Author: LisaSaysThis

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

What would Mary Seacole do today?

Mary Seacole Trustees Karen Bonner and Jermaine Sterling

On International Nurses Day, I have been thinking about what nursing means in our troubled world. And how nurses through the ages and across the planet have devoted their lives to helping others.

It was lovely for the Mary Seacole Trust to be invited by one of our trustees Karen Bonner to hold a stall at St Thomas’ Hospital as part of the Guys and St Thomas’ NHS Foundation Trust’s International Nurses Day celebration. Our display was right by Mary’s beautiful statue. We sold books and badges and signed people up to our mailing list. But most of all we talked with nurses and members of the public about the legacy Mary Seacole has left us. Despite all the challenges she faced, she refused to give up on her mission to help the sick and dying, including soldiers in the Crimea fighting a world war. She knew that nursing, in the 1850s not yet a recognised, respected profession, is so much more than delivering medicine or other treatments. It is about being with people in life and also in death. It is about combining compassion with practicality. And it is about speaking up when something is wrong and fighting for the rights of those at the bottom of the pile.

Mary continues to be a role model for millions of us. As a middle-aged woman of colour, she knew discrimination and hardship. Mary’s mother was a free-woman in around 1805 when Mary was born, having previously been a slave. Mary experienced racism when she came to the UK, as well as many other challenges and setbacks. But through her courage, tenacity and entrepreneurship, she gained recognition and gratitude not just from those she nursed, but also the British government and media, and even Queen Victoria herself. And yet Mary died in penury. It is only recently that her legacy has begun to be recognised.

Some of the skills and knowledge I acquired as a nurse from 1973 – 2000 remain with me, although I would need considerable retraining if I wanted a job in nursing today. The same would apply to Mary. But the core qualities and values needed to be a nurse have not changed. The ability to listen without judging. To see the person not just their disability or disease. To stand up for those who cannot stand up for themselves. Never to give up on anyone. And to seek out and build on the shared humanity that brings us together rather than the differences that can drive us apart.

Were she alive today, on International Nurses Day 2017, I wonder what Mary Seacole would do? And as I look at her statue as she strides calmly but resolutely towards the Houses of Parliament, I can almost hear her telling me and others who have chosen to become nurses never to give up on our fellow humans. Because we are all part of one human race.

All in the Mind?

I love BBC Radio 4’s All in the Mind. It takes a compassionate, measured view of what’s new in psychiatry and neuroscience. Presenter Claudia Hammond considers research into the normal functioning of the mind and brain as well as mental disorders and brain diseases. Claudia has been quietly beavering away on All in the Mind since 2006, debunking myths about mental health and mental illnesses. She does other cool stuff on mental health too.

In 2015, I was interviewed for All in the Mind about The Recovery Letters, written by people like me who have experienced depression to help others facing something similar. This is my letter. James Withey, the inspiration behind the Recovery Letters, has been working on a book which will include the original letters plus some new ones. It comes out later this year.

Anyway, Claudia ran a positive piece about the letters. So when I was contacted a few weeks ago by All in the Mind producer Lorna Stewart about making another contribution to the programme, it was easy to say yes. This time, it was to ask for my thoughts on a series of questions from listeners about getting the best from mental health services.

I went to the studio and had what felt like a good conversation. My understanding is that there will be short inserts most weeks amongst the main items that make up the programme. It is called An Insider’s Guide to Mental Health Services. Here is a link to the first programme.

Are here are some things I thought about before I was interviewed.

