start performance report 2008-9.screen

Start service 2008 – 2009 – quality and innovation in NHS service delivery

Manchester Mental Health and Social Care Trust : together we are better

creativity, self-care and wellbeing – performance report 2008 - 2009

Praise from the Top

When Professor Louis Appleby, Director

for Mental Health (England) came to visit

our ‘Held’ exhibition at Manchester Art

Gallery, and to open our ‘Arts in Recovery of

Mental Health’ seminar, he said:

“I am a big fan of Start and the tremendous

work they do. I love the philosophy that

anyone can get involved in art and this is

really pioneering work. The work on display

here succeeds as art, as a project in its own

right that is fit for public display.”

Read more about ‘Held’ and the

tremendous public response on page 4

Start: An Impactful Approach

John Boyington, Head of Mental Health and

Director for the Mental Health Improvement

Programme NHS North West, launched ‘Held’

at the Manchester Art Gallery. To the 350

people present, he expressed admiration for the

work and the approach taken by the Start users

and staff to mental health issues. He highlighted

the likely positive impacts on public attitudes

and especially commended the platform the

exhibition gave for users to share their

knowledge and experience. In praising the

courage of those communicating often difficult

issues, John closed by saying that viewers would

be inspired, challenged, provoked and amused, but above all affected by what they saw.

Start

John

Boyington launches the exhibition at

Manchester Art Gallery

Professor Louis Appleby at ‘Held’, chatting to Start Lead Artist Wendy Teall, MMHSCT Medical Director Mark Spurrell and Start Occupational Therapist Juliette Angus

Award-winning Start

Winning the Trust Star Award for

Innovation in March 2009 was a great

accolade for the team and service users,

and we were all delighted to be

recognised for the improvements and developments we have lead.

The Start team with their Star Award for Innovation, at the

ceremony earlier this year, where actress Julie Hesmondhalgh (Hayley Cropper in Coronation Street) presented the awards. Julie is patron of the mental health charity Maundy Relief based in Accrington.



Top Ten Start: A Service with Integrity

Professor Aidan Halligan, former

Director of Governance for the NHS, who launched the exhibition ‘Now,

Voyager’ in 2006, described this

achievement as “exceptional and extraordinary.” He went on to say:

“I believe that the recognition of the

‘Now, Voyager’ scheme reflects a growing

understanding that there is so much

more to healing than medication, time

with a doctor or nurse, or admission to

a hospital…For too long now, the

solution to the NHS’ ills has been

considered to lie in targets and more

money.

The real solution lies in discovering the

soul of the NHS and putting ourselves,

as much as humanly possible, into the

shoes of those who are the recipients of

its care. What ‘Now, Voyager’ does more

than any other intervention that I have

encountered to date is to give the NHS

back its soul.”

Top Ten Start

Start has been given a great accolade from

the NHS Institute for Innovation and

Improvement. Through recognition of the gallery partnership project and exhibition

‘Now, Voyager’, our service has been hailed

by the Institute as one of the ten most

innovative services in the whole NHS,

through the publication of the book ‘10

reasons to be proud’.

Raising the profile of the Trust

2010 calendar: Foundation Trust launch

The warm reception given by the public to ‘Held’,

which attracted 125,000 visitors, led us to create a

calendar for the Trust based on the exhibition

artwork. This will help launch the Trust campaign to

convert to Foundation Trust status.

For the calendar images we asked two dancers to

interact in expressive ways with some of the ‘Held’

artworks. Each page features a striking image,

together with quotes from people using services

across the Trust. 10,000 calendars will be

distributed later this year as part of the Foundation

Trust campaign.

To find out how to get your copy, call the

Foundation Trust Project Team on 0161 277 1222.

Representing the Trust

Mental Health Today

By special invitation, Start had a stand at the

prestigious Mental Health Today event which, for the

first time, ran at Gmex, Manchester.

Start was also invited to publish a follow-up article in

the Mental Health Today journal, which concludes its

series on ‘Arts and Opportunity’. Read the articles at

Start’s website – www.startmc.org.uk

The Start stand at the

Gmex Mental Health Today event

Images from the Trust 2010 Calendar



NHS Values: Everyone Counts

Self-care with a difference

When Mike Farrar, Chief Executive for NHS North West, launched Start’s popular healthy

head toolkit ‘Create Space’ he praised it as

innovative and full of potential for helping all

of us to deal better with everyday stresses

and strains in our busy lives.

