Author: LisaSaysThis

Loves people and Brighton and Hove Albion FC. Find me on Twitter @LisaSaysThis

Sssshhhhh….

​My first blog for a month. A number of lovely people have been in touch to check if I am ok. They know that going quiet can be a bad sign with me.

The reasons for my recent radio silence are several. I admit that I have had one or two days of lower than optimum mood. Nothing terrible, just feeling a bit bleurgh. This came as no surprise; my mood tends to reflect the lack of daylight at the start of the year. As usual, I am perking up with the lengthening of days.

I have also been busy. Family stuff, domestic projects, volunteering and my coaching work.

As a coach, it is important that I practise what I preach, and develop non-preferred ways of thinking, doing and being. By nature I am an extraverted thinker; I tend to work things out by writing about them or talking them through. What comes naturally to an introverted thinker, ie working out ideas fully before expressing them, takes considerable concentration and effort on my part. But I can do it when I need to. And I have felt that need recently.

Something I have been pondering is the personal cost of sharing, specifically in relation to the book I have written. It is a memoir of my NHS career as a leader, including a how-not-to-do-it guide plus a bit of polemic about the future. The style is similar to many of my blogs. It is ready to be published this year. But I have been wavering. What added value might publication bring? Maybe the benefit was in the writing of it? Some may find the stories of interest and the lessons useful. But there will also be criticism and negative comments about difficult stuff from the past. Can I face this? Do I need it? I grow increasingly unsure. Thoughts on a postcard please…

I have also been thinking about the nature of mental illness, and how some of us are prone to it while others seem to have greater immunity. I tend to agree with those who say that that there are few people, if any, who, faced with enough mental trauma, would not crack under the strain. Some of us simply experience mental distress more readily than our fellow humans.

But despite all the evidence about the impact of genetics, other inherited traits, early experiences of trauma and loss, plus environmental factors, to have a tendency to experience mental illness is still seen by some as an indulgence, a weakness, even a personality flaw.

Those who, despite all that has come their way, have learned to tame their mental health, are heroes in my opinion. They should be admired for their assets, not pitied or shunned for their deficits. Many are the kind of people you would most want to be stuck on a desert island with. They are kind, resourceful and patient, and often less prone to judge others than those at whom life has thrown less excreta.

I have also been thinking how lucky I am. When I was last off sick with depression (from my old job as an NHS chief executive), I didn’t want to be alive. But I wasn’t worrying about paying the bills, losing my job or being made homeless. A few nameless folk were judgemental, but the ones who mattered most were hugely supportive. I got excellent treatment when I needed it from a wonderful psychiatrist and GP. When I was ready, I had the wherewithal to pay for psychological therapy. And as I got better, I didn’t have to waste precious emotional resources fighting a hostile benefits system. Nor did I find myself in accommodation where I felt unsafe, or removed from a caseload because I no longer met their treatment criteria. And I had no fears of deportation or having to hide from an abusive partner, people traffickers, drug dealers, pimps or lone sharks.

It is true that mental illness can happen to anyone. If we can find the strength, most of us can do something to help ourselves. But people who are lucky like me have many times more chance of a meaningful recovery and successful management of relapses than those who have been dealt a less favourable hand.

It was always so. And as austerity sinks its vicious fangs ever deeper into public services, it is those who already have the least who are most negatively affected. Instead of achieving their optimum, they are diminished and disabled, not necessarily by the condition itself, but by the need to fight battles every day, the lack of immediate and ongoing support, and by not having all the other things people like me take for granted.

And that is why I have been quiet. I have been thinking about this a lot. I am privileged in so many ways, including having a voice. And I feel I have a responsibility to make use of it.

More anon.

What to do on a bad day

If, like me, you experience depression from time to time, you will know about bad days. They come and they go. Some are worse than others. On the very bad ones, it may be impossible to speak, even move.

It is not always the case that an accumulation of bad days will build up into a severe depression. But they might.

What is unfortunately true is that, on bad days, we may do things that we later regret. We may hurt ourselves, others or both.We may damage relationships and opportunities. And we may develop destructive habits that are hard to break, especially when the next bad day comes along.

If we are lucky, the good days outnumber the bad ones. On good days, it is easy to pretend that the bad days don’t happen. Or to forget what they are like. And the reverse is true also. On a bad day,  we can believe that we will never feel calm or happy again.

