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SoWhoCaresAnyway E6 An Inconvenient Truth · SoWhoCaresAnyway

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Hello, and welcome to So Who Cares Anyway? The podcast that shares learning, innovation, and ideas from the world of health and social care and beyond.
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My name is Ruth Germain, and I'm inviting you to join me each week with my inspirational guests to hear about who cares, what they do, Their passions, their knowledge and ideas, and importantly, the difference they are making to improve the health and well being of people in our communities.
I consider each of my guests to be incredible individuals working with people in new ways or with key messages to share.
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People from healthcare, social care, the voluntary sector, community groups and more.
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To join me each week to find out, so who cares.
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Anyway, to find out more about me, who I am and what I do, please head over to my website, www.reflectiveruthconsultancy.com,
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where you can also catch up with previous episodes and read my blogs.
hello, and welcome to the next episode of So Who Cares Anyway.
Today, I'm delighted to be joined by my guest, Dr.
Rebecca Myers.
I invite you, Rebecca, to join me after recently reading an article that she co authored with Alison Neary, and it was titled, So Why Are Healthcare Professionals Leaving NHS Roles? I'd seen some posts that Alison and Rebecca had both put up on LinkedIn and I decided to read the article right through.
And although I didn't actually leave the NHS, years as a nurse, so I didn't leave until last year.
Much of the article really resonated with me and my personal experiences, maybe when I changed from one role to another, and also things that I'd seen for other people, and I just thought, you know, this would make a great podcast episode.
So I decided to invite Rebecca to join me.
To introduce Rebecca a little bit further, she's got quite a wealth of experience actually.
So Rebecca is a registered nurse, primarily with a background in community nursing, and she's also a board of the Queen's Nurse I'm a board trustee at the Queen's Nursing Institute.
To introduce Rebecca a little further, Rebecca is a registered nurse and she has,, the majority of her background in community nursing and is linked quite closely with the Queen's Nursing Institute where Rebecca is a board trustee.
She is also a visiting associate professor at London South Bank University and an organisational development practitioner.
So I've given a little bit there, Rebecca, about your background, so what I'm going to do now is pass over to you so you can give a bit more context.
Thank you, Ruth.
And thank you very much for asking me to join you in conversation.,
I think, as you said, I've got a long career working in and around the health service, in different roles.
And I those different roles have probably been shaped by, my experience at the time and thinking about what was going on and how could I help to improve the experience both for patients and for staff.
So I think that's been a sort of driving force all the way through my career and hence the different hats, that I have worn and now wear.
So, that's been probably what's been driving it.
So, I've heard there was the bit about improving things for staff.
So I just wonder if you could tell us a little bit more about that.
What it is perhaps that you've done, but also why that's been your drive.
What is it that you've seen and why do you think it's important? I suppose is what I'm asking about.
So I think,, as I've said, I've been in the health service for a long time.
I've held many different roles, clinically, managerially, have a lot of friends and obviously colleagues that work in the health service.
But I've also,, use the health service, either personally or as a carer.
And I think the thing for me that's always stood out is the importance of that relationship, the therapeutic relationship.,
and in order for people to feel cared for, the people that are providing that care really do need to be cared about.
And if we don't provide that sort of support for people to help them to do the work, which is intensely, emotionally challenging, it can be, inherently risky.
Then I think, people find perhaps less constructive and healthy ways to manage some of the difficulties that they confront working in this field.
So for me, it's about the more that we can support people, the more that we can help them to process what it is that they are dealing with, the more they're going to be emotionally available for their patients and their colleagues.
So it creates a better environment for everybody.
Thank you.
So what I'm quite interested in there is, I think that there's been quite a lot around this recently, we had,, the people promise and then we've had the workforce plan over the last few years from the NHS.
So there is this sort of recognition now more and more that actually we need to look after the people we care for.
But, just as importantly and probably more importantly, we need to look after the people that are providing that care.