Mike went on to encourage Start to develop

the self-care aware ideas in ‘Create Space’,

and this year we have produced a brand new

creativity and wellbeing publication.

Launched at the ‘Held’ exhibition, the ‘Get

Creative’ booklet is produced by Start in

partnership with Manchester Public Health

Development Service, Manchester Community

Health and Manchester Art Gallery. It’s packed

full of creative things to do, as well as tips

and advice about mental health. Gallery staff

say the booklets have walked off their racks.

In tandem with ‘Get Creative’, we also designed

and launched the Manchester Art Gallery

Wellbeing Trail leaflet. Created by Start users,

with gallery and Start staff, this leaflet takes

gallery visitors on a walk around the gallery

with wellbeing in mind. Six paintings are

reproduced, accompanied by simple wellbeing

exercises to try. During the exhibition, this trail

was animated by live music as a special public

event, courtesy of the Royal Northern College

of Music.

‘Create Space’ continues to be regularly

downloaded by people as far afield as the

USA. Because of this, Start service users and

staff plan to develop more web-based self-help

downloads in the coming year.

Self-care aware

Susan Summers, Assistant Director for

Quality Assurance and Self Care,

Performance, Nursing and Quality for NHS North West, was also impressed by

‘Create Space’. She invited Start to present

at the Self Care forum last year, and this

year at the NHS NW Self Care Aware

conference in Liverpool.

On visiting ‘Held’ she again praised Start’s

unique approach to self care, and

commented:

“The messages behind each of the exhibits

is deeply profound. I found the whole

experience visually stimulating, mentally

thought provoking, and on a humanistic

level, very humbling.”

NHS NW also invited Start to exhibit at

their stand at the NHS Innovation Expo in

London, as an example of an outstanding

service within the region.

Left: The brand

new’ Get Creative’ booklet,

launched at the ‘Held’ exhibition.

Top right: the popular download

‘Create Space’. Bottom right: the new Gallery Wellbeing Trail

leaflet



NHS Values: Everyone Counts

Partnerships in the Community

Extending the benefits of being self-care

aware far beyond those directly cared for by

Manchester Mental Health and Social Care

Trust, Start has reached wide audiences –

hundreds of thousands in this time period -

with its public mental health promotion work.

The Start team work closely with users to

enable them to share their wealth of

knowledge and expertise with the public via

themed art exhibitions, wellbeing publications

and recovery stories.

Much of our work in the community involves

partnerships. Key partners in the community

are Manchester Art Gallery and Manchester

University’s Whitworth Art Gallery.

Whitworth Art Gallery

With the Whitworth, we’re piloting an inclusive

art course for Start users and the public, to be

held at the gallery and run in partnership with

gallery experts.

Start artist Jill Cunningham, who is coordinating

this project, says: “The course aims to be a

pathway out of Start for service users, and a

foundation stone in building supportive

wellbeing-themed resources at the Whitworth.”

Manchester Art Gallery: ‘Held’

With our partners here we’ve continued to

develop our specialised model of working

with collections to explore self-care and

wellbeing. Originally begun with the Whitworth

Gallery, this model of service delivery gives

users a chance to work with gallery curators

in the mainstream setting of a gallery,

studying art and relating their learning to life

and health management skills.

We began the partnership with a course,

attended by more than 40 users, running

over summer 2007 at the gallery. Following

this, we designed an exhibition idea for

users to take part in, that encouraged them

to explore their experiences at the gallery

and express what they had learned as a

piece of exhibition art.

Partners from the

Trust and MAG take a moment

from the busy ‘Held’ launch to

pose with John Boyington

The Start exhibition ran from February – July

2009. We titled the show ‘Held’ because its

theme, about being self-care aware, reflects on

those strengths and abilities to help ourselves,

that we hold in our own hands.

The exhibition showcased work by more than

40 users. Ceramics, textiles, painting and

drawing, photography, animation, and mixed

media featured, alongside personal recovery

stories, wellbeing information, self-help

literature and interactive wellbeing resources

for adults and children.

Viewed by 125,000 visitors, including many

children and families, the exhibition has

enabled the Trust, through Start, to reach

great numbers of people with preventative

mental health information, and positive images

of recovery.

