Posts Tagged ‘NHS


Thinking Aloud – the value of unexpected learning

Wow. Where did the last six months go?  I last blogged the day before I started my new job.  So I guess that’s my answer.  Thoughts rich, time poor.  But here I am enjoying the last few days of a two week break, thus giving me the time to order those thoughts and commit them to this post. So much material to choose from, and I’ve settled on a reflection of my personal learning since joining a new organisation.

As my last post indicates, this has been the most mindful job transition I have ever made.  In its build-up, I focussed less on whether I could do the job itself (it’s familiar territory), and much more on how I would find my ‘fit’. I’d been pretty thorough about it and was embarking on this new journey attentively and proactively…wasn’t I?  Well yes, I think I would still maintain that was the case, but of course this doesn’t mean I possess the power of prescience. So, here’s the learning, the things I had not anticipated, or under-estimated.  It fills the gap between my preparation and my real experience:

1.  I didn’t realise til I left it just how much of me I had invested in my last job, and therefore how difficult it was to be separated from it, and the people who made it.  Familiarity and shared history are enormously comforting in tough times. I didn’t have either anymore, and my time with it was over. Letting go was harder in the aftermath than it was in the moment.

2. I was a stranger to my new colleagues, and I hadn’t anticipated the impact that would have on my ability to make a positive impact at pace.  What I know about me and what they knew about me was worlds apart.  I know enough about my impact on others to understand it can be difficult to know me (why remains a mystery to me), but I don’t think I had really tied that up with being able to get on with the work at the pace it so needed.

3.  the spotlight was brighter than it has ever been, not because I had done anything to earn it but because there was a huge sense of expectation of the new post holder (as distinct from me personally). It’s not my natural place of comfort at any time, but more than that, it wasn’t right.  I’m of the very clear view that the days of the hero/villain leader are over, and the focus on a single post holder to hold the destiny of services in their hands is wrong in every way.  Yet a new approach has wide-ranging implications for everyone which means it won’t be achieved easily or overnight.

4.  the status quo bias amongst people is real – it doesn’t matter how illogical it may be, it does get in the way.  We know the status quo is unsustainable but we are so weary with change that we just have nothing more to give. I really struggle with this and it’s been the toughest of all my learning – connecting with it, trying to address it in a way which isn’t about judging it, but is about validating it and building the energy and capability to break away from it.

5.  an executive job title brings with it a whole load of assumptions and prejudices from others that bear no relation to me and my values as a person or a professional.  Rationally I understand why this is.  Personally, not so much.   The idea that I should be motivated by  anything other than helping people, including me, to be the best we can be is offensive and exhausting. I spend much more time than I expected talking with people about this shared purpose as the basis for our shared effort.

6.  talking about things once, or twice, or even ten times may not be enough.  There’s no right number. I have learnt to reassess constantly, check in, encourage, coach, clarify, seek feedback, to understand if we are all in the same place.  And if we’re not, to talk more until we are, while trying not to let any frustration on my part show.

7.  going home at the end of a long day and wondering ‘is it me?’ is OK. The important thing for me is to have space for reflection and objective challenge from people whose judgement I trust, and to come back the next day to push forward with what I believe to be the right thing to do.

If I had known these things six months ago, would it have made a difference?  Actually I’m not sure it would, because this is an adventure and I feel I am better for the experience.  While I hope that familiarity will, in time, help me to create a smoother flow in my leadership of our services, these lessons are valuable at any time.  I try hard every day to approach them with humility, courage, quiet confidence and an openness to learning.  I get it wrong at least as often as I get it right, but I hope my new colleagues can see in me a determination to do the best I can for as long as I am here.  If I can achieve that, I will be happy.

Be brilliant!



Thinking aloud – the job that changed me

It’s two months since I last blogged.  In that time, I have been asked frequently if I have been ‘winding down’ as I worked my notice period in my job.  If only!  It’s been busier than ever, and despite having several topics in my head, blogging just hasn’t hit the top of the priority list.

Endings, we are told, are important, and easily usurped by exciting new beginnings.  My job over the last 3.5 years has been such a huge part of my life, that I want to bring it to a conscious end.  It’s the job that I have lived and loved; the job that has changed me.  It has taken me to a new understanding about what I am about as a leader and even as a person. So forgive a self-indulgent reflection and help me say ‘goodbye’.