Today is a good day for me. And so I am making myself think about the things I would like to remind myself of when the next bad day comes along.

DO

  • Get up. Do it slowly. But do it
  • Make the bed. It gives a sense of control. And it is nicer if you need to go back
  • Make some, albeit minimal, attempt at personal hygiene. Maybe wash your face gently in warm water with a soft flannel
  • Get dressed in comfy clothes
  • Accept that this is a bad day. Embrace it. Only do what you must.
  • If you can, use mindfulness to notice the bad feelings as they come and then go by
  • If you can, use CBT so as not to engage in the negative thoughts
  • Make a plan to do very little. And then do what is on the plan. Drink tea. Eat toast. Watch comfort TV. If you can’t bear TV, listen to the radio
  • Spend time with the cat. He knows what to do
  • Cancel things that you can cancel for the next couple of days to give yourself some breathing space. This will probably include asking for help, which can be really hard.
  • Plan to go out for a little walk – if not today, then the next day. Or the one after. You will know when.
  • Tell someone you trust how you are feeling. I know this is the hardest part. But please, do not avoid this.
  • If you haven’t been recently, make an appointment to see the doctor
  • If you are desperate, call Samaritans

DON’T

  • Don’t tell yourself you are a useless lazy good-for-nothing selfish cow for not being able to do whatever you feel you ought to be doing today
  • Do not make any important decisions (like resigning from your job)
  • Do not stop your medication
  • Do not force yourself to exercise or berate yourself for being unable to exercise
  • Do not work, read anything other than the lightest of fiction or do anything else demanding
  • Do not watch the news
  • Do not read emails
  • Do not use social media
  • Do not write lists of how useless you are
  • Do not worry about the world
  • Do not go outside in your pyjamas. Or if you do, wear a coat

This is only my list. It might help you. But, even better, you might want to write your own.

If you do so, I would love to hear whether you found it useful.

Remember this; we are not alone.

 P.S. A few hours after posting, someone v wise pointed out to me that those with caring responsibilities don’t have the luxury of “duvet days” (they didn’t call them that but I know what they meant.) So I have amended the Do list slightly. 

It is still only my list. I don’t recommend any of it really. But I do recommend that you consider writing your own.

Social media meanderings from Saltaire

Image by Dan Bailey

Saltaire

By the time you read this, I will have given what has been billed by my Twitter chum @PGTips42 at Bradford District Care Trust as a Social Media Master Class. 

In fact you would have to look hard to find someone who is less of a social media master than me. If they were paying me, the 60 attendees would by now have asked for their money back. Luckily, I am doing it for free. This gives me a chance to explore some recent thoughts with them and to visit the beautiful model village of Saltaire in West Yorkshire. The legacy of Sir Titus Salt could teach us a thing or two about philanthropic investment in social capital and infrastucture for the good of everyone, not just the richest.

Back to social media. One of the promises I made to myself when I retired from the NHS was that I would accept speaking engagements only when they were about something that really interested me, and that I would never again use Powerpoint. I’ve stuck to this for 2 1/2 years and it has served me pretty well. I did think about breaking the second rule for this session, as some screen grabs from Facebook and Twitter would have been nice, especially if they included kittens. But I decided against it.

Instead, I will have meandered through some personal insights, drawn from this blog and the references herein, and even better, found out what the attendees think.

My personal approach to using social media is how I tend to approach most things – I jump in and have a go, ignore wise advice and instead work out the rules as I go along. This isn’t the wrong way, but nor is it the right way. It’s just my way. But however you choose to get started, putting yourself out there via social media is undoubtedly scary. It is important to take care. I do highly recommend this very well constructed article by Annie Cooper and Alison Inglehearn. It will help you stay safe.

Once you have chosen your preferred social media platform – such as Facebook, Twitter, Instagram etc (and this can feel like a Betamax v VHS choice), here are an updated set of rules I shared in a previous blog that might help a social media novice get started.