But when I looked at your article, some of the things that were coming through in that were things that I'd been hearing since the start of the NHS really, or the start of my career in the NHS, I apologise there, obviously I haven't been there since the start, but I've certainly seen those things and I've heard those things and I can probably say that I've said very similar things to those,, things that people wouldn't think about moving up a ban, getting a promotion, and then because you lose your, out of hours or your additional payments that perhaps you had for work in those extended hours, suddenly you find yourself earning less money, but with more responsibility and more work.
Or, various things like that, as well as things that we might expect around sort of culture and what that looks like.
But I wonder if you have any thoughts about what it is that needs to happen, or what else we need to do to understand what's happening to make that difference.
Yeah, I think, you say, you've recognized this from many years of working in the health service.
And I suppose, if I'm honest, that's part of my frustration.
This is not new.
What we wrote about in that article is not new.
The impact of working in health services has been well researched for many, many years.
And I suppose when I was doing my doctoral thesis, looking at some of the emotional labor in health care, I wrote about the sort of parallels with climate change,, and it's Our goal talks about an inconvenient truth, and I think the experience of working in healthcare and the impact it has on staff is an inconvenient truth that we don't necessarily want to confront that it takes its toll.
That actually it's an occupational hazard that if you're exposed repeatedly to challenging emotionally difficult situations, unless you find ways to be supported to process that you're going to absorb it and it's going to have an impact.
But I think that, in an environment where there is huge pressure, understandably, to provide more care for people as people are getting sicker, people are getting older, and the health service is trying to respond to that, creating the time and space for staff, to have time out to process.
these things is challenging when what you're trying to do is get them to see more and more people.
And so there's a huge pressure on productivity, which is understandable.
But the reality is that people aren't going to be more productive if they're burnt out and they're overwhelmed.
So it's a false economy not to invest in staff.
We know that we have retention challenges.
And what we see is that people are leaving.
and taking a huge amount of experience and skill with them.
So that's leaving more junior staff to provide care, which is becoming more complex.
And so therefore, you're exposing people to greater risk, both the patients and the staff.
And I think that unless you Really understand the nature of the work.
You can't fully appreciate that.
I've worked managerial, and I've worked clinically.
And I think managerial colleagues, they can intellectually understand.
When people are saying, what it takes to provide, services.
But they don't have the visceral experience that clinical staff do.
When you're sitting in a situation where exposedly you're confronting somebody who is unwell, there are huge risks involved in terms of treatment or not treatment.
It's not that it's treating is, risk free or not treating is risk free.
There's risks in all of those sorts of things.
And you as the health professional with that knowledge are often holding and trying to manage that risk.
And if you don't feel able either because you don't have the competence or the resources to provide that service and provide that care, it increases that level of anxiety and increases the distress that you're holding.
And I think that unless you understand that when you're organizing and managing services, you don't build in different aspects of providing support.
That is critical to maintain and support people.
What do you think that support might look like? You've talked about that time and you've talked about trying to constantly keep up with the demands effectively.
So I think you use the word productivity.
So whether it's nursing or allied health professional roles, our medical colleagues, we know that actually The expectation is to keep managing what's coming in, which really resonates with myself because I know that's exactly what happened to me and probably yourself in the past.
What would that time look like? Let's put the ideal world into place.
Have you thought about that, what that could or might be? Yeah,, I think there are things that need to happen at different levels.
you were talking before about having Adam Lenton and some of the work that he's done about the role of community in looking after oneself and providing care and support to each other so that actually the default position isn't always the health service to provide care, that there are other things that can be put in place to support people, in terms of looking at the demand, that if we're meeting people's needs.
and actually the demand will go down.
So there's something about societal's response to wellness and illness and, how it,, organizes in the communities and other factors.
But I think within the health service, that actually building in proper time for reflective practice, building in, downtime.
So people often talk about running occupancy rates, of 90 90 95 You know the actual people's capacity to respond To demand at that level is incredibly difficult to maintain working at that pace so actually then You're more likely to get errors.
You're more likely to get, as I say, people becoming frustrated, conflict increases.
So actually when you're looking at demand and capacity, when we map out demand and capacity, we need to think about what is the emotional labor demand and how do we build in capacity to deal with that? Not just the sort of physical demand of seeing people.
and I think, it's difficult because, partly as health professionals, I think, we haven't really talked about that.