One of the defining moments in my early career was the experience of sitting in on  a ward round on a busy acute mental health ward.  I was so appalled by the way in which the consultant psychiatrist spoke to (at) the patients he ‘reviewed’, reinforcing misery and hopelessness in disrespectful and inhuman tones, that I knew I wanted to stick around and make a difference.  That was 12 years ago.  My approach to making that difference was to become technically competent in my work. I thought what I needed to do was to build up a knowledge base, develop management skills, know how to handle situations that arose, and drive service improvements so we were always pushing forward.  The focus was on the execution of the job.  Success was based on delivery of tangible goals.  Of course all those things are necessary and to be valued, but it wasn’t until I was nearly a decade into my career that I realised this just wasn’t enough.

People are rarely inspired by competence.  They may respect it, trust it, rely on it, take it for granted, but it’s unlikely to light a fire in their belly. People are inspired by people.  That means allowing the person behind the job title to show.  Now this is where it becomes difficult.  On top of my introversion preferences (already well documented in my blog!), I grew up in an environment both at school and at home where reserve and modesty were the prevailing values.  Quiet diligence, cleverness, belief and courage, alongside self-effacing humour, characterised life. That conditioning runs very deep.  So the idea that I might have to talk openly about my values in my work, what drives me to do what I do, was pretty intimidating.  Couldn’t I just be competent? No, actually.

So what brought about this revelation? Two things and some perfect timing.  I began a year-long leadership programme at the same time as I was co-leading the most comprehensive service redesign our organisation had undertaken, the most important feature of which was cultural transformation.  The programme gave me new insights into the way I worked and the impact it had on others, while the redesign gave me the opportunity to put new approaches into practice.  I made a huge personal effort to let go of some of those inhibitions, and verbalised the longstanding passion I have always had for better services which value the person ahead of all else. And I know it’s an old cliche, but yes, it has been liberating.  I nurture things that I used to dismiss as unimportant to my work – my personal narrative, my values, my connectedness, me.

I have a chronic uneasiness with aspects of leadership behaviour in which said leaders ‘big up’ how fantastic they are at doing it.  The obvious question is, by whose measure? It should only be their ‘followers’ of course.  Showing the human side often seems to tip over into self-publicity and a worrying absence of humility.  I have been overwhelmed with the generosity of comments from all sorts of people, who have nothing to gain in offering them, as I leave this job.  While these comments often leave me feeling awkward or embarrassed, I also feel a real sense of achievement, to an extent I have not felt in any other job.  From that, I conclude that a conscious re-evaluation of what is important in the way I work, what I pay attention to, has produced a real impact for people working in and accessing services.  I walk away from this job knowing that I have achieved good things, learnt from and spoken about the mistakes I’ve made, and found in myself a better leader.  I doubt those enduring values engrained through childhood will ever leave me, nor would I wish them to, but I have learnt to harness them rather than being constrained by them.  So perhaps this is not an ending, but a staging post in a lifelong journey.  Either way, this is the job that changed me.

Be brilliant!



Thinking aloud – just thinking

Have you ever been exhorted to stop doing something which is so fundamental to who you are that you might as well be asked to stop breathing?  I have, for as long as I can remember.

‘You think about things too much’.

‘Stop thinking about it’.

‘Tell me what you are thinking?’.

‘You’re over-thinking’.

It’s stifling.  The external interference in the internal conversations is perpetual, and ultimately futile.  I am not having thoughts of brilliance or genius.  I’m not breaking new ground.  The world is not benefitting from my thinking.  Often neither am I; it can feel burdensome and tiring.  But it is who I am, and it anchors me to life.  There isn’t an off switch.

Until quite recently, I would resent that interference,  hearing only criticism or judgement in those messages.  When did thinking become a problem?  An enquiring mind is something to value, isn’t it?  What I have come to understand better over the last couple of years is that my thinking preference has an impact on others, as well as me.  And for that reason, it matters.

I work in a field I love, doing a job I love, and I feel confident that I can and do make a difference.  I also know that self awareness of my impact on others has the potential to bring about a step change in my effectiveness as a leader.  This is still work in progress, a lifetime’s effort, but I know that I have moved positively and markedly in that direction over the last couple of years.  The insight I now have arms me with a perspective previously absent.  Thinkers amongst groups of speakers can come across as distant, aloof, detached, arrogant.  That hurts.  It’s so far from my intent that my first instinct is to be distressed by it.  When faced with that realisation, I went through a period of thinking (!) that I must be in the wrong line of work.  I was starting to feel myself being led to a conclusion that leadership just didn’t fit with me.  A conclusion I was reaching for myself, yet driven entirely by external influence, leading to self doubt.  When I triangulated that conclusion with other self knowledge, experience and consistent feedback over many years, I had a stern talk with myself and realised this just wasn’t true.  It didn’t fit with the other evidence about my job performance or career.  I was lucky that this ‘moment’ coincided with a fantastic learning journey through a leadership programme with the King’s Fund; an experience that will stay with me for life and for which I will always be enormously grateful.

