I heard a few mentions this week of the NHS Quality strategy, so i looked it up. I feel a heartsink reading it tbh. It reads as another document saying all the right things & yet i have never known anything like this actually filter through to the front line. What are these documents actually for?

A wonderful conversation here. I loved listening to it. Such a powerful, important combination to bring together deep medical expertise with a genuine care for people's real lives. Really heartening, thank you.

It's tricky when a leader has a style which works against psychological safety, where people don't feel comfortable to speak up. The leader typically doesnt have insight into the effect they have My sense is in a hierarchical org like nhs this is EVERYWHERE & we don't have a good way to address it

I understand it carries a positive message to promote the idea you can live a normal life with a chronic condition. And... time & again I meet with people who need to express some of the loss, the frustration, the exhaustion, of living with a chronic condition. It's important there's space for this.

Working with people with chronic health conditions, so much of it is about 'grieving loss, & affirming life'. Lovely blog here on making the space to honour grief in all its complexity.

I've had requests lately to help colleagues develop hospital services to be better at caring for patients' psychological needs. Feels like progress, after years of banging my head against a brick wall. But it's huge. Seeking silver bullet solutions isn't helpful. But where would you start?

Deprived areas don't just face higher rates of chronic illness- people also have a harder time coping with the health condition. Where people are struggling with money, housing, employment, school problems... health conditions become more complex & tangled up with psychological distress.

As Psychologists, doesnt matter if you're newly qualified or have 30yrs experience, everyone has regular clinical supervision. It's not a luxury, or something we fit in if we have time. It's just normal, it's a core part of our work. That's why i know it's possible, & why i know how much it matters.

I was looking up things that can help with autistic burnout in kids: reduce pressure & expectations practical help quiet space space to unmask prioritise genuine rest All seems very sensible. And... very much at odds with today's noisy world, where parents are stressed with so much to do.

Encouraging to see so many posts about health creation- the conditions we need to live healthier lives. And... if you go into any team in any hospital, we'll tell you we're constantly stretched & fire fighting. Important we try to reconcile these, rather than one being pitted against the another.

This article is everything that’s wrong with the way we talk about health in the UK. Healthy life expectancy is framed almost entirely as a problem of healthcare rather than the conditions we live in. Despite valiant interventions from @sebrees1.bsky.social and @martinmckee.bsky.social

As the time we get to spend with patients gets less, interactions get more transactional & technical. Taking the time to care, listen, & connect with the person is all squeezed out. This is not progress.

There's a whole industry in healthcare that seeks to come up with quick wins & tips for improving the human quality of care at minimal cost. This hides the fact we dont actually invest in what we know works- people having time for unrushed conversations, listening well, continuity in relationships.

The increase in significant psychological distress over the last few years shows how many people were just getting by, just holding on before. Then systemic disintegration has tipped people over the edge. What if our society enabled all of us to live decent lives, rather than 'just getting by'.

Through psychological therapy we can develop self-awareness & capacity to be more conscious of our own thoughts, feelings, & patterns- enabling us to be more intentional. It's transformational. How could organisations develop this self-awareness? Regular reflective practice for everyone? What else?

In the midst of the circus & power games, there are actual people in Clacton with actual lives that might actually want to have an MP to be a voice for local people, for the local communities, & for improving local people's lives. Does this matter?

Do patients with chronic conditions really need to be told again what they SHOULD do? The same advice, the same message "you need to prioritise looking after yourself" Patients know this. If it's not happening it's unlikely because of a knowledge deficit. There will be deeper things to understand.

It's as if- with the right leadership formula, the right quality improvement tools, the right transformation plan, the right systems thinking, the right 'can do' attitude, the right wellness offers... we can do it all! And with joy! No. Sometimes it's necessary to say "no that's just not possible."

When someone you love is under the care of an institution like a school or a hospital, it makes the world of difference to feel that people are kind, and making an effort to understand & be helpful. I know this is totally stating the obvious, but sometimes amidst all the noise that's important.

I'm all for 'supported self-management' as a concept, but the 'supported' bit is absolutely key, & too often lacking. What some patients are managing with next to no support causes significant anxiety & makes chronic conditions even harder to live with.

We get inpatient referrals for patients who “would benefit from someone to talk to”. It’s so hard bc I’m sure this is true- & the reality is this could be any of 100s of patients in the hospital. But this doesnt need psychologists. It needs ward staff who have time to meaningfully listen & care.

I see organisational plans & can see how they make sense 'on paper'. We're here We're trying to get there Here's how we'll do it That kind of thing. I've never known these plans work in reality... because orgs are made up of people & relationships, not widgets that you can just reorganise.

A hopeful, wise thread here

The NHS would be dismantled beyond recognition. This would massively impact the possibility of integrated care for people with complex needs. A harsh welfare system would exacerbate mental health difficulties. Immigration policy would crash NHS workforce. Meanwhile some people would make tons of £$.

You don't create psychological safety because you announce "this is a safe space", or with some kind of ice breaker. The key thing is WHAT ACTUALLY HAPPENS when someone expresses disagreement or a different view. Is it welcomed with openness & curiosity? How does it genuinely FEEL in the room?