So even though the research has been, present for a long time, we might talk about it in private, but we don't talk about it in the public space.
And I think what COVID did, which was quite interesting, was it really extended exposed the, level of emotional demand placed on health professionals to provide care.
And so people saw for the first time the poll that it took, but that was a acute episode of a chronic condition.
And so people were responding, so it was interesting, the response to that was to put in a lot of well being activity into the health service, create these sort of hubs for staff to go and have downtime, recognize psychological support being put in for staff.
And then, as people say, well, we've recovered from the pandemic, which obviously we are still recovering from.
But,, it's not in its acute phase.
You're seeing the funding for those sorts of things being withdrawn because it's felt that it's not needed.
One of the things that I'm very heavily involved in is Schwartz rounds, which are a forum for health professionals, and that's not just clinical health professionals, but people working in corporate roles as well, where they actually have time to talk about what it feels like, what's the emotional impact of working in this space, and processing that to realize that these feelings are normal.
Often what we do is we pathologize these, feelings where people are feeling, distressed about what they're seeing or feeling guilty and seeing people as they're not able to cope.
And so they get sent, to have some support rather than it being a proactive, intervention.
I draw the parallels,, often when I'm trying to explain this to people with, radiology and people being exposed repeatedly to radiation that actually that's monitored so that people aren't overly exposed to it.
And there are mechanisms that are put in stop people having that overexposure.
We don't do the same with, the exposure to emotionally difficult situations.
and yet over time, it builds up.
So I think recognizing that and actually being proactive to give people time out space to process, see that their feelings are normal.
I think it's going to help to support people to.
Be able to deal with it.
We can't take away the emotional impact of the work because that is the work.
It is the emotion.
If you're dealing with people who are confronting mortality, morbidity, life changing situations, then that has an impact.
So we have to help people to deal with that and recognize that as much as we recognize the physical input that we need to do to provide care for people.
You've spoken a bit there, Rebecca, about Things being normal, and actually rather than sending people for support, what I really liked what you were saying about there is actually that support should be there anyway.
I think that's what you're essentially saying, that it's not seen as something that, oh, you're not coping or you're not managing.
And I wonder if you've had much where people have brought up, those sort of types of comments, suddenly see it in your work where people feel like, I don't want to say that because it seems like I can't manage with my work, I can't cope, I can't do these things when I should be able to because that is my job.
Because as you've just said, that is a job.
That's what we need to be able to do.
So yeah, I'd like to ask a bit more about that, please.
Yeah, I've seen lots of experiences I've been coaching now for about 20 years.
And I've coached, all different levels, board level, junior staff, clinical staff, non clinical, corporate staff.
And I think one of the things that's really interesting, I've done a lot of coaching, with doctors, doctors in training, resident doctors, as they're now called.,
and one of the things that I have found,, quite distressing actually at times to sit with them is to hear them talk about the impact of being in situations where they were out of their depth, they didn't feel supported, they were making decisions that they didn't feel necessarily, they were confident of,, and the consequences of some of those decisions that, that sat with them and they were still holding the impact of those 10, 15 years later.
And same with nursing colleagues talking about patients, and experiences that had really affected them.
And I suppose, at the time you're reflecting with them about, what was the response to people around you, there was a sort of suck it up mentality, that this is the job, you need to be able to deal with this.
Now, of course, you do need to learn how to, in the moment, deal with very distressing situations.
But you are human, and what you also need to be able to do is to be able to then, after that situation, have a space where you can talk about it and feel supported.
I think there was an article written in the BMJ by a, doctor who was a paediatric, I don't know if she was a registrar, but she talked about the death of a child, witnessing the death of a child quite early on in her training.
And being disciplined for getting distressed over it.
And I remember that as a student nurse being disciplined for getting tearful about the death of a patient that I'd become attached to.
So if our response to people caring and getting upset about something is to discipline them, what does that do to people? It's not a healthy way to respond.