Work from the Held exhibition



What did users think of ‘Held’?

For many, this was the first time they had

worked towards such a high key project, and

it was challenging but exciting.

“This project has taught me to believe in

myself. Because I have completed work and

seen the finished product it makes me proud

of my work, my skills and my confidence.”

“For the first time in several years I have

composed a piece of music. Writing it has

reignited my self-belief…This project has

helped me with rediscovering who I am.”

Several service users enjoyed the experience

of work placements at the gallery during

the project, helping to mount the exhibition

and design the Wellbeing Trail leaflet (see page 3).

Royal Northern College of Music

Supporting the ‘Held’ project throughout, our

new partners, the Royal Northern College of

Music, worked with users to help them explore

the power of music over mood.

Adding greatly to the success of the animation

work, musicians from the RNCM also worked

with a number of users to create original

soundtracks for their films.

RNCM musicians who worked with us on ‘Held’ treat us to live music at the ‘Held’ launch

Jim Reid ,

along with manyother Start

service users, felt pride and

delight at the opening of ‘Held’.

What did the gallery think of ‘Held’?

Visitor Services staff at Manchester Art

Gallery reported the public’s response:

“It was one of the best exhibitions we’ve

had in that space for a long time and

visitors received it very well.”

“I think people found the exhibition really

inspiring and I’m sure it helped to get rid

of some of the stigma that exists around

mental health.”

Importantly, staff also reported their own

enjoyment and learning:

“The interactive wellbeing resources and the

self-help leaflets were popular. I felt that

people were using the space for self help.

That goes for staff as well as visitors.”

“For me the exhibition just hit the nail

right on the head. It is in your hands isn’t

it, your own wellbeing? The exhibition

showed that there is help and there are

things you can do.”

Director of Manchester Art Gallery Moira

Stevenson says:

“Manchester Art Gallery was pleased to

collaborate with Start…bringing together

the areas of art and health to the benefit

of both worlds.

“Our gallery, and Renaissance in the North

West, are convinced that the arts

organisations and museums of the region

can make a significant contribution to the

mental health and well being of our

communities and are committed to working

with the NHS Mental Health and Social

Care Trust on future projects.”

Clare Garner

poses with her mixed media piece at the launch event.



What did the visitors think of ‘Held’?

Invited to reflect on what brightens their day,

visitors filled in 100s of wellbeing cards on the

wellbeing wall, and tried out the interactive

wellbeing resources.

Visitors of all ages enjoy the Start exhibits at Manchester Art Gallery

Held: BBC Big Screen features Start’s work nationwide

The Start animations from the ‘Held’ exhibition

are now mounted on YouTube, and have

enjoyed a lot of success as a result.

Selected by the BBC Big Screen project for

public viewing, the animations have already

been shown for two weeks in Manchester, and

in October will be shown on city centre Big

Screens across the country as part of the

BBC Learning Headroom Campaign.

We will be able to reach hundreds of

thousands of people with positive mental

health messages through this opportunity.

One of the interactive wellbeing resources for

‘Held’ included a specially designed Wellbeing

Wheel based on the recent Foresight report

recommendation to ‘Do 5 Things a Day to Keep

Well’.

Spinning the wheel revealed 5 options for doing

healthy, fun things, based on the 5 categories

suggested in the Foresight report ‘Mental

Capacity and Wellbeing’.

Foresight expert Roxana Bakharia praised

Start’s imaginative and practical usage of the

report’s recommendations. The Wheel was also

commended to the department directly by

Professor Louis Appleby, after he tried out the resource for himself on visiting ‘Held’.

Visitors try out the praised Wellbeing Wheel at ‘Held’

Held: Foresight Government Think Tank praises Start

Some comments from visitors included:

“Great insight into what people experience”

“Absolutely stunning…fantastic, engaging, funny,

cathartic and warm.”

“So impressed…deeply thought-provoking…”

“Really interesting and inspirational…”

Wellbeing cards responding to the questions ‘What Brightens Your Day?’ & ‘How Could You Brighten Someone Else’s Day?’



NHS Values: Commitment to Quality of Care

Service improvement

Learning about yourself and developing inner

strengths through creative activity is one of

the key experiences that Start offers.

