I'm feeling a heightened appreciation for people who do so much behind-the-scenes caring. It can be practical tasks- like making life easier for others in families, communities, or work; or it can be about holding in mind what's going on for people. This 'hidden' care holds so much together.

Heard two consultants describing how they are used to receiving criticism from patients these days & they know they can’t offer anything like the level of service they want to. And this has just become normal. Highly compassionate & skilled people... reduced to ‘getting through the numbers’. So sad.

I hear experts on the radio arguing about the state of the NHS- citing various stats to indicate areas that are improving or where it's really bad. All feels a bit removed from reality. It's hard to put into words (or data) the widespread exhaustion there is in the NHS. The sense of powerlessness.

I often share this 3min video, about acceptance, by Prof Tamar Pincus. It's a good prompt for conversation. It's about chronic pain, but the idea's transferable to other chronic conditions. Acceptance is hard, & involves a lot of grieving. youtu.be/ZUXPqphwp2U?...

It can be really hard to get into more 'healthy behaviour' habits. Wanting to make changes is important, but intention & will power is not enough. It's not a personal failing to struggle with making changes. It's totally realistic.

I meet young people weighed down with the state of the world & you can really see how remarkable, resourceful, thoughtful souls are facing into a void of not knowing what to do. Many of the usual paths seem inaccessible. You can see how debilitating it is. Just a sense of being lost. I feel for them

I see the word 'thriving' a lot atm to describe a kind of aspirational state for nhs staff. "Shift from surviving to thriving!"🙄 It's shallow nonsense & I don't buy it... Instead- always remember the systemic context. Do what you can with what you've got. Help each other out, & rest when you can.

Had an email from a colleague who's been into work to help with a difficult situation, which has arisen in a very stretched context. Part of me is like wow that's amazing, & another part is- it's not sustainable for staff who care to patch up the impact of system deficits by going above & beyond.

I'm walking up the Malverns today. Just driven up the M5 in some fog, & now come into Malvern town the light is *amazing*. Tiny dots of sheep in the distance. Spectacular autumn colours. Bright blue sky & a big watery moon. Can't wait for the view at the top, be able to see for miles today😃

When there's poor care, i think it's reasonable, as part of apologising, to describe the very stretched context. But we need to be careful we don't make patients feel guilty for having needs. That's not OK. Patients arent responsible for the context, patients arent responsible for our moral injury.

So many people who come our way for psychological therapy desperately need practical help- financial help, help with childcare, extra pairs of hands for just keeping life going. Times are hard for so many. There's so much anxiety. People coping in whatever ways that offer relief. It runs very deep.

The thing I appreciate most about my professional lead is she supports me to be myself. And this is a culture she leads throughout our whole department. I really don't think it gets any better than that. Simple as a concept, but remarkable in reality.

Maya Angelou's classic quote that "people will never forget how you made them feel" resonates with all of us. Instinctively, we know what matters most is how we are with each other. Imagine if we could live & work in ways that truly honour this.

I really wish there was more time & space in the NHS to sit down & listen to each other. There's such a strong culture of managing tasks & doing doing doing. Clearly, having very stretched, understaffed environments impacts this. But I think it's a culture thing too.

From next month I'm dropping from full time to 4 days a week. Feels good to make a proactive decision in an attempt to find a bit more space, a bit more rest. Already I notice a different kind of energy & attention when I'm with the kids.

It can take months, sometimes years, to truly see and understand a person, a place or a culture at depth. There are no shortcuts without immersion — the more intimate and consistent your entanglement, the sooner patterns appear.

A question I ask in the context of chronic health conditions is: What do you need to be more at peace? Most responses fall into two themes: (1) is about access to medical care when needed; & (2) is about being heard & understood. Both of these seem do-able, but sadly in reality are often missing.

Part of ending Psychology work can be to explore & work through disappointment. Maybe there was hope that the sessions would lead to a much improved life, or some amazing eureka moment. IME it's more realistic to find a quieter & bumpier process of acceptance, which includes a lot of grieving.

Called in to see Nana & Grandad. Aww. Isn't it brilliant that kids can make people's day by just turning up & being themselves. It's special that.

Getting out of Bristol today & heading down to East Devon. The plan is just to see the sea & feel the breeze. And take it from there. It's a "wrap up warm" day. The boys will be climbing on the rocks, we'll be chucking pebbles into the sea. Have a lovely day folks👋

It's very easy to talk a good game about valuing kindness, listening, empathy, relationships etc. And i mean, who would disagree? But what about actually walking the walk? Too many times, i've experienced people promoting these important ways of being, but not actually enacting them.

We're a tiny psychology team in the NHS. Our ability to function & offer a decent service has been really impacted by a loss of admin & management support. Our clinical resource hasnt reduced but our ability to be organised & effective has. And stress levels have gone up. This is happening all over.

Heading into winter, I'm reminded today how sustaining good work relationships are. Might just be the few minutes of chat before or after a meeting. Someone asking you about family, or remembering what's been going on for you. Making the time for a cuppa. Little moments of care that matter so much.

Grand strategy and top down visions won't fix the NHS. Paying attention to how typical clinical processes are designed and managed might: www.hsj.co.uk/daily-insigh...

Thinking with a person "how can you get your needs met?" opens up questions like Do my needs even matter? How do my needs show up in relationships? Do I tend to put others' needs before my own? How can I communicate my needs? It's often more complicated & emotional than it seems, & it's important.