We are all as different on the inside as on the outside. Advice that works for one person will not work for another. To be honest, the concept of even giving advice on such a sensitive subject troubles me.
On the other hand, there are things it can be useful to think about which people who are distressed or in crisis may either not know or they may forget. Plus, mental illness messes with your head. It can make you think bad things about yourself and consider doing bad things to yourself which you might later regret. It certainly did that to me when I had my last episode of depression. A kind word from someone who has been there might just be a lifesaver.
Just as with physical illness, mental illness isn’t one thing. For example, a chest infection can be painful, even dangerous, but will almost certainly get better with treatment. Whereas lung cancer is likely to be more serious, and some types cannot be cured, just palliated. While no mental illness is nice, they can vary hugely in severity and impact. In our modern world we have become preoccupied with diagnoses, so I won’t start listing all the possibilities here. Suffice to say, some people will experience mental illnesses which cannot be cured. Therefore they have no choice but to find ways to live the best life possible with that particular condition and all it entails. Others may experience episodes of mental illness from which it is possible to make a full recovery. This is a great blog on the subject by Bipolar Blogger.
Staying in bed all day and avoiding other people may be all you can face when you are experiencing an episode of mental illness. But in almost all cases, it is not a good idea. Humans are social and even the shyest and most traumatised among us need human contact. This is why we are encouraged to talk to someone – a GP, a trusted friend or family member, or to call a helpline. Here is a recent blog by me called What to do on a bad day.
All sorts of things can go by the wayside when we are experiencing mental illness: getting enough sleep; drinking sufficient fluid; eating healthily or even at all; taking exercise; going out in the daylight; spending time in nature and/or with animals; being with those who love and care about us; personal hygiene; wearing comfortable, weather appropriate clothes; not self-medicating with alcohol, nicotine or other substances; and spending time doing meaningful things. It is important not to force yourself, but trying to reintroduce a few of these gradually will almost certainly help, even if you don’t feel like it. Just do it gently. Take baby steps. And be kind to yourself. Progress towards recovery is likely to be slow and not linear.
I am sure there will be quite a lot in the programmes about medication. It is a hotly debated topic. I will just say this: the best clinicians will work with you to find the right treatment for you. It might or might not include medication. What is right for someone else may not be right for you. Also, most medications take time to start working. And sometimes the side-effects can be really tough.
It is true that anyone can experience mental illness. But people who face other major challenges find it even harder to cope with and experience more lasting damage than those who do not. These include financial hardship, homelessness or insecure housing, loss of job or role, social isolation, bereavement, loneliness, abuse past or present, bullying and relationship problems can both cause and exacerbate a mental health problem. We are all born with a level of mental resilience which is then either added to or depleted depending on our childhood experiences. How we respond to later trauma is linked to these early experiences. Most therapy is about learning to understand ourselves better and to care for ourselves in a positive, kind way.
Specialist mental health services are experiencing unprecedented demand. They are all making attempts to modernise and improve access to services and the appropriateness of treatment. But severe cuts have been made over the past 5 years which have reduced availability and in some cases removed very good services altogether. The government says they are reversing this. Some of us are keeping a very close eye to see whether they honour their word. But this doesn’t mean you will get poor care if you are referred to mental health services. You may have to wait a while. But you will find that most staff go out of their way to provide effective, compassionate, safe care.
Your key mental health professional is your GP. Many GPs are really good at mental health. It is a significant part of their work. But they are also under huge work pressure. If yours seems to be one of the minority who are not so good, or you can’t get an appointment, you can arrange to see another doctor at the same practice or even change practices. It is a good idea to do this at a time that you are not in crisis.
People who need help with mental health problems are not weak. In fact they have to be very brave to ask for help, and to do the things that are needed to recover. Doctors, nurses and therapists can help, but most of the recovery work is down to you. People who live with serious mental illnesses are heroes. They should be applauded every day for their tenacity, patience and courage.

The most important lesson I have learned, and it has taken me far too long to learn it, is that I need to listen to myself and be honest with myself about how I am feeling. At the time, it seemed that my last major episode of depression came out of the blue. With hindsight, it had been brewing for many months. How ironic that I, who was running mental health services, should have been so bad at spotting my own warning signs.

Intervening early and getting help when you need it should be standard across the UK. I make no apology for encouraging listeners to All in the Mind to ask for help if you need it, and not give up if it seems you aren’t getting it.

And if you are feeling desperate or suicidal, please talk to someone. There are various helplines listed here. The one I personally recommend is Samaritans on 116 123 or email Jo@samaritans.org. They will listen and help you make your own decisions. It may not sound like much, but it can be the greatest gift of all.

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.

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

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.

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

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?
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.
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.
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.
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.
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.”
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.
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.
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:

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:

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

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.

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.

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.

Take good care of yourself

Leaving flowers 2014

Another longer blog based on a talk, this time for Point of Care Foundation Community Conference on 27.10.2016

These days I usually introduce myself as a writer, coach and mental health campaigner. Sometimes I say I’m a charity trustee. I might talk about Grassroots Suicide Prevention and how we help to save lives by training people in mental health awareness and suicide prevention techniques. Or the Mary Seacole Trust and that now we have achieved a beautiful statue to the first named black woman in the UK, we intend to smash the glass ceiling that still holds back the careers in business and in public life of women and, even more so, BME people. Occasionally I mention my voluntary work with Time to Change, or that I am training as a Samaritan. And I might say that I love writing fiction, cryptic crosswords, cycling, making jam, Brighton and Hove Albion FC, the Archers, and my family and friends.