Creative activities such as art and gardening

engage people in many ways because they

involve the hand, heart and head. People

can learn to think in new ways, find new

roles for themselves, visit new places and

begin to change the way they look at the

world around them. They can also learn that

creative activities are helpful in managing

stress and building awareness of self-care

strategies.

The team at Start use a structured approach

to help each user benefit from creative

activities in the ways mentioned above.

We’re committed to improving the effectiveness

of service we offer each year. In the last 18

months we’ve continued to make key changes

to develop the service:

• Through new self-assessment

processes, we are helping users to

better understand how to use creative

activities as well-being strategies.

Almost 90% of users filling in

questionnaires after the ‘Held’ project

said that they were more aware of

self-care strategies after the project, as

compared to before.

• We’ve introduced more structured

review and goal setting processes –

100% of users now have SMART goals

that are negotiated in regular reviews

• We’ve continued to improve the

rotation process (short placements)

around studios within Start, and have

now included Horticulture in the

process. Rotations aim to help users

develop change management skills.

Over 70% of users are now involved

with rotations as compared to

approximately 25% 18 months ago

• We’re setting up performance measures

for aspects of the service so that we

know we are meeting our quality

targets

• We’ve established regular joint-working

between the Start creative professionals

and Occupational Therapist – these

have led directly to several service

improvements

• 40% of users are now recording their

progress via the validated outcomes

measure WEMWBS (the Warwick and

Edinburgh Mental Wellbeing Scale). The

scale shows progress across a range

of domains for the majority of users.

We aim to increase take-up of

WEMWBS in this coming year to

include all users

Left: In the studios: top – Textiles,

bottom – Mixed Media & Mosaic



NHS Values: Improving Lives-The User Experience

How users say Start helps them

Service users say they feel the benefits of

attending Start in a number of ways. One

person explains how he feels about having a

new interest:

“Because the work is very hands-on, it takes

the pressure off you and enables you to focus

on something other than yourself or what

other people are thinking.”

Another person highlights the help gained

from learning to think in new ways:

“Working with art has motivated me to do

things and also to keep well ‘in my brain’...

I enjoy the problem solving that is required…It

has made my mind open up to my problems

and what can make me feel better.”

Improvements felt at Start impact on users’

wider lives too:

“By developing my creativity I have developed

self-confidence that not only overlaps into

everyday life but has also allowed me to take

on challenges that I have avoided for

decades.”

Some people say that learning specific self-

help skills, as well as new outlooks, are what

they most value about their interventions at

Start:

“Artwork is a way of opening the mind – the

learned skills and experiences can be returned

to and used in life and art.”

Carers see the benefits of Start’s arts and

horticulture activities for their loved ones too.

“I think T has got a lot out of being engaged

in Start. He has become more confident

through working regularly and has been able

to focus and concentrate.”

“I think P has definitely gained in

confidence…more capable and in control of

his life…and has started to have aspirations...”

The benefits of goal setting

Start Lead Artist Wendy Teall explains:

“Everyone at Start works with a personal set

of goals. The goals are set by users, in

discussion with the Start creative

professionals and OT. Goals apply to each

12 week rotation and are a mixture of

creative and technical goals, learning goals,

and life skills goals. They are all realistically

achievable through creative studies.”

Each person has personal diary sheets, in

which they record their goals, and the notes

from their diaries inform the reviews at the

end of the rotation. Following the review,

new goals may be set, or discharge plans

may be agreed.

Users say that they like to have the

structure of goals, and that this helps to

shape their time both in Start, and beyond.

“These days I have goals in my life. I find I

can enjoy the friendship of others again...my

family…are happier now because I’m feeling

better… My advice to anyone who is feeling

low is to set yourself goals for each day

ahead. I think you can feel a sense of

achievement that way and get your life back

in your own control.”

Above: In the Photographic studio



Moving on

There are many pathways out of Start – the

more formal pathways are work, training and

education. Some users over the past 18

months have enjoyed success with these

pathways:

“Thanks to Start I am back at work, doing a

job that I enjoy. I would never be where I am

now without that help.”

Less formal pathways are just as important.

Start OT Juliette Angus says:

“These pathways are about re-entering the

community or personal life with a toolkit of

life skills and self-care strategies that will

help protect and maintain mental wellbeing

for that person in the future. We know it’s

vital to support these informal pathways as

well.”