So the conclusion I came to was not that I needed to change who I was to do the job I love.  Instead I needed to become more adept at self mastery, a concept I have connected with again recently through the inspiration of Helen Glover.  For me as a leader, that means working with what I’ve got, conquering my limitations by managing them, and maximising my positives – like knowing my own mind, being confident to make tough decisions, having faith in my judgement, seeing things from a different angle, and being unwilling to settle for conventional wisdom.  It also means putting the work in – pushing myself, committing to ongoing personal development (including learning how to ‘quieten’ my mind to give it a rest), and taking risks. As I contemplate starting a new job this summer, joining a very well-established and, I’m told, ‘lively’ team, I do so with more insight and mastery than I have known, and I can’t wait.  For the first time, I’m not worrying about being a bit different in my peer group.  As my new boss said to me, ‘just be yourself’.  Clearly someone worth listening to.

For anyone thinking this is just all too self-obsessed, a couple of years ago I would have agreed with you.  All I would say now is try it for yourself.  Seeing yourself as others see you can be scary in so many ways, but if you grab it and master it, and use it alongside your natural talents that others also see and value, you will see your personal impact in any aspect of your life increase significantly.

One last point.  Self disclosure is not something that is top of the list for most introverts, so why write this blog?  Of course there is a selfish element to it.  I started to do it to create a bridge between my introversion and the rest of the world.  But I also do it because I know I am not alone, and I know that talent is being lost at a time when it is so needed, because the world of leadership often seems biased towards extroversion.  I have learnt that I can master the natural abilities of people with extroversion preferences; it just takes more effort, practice and perseverance.  If I can have a tiny part to play in helping others to see that diverse contribution is something to be embraced and valued, and that introversion is something to cherish, not fear, then it’s worth the risk.

Be brilliant!



Thinking aloud – you don’t know what you got til it’s gone…

Last time I posted, the Francis Report had just been published and I was reflecting on what it would take for the NHS to become patient-centred.  That was over a month ago, and normally in that period I would have posted two or three times.  So why haven’t I?  Well, there are some practical reasons – work pressures as we build up to the new year in April, and also being knocked off course by a winter bug.  But more than that, I haven’t known how to organise my thoughts in the wake of Francis.  Most days, there are more headlines about new investigations, new revelations, new allegations, and confidence apparently leaching from the NHS at an escalating pace.  I’m told we’re ‘coasting’ by the SoS.  This provokes all sorts of emotions in me – conflict, shame, grief, anger, shock, fear, despair – but most of all, an immense sense of sadness.  When a gulf emerges between intent and experience, it is really difficult to stay motivated.  And it’s not as if working in the NHS is easy at the best of times.

Amongst so much negativity, it’s easy to find yourself succumbing to the media bias, generalisation and political spin, and even to join in.  The legitimate outrage over Mid Staffs is likely to run and run until there is a sense of justice for the families, and we’re nowhere close to that yet.  But meanwhile there are services to run, patients to be seen, staff to be supported to be the best they can be.  Today, tomorrow, next week, next month.  It was NHS Change Day last week that snapped me out of my post-Francis slump.  The idea was that thousands of people would pledge to take action that would make a positive difference – big or small, it didn’t matter.  I watched as the value of this day was debated on social media.  All views from blind faith to outright dismissal of its potential were aired.  I found myself responding to a doubter on Twitter.  To me, it was about galvanizing the passion of thousands of individuals who share a common set of values and who together are a force for good and need a channel for their energy.  Now more than ever, we need our staff to ‘feel good’ about what they are doing.  They are human, and indeed it is their humanity which is their most precious offering to the NHS, yet as devastating events have demonstrated, it can be squeezed from them in an environment which loses sight of what is important.  I don’t think even the most fervent supporters of NHS Change Day claimed it would be the turning point, or that if we just did this, all would be well again. Our responses have to be multi-faceted and tailored to the infinite complexity we face.  But what it did do was create a vehicle for 100,000+ people to stand up and re-state their commitment to doing better, striving for more, and re-connecting with the values that motivate the vast majority of NHS staff to do the work they do.  It’s good to know that the most popular pledge, with nearly 56,000 supporters, was about sharing hope in the face of despair – so impressively championed by Dr Alys Cole-King in the context of suicidal thinking.

