To move away from behaviour that is not adult and responsible to be honest and authentic people is a journey. Our good friend, Anne Cooper, the Lead Nurse for Informatics for NHS England, wrote a very powerful blog about this road to being authentic.  Anne ends it with these wonderful words, 'So authentic leadership is, I believe critical; the ability to be myself and be human, not to be a robotic corporate being, to help others to understand the whole me, flawed as I am.' To be responsible is to own ourselves and take responsibility for one's self. It's actually to love ourselves just as we are but also to love ourselves enough to want to change and develop too.

Respect. What does respect look like? Perhaps it can be defined by what it does, not look like. The subject of domestic violence and abuse we discussed offers a contrary opposite picture of what respect isn't. Those words, attitudes, actions, undermining, bullying, nastiness and hate are what we find at the heart of domestic violence and abuse. The opposite of these may be deemed acceptance, developing, affirming, kindness, love, gentleness and goodness. This to us is respect and whenever humans find these values they usually start to warm up themselves and open up like new flowers to the sun. These things - kindness, respect, gentleness - are infectious and can change so much.

What about relationships? Any one who has worked in care for a while and who has really been listening and learning knows that relationships are the heart of all that good care work is all about. We can do the work it's true but we can't do work that connects and changes people without positive therapeutic relationships. At York Street one of the theoretical images of the work we use is that of the circle. The circumference is the doctor giving the prescription, the nurse bandaging the wound and the support worker filling in the form. Yet the centre of the circle is and has to the rapport, the connectivity, the relationship. All good health work has to focus on creating and sustaining this relationship. It's the relationship that makes the difference. After the tragedy of Mid Staffs we have a real call to ensure person centred dominate all our work.

So how do we become conduits for responsibility, respect and positive relationships? There are a number of ways. In fact each of us receive dozens of opportunities every day for this to happen. A story might help here. Last year at a conference outside Leeds one of the authors was approached by a student studying health asking to visit their service. A few weeks later the student arrived and had a tour and talk about the service. After this the young student started to talk about an issue she was facing in her placement. She saw a clash between what she was learning in her classes and what she saw in her present health placement. We were able to say two things. The first is that what she saw in her placement was culture. She mustn't think the great things she learnt in class - the patient centred approach, great team work, vision and values - were just ideas that couldn't work in the real world. What she was looking at in the placement was culture and that culture had been made by human beings. And it could be unmade or remade by human beings too. The second thing was that in the NHS that there is an army of us - thousands and thousands working for better cultures and care. She was part of this movement and she could be - indeed was - the change needed. The call was to light a candle rather than curse the darkness. That young student - with no power and authority - went back to her placement and course to be that difference. That's not good leadership - that's really great leadership. What we see in this young woman is how to be a transmitter of the responsibility, respect and relational approach that we are talking about in this blog. Great leadership isn't about where we are - it's about what we are. We can be people who own their own being and potency to serve and care for others. If we can do this we don't have many worries that the '3 R's' - responsibility, respect and empowering relationships - will quickly start to appear. 

Dr Farah Haider, CaSH,

John Walsh, York Street Health Practice