One ex-user explains, a year after leaving

Start, that she is feeling able to help herself

through the art techniques she gained:

“Start has helped me refocus on what my life

is about. New creative textile skills learnt at

Start help me keep well. I can influence my

mood towards uplift, to feel well and happy.”

Another user explains how confidence

acquired at Start will help him to embrace

other opportunities in his life:

“The way I benefited [from my Start course]

was I think I lived up to the challenge so

that felt pleasing. I felt different in myself,

after the course, different in a good way…

I felt less shut in.”

Occupational Therapy at Start

Having an Occupational Therapist on the

team helps users to shape goals both within

and beyond the service.

One service user explains:

“Everyone should work with an OT. I used

to be in a cycle for years, of rushing into

things, being unsuccessful and taking a few

steps back. Working with Occupational

Therapy helped me look at what I really

needed to do; it helped give me a structure

and a plan and stay focused.”

NHS Values: Compassion, Respect and Dignity - The User Experience

Users have continued to praise the service at

Start for its caring and enabling approach,

during this last year.

“The thing I found most helpful at Start was

being treated with respect by the staff - yes,

someone with a mental health problem, but

also an intelligent, ambitious, skilled person…

They helped me to regain my ability to trust

people and show affection and humour.”

Start artist Cathy Fortune adds:

“We’re always delighted to know that users feel

our service is as considerate as it is effective.

Listening and empathy are important parts of

our professional approach, as this helps us to

learn about what works for each person.”

With listening in mind, we’ve now introduced

new self-assessment ‘diary sheets’ that give us

the chance to gain and listen to users’

feedback and concerns regularly. This makes it

possible to be more responsive to needs as

they come up.

Above: Horticulture at Start



NHS Values: Working Together for Patients

Liaison within the Trust

Moving on is the target from the beginning of

attending Start. During initial interview our service

OT chats about moving on and ensures that each

user is comfortable with the idea that Start is a

stepping stone to other opportunities.

Start OT Juliette Angus explains:

“The journey through the service aims to help

each person gain whatever support they need,

from the right source. That means working

effectively with others involved in the Care

Programme Approach process. We make sure that

we keep Care Programme Approach Care

Coordinators regularly informed about users’

progress, through review notes and AMIGOS (Trust

computerised notes system).”

Users at Start are quick to acknowledge the high

quality package of care they receive from services

working together in the Trust:

“I still have bouts of deep depression and/or

anxiety but through the work done at Start,

combined with cognitive behaviour therapy and

interventions from my own Occupational

Therapist…and primary care worker I am slowly

beginning to gain confidence and to set my own

goals…for the first time in a long time I

am…hopeful…” For more information on Start, visit

www.startmc.org.uk

Contact us at:

Start

High Elms

Upper Park Road

Victoria Park

M14 5RU

0161 257 0675/ 0510

For more information about Manchester

Mental Health and Social Care Trust visit:

http://www.mhsc.nhs.uk

Report by Wendy Teall, Start Lead Artist/

Service Manager, September 09

Above: activities in Photography and Horticulture

Above: activities in Ceramics



Reaching the public and growing the Trust’s impact via Exhibitions

Date Venue/Activity Audience figures

Sep -

Oct 09

Start ‘Held’ animations showing on BBC Big

Screen across the UK for mental health

week celebrations

100,000s

Feb 09

– July

09

‘Held’ on display at Manchester Art Gallery:

Mental health leaflets distributed (1320 +

1600) MPHDS

Visual arts and wellbeing resource

Wellbeing wall responses

125,000

3000 approx

5000

400+

2-16

May 09

Start ‘Held’ animations showing on BBC Big

Screen in Exchange Square Manchester

Based on the fact that the

given footfall for the square

is 60,000 per day : 10,000s

18-19

June 09

NHS Innovation Expo: NHS NW displaying

Start animations as part of their stand at

this expo

100s

May 09 Start ‘Held’ animations submitted to range

of art and film festivals

Further details to follow

May 09 Start animations showing in Bar Iguana as

part of the Chorlton Arts Festival

100s

11 Nov

08

Start stand at Gmex Mental Health Today

expo – by invitation, Start displayed

artwork, film and literature at this show

100s

March –

May 08

Inner Word display on show at Norton

Priory ‘Healing’ exhibition

4300



Reaching the public and growing the Trust’s impact via Journal Articles and Special Publications