  1. Do it yourself.
  2. Listen twice at least twice much as you speak.
  3. Don’t rise to the bait or post when angry or under the influence of dis-inhibitors.
  4. Share opinions but remember they are only your opinions. Others are allowed to disagree!
  5. Where possible, stick to facts and values.
  6. As in face-to-face conversation, seek common ground.
  7. Don’t believe everything you read.
  8. Don’t only talk to people you know you will agree with. Some people describe those who do as living in an echo-chamber.
  9. There ARE trolls out there. But not as many as you might be led to believe.
  10. Be kind, always – to yourself and to others.

It is possible, and great fun, to crowd-source a seminar, as I have now done a few times. Yes, it takes more time than the usual approach. (And it doesn’t finish on the day. It is important to thank people properly who have made the effort to help you.) The benefits are the potential to engage many times more not only with your direct audience but also with others via social media. And to widen your own learning in ways you could not have imagined. Most of what you see here has been achieved with the help of my social media friends. 

Given my passion about mental health, I must mention the impact of social media, which can either be overlooked or understated, in my experience. I thank my friends for reminding that social media is only a very small part of the world. It can be a source of solace and support, as I have sometimes found.  But it can also cut you off, if you let it. And it can be vicious, self-righteous and damaging. People can hide behind anonymity, so bad behaviour is invariably worse, goes more unchecked and can be more intrusive than in face-to-face interactions. I wrote this blog about Twitter  in 2014 which you might find helpful.

Blogging is not compulsory. If you like sharing thoughts in writing, you will probably enjoy blogging and learn to do it well. Like everything worthwhile, it takes practice. And if you don’t, you won’t. 

I would also mention that, however much you like the blog site you have chosen, unless someone (i.e. you and/or your readers) are paying for it, you and they ARE the product. The same applies to all social media platforms and indeed all publications, such as “free” newspapers. If we want original, independent writing to thrive, we MUST pay for books, journals, newspapers, even blog-sites. Otherwise it won’t be long before the only things available are products sponsored from a commercial or otherwise partisan perspective. And that is a very sinister prospect. 

Some people use social media platforms such as Twitter for swift repartee, and blog about more considered and complex thoughts.  I would argue that blogging can help us to work out what we think. And that we can use Twitter and other chat sites for this too. After all, there is no point getting involved in conversations if we have already made up our minds about something. Here is a bit more about why I write a blog.

Just to show that I have been thinking about social media for a while, here is something I wrote for the HSJ in 2012.

This slide deck on the role of social media in health is the extraordinary Dr Helen Bevan, @HelenBevan on Twitter. Helen is a genius in improvement methodology and practice as well as new ways of working, including using social media. 

And I thank another wonderful friend @AnnieCoops for introducing me to this lovely video poem about the social media imprint we leave behind us. Like all good things on social media, it will make you think really hard. Which is the best sort of thinking. 

Here are some of my new friends at Bradford District Care Trust. They were AMAZING!!!

And given that I mentioned kittens, here is William to wish you all well for 2017.

Suggested Ambridge New Year Resolutions 2017

Brian

Stop behaving like an ageing alpha male lion. Otherwise you might lose more than your pride. Give in graciously to Adam’s plans. Once you accept that you are, just like the rest of us, completely replaceable, you will be a lot happier.

Adam

See above. Also, maybe you could get in touch with Charlie?  We liked you being with him much better than poor old Ian.

Jennifer

Keep Brian on a shorter leash. Buy plenty of tissues for Lilian. And make more time for your writing.

Lilian

Dump Justin before he dumps you. He’s not nearly as much fun as you think. You can do much better than Ambridge’s answer to Sir Philip Green.

Toby

Don’t let people’s low expectations define you. Get a proper job, preferably in Brighton.

Tom and Kirsty

Buy a pram.

Helen

Do not, on any account, let Rob back into your life. Whatever he tells you, abusive males like him are extremely unlikely to change. Do everything you can to keep your lovely boys safe. One day you might meet someone else. But for now, while you recover from such a damaging few years, you are much better off alone.

Pip

Do not let other people tell you who to go out with. But equally, don’t let the poor opinions of your family cast Toby as Romeo to your Juliet. Like Lilian, you can do better. You won’t meet new people working on your parents farm and living at Rickyard Cottage. Time to spread your wings in 2017.