No, that's a massive impact, isn't it? Because I think most people that come into these, into the care and professions, come in for the very fact that they care.
So, of course, you're going to have that care and response as many people would.
And I can remember myself having an award sister telling me not to get upset.
I wasn't disciplined, but not to get upset.,
I need to be that sort of stiff upper lip.
So maybe there's something about our culture there.
What I'm thinking about as well, as you're talking is I remember reading an article about compassion fatigue.
So I wonder, If that leads into this thing where people, because we're being compassionate all the time, but actually haven't had that chance, to then relax afterwards, does that perhaps, impact on the way people cope, with their compassion and the way that hair is delivered? I don't know what you think.
Yeah, it's really interesting.
There's a book by somebody called Arlie Hochschild.
She's an American sociologist and she wrote a book called The Managed Art.
And it's all about the emotional labor of different roles.
That we are expected to perform.
In a particular way, emotionally to situations.
So nursing is quite interesting in that, always to have a sense of kindness and compassion and to put the patient first.,
which in of itself is difficult to argue with, but actually to not, then also enable nurses to express other feelings and emotions.
Not necessarily in front of the patients, but to have a space where they can talk about, they are finding it difficult, but actually there is tension in this relationship with this patient or the family.
And how do I deal with that? But if they're forced to suppress it, they're never learning about how to recognize their own emotional responses to situations and how to support themselves as well as support the patients.
There's some fascinating work and again, this work is not new, written by, a organizational psychologist from Tavistock, Isabel Mengist Leith, where she talks about the social defenses against anxiety and distress that, happen in healthcare.
And she was writing about, nurses and nurses having to deal with, not just people who are ill, but also dealing with.
Bodily fluids, sorts of things that, most people in public don't deal with on a day to day basis, and how they were having to respond to that.
And that what people were doing was finding ways because they weren't being given a sort of helpful ways to deal with it.
They would find ways to manage those situations either by becoming very distant from their patients.
Avoiding going in to see people, or organizing.
They would have a sort of organizing response from ward managers who would say, well, we won't give you that patient repeatedly over a few days because actually you're becoming too attached to that patient.
So we will give you somebody else to look after.
And all of those sorts of things weren't dealing with the emotional impact, they were just avoiding dealing with it.
So people are never learning how to process and respond in those, with those emotions in a constructive way.
So I think, again, one of the things, it's a bit about, for me, there's something about what gets valued.
In terms of knowledge and, skills and practice that the emotional side of care is, I think, less valued by probably by the system than the intellectual sort of what is described as the academic intellectual technical skills that are required.
So it's almost like, well, anybody can care.
So we don't necessarily value that.
We don't value it in terms of recognition of it.
We don't pay particularly for it.
But what we do value is more of the technical skills.
And it's interesting in terms of the trajectory of nursing, and what's happened again, in terms of when nurses tend to get promoted, they take on more, advanced skills.
They take or see what are seen as advanced skills.
skills that which are technical skills, or they go into managerial positions, the sort of care, the emotional care aspect of nursing, I don't think tends to get valued in Both in terms of recognition of it, but also in terms of reward, financial reward of it.
And I think people often say, Oh, it doesn't cost anything to be kind.
I actually don't agree with that.
I think it actually can cost quite a lot for people to be kind when they are not in an environment where they are supported to do the work.
I think it takes its toll on that compassion fatigue and burnout is one of the things that we are seeing.
So people then become, again, I suppose there's a sort of disciplining process that goes on when people do become completely fatigued or not kind, rather than recognising what has led to this? What are the systemic conditions that people are working in that has led to them becoming almost brutalized by it? That's really interesting and I'm thinking about a conversation that I had the other day with, him that's going to be coming out this, the next podcast, Kim Manley, who you may or may not know, she's done a lot of work around the advanced practice, arena.
And some of the things are about those sort of skills and upskilling.
But recognizing that working at that advancing or that consultancy level actually, isn't always about having those capabilities about what we see as the typical things that we need to have those intellectual skills around, a procedure or a process or a medication or something like that.
But it's actually about having those advanced skills around far more.