The *experience* of healthcare is psychological- what someone feels & understands, what someone believes, how someone engages & relates. It's core to everything. The proposed 'neighbourhood' health service model presents an opportunity to really front load psychology & psychological thinking.

There are patients i see where there's just stuckness, or limbo. Situations where there's no solution or different way of thinking about it, there's no clever question that's gonna unlock some new insight. It's a case of hanging in there- being alongside. It's hard for everyone. And it's possible.

Classic honesty from the 10yo- Me: "you call that 'shabby chic'" Him: "you should call it 'old & knackered & needs repainting'"😆

Been thinking about that phrase 'the map is not the territory' Seems to me there's so much more MAP these days- multiple maps- offering competing representations of reality, but none of which are reality. It's in the TERRITORY, in actual reality, that we find a sense of connection, truth, & trust.

Blaise castle, Bristol. 7.10am Sunday Beautiful light

I think the core role of psychologists in the NHS is to support services to become ‘more psychological’. How successful are we? I think there’s far more awareness now of the importance of psychology in healthcare. But... the absolute driver remains fire fighting, & psychology is never prioritised.

Remember when we had the whole trendy thing about being authentic? 'Authentic leaders' & so on. Well what if those people have actually been quietly sidelined, in favour of just a continued culture of 'alpha' types, people who will 'drive change' & 'deliver at pace' etc. Was it all a bit of a con?

There's always the lure of new service development or shiny improvement projects. But so often these are false gods. 'Success' these days is about the basics- nurturing a good team environment where people still want to be; where good quality clinical work can still happen; where people still care.

The surge in support for the Greens is very welcome. Like it's ok - and actually a fairly reasonable position to take - to care about people, community, & the earth.

The amount of times atm I'm hearing people say "there are things I need to let go of" & yet without a clear sense of what these things are, or how to do it... myself included. It's like some kind of background grief, & need to grieve, but with a cloudiness to it.

Can someone somewhere work out what it COSTS to 'save' ££ by cutting admin? It's such a monumental act of systemic self harm to think we can cut admin, & somehow make processes more efficient. And the upheaval may well be the final straw for a lot of us who have just been hanging on to our sanity.

I got an email today saying our team manager is being replaced by someone else. No discussion, no forewarning The hospital's in a really grim place & communication suffers- i get it But I will try to feed back, kindly, how it'll be a loss for us Our relationships matter, it's not just about roles

A feeling of 'here we go again' in the hospital. The darker mornings, the emails about operational pressures. Feels to me like a strong sense of managers & clinicians doing everything they can, & there's good will. But also realistically there's an upper limit on capacity, & on people's good will.

I've been thinking about patient letters. I'd love to imagine one day it being standard in healthcare for patients to receive a draft clinic letter inviting comments, before letters are finalised. Clearly this would need a lot more admin time. But I think the value could be really important. (1/3)

New post just out: "On the edge" On my unexpected week in hospital and five things I learnt about the state of the NHS. (Free to read) open.substack.com/pub/samf/p/o...

I look at the Health section of the news & there's always the latest 'exciting', 'game changing' breakthrough. What isnt in the news is how the basic conditions for good quality healthcare are often missing. Infrastructure that supports care, critical thinking, reflection, dialogue, relationships.

idk this is such a big generalisation, but it seems like there's so much expectation these days of uncaring, rushed interactions, that when you show just small moments of care or you take the time to hear someone out, it really seems to matter. It's something meaningful we can do for one another.

Within a small Psychology team it’s completely normal to have amongst us direct personal experience of some of the issues that our ‘patients’ bring. This is because we're all people, & life happens to all of us. Our shared humanity is a strength. The need to be seen & heard, & loved, is just human.

There are many health situations where we know stress makes things worse. And then it's all to easy to get stressed about getting stressed, so it spirals. Telling people to 'not worry' is unhelpful. Instead, normalise that many people would worry, & be available, listen, hear people's concerns.

There's so much despair & overwhelm out there. And it's often multiple things- health concerns, worries about kids, financial worries, parents not well. This is coming up against support services with narrow criteria to get help (services also trying to not be overwhelmed). It's not working.

Very inspired today chatting to a senior medic who's leaving our hospital for a Medical Director role. Really gives me hope that she's been appointed- she's such a genuine, kind, thoughtful, courageous person. Restores some sense of faith that these qualities matter, because they really really do.

Our team admin left as part of 'headcount reduction' & the role is being absorbed into other admin people's busy jobs. Already I see the impact. Calls get missed, patients dont hear from us, clinicians doing more admin. General uncertainty. More cutting corners- more stress for the team & patients.

The way it's become normalised to be doing the work of two people. I hear this so often. People wanting to have more time with family, more time to rest, more time to properly look after their health. The grind is the norm. It makes us ill, & we're made to feel guilty for struggling to keep up.

The vulnerability of having a chronic condition is made far worse when people can't rely on care being available when needed. Symptoms get worse, & it adds a layer of anxiety that turns something that could just about be 'lived with' into something far more disabling. It's devastating, & unnecessary

We're reading the Swallows & Amazons. It sounds so dated- the ways the kids play together, the adventures & freedom they have. But my sons are listening to it in a way that's very much alive... makes us want to go & row across a lake & set up camp & boil potatoes over a little fire...