Only if relevant do I refer to my 41 year NHS career as a nurse and health visitor, then manager. I prefer not to be defined by what I used to do. I don’t want to live my life in retrospect. I may be over 60, but I feel I have so much more to do and give.

However, for the purposes of today, I need to explain that I was chief executive of a mental health trust in Sussex for 13 years, from 2001 – 2014. And now I am a recovering chief executive. I have Professor Sir Simon Wessely, President of the Royal College of Psychiatrists to thank for that description. And he is right; it describes me well. I have been writing a book about my experiences. I thought I had finished it. But then a few things happened and now I’m less sure. Nonetheless, I have insights I want to share with you.

The main one is this: please don’t do what I did as far as looking after yourself is concerned. I didn’t always make a good job of it. And it wasn’t only me who suffered.

It started with that over-developed sense of responsibility that many of us who choose a career in healthcare seem to have. We are often the first child in the family. If not, we are the one who looks after our siblings, even our parents. In my case, I was also the only girl. Being caring and helpful was expected, and the best way to evoke praise.

People with certain personality preferences have a tendency to choose a career in a caring profession. Another tendency of those with these profiles, and I am one, is to find it hard to say no. We also tend to take criticism personally, we can be overwhelmed by setbacks, and we can experience guilt more readily than those with other profiles. We are also find it very hard to tell others when we are not OK. None of this is set in stone, of course. They are only tendencies; one can learn to modify one’s responses.

The classic personality profiles for people in senior leadership roles are different. They tend to be confident go-getters, driven by vision, analysis and logic rather than feelings of responsibility. They like making decisions, challenging others and being challenged themselves. And so the tendency of leaders who do not fit such a profile is to try to act as though they do. And to pretend not to mind things that they actually mind very much.

I struggled a bit as a student nurse. But once qualified, I got huge satisfaction from clinical practice. I loved helping people, especially those down on their luck. I always will.

I eventually moved into management via a series of lucky accidents.I had no long-term plan to become a chief executive, even a director. It just happened. I fell in love with the trust I eventually ran because of a chance meeting with some adults with learning disabilities who I had known as children many years previously. Their care wasn’t terrible. But it could have been so much better. And then a senior colleague told me that mental health services were a backwater and that if I took such a job, I would never escape to do anything else. And that was it really; I was hooked.

For the most part, it was wonderful for me to be able to influence the care received by people who were usually at the bottom of the pile, to challenge stigma and discrimination locally and also nationally, to be busy and in demand, and to have the opportunity to work with a bright, engaged team I had the good fortune to build from scratch. Whilst we were all different, we each cared deeply about providing care that we would be happy to receive ourselves or for a member of our own family to receive. And when the care we provided failed, we minded very much and did whatever we could to put it right.

But I also got some things wrong. I can ignore details if they don’t tell me what I want to see or hear. And I wanted every project to go well. So I sometimes reacted badly when not all of them did. I was often overwhelmed by self doubt and imposter syndrome. I had sleepless nights, especially after incidents when things went wrong for patients. I felt very lonely at such times, but I didn’t feel I could tell anyone – I thought I had to tough it out. And this was counterproductive because trying so hard to appear competent made me less approachable to others who were also struggling.

I also wanted my team to be one happy, harmonious family. Without breaking any confidences, I would overreact to disagreements and try to play the peacemaker when what we needed was more discussion and debate. It took me a long time to realise that I had assumed the role of parent or older sister, when a more adult to adult relationship would have served us better. I am grateful to those who persuaded me eventually to see this – we got there in the end.

Although suicide amongst those using mental health services accounts for only a quarter of such deaths, it is, very sadly, not an infrequent occurrence. It took me a long time to admit to myself that the reason I found it so distressing was because I knew something of how desperate those who took that step must have been feeling. And even longer to admit it to others. Although I worked hard not to show it, I found it almost unbearable to be criticised by regulators or via the media for failing to stop someone from taking their own life. I felt guilty both that we had failed, and that I wasn’t always successful in defending the efforts of the staff, who had often kept the person concerned safe for many years and were themselves also devastated. I also know that the effort of hiding my own distress sometimes made me less sensitive to theirs.

