What if public health nurses helped people facing disadvantage to get back into work? Is this a legitimate role? How would that happen? Why is it important?
This week a mum I know from my social innovation work got a cleaning job. Big deal. Well yes actually. I’ve known her for about 2 years and she’s helped me in my work. I’ve given her a character reference, helped her with her CV and spent time talking to her about her progress. She’s been out of work for several years, she has three children and she is separated from the father of her children. As well as money, this is also about something more important- her own self-esteem and control over her own life.
I didn’t set out specifically to get people back into work but it has become a natural consequence of my social innovation work. As I sit with people from disadvantaged communities, they tell me about themselves and I watch how they live their lives. Because I practice a strengths-based approach I notice what they are good at and then I tell them. The effect of a health care professional doing this seems to stir self-belief. Sometimes they are not ready to hear it and, sometimes having been told (often by their own families) that they lack intelligence or are not good at anything, they don’t seems to have the psychological processes to deal with praise. But I persist.
And then I issue them a challenge. I need them to help me. Generally by this time, we have built mutual respect and they don’t want to let me down. And I leave them to think about it and I give them an out if they feel they can’t cope with it. Few seem to take this option and they then have a point to prove.
The challenge relates to them demonstrating their strength, overcoming what they perceive as a weakness and building their confidence. This is about growing community resilience so they can resist the severe disadvantages that they meet every day. When someone who hasn’t worked for years gets a job, their peers start to believe it’s possible. It becomes a snowball effect and the whole community starts to notice.
In contrast, I aim to make myself redundant as soon as possible. The community know when I start that I will move on, so I don’t create dependency, but I always tell them I’ll be there for them whenever they need me. Few believe this until they see it, but that’s captured in another blog on the Health Creation Alliance website called the Hokey-Cokey theory of community involvement. Please look it up if you can.
So for A, his challenge was severe social anxiety. I invited him to a charity night at a local working man’s club. I am a trustee for that charity and I said I needed his support. Needing him is important- he was also one of the few I’d met that had run a community group before. I said I’d get the ticket as it was my treat for all the hard work he was putting in, and several others were going who were working alongside me that he really liked. And I sat and waited on the door so mine would be the first face he would see
He looked anxious as he appeared in the doorway. He was wearing a shirt freshly purchased from the charity shop. And he said ‘I’ll just be five minutes’ and I thought ‘I’ve lost him’. But he gathered himself and came back in. After that night he wrote a blog in which he said that it was the first time that he had been out socially in 10 years. Social isolation is rife in such communities-and not just in the elderly.
A now volunteers not only in his community but also with a national foundation that supports severe and multiple disadvantage. He goes to London alone and meets with strategic thinkers in health inequality. He narrowly missed out on a job recently, but he will get there. I believe in A, who knows more things about addressing inequality than I ever will, because he’s lived through it. He’s a different man to the guy who literally had to be dragged in by a mate to meet me.
D is a mum I know. She barged into our project and was in danger of putting at risk what I was trying to do. I had to tell her to back off. She told me I was too posh to be accepted in this community and only local people like her could do it. So I told her she was right and I did need her help but not in the barging in sort of way. I noticed that she had events management talent. Meanwhile I was working with the local GP surgery, telling them that they should start thinking of the community as a source of help and not just a source of insatiable demand. The surgery boss laughed heartily at this, so I said ‘why not let the community organise a party to celebrate the 8th anniversary of the founding of the practice?’ The boss said ‘ok find me the help’. So I did. I asked D and she not only organised the party she also organised a successful community event about keeping well in winter. The surgery boss gave her a job after that. He no longer laughs at my suggestions.
H is clearly destined for nursing. But H is a mother of 3 and has no qualifications to speak of. So I said to H that the first step might be to consider becoming a health care assistant and that I’d introduce her to one so she could see if it was for her. She backed away at this. I asked D if H could visit and observe in the practice she now works in. Then I asked H to come to a steering group to report first hand on some asthma work we’ve been doing together. This was her first challenge. Despite her toddler having a bit of a temperature, she surprised me by turning up, toddler in tow, dosed up with paracetamol. She spoke up and made quite an impression. D gave her a lift home and on the way told her the story of how I got her into work. H is now ready to meet that health care assistant.
B is a comedian. A pretty single mum, but with a tough past. She’s loud, she swears like a Navvy and she makes the small group of mums at their coffee morning laugh with all her antics. But she thinks she’s thick. She told me so. After several occasions of sitting with her over coffee I told her she wasn’t thick and would she go with me to a tiny venue where I would perform some poetry I’d written and she could tell a joke. She looked horrified and refused. I’d forgotten to ask her for her help- to be my audience, to hold my hand. I missed her that night. I don’t always get it right.
J met me in a cafe. He was one of several fathers who I planned to rope into judging a children’s competition to find the best dad in town. He was so bundled up in his hoodie I could barely see him. He had an adulthood full of agoraphobia and post traumatic stress. He called that cafe his ‘last chance saloon’. Nothing had fixed his mental problems so far, but he really liked our project engagement worker, from a similar background, who spoke to him like a mate who cared.
J did the judging for the competition but come the day of the grand finale he didn’t turn up. He’d lost his nerve. He disappeared for weeks and the engagement worker found him and made sure he was ok. J started following the engagement worker around and I watched his boundless personality with people he knew. He could engage them with just one sentence. J is naturally likeable, relaxed and friendly and he openly speaks about his problems which encourages reciprocity. So I asked him to come and observe a board meeting at our HQ in the hope that a) he would travel to overcome his agoraphobia and b) he would get a chance to tell the board about our work together. He refused the lift I offered him and drove himself the 7 miles to our HQ. He arrived safely and told a surprised board that it was the first time he’d travelled alone out of his home town in a dozen years. Ever since that moment our board has backed our project to the hilt.
When our engagement worker left, J applied for his job, the first job he’d been interviewed for in 13 years. He’s worked with me for 2 years now and travels round the country with me to present our work. He no longer needs his GP or mental health services. His 3 children have a different dad now.
So you see, there is something beyond health improvement to address health inequalities and at Health Creation Alliance we call it health creation. It’s characterised by 3 Cs: control over your life, contact with others and building confidence.There is a longer paper explaining health creation on our website. It is about finding and building strengths, not just fixing problems. And in the process it’s about stretching and challenging those residents. It’s about building relationships not just delivering factory-farmed illness services. It’s about professionals pointing people towards meaning and purpose in their lives. Here I talk about nursing, but this is just as relevant to workers in housing for example. I think all public health nurses know this and some of them used to practise in the same way that I do now, in the old days, before activity was the only currency in town and before they barely had time to run from one appointment to the other.
Just as Buurtzorg is about self-managed teams of district nurses, I think we should have ‘free-range’ public health nurse teams too. Give public health nurses back their freedom, so we can give our communities hope and lead them towards meaningful work, which is a fundamental determinant of wellbeing. Work gives pride and purpose. It gives you more choice and control over your life. And it can build a different future for the next generation.
Heather Henry is an independent public health nurse, Queen’s Nurse and co chair of Health Creation Alliance. You can join Health Creation Alliance for free here.
