Most people you'll meet in an organisation (like an NHS organisation) will tell you - genuinely - that relationships are the key to everything. But simultaneously- our systems, pressures, demands, scarcity, the organisational 'machinery' we maintain... all tend to work against these relationships.

Still thinking about the scenes earlier this week when Iranian people formed human chains around key infrastructure. Who knows the difference this made, but I like to think a lot. After so much dehumanising language from the US, it brought attention sharply back to the people & real people's lives.

People positioned as leaders, people who get things sorted, listeners, 'go to' people, people seen as 'rocks', the 'strong ones'... We all know people like this. These people have worries too, these people can have vulnerable times, tender times, wobbles. These people also need care & love.

Reminder to self as I see some patients again after a few days off work... people with chronic health conditions don't get a 'day off' from having to cope, to manage, to think about how they are, how their treatment's going... important to remember this.

It's not unusual that people ask me- why don't you do private work? i guess the idea is you can get on with clinical work without being weighed down by so much system headache. But you know you'd miss your colleagues, & working in the NHS means a lot. Will it ever feel less of a headache though?

If Iran stands its grounds, which seems plausible, you can totally imagine he'd launch a massive bombardment just to save face. There's no courage or strength in this. It's totally pathetic. My whole feed here is people posting different forms of defiance & resistance. THERE is courage & strength.

Was thinking about authenticity again today. There was a time in recent years when it was the buzz word. And it's obvsly preferable to fakeness. But what if 'being authentic' means knowingly distressing someone else? Sensitivity to other people's needs also matters. There needs to be some balance.

No doubt how powerful these weight-loss drugs are, but it'd be nice to imagine as much investment & enthusiasm would go into creating an infrastructure that addresses the psychosocial & systemic drivers for obesity. Investment in the availability of holistic support & healthy environments.

The royal visit should absolutely be cancelled, & very publicly- not despite the fall out it'd cause, but because of it. If ever there was a time to take a stand it's surely now.

This essay is superb- feels a relief to read it. Think it gives clues about some of the grief that just continues to hang around that I can never quite put my finger on. There have been multiple forms of loss of community & you can't just recreate that somewhere else. Important to understand this👇

Our team has lost admin/management support, while simultaneously facing big changes bc of a hospital merger. Colleague recently said "I just wish there was some acknowledgement from execs of how shit this is". She's right- it's not normal to work like this & it matters to say so.

It’s entirely possible to be assertive, self-confident, radical in one context; & oppressed, anxious, self-doubting in another. CONTEXT is everything. We totally over-estimate how much we can 'choose' how to be, & under-estimate the role of context. Understand the context more, judge people less.

How hard can it be to stand back & be curious about what kind of society would help us be healthier, & what kind of services would support us when we have urgent/ongoing needs... & then be working towards that, with funding to make it happen. I just don't get the sense that this is ever the driver.

There's a lot to be said i feel for looking back & giving yourself a bit of credit for having come through something difficult. Might even look back & think "how on earth did I get through that? idk...but i did." Just a quiet encouraging word to yourself...

The doctors strike is obvsly distressing for so many people. But I think psychologically it's also come to symbolise a lot about where we are in the nhs- the widespread sense of total stuckness, & how huge amounts of effort & £ go into reactive fire fighting rather than addressing underlying issues.

So much discourse seems to be set up with a dynamic of "I'm right, you're wrong", it's so exhausting. Feels exceptional to be in a conversation where there's actual listening & understanding going on. Hard to imagine that this could ever be the norm, but jesus imagine what a radical shift that'd be!

We are facing a massive change in our local hospitals, & it’s realistic there’s high levels of anxiety, & everyone knows it’s about saving ££. Why not just acknowledge that? When all the messaging is all so sickly positive, about all the ‘opportunities’, it just feels like senior leads dont get it.

If your service gets too ‘tight’ in its inclusion criteria, you can end up spending what little time you have on ‘gate keeping’, when you could spend that same time actually helping people. Really need to watch out for this. it happens all too often.

We always think carefully about how to get most value from our Psychology resource. Then the ask is to spread even thinner so ‘everyone who needs it gets something’. But there’s only so thin you can spread before you're not really helping anyone effectively, & you just become a shell of a service.

I love how Zack Polanski & the Greens are giving such a consistent, clear voice to issues around inequality, caring for public services & the climate. Basically, a fairer, healthier society. Refreshing to hear such moral clarity.

I've heard a few times lately that a solution to being overwhelmed is to 'work on your boundaries'. Hmm. It's obvsly a good thing to be self aware, but there's a big risk here of putting responsibility on exhausted individuals to mitigate the effects of knackered systems & relentless demands.

If the Royals are seen happily getting along with bullies, it sends the message that bullying is somehow okay. It’s easy to hide behind 'ceremony' & rehearsed speeches, but it's times like these that values matter more than just going along with the charade to keep things nice. Urghhh...

Threatening people ("if you dont accept the deal, then..." etc) produces really bad energy. It's absolutely not the same as having healthy boundaries.

I feel for people dependent on broken-down, unreliable health services. The powerlessness & anxiety this causes. I feel for people working in health services- chronic moral injury, fatigue, frustration, huge demands. And the damaging impact all this has on the relationships between us.

