I have an almost allergic reaction to fancy improvement toolkits that supposedly deliver organisational change. I find it so meaningless. What actually matters is how we talk to each other informally- just mundane day to day getting to know each other, so we can work through the difficult things.

I'm thinking a lot about 'simple doesnt mean easy'. We can see things that are wrong & have a sense of what would be better, & it seems so simple ('just do it!'), but the reality is much more complex. There's no shortage of people selling simple snake oil solutions, which creates more illusion 1/2

When you work in a hospital, nearly every meeting has some reference to being stretched & 'not enough resources'. But you chat to colleagues trying to develop local communities, they see the hospital system as a gigantic powerhouse. Both these things are true. Where is the conversation about this?

I keep hearing about 'bold leadership', 'getting it done', all sounds so heroic. Action. Delivery. But under the surface, there's nothing but slogans & spin. Empty words. What's actually bold is to have honest conversations about where we are, to speak truth to power, & to care about people.

Patient after patient the theme is the same- people's capacity to cope with chronic conditions is eroded by- not being able to access services, not being able rest or prioritise self, family & money worries, relationship strain. People who have managed for years now struggling so much more.

We can grow hope in our conversations every day. In the way we listen & care for each other. In how we care for the environment. Big media & loud voices can't take this away. "I pin my hopes to quiet processes & small circles, in which vital & transforming events take place." ~Rufus Jones 1937

Over the last year or so, there’s been massive organisational changes proposed, & I have never known so much comms & invitations to give feedback & engage with ‘Town Hall’ events. I'm ALL FOR engagement, but I’ve not engaged with any of it. I'm a bit disappointed in myself for being disengaged 1/2

Whether it's NHS, how to help NEETs, big infrastructure investment etc., most people can get behind the idea that things cost money. The point is- what's going to give value, & are decisions made on the best available evidence rather than on vested interests or people trying to make tons of ££.

I experimented with sending an assertive & direct email to someone, rather than my usual tentative, bumbling self... Today i had such an exciting, positive response, which ended with "I really hope we can make things happen." How COOL is that.

So many older people in hospital who express hopelessness get rapidly pathologised, it's named as depression & meds are given. An alternative is to make space to hear what's going on for the person. Usually then it starts to make more sense, both to the person expressing it, & the person listening.

AI is clearly a game-changer & we need to engage with the reality of it. There'll be massive benefits. And, there are also deep concerns that need thoughtfulness, care, & time to understand. The big problem is you can't trust people making mega ££$$ to also be the ones being thoughtful & ethical.

Always seems like Tony Blair is desperate to be relevant & to be admired as some kind of statesman. He seems so lacking in humility.

When you challenge or speak up, you risk that your 'difference' gets positioned as somehow weird, irrelevant, or missing the point. If we're serious about diversity, then it's moments like this that need a response that acknowledges the contribution, that listens. "Thanks for sharing this".

In cancer services everyone can see it just makes sense to have psychological support built-in as standard. We don't refer people out to separate 'mental health' services. The same should apply with other health conditions- there is always a psychological impact. We need holistic care as standard.

The NEET issue isnt just about the current environment. What young people have experienced, the disintegration of their normal worlds while growing up. This really needs to be understood- the developmental psychology of it- so intervention can be meaningful & go beyond superficial initiatives.

People dont change in big ways But tiny adjustments are possible- in how we think, what we tolerate, how we speak to ourselves, how we love others Then maybe we start to notice change everywhere in relationships in perspective in how it feels to be alive Small inner movements can make big impact

Pretty often we meet patients in the hospital & it becomes clear that what would make most difference to the person is not a hospital treatment. So much is about poverty, housing, strain on relationships, & not having access to the basics of a decent life. Hospitals can't address these things.

It gets on my nerves when people in positions of significant power share 'inspirational' messages about making a difference, creating impact, or being a 'change agent'. It ignores the reality that not everyone has the same access to power, resources, opportunities, or support.

Last year I took a month off with burnout. Helpful in itself to rest & recover, & also to take perspective on how to relate to work differently. What helped was a senior colleague who told me about time he'd taken off. He role-modelled that it's a legitimate thing to do Carla Denyer is a role-model

There's risk in healthcare all the time. It's an intrinsic part of the landscape. The key thing is to be conscious of it, be willing to name it & talk about it. And this is where trusted relationships are so important- so we can speak openly about what's going on & any concerns.

Really important message here from Liza about recognising & responding to emotional needs in healthcare. The hero/brave narratives can be invalidating...

People with complex needs bounce around the system with all kind of multiple comorbidities, never quite getting their needs met despite multiple appointments & treatments... The big unmet need so often is high-quality long-term trauma therapy. It just doesnt exist. And it'd make such a difference.

Where there are different views between healthcare professionals & patients, don't just assume that the professional is right & the patient is wrong! Be curious, what's going on, let's share understandings & listen.

An afternoon thinking about ‘wellbeing’ in our NHS teams. There's totally a place for wellbeing stuff- ways to get to know each other & support relationships. Heard about a team proactively looking out for each other- amazing, really came from the heart. A sense of agency around this seems good 1/3

There's an opportunity here to help inform new mental health strategy which intends a shift from crisis intervention to preventative care. Please consider engaging with it. The text here is encouraging. Though the gap between aspiration & current reality is GIGANTIC 1/3 www.gov.uk/government/n....