The best 'reasonable adjustments' are just built in- just the standard way of doing things to make life go as smoothly as possible for people who have extra needs. It shouldn't be a big deal, & it's not something people should be made to feel grateful for.

Doesn't matter if it's parenting, being there for people you love, supporting colleagues, or working in 'helping professions', our capacity to care is much enhanced when we feel cared-for, & cared-about, ourselves. It's the point about caring for carers, & it's so important.

We made a short (3.5min) film introducing our @sprockethub.bsky.social innovation hub for improving the lives of children with complex health needs and those that care for them. Do have a watch! I think it really captures what SPROCKET is about. youtu.be/WIjhjciUfD4?...

My heart goes out to the women who shared their experiences for @theguardian.com It is important to understand the experiences of black women maternity care come in the context of lifetimes experiencing micro aggressions and discrimination. Harm is compounded and trust undermined further. 1/

Every time I see a story about vaccines it's accompanied by an image of a needle. Why? This is the way to administer the vaccine not the vaccine itself. Why not show imagery of the intended outcome? eg., a healthy person/family/community. How much does needle imagery shape perception about vaccines?

Meaningful change in the NHS is relational- it happens because of relationships. That's why when something works, you can't just 'roll it out' by defining the operational process & applying it elsewhere. The absolute key factor in what worked was the relationships, & you can't roll out that bit.

idk how you'd ever quantify how much psychological harm happens in healthcare- beyond 'a lot'. The dominant narratives of 'being grateful' & 'how lucky I am' silences the expression of distress caused by healthcare.

If a group of healthcare people are asking for help to care in ways that are more emotionally/psychologically attuned, where would you start? For me: 1. See patients as people- this video is helpful👇 2. Set up regular supportive, thinking space And then let local developments grow from there.

Today my hospital merges with the neighbouring hospital to form a mega Trust. It's happened quickly & with ++momentum Also today I have a meeting abt a small project to improve the emotional/psychological side of hospital care. This has been around for decades & it's like shovelling water up a hill

YES patients need to be listened to more. How to make this happen if we're serious about it:- Development of listening skills & ongoing support (eg reflective practice) A culture & environment that's set up to support listening Shift in power dynamics to something genuinely more collaborative

Keep on checking in with colleagues, keep asking each other how we’re doing. Ths need for this has not gone away. Quiet, genuine moments of care & listening, amidst all the rushing around. It still really matters, & we just never know the difference it makes...

If we want to understand the increasing anxiety in kids & actually make kids' lives better, then we need to think about the psychosocial, relational, & material conditions in which children grow up. Access to children's mental health services will not change the conditions kids grow up in.

I agree with this entirely- who wouldnt? But what are staff in these environments to do? To spell out the very obvious point: if services are constantly under pressure & staff stretched, these conditions work against the likelihood of good listening. This is not an excuse it's the daily reality.

There isnt capacity to spend time comforting distressed patients. So hospital is even more anxiety-provoking, less healing, & morally distressing for staff. This isnt about add-on 'mental health' resources- it's about an erosion of core ethical principles that should be at the heart of everyday care

If you want a short (8min) video showing why so many people are finding hope in Zack Polanski & the Greens, watch this. It's a clarity, a humanness, & way of engaging with loads of examples that just feels real, & hopeful.

"The overwhelming focus of a mother is on the safe delivery of her baby and, to that end, mothers will allow significant injury to themselves; but this does not mean they should have to." @susannastanford.bsky.social #AnSky #ObSky #MedSky #PainSky doi.org/10.1111/anae...

The doctor who somehow seems to have more time to listen to patients The nurse who remains compassionate despite being so busy The leader who retains a humanness when dealing with crisis after crisis I hope these people get good support, as 'staying human' when fire fighting often comes at a cost

Recently I've found myself thinking I need to find more work, I need more income. I need to use evenings or days off to fit in more. More more more. More grind. This is crazy. Life is already so full with NHS & the kids. What I need is for basic things to cost less.

Another helpful, thought-provoking thread from @policyskeptic.bsky.social thanks Steve. If you're interested in deeper, critical thinking about NHS, follow Steve...

Within the NHS we can look over to Nottingham & comment "isn’t that terrible". But perhaps a better way to respect the findings would be to think- What will I personally do if someone raises concerns about my service? How will I remain open & curious? How will I notice if I'm getting defensive?

As Ockenden review comes out, I hope there's a spirit of care & compassion towards the families. Obvsly justice, accountability, & commitment for improving things. But underpinning everything I hope there’s a genuine effort to connect with the reality of what these poor families have been through.

It doesn't make healthcare safer to downplay the potential for harm, or to treat 'risk management' as a series of boxes to tick. Part of increasing safety is to name the potential for harm, to be conscious of harm, to be open about it & talk about it- as an active, ongoing part of conversations.

How much more work & stress do we create for ourselves & for patients because we don't say a genuine sorry when we've messed up? Most people I've known who've had some form of harm in healthcare just want some acknowledgement, some accountability, some honesty. It's not about litigation & ££.

Whatever issues get presented as more pressing, it's all irrelevant on a dead planet... The climate energency is not something happening 'over there' or some time in the distant future. It is here. And now.

You can imagine the future sales pitch from private healthcare providers. "Speak to REAL human doctors..." The wow factor. Fs.