Publication Article Readership

‘Get Creative’ Visual

Arts and Wellbeing

resource

In partnership with Manchester Public Health

Development Service, and Manchester PCT

5000 +

Toolkit website

Start’s mental health awareness training pack

for artists

1000s

NHS Live website Case studies newly mounted about

MMHSCT’s partnership work with museums

and galleries

10,000s

Wellbeing Newsline-

Mental Healthcare

Magazine online

Start’s regular column – also published on

social network sites Twitter, Delicious and

Wikio

1000s

Create Space healthy

head toolkit

15-20 download requests per month. Now

featured on brand new one stop shop

website for Mental Health in Manchester,

launched by Manchester Public Health

Development Service

1000s per

year

10 reasons to be

proud

NHS Institute for Innovation and Improvement

publication

Distributed to national Medical Directors,

senior members of the Department of Health,

members of the Government's Select

Committee for Health

5000

published

Inside Out issue 1

Autumn 2008

Article featuring Start publication ‘Create

Space’

1000s

Mental Health Today

May 09

Picture feature about Held 25,000

Mental Health Today

July 09

Article Arts and Opportunity 2 25,000

Metro News Trafford Article on Held 27 Feb 09

10,000s

Mcr Evening News Article on Held 2 Mar 09

Article prior to Held publicising it-18 Feb 09

10,000s

Muso on-line music

journal

Article on Held 26 Feb 09 1000s

Metro News Article on Held 26 Feb 09

10,000s



Service User outcomes July 2008 to October 2009

User percentage

Outcome

100% Service Users actively engaged in negotiating goals

90% Service Users (who returned their ‘Held’ feedback

questionnaire) say their self care strategies have improved

77% Service Users engaged in change management (rotations)

70% Exhibited work as part of Start exhibitions

44% Service Users independently engaged in art as a self care

strategy (undertaking homework outside Start/ using

studios independently at Start)

42% Service Users regularly completing WEMWBS as an insight

into their well being

40% Achieved publication of their work

25% Studying at an Adult Education or other mainstream class

12% Had their films shown nationally on the BBC Big Screen

10% Attending another project

10% Actively participated in mental health awareness activities

by writing recovery stories for the “Held’ exhibition

8% (average) Working towards a planned discharge date at any one time

7% Report increased engagement with hobbies outside Start

6% Gained voluntary work placements

1 user Discharged to Higher Education college course

1 user Promoted service locally via live radio broadcast

During the time period of the report the service has worked with an average of 60

service users each week, offering 1 – 3 sessions per week.

The average time a person stays within the Start service is 30 months, down from

an average of 42 months two years ago.



Both my children’s faces in the morning and

my dog rolling around on the bed!

My grandpa’s dog

What brightens your day?

By just letting someone know you

have understood what they said

and care about their issue they

have chosen to talk about

Being scared, fighting it, beating it

Look for the light, feel bright, look up and smile

My family and friends always keep me smiling.

What brightens my day is going out with dad

My little son looking up from my lap

When I hear people laughing and see people smiling.

It reminds me how good life is!

Have lunch with a friend you haven’t seen for ages.

Make eye contact! Smile at someone you don’t know.

Seeing you smile

I think laughing with family and friends is fun

Hearing my two year old nephew’s belly laugh

Laughter…I like to make somebody smile

Being with my dad

My best friend and chocolate and music!

A big hug and a smile

I love my mummy so much

Seeing my gorgeous son’s smiley face.

Engaging the public with wellbeing: Selections from gallery visitors’ wellbeing cards

‘Held’, Manchester Art Gallery, 2009



Picking up a bargain at a charity shop

Doing something new everyday.

Feeling the real art and real me in the gallery.

Love Manchester.

Exploring Manchester for the first time even

though I’ve lived here since September

Dance, dance, dance, dance

Go to the theatre as much as you can. You

don’t need anyone to go with. It can be

good fun on your own. Enjoy all your life.

Looking out of my window in the morning.

Listening to birds singing

Cold, crispy morning, blue sky and absolutely no-one around.

The sun brightens my day!

When the sun is shining and the birds are singing

A beautiful sunset, a person’s happy smile, children’s laughter,

the colours of our city, talking

Sunny days, flowers in spring, a cat, smiling people, when a

friend calls me

I love watching pigeons

A bright blue sky, flowers

start performance report 2008-9.screen

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