I said to my son as he was drifting off to sleep "I'm so proud of you", & he whispered back "it's nice to hear you say that", & that's 12 words that have made me feel very content😃

Helpful thoughts on NHS workforce here. Including this para on 'Retention', which lists factors that matter. For me, being able to reliably do a good job (having the infrastructure for this), & feeling valued for doing so (including relationships, ££), is key to people wanting to stay around...

I dont refer to "living well with" (a long term condition) any more. I just say "living with". It's really important to make space for how unfair it is, how annoying & shite it is. How it's ok to not 'focus on the positives'. This is all realistic & legitimate, & can easily get silenced.

Reflecting on the last few days, I think the MSM has really embarrassed itself. All that frenzy & the stirring up. All the headlines about "chaos"- it was the reporters rushing around with 'all the latest speculation' & hyperbole- THAT was the chaos. I do wish we could just dial down the drama.

Something I care about lot about is how we might shift to a healthcare system where all colleagues have protected time to access regular clinical supervision/reflective space- to promote deeper thinking, patient safety, & clinician wellbeing. Headlines like this make me think I must be crazy...

Don't assume that people know they're appreciated. Seems to me genuine appreciation & being seen for making an effort at something really does land. It's something we can do for each other, & can make more difference than we know.

I drove through a part of town I dont normally go to yday, flags everywhere. It was a very run down, forgotten area. Felt pretty unsafe tbh Horrifying as they are, the far right have made specific communities feel like they MATTER. Surely part of a way fwd is to invest meaningfully in these areas?

If anything to do with 'mental health' comes up in health services, look out for 'othering' happening. An us/them dynamic. It happens constantly, & this totally fuels stigma. It makes no sense to have services like this, while simultaneously having campaigns to 'reduce stigma' around mental health.

Sitting here reading my book, while the kids are gaming. Every few minutes I'm cracking up laughing it's so funny. And I don't think the boys knew that books can be funny like this. I don't think they knew I could laugh like this tbh😆

The outcome of psychological therapy wasn't to somehow sweep her distress under the carpet or get rid of it. The outcome was that the distress made more sense & it came with less intensity & she knew she could manage it & be ok.

Having a well-managed chronic condition isn't equivalent to not having the condition. Even when well-managed, there is a baseline of demands, mental labour, worry. Even when well-managed, there is loss- loss of freedom, loss of a sense of being healthy & care free. It's a load to carry.

Makes obvs sense that oppression, power, & hierarchy can make it hard to speak up. But maybe less obvs is how silencing happens when everyone seems bound by being all polite & agreeable- almost like an oppressive 'niceness'.

I'd like to see a new Health & Social Care Secretary commit a couple of hours every week to staying connected with the real human side of care. It'd be useful for staying grounded in the day to day reality of both staff & patients. And it'd also role model the importance of this to NHS leaders.

The idea of an MP standing down to create a by-election just doesn't feel right to me. Feels like a big game that powerful people are playing, while people up & down the country are just struggling.

When you read a report about someone you know, & it's full of labels & you just hardly recognise it as the person you know, then you can see this way of writing is not upholding the person's humanity. Labelling needs significant caution & care, & it's important we honour the humanity of the person.

“The doctor said she’d call me back, & she did” Maybe a tiny gesture in the grand scheme of things, but this meant so much to someone who was worried sick. Even amid the chaos & uncertainty that seems all around us, don’t underestimate the difference little things like this can make to people.

A brilliant publication here. Absolutely resonates the different language used in the centre compared to the edges, & some practical ideas on what we can do. Really relevant for how we might think differently/more broadly about creating healthier communities, how we balance healthcare with health.

Some simple guidance for Quaker business meetings taken from one of their leaflets: “Come to the meeting with heart & mind prepared – not heart & mind made up.” This seems to me a useful intention. To be thoughtful, self-aware, & open.

So much distress & uncertainty around- where's the containment? Where are the people with a calming presence who can take in what’s really going on & give a meaningful, caring response? These people are out there for sure- down to earth leaders quietly making a difference amid all the drama & noise.

Can a Prime Minister be competent, serious and still fundamentally fail as a political leader? I think Keir Starmer may be proving the answer is yes.

I sometimes get this feeling of missing 'home'. Like I just want everything to feel really familiar & safe & comfortable & warm & homely, & i want to be looked after & have all my needs met & have no responsibility for a while. That is all😆

I heard about a newly set up service today, & could I help identify patients who might engage with it... There's too much of this- a service-centric approach, then try to fit patients into what's available. Instead, why not engage with patients first & see what patients need, & then set that up?

The idea that giving a big speech is so pivotal is part of the problem- says something about the superficiality of where we are- soundbites, gimmicks, today's headlines. All stirred by the media. Surely what counts is competence over time, consistent values, genuinely caring about a better society.

The best way to keep high-quality psychology provision is to be embedded within wider multi-professional teams. This is when we give most value to patients, & colleagues see our value too- when we’re integrated within a network of holistic care. Having separate psychology services is less effective.

It's always possible that you're not the 'right' service to help someone with what they have going on. But it IS possible to care & show kindness. And ideally help someone with a meaningful onward step to where they might get the help they need.