Risk assessment, of which much is made these days, is an imprecise science. Some believe it has no scientific validity in preventing suicide or homicide by someone who is mentally ill. And yet people lose their jobs, even their careers, over not applying it correctly. They are judged by those privileged to look at the full facts of a case at leisure, with the benefit of hindsight. Rather than under pressure in real time in a busy hospital or clinic or on a difficult home visit. And without enough of the right resources. Families can be led to believe, sometimes erroneously, that a chance event that has changed their lives forever might somehow have been predicted or prevented, and that someone must therefore have been at fault. Unless NHS staff have erred deliberately or been recklessly careless, it is seldom the right thing to do to blame them, whether they are a junior nurse or a very senior manager. It is cruel and reductive and unlikely to bring about positive change. In fact it is likely to make people fearful and to drive poor practice underground.

I am extremely grateful to those who helped me to understand a more nuanced way of thinking about suicide, especially to Dr Alys Cole-King of Connecting with People, my friends at Grassroots Suicide Prevention, and Samaritans. I also thank John Ballatt and Penny Campling, whose book Intelligent Kindness enabled me to understand what was wrong with the traditional NHS approach to serious incidents, as well as a few other things. And to the Point of Care Foundation, whose outstanding work helps professionals to nurture their compassion and non-judgemental curiosity, despite the challenges of today’s NHS.

Some people reading this know that I saw my first psychiatrist aged 15, and have been troubled off and on with anxiety and depression throughout my life. I am still trying to make sense of why i felt so ashamed of this for so long, and how I managed to get through 12 of my 13 years as a chief executive of a mental health trust without blowing my cover. All I can say is that I am well-practised at pretending to be OK when I am not.

I eventually began to talk about it the year before I retired as my personal contribution to reducing stigma. It was even more painful than I had expected. I felt exposed and brittle. I couldn’t sleep or think straight. I was forgetful, jumpy and irritable and my judgement went downhill. I wondered if I was going mad, and in a way I was. I had such terrible stomach pains that I thought I might die. It would honestly have been a relief. And then I started to cry, and couldn’t stop. Driving home, I nearly crashed the car on purpose into the central reservation. It was only the thought of the fuss it would cause for others that stopped me. For the next 8 weeks I huddled in the dark. Slowly the kindness of my GP and psychiatrist and that of my family, closest friend and work colleagues made me realise that perhaps I wasn’t the worthless pile of ordure I had thought I was.

Although I will let you into a secret; it wasn’t until I had been back at work a few months and had undergone a course of therapy that I finally accepted that I hadn’t been faking my latest bout of depression. And that I wasn’t the selfish, lazy, waste-of-space I was called by a nurse when I made an attempt on my own life many years earlier. His words stayed with me because I agreed with him.

If speaking up was hard, going back to work in January 2014 was harder. But it was also part of my recovery. It felt liberating to be able to be open about why I had been off. I found conversations with clinicians, managers and most of all patients were deeper and more meaningful. I was a better listener, and I wasn’t rushing to solve everything, as had been my wont. I found that I could listen properly to criticism, and appreciate what the other person was trying to say without feeling the need to defend the trust or myself. My final eight months before retiring in the summer as planned were the happiest of my whole 13 years.

If you have the sort of tendencies I have, here are five tips from me to help you take care of yourself.

When something goes wrong and you or those for whom you are responsible make a mistake, try not to be disheartened. Allow yourself time to process what happened and why. Apologise wholeheartedly. But do not be rushed into snap decisions. Treat yourself and your team as a work in progress.
When someone offers you criticism, try hard not to be devastated by it. But also try not to reject it out-of-hand. Take it for what it is, just an opinion that may or may not be useful.
Don’t pretend to be someone or something that you are not. It is exhausting.
Exercise is important, and so is eating well. But sleep is healing. We all need it or we can’t function. If you are having trouble sleeping, then you deserve some help. This advice from Mind is a good starting point.
Remember that being kind to yourself is not selfish. It is actually extremely unselfish. Because it is only through being kind to yourself that you can truly be kind to others.

It was Carl Jung who initially wrote about the wounded healer. There is nothing wrong with being motivated to help others partly because one has issues oneself; such experiences can help the care giver to be more empathetic. But if we truly care about others, as I have learned at great cost, it is very important that we do not pretend to be OK when we are not.

Because, as Karl Rogers, a successor of Jung said: what I am is good enough if I would only be it openly.

Lisa Says This

Using what I've learned to help others