Jill

What is going on with you, Jill? Why do you hate Toby Fairbrother quite so much? You have alienated your beloved granddaughter, you risk doing the same with your daughter-in-law, and as a church-goer, you are showing some extremely un-Christian attitudes. And you won’t listen to reason.  It isn’t really about Pip, is it? Nor is it about Toby’s father and his long-ago affair with Elizabeth. It goes much deeper than that. I suggest you talk to someone outside the family who you trust, possibly Reverend Alan, and explore these feelings. You may need some professional help. Because such uncharacteristic vitriol at your age is really worrying.

Ed and Emma

Stay as sweet and honest as you are. Undoubtedly we could do with more working class characters who are in the cast for more than just their comedic value. But you two are brilliant. Please don’t change a thing.

Usha and the new vet lady

Likewise, we need to see much more of you both, as well as a few more characters who just happen to be Black, Asian or from other Minority Ethnic backgrounds. Or those of us who argue that The Archers is no longer totally white and middle-class will have to admit we are wrong. Bring back Iftikar Shah; he is much more glamorous and interesting than that boring doctor, Elizabeth!

Pat and Tony

If you thought semi-retirement was going to be quiet, think again. Prepare for incoming grandchild number 4. And congratulate yourselves on being true to your characters but at the same time amazing in 2016.

Here’s to a wonderful 2017 in Ambridge, which remains an oasis of compassion and commonsense compared with the rest of the world.

My nine lessons for Christmas 2016

  1. In November, my friend Sally took me to The Church of St Mary the Virgin, Putney and reminded me about The Levellers. As she read aloud from Thomas Rainsborough’s famous quote, I felt a shiver. “For really I think that the poorest he that is in England hath a life to live, as the greatest he. After this terrible year, surely we can remember this, and act accordingly?
  2. History shows that, when times are hard, false prophets can persuade those who are suffering to blame the “other” rather than the ones who are the true source of their misery. And cause them to use their precious vote in ways that challenge more liberal values. But if we merely condemn such choices, we have no hope of turning the ugly tide lapping our shores. After the results of Brexit and the US presidency, I have come to realise that we need to judge less and listen much more so that we can understand why people are so angry with the established order.
  3. This year we lost far too many extraordinary people, including the wonderful Jo Cox MP. She wasn’t afraid to work with those on the opposite side of the political divide nor to challenge orthodox views. I have concluded that members of political parties who spend all their time arguing or blaming one another rather than seeking common cause, as Jo did, are a major part of why so many are mistrustful of politicians.
  4. This month, the government announced that, as a society, we are not doing enough to prevent suicide. And that there will be league tables published soon to show which areas are lagging most. As one who devotes time to volunteer in suicide prevention, I find this extraordinary. We can do a great deal to reduce the incidence of suicide by tackling stigma, offering education and training and supporting voluntary services such as the Samaritans. But ignoring the main reasons for the rise in the rate of suicide is dishonest. Benefit sanctions, fitness to work assessments and cuts in social care support are causing hunger, homelessness, and shame from being a burden amongst the most vulnerable of our fellow citizens. And for a growing number, the only options at night are a tent, a homeless shelter or a shop doorway. No wonder that life feels increasingly unbearable to some.
  5. And while the government congratulates itself on low rates of unemployment, zero hours contracts and minimum wages are directly causing the rise in reliance on food banks, payday loans and other expensive credit. It is not refugees or so-called benefit scroungers we need to fear. It is people who “create value” (what a meaningless and loathsome phrase) from the misery of others. The Mike Ashleys and Philip Greens of this world. And the Rupert Murdochs and Paul Dacres who would have us believe that fear of the other, rather than compassion for our fellow citizens, is what should drive us. But I realise that grumbling to those who already agree with me is not enough. I’m going to do better in 2017.
  6. I have been learning how to apply the Myers Briggs Type Indicator (MBTI) to use in my practice as a coach. I could bore for Europe on this subject, but suffice to say, it has been a revelation. And the greatest insight of all has been finally appreciating at a very personal level what Carl Rogers meant in 1961 when he said: “What I am is good enough, if I would only be it openly.”
  7. I have also been learning how to be a Samaritan. I will be writing more about this next year. All I need say for now is that I gain as least as much as I give, and that the training and support for volunteers is absolutely wonderful. And with all that I mention above, and at this time of year, Samaritans are needed more than ever.
  8. This year, we lost so many wonderful people, including Twitter friends @GrangerKate and @GraceAndGloryDan. I would like to thank Zoe, courageous mother of Adam Bojelian. Adam sadly died last year. And Zoe reminded me that people who are bereaved value nothing more than being given the kindness of time to talk about the person they have lost.
  9. Finally, I have learned that people like pictures of cats. So here is William, my personal pet therapist, to wish you peace at Christmas. And may those who are lost, lonely or grieving find kindness among strangers as well as friends.