Watching & waiting... We enjoyed a bit of birdwatching at some local wetlands. The stillness & quiet was so welcome.

A key measure in the hospital is the activity you're getting through, & ofc this matters. But the value of psychology work can't be reduced to number of contacts. A lot of our work is subtle, quiet, behind the scenes, & I know we're valued. But when everything's tight, we're vulnerable to being cut.

I see so many medical colleagues under massive pressure to do more, to fit in more clinics. We can talk all we like about 'boundaries', but realistically it's very hard for individuals to stand against this when there's a local team culture that's going along with it. It has to be a collective stand

An important piece by @elspethdavies.bsky.social in the @bmj.com. “Being at elevated risk of disease can fundamentally disrupt a person's sense of trust in their body. Helping people live with risk is not only about offering further monitoring and investigations” Link: www.bmj.com/content/bmj/...

We know that genuineness, warmth & listening are good things. We don't need fancy models or evidence for this. They're just basic human ways that help us muddle along. We pressure ourselves to do 'big things' to make a difference, but the real challenge is to embody the basics when times are tough.

Oof it's been a hell of a non stop, just hanging on by my fingernails kind of parenting day. Kids just asleep now, i am knackered, & just opened up this app. How uplifting is that to see all the posts of defiance, strength, community, humanity. This is really cool.

In psychological work there can be a fantasy of a eureka moment, a key that will unlock everything. Part of the process ime is to challenge this fantasy & replace it with an appreciation for 'working through' & an unfolding genuine relationship that slowly can carry over into a more meaningful life.

As a clinical psychology service in a hospital, we see a tiny tiny fraction of patients. But ALL patients have psychological needs. Clearly not everyone needs to see a psychologist, but psychological care should just be an integral part of normal care.

I’m so struck by just the diversity of people’s lives & what a privilege it is to get the time to hear a bit about people’s stories. Life contexts within which people are living with health conditions, work pressures, hopes, & losses. Being seen & heard matters so much- it's about respect & dignity.

If it's always the same people, saying the same things, in the same ways, then maybe there's a clue as to why things don't progress? Like I keep hearing leaders talking about listening & ‘shifting the culture’ around power, & yet it’s always the same people talking about it in the same old ways...

The slow decline of admin support in NHS and the loss of valuing it is such a problem I think

Important to keep caring about the things you care about, while not getting drawn in to feeling responsible for the state of how trashed everything is. Slowing down & having good conversations helps with this.

There’s so much survival mode rn. I know it can feel a bit cringe to ‘appreciate’ each other in teams. But when it’s heartfelt, it can really mean a lot. Maybe it’s not so much gushy type comments “you’re so amazing”, but more about being seen- noticing the little things we each do despite the slog.

Menzies-Lyth described social defences in hospitals (1950s)- how procedures that appear to offer assurance, in fact function to avoid anxieties stirred up by working with patients. When things go wrong- we tighten up our systems. But what we need is to support healthier, more human ways of working.

I've talked before about 'recovery' & 'healing' in terms of nhs staff. Idk if these words are right. For me, I think I can adapt, & engage with whatever's next, but I'll always remember these last few years, the sense of widespread grief & damage. And I don't think 'healing' feels quite right to me.

I was asking the old guy next door for advice about gardening, & he smiled and said "just enjoy yourself, & be prepared for some failures as well as successes". And i think this is brilliant advice- so freeing.

In big healthcare organisational change, you can see how taking a more organic, unfolding, relational, 'learn-as-we-go' approach comes up against a need to know, a need for certainty, a need for clear solutions & things to measure. Think we'd do well to name this tension more than we do.

As a parent you just want to know your kids are gonna be ok- that they'll be able to navigate the future world & there'll be help along the way when they need. This often feels out of reach, given how harsh things are atm- it's hard to be confident there'll be compassion for people who need it.

I guess we typically understand "you're so strong" as a compliment, but i've heard a few times lately people saying "...but i'm so TIRED of having to be strong all the time". This is important. Yes, let's value strength. And also let's support rest, duvets, softness, caring for one another...

I think the key to 'better productivity' is local people having space- to think clearly, to grow relationships, to understand what's needed, to design processes that work. So it's important to create conditions that support having that space- & keep coming back to this.

The start of covid was an extreme unique context, but the shared motivation & energy for organisational change was remarkable. You cant replicate that context with 'inspiring leadership' etc, but it was mind-blowing seeing what's possible when people are united, open, & willing to make things work.

It's a subtle & important difference between: Doing an 'assessment' with the aim of establishing if a patient meets criteria for your service. And- Having a conversation with someone to try & make sense of what's going on, what a person needs, & what might be a helpful next step.

In the absence of meaningful therapy & support options, you can't judge people for finding their own ways to get by.

The thing to remember is- it's putting our efforts into the seemingly 'little things' that actually makes the difference. It's where we find our agency & sense of connection. Resist the constant pull into the bullshit- it's deliberately stirred up to drain our energy & create hopelessness.

So many caring, experienced people in healthcare I hear say things like- If only we had the time & space to pause & think creatively about how we do things.... But everyone's stuck in fire fighting.

It’s amazing how letting go of something that's taken up so much space in your mind & body can make space for new things- lightness, love, care, new opportunities...