There are plenty of commentators who lead us to believe that the negativity around the NHS is exactly what is required to create the political and ideological platform for the break-up of what we have known as a national health service for more than 60 years.  The perfect storm is brewing.  I don’t know if this is true or not, although my own observation is that bad things happen more often through cock-up than conspiracy.  What I do know is that it’s easy to lose sight of what we do have, and by the time we realise it, it’s gone.  Yes, the NHS and all those with an interest in it have got a lot to do to make it fit for purpose.  Yes, there are tough decisions ahead.  Yes, there seem to be circumstances conspiring against us.  Yes, we need a greater distance between political influence and service delivery.  But next time I hear a headline and feel a sense of irretrievable despair, I’ll be thinking about the line in that song – ‘you don’t know what you got til it’s gone’.  Will you?

Be brilliant!



Thinking aloud – diagnosis; the tip of the iceberg?

Several things have brought me to this blog post over the last week.  First, I was asked to share my thoughts on the new DSM (Diagnostic & Statistical Manual of Mental Disorders) and in particular its widening of the definitions of mental illness.  Second, I started reading ‘Inconvenient People’, a well-titled book telling the stories of Victorian men and women who were shut away for life in asylums, generally by their families, because they didn’t fit within the social norms of the day. Third, I caught the end of a tweet chat about the value of diagnosis to people experiencing mental distress.

The question common to all of these things is where, on the spectrum of mental wellbeing, do you place the line between sanity and insanity – at what point does a medical explanation for life experience replace an explanation based on the human condition? And how does the drawing of this line help or hinder us in alleviating distress?

It seems to me that the answer to the first question is as much cultural as it is scientific.  We judge behaviours against subjective benchmarks which are culturally and socially referenced.  This is evident when we look across the world at the different interpretations of mental illness in different countries.  It is also evident when we look at the history of what has constituted ‘unsound mind’ over the centuries – many examples of which are considered entirely ‘normal’ today.  So if we’re not dealing in absolutes, then the scope for convenient interpretations of human distress is broad, isn’t it?

So to the second question.  When might it be helpful to an individual to have a diagnosis of mental illness or disorder?  Perhaps as a validation of distress?  Perhaps to access services?  Perhaps to inform treatment?  Perhaps to make sense of what’s going on?  Perhaps as a means of understanding self?

And when might it hinder?  In getting a job?  In having somewhere to live?  In securing and retaining friendships?  In focussing on deficits at a cost to strengths? In medicalising the experience of distress? In driving social isolation? In looking for external solutions while overlooking the potential for personal recovery? In chasing solutions which seek to standardise experience and treatment at a cost to individual needs?

I find all of these explanations plausible.  On the help versus hinder balance, I’m erring towards concluding that diagnosis is something which is more useful to ‘professionals’, services and people ‘looking in’, than it is to the person experiencing distress.  What can be expressed and articulated as symptoms are likely to be the tip of iceberg of the total experience of living with mental illness.  Hence the power and value of personal narrative.  Likewise, the drawing of the line between sanity and insanity is something which is socially driven and ‘normed’, but can isolate, ostracise and ultimately disadvantage people who don’t fit.

This isn’t an anti-psychiatry viewpoint.  Rather it’s about seeing the issues through a broader lens, one which doesn’t stop at diagnosis as if it’s an end point, but sees beyond  symptom reduction, framing responses which are about life, not illness.  Services, and society, are responsible for nurturing an environment in which recovery, or life beyond illness, can thrive.   That means seeing and understanding people as people, in whatever shape or form they live, and valuing the diversity, mystery and uniqueness of the human condition. This, in turn, is immensely empowering and begins to redress the power imbalance which is still so prevalent in clinical practice, and society.

To finish with a quote from Inconvenient People, it seems these questions were as relevant 200 years ago as they are now.

‘The ‘lunacy panics’ of the nineteenth century highlighted the fear that the English were sleepwalking into allowing the medical profession to curb individual freedom by labelling unconventional behaviour as a pathological condition, in need of cure or containment.’

Let’s hope we can make more progress over the next 200 years.

Be brilliant!



Thinking aloud – doing what it says on the tin?

I was hurrying to get petrol this week, on auto pilot and with my head turning over my next meeting, when I noticed a display stand outside the kiosk.  It had a sign at the top of it saying ‘logs, coal & charcoal’.  What it contained was anti-freeze, de-icer, and screen wash.  I smiled as I thought what their corporate marketing dept would have said about it.  My next immediate thought was that it had a relevance to the NHS.

Growing public expectations are frequently cited in the top three challenges facing the NHS in the 21st century.  While there seems little doubt that this is true, I wonder if the NHS could manage this better by being clearer about what it can realistically offer.