Dear Govia. Dear Government

Dear Govia

Another week of cancellations, delays, overcrowding and stress-inducing journeys for passengers who travel on Thameslink, Gatwick Express and Southern trains. Please don’t insult us by calling us customers. We can’t make a choice – you run all of our trains. And you treat us with as much contempt as you treat your staff.

Last week, when some commuters were stranded overnight in London after all trains to Brighton were cancelled for 3 1/2 hours, we learned it will get even worse. Your train drivers have voted Yes in the ASLEF ballot to join the RMT industrial action, stopping all overtime and holding strikes on additional days to the RMT. We face further disruption, plus 3 strike days a week throughout December on top of the usual railway closedown for the holiday period. And more in the New Year.

We have had problems with reliability for at least two years. They got much worse in December 2015 when a new timetable was introduced. And yet you refused to admit the dispute until April 2016. Why not?

You communicate as though only Southern trains are involved. This is more deceit. We know to our cost that all your trains are affected.

The excuses you give are pathetic. “Short-term unavailability of train crew” is the default. Is a year short-term? How about employing more staff? People want permanent jobs, after all. You knew 2 years ago that you were heading for a driver shortage. Was it greed or just incompetence that you let it happen?

Other excuses include broken down trains at stations unrelated to the journey in question, line-side fires  – sounds reasonable until we remember we are no longer in the era of The Railway Children, signal failures – in other words, blame Network Rail – and an epidemic of passengers being taken ill on a preceding train. The best one so far is “congestion on the line” –  are we to believe that runaway trains have trespassed onto tracks that only YOU are franchised to use?

And instead of accepting responsibility, when you aren’t blaming Network Rail, you blame your staff. You “apologise” by saying that the unions are causing the problems. As anyone who has ever managed anyone could tell you, Rule Number 1 is that you support your people in public. You do not badmouth them. Especially when times are tough or you are in sensitive negotiations. For this alone, you should be drummed out of office. You are a disgrace.

I am a season ticket holder at Brighton and Hove Albion, where customers are treated with respect. We pay for home game travel via our tickets, with the football club passing a substantial sum each year to Govia. The train service to and from Falmer station on matchdays has always been unreliable and overcrowded, but over the past year it has become unuseable. After our last evening game, with no notice whatsoever, you cancelled all trains. Thousands of people, including young children and the elderly, were stranded late at night. Many had to walk miles home along the dual carriageway. Those from further afield, including away supporters, were forced to spend the night in a car park. Despite the club chasing you for several days, you gave no apology. Eventually, you blamed your own staff. Again.

We have to ask why you have completely lost the goodwill of your people when other railway companies have not. We appreciate that the margins for error on our crowded railway are tight. We know it is not difficult for staff to cause delays and worse by small acts of sabotage. But the decision to strike and to stop overtime affects them personally. So they must be desperate. You control the trains and you employ the people. The answer lay with you. But you blew it. After the latest announcement and your woeful response, there is no way back.

Hand the franchise back now. It is the only honourable course of action left.

Dear Govia, please resign. Thank you.

Dear Government

Our national economy is being affected through lost productivity. Commuters are losing their jobs. The negative morale of millions of passengers and staff affect safety on the railway and the mental health and wealth of all of us.

Please do not hide behind franchise rules. They are in your gift to change.

And there is a feasible alternative. Transport for London have longstanding expertise in running a complex transport network. The Mayor for London has offered to take over the franchise and sort things out.

If, as we suspect, part of the solution requires major investment in rail infrastructure in the South East, know this. The people who are forced to use these trains pay higher rail fares than anywhere in Western Europe, up to six times in some cases. There is no law that says that rail companies are entitled to create huge surpluses. Govia are taking you and us for a ride as they oversee a burgeoning catastrophe while they continue to trouser profits.

It is time to stop making speeches about how bad things are. We know. Instead, take action. Yes, it may be complicated and will require cross-party co-operation. But that is why we elect you, to do difficult things on behalf of all of us.

Thank you.

Baby boomer meets digital natives

The organisers @DanielOyayoyi and @RebsCullen and me

On Friday I spent a morning in Leeds with 100 trainees from the 2015 and 2016 intakes of the NHS Graduate Scheme. They had arranged a conference about digital media #NHSGetSocial. Thank you  @DanielOyayoyi and @RebsCullen for inviting me to talk about raising awareness via social media. That I, an ageing Baby Boomer, should address a group of Digital Natives on this subject felt hilarious. As so often these days, I gained much more than I gave.

En route to the event I did a bit of crowd sourcing via Twitter to help illustrate my session. This was the first response:

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The audience seemed to agree. They could think of examples of leaders who seemed uncomfortable with social media using it poorly, mainly to broadcast rather than interact.

There were also differences between how those with extrovert and those with introvert personality preferences interact with social media. Some had very sensible anxieties about tweeting first and regretting later. And others were honest about how hard they found it to decide what, if anything, to say via social media.

So I shared my social media tips:

  1. Do it yourself.
  2. Don’t rise to the bait or tweet when angry or under the influence of dis-inhibitors.
  3. Share opinions but remember they are only your opinions. Others may disagree.
  4. Where possible, stick to facts and values.
  5. Don’t believe everything you read.
  6. There ARE trolls out there. But not as many as you might be led to believe.
  7. Be kind, always – to yourself and to others.

And I shared some of the responses I had received that morning, including these from @nedwards1, @forwardnotback and @anniecoops

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The audience also seemed to agree with the Twitter response to my second question. We talked about the Daily Mail and other media that love to name, blame and shame politicians and those who work in public services but seem much less keen to call out wealthy tax avoiders or those who “create value” by paying minimum wages and offer zero hours contracts. And how even when they get things wrong they rarely apologise.

We talked about agent provocateurs and others who make things up and then either delete them or simply deny they have said it, even when there is photographic evidence to the contrary. The conspiracy theorists who lap this stuff up. And the anonymous characters who lurk on comments pages and bang on about no smoke without fire.

And we talked of the damage this all does to those who dedicate their lives to working in public life, but also how clinicians and managers can work together to call this dishonesty out, live by their values and counteract the post-fact world poison.

My other three questions were about patients and a paperless NHS.

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Again, although hardly a representative sample, my Twitter replies accorded with the audience. They said that attitudes mattered as much if not more than IT. I told them the story of a medical colleague who would write to me every six months or so during my 13 years as an NHS CE listing everything that he felt was wrong with how I was leading the trust, including the inadequacy of his secretarial support, in a 3 -4 page letter typed, somewhat ironically, by his secretary. I would always reply, by email. By contrast, my own psychiatrist, a world renowned professor at another trust, personally typed his update letter to my GP during our consultation and gave it to me to pass on. He would have used email but it wasn’t yet sufficiently secure.

We also discussed the pros and cons of clinical staff spending increasing amounts of time away from patients collecting and recording data that someone somewhere thought might be useful. And that the gold standard of a fully connected wireless NHS when patients and staff  freely shared information via iPad or other tablet device would happen one day. But that given the current state of connectivity, they probably shouldn’t cancel the contract for supplying paper and pens anytime soon.

Finally, I shoehorned in a reference to my muse Mary Seacole. I said that she, a 19th century health care entrepreneur, would have loved social media. And I gave Daniel and @HPottinger, in the picture below, my last two Mary Seacole enamel badges.


At the end I said that I would be writing a blog about the day. And I really hope some of them read it. Because those 100 young people made me think. Despite the financial challenges, morale problems, almost infinite demands plus the debilitating impact of our post-fact world, I think the NHS may be OK.

nhs-grads

And you know why I think that? Because these young leaders, and thousands of other clinicians and managers like them, will make it so. With shining integrity, stunning academic AND emotional intellect, insatiable appetite for understanding, capacity for working smart as well as hard, courage to speak truth to power, and wisdom far beyond their years, they will do it. They will help our creaking NHS adapt for the new era. Whilst holding hard to our core values of high quality, safe care for all, regardless of ability to pay.

And as one who is likely to need a lot more from the NHS in the future, that makes me very happy.