As consumers of healthcare (and often more significantly as voters and taxpayers), we are led to believe that all things are possible – if science has found a way to cure an illness, alleviate suffering, prolong life, then our NHS will provide it.  Think of the high profile cases and public outrage when this proposition has been tested by an individual going through immense suffering and distress, who has been refused the latest drug or treatment. Sometimes these cases change national policy overnight.

Think also of the assertions that the NHS is ‘protected’ from frontline budget reductions.  This was one of the most frequent points raised by staff, service users and local communities when we were going through a public consultation process last year to make some major changes to our services.  Reconciling political messages with local realities is one of the hardest parts of my job.

Governments of all colours know that public feeling about the NHS is a deciding factor at the polls.  So despite the constant media attention around ‘cuts’, and the current questions about quality of care, most of us still hold onto the hope that the NHS will come good for us if we need it.

Meanwhile NHS organisations all over the country are building up to a new financial year, in a new and diverse commissioning environment, trying to work out how to sustain high quality care while reducing costs….again.  And the national messages seem to be that it’ll all work out alright because clinicians are now holding the purse strings, and are bound to make better custodians of the public purse than the beastly bureaucrats.  This may be true, but it surely won’t be enough to match the scale of financial challenge the NHS faces.

So perhaps the silver lining in this cloud is that it will force a more open and honest dialogue with the public about the limitations of our NHS as it is currently configured and funded.  What better opportunity to engage in this debate than these times of austerity.  Within the local services I’m responsible for, I want to improve the information we make available to our service users, be much clearer about the purpose of the care we offer, focus care on supporting skills in self management and independence, and helping users to take more control of their care through self directed support.

These things won’t solve the problem of increasing public expectation, but they may go a little way to closing the gap between rhetoric and reality.  Let’s stop advertising one thing and producing another.

Be brilliant!



Thinking aloud – bias masquerading as conviction?

One of the joys and privileges of my job is that I get to work directly with people who use the services we provide.  Not something that characterises the role of all NHS managers.  I have learnt so much from this over many years, and the achievements I am most proud of have been inspired by these experiences.  When I started to listen to the individual narratives that shape us as human beings, I quickly became attuned, in a very real and tangible sense, to the horrors, injustices and marginalisation that people with mental health problems encounter.  I also became much more aware of the extraordinary instinct to survive, to get through, to find hope when all hope seems to have gone.  As someone who has a love/hate relationship with optimism, I have often felt embarrassed by my own self indulgence at times of difficulty, when I look around to see what others are going through and coping with.

So, much of what drives me is about wanting to play my tiny part, as a professional, citizen and fellow human being, in making the world a better place to live.  Not, I hope, in a ‘do-gooding’ or patronising way.  Nor in a naive way.  But in a way which levels up the playing field wherever I might be able to influence it.  So when I encounter something which reinforces stigma or marginalisation, I am keen to leap in and try to do something.  They may be small things, but together they can have an impact on culture and expectations – dismantling the architecture of institutionalised service provision and opening up care for people with mental health needs so that it is mainstream, not ghettoised.  People I work with know I have a particular hatred for minibuses – the vehicular representation of institutionalisation!

Bricks and mortar remain a defining feature of services – as members of the public, we identify our local services through the buildings they occupy.  Buildings are tangible, they give us places to go.  But they soon become a magnet and can quickly become a rigid, immoveable feature which lock a service into a narrow interpretation of its role and function.  If you build it, they will come.  So when I first heard about the concept of a Recovery College, through our work as a pilot site for ImROC (Implementing Recovery – Organisational Change), my instinctive reaction was that this was not going to be something I would embrace as a priority for us.  Not because the idea of using adult education to develop self management skills, in partnership with service users, was alien.  We’d made good steps in this direction already.  But rather because it was about a building, a building with a mental health label, a building that would represent a closed shop.  Given my passion for supporting mainstream opportunities for people with mental health needs, this just wasn’t consistent with that.  Right?

Wrong.  As I learnt more, and as I listened to others, I started to realise that this would allow us to open up our world to an entirely new audience.  We could make this part of our local community.  We could adopt a co-learning approach, so that the only label that identifies you as you walk through the door is one of ‘student’.  We could take it on the road too – operating out of lots of different venues across our wide geography.  This idea had the potential to do exactly the opposite of what I had first feared.

So we’re doing exactly that.  In April we will open our doors, and in September we will start our full curriculum. Modest beginnings but big aspirations, which could unlock long-held discrimination in communities and public services.  And the lesson for me?  When you care passionately about something, don’t let your conviction become a bias or a prejudice.  Treat every situation on its own merits, keep an open mind, and listen to people around you.  Drive and determination is one thing; dogma is quite another.

Be brilliant!


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Mental Health Geek

Just another day in the life of a passionate health worker & lifelong learner.