Softer skills, I'm going to use the word, it isn't the word that Kim used, but I'm just trying to think of it at the moment, there's so much that we need to do, and so many other ways of working with people and doing things for people, and actually, as people move up, what we find, tend to find when I speak to people, and I know my own sort of background, when people start to work at that advanced level, it is those intellectual skills that are really valued.
So there's the four pillars of advanced practice, which you well know, Rebecca.
Okay.
For the people that are listening, you've got that clinical and everybody jumps straight onto that.
But the minute you start talking about leadership, research and education, and actually what are those and what do they need to be, even the research pillar, if it's recognized, is often quite medicalized in the way that it's understood.
And leadership tends to be those lead roles rather than leadership in its fullest sense of, working with people and bringing people on.
So that other side of leadership.
So I think there is this thing that as people move up into those higher roles, whatever profession they're from, we start to see an expectation of clinical in that expertise part that people really value of moving up.
So things aren't moving up either as they go through.
Yeah.
It's really interesting that, I suppose, I was just thinking as you were talking about it in terms of the, you called it soft skills, but I think it's, for me, it's the psychosocial skills that enable people to relate.
to other people, and to have some form of if you like, empathy and compassion and be able to be stay curious about what is going on here, how, and being reflexive so that actually in this moment, working with this particular patient and this family, I'm picking up all sorts of different cues about what might be going on.
And I'm working with them to understand what's important to you, what might be some of the context.
in terms of what's happening.
And, again, there's huge research around the therapeutic relationship and the effectiveness of those relationships.
And yes, of course, the technical skills are, really important, but if there isn't that.
sense of trusting relationship.
We know that people then are less likely to follow the advice, they're less likely to take up their, take their medications, all of those sorts of things.
And so my husband, it's interesting, he's a GP and he talks about what he used to do, teaching undergraduates, and he would show them the graph and looking at clinical practice and patients who trusted their doctors.
And I was asking them about what do you think leads to that? And what do you think the impact of that is? And, we know for ourselves, if I go to see a health professional and I think that they're really interested in what I've got to say, they're really listening to me.
They're working with me to try and think about what is the right response to whatever it is that I'm, presenting with.
That I'm more likely to be receptive to what it is that they're saying.
Whereas if I'm with somebody who might be just giving me this.
the technical response to what it is that's going on, I'm thinking, well, are you seeing me as a human being in the holistic way? Or are we just seeing the illness or, the condition in which I'm presenting myself? So I think, there is something about, we really do need to value.
Those skills and those ways of relating to our patients, because actually, coming back to effective therapeutic relationships and productivity, it's absolutely cool.
A lot of the failure demand that we see in the health service, is also related to the quality of the relationships that patients have with their professional, their health professionals.
If I don't trust you, I'm going to go and get a second opinion or I'm going to not going to follow the treatment plan.
Yeah, I think that's, paramount and so many things it's that you've mentioned that doing with which was what Adam Lent was talking about.
So you mentioned just there.
Listening, working with me, it's people really and building that trust and creating that trusting relationship, but actually that all stems from the fact of building that trust and that relationship between the team and the people that are working together.
So, supporting each other and making that sure that support is there for our health professionals.
So, what I'm going to do, Rebecca, because I think we've explored this quite a bit and I think we could probably go on for quite a long time.
I'm going to go back a little bit.
To the article that I mentioned that you wrote with Allison Erie, and I know there were a few others as well, so apologies for not putting those names up straight away.
I think there were four of you that authored that.
It was around the,, why professionals are leaving the NHS.
And one of the things that I'm thinking about, and I was reading it, just reminded myself of it this morning,, I think one of the quotes said, I was left, at night to manage two wards as the only member of staff.
So they had 60 people that they need to be looking after.
And what you're talking about here is having that support and having that supporting network.
And of course, one of the things that we talk about a lot is about developing a team.
But reading that, what really struck me was actually if people are leaving it in these numbers and we're putting people in this situation, how do we develop that sense of team? And that, support around them.
And the first answer would be that we can't, but the second bit is we have to do something in order to be able to support those people to stay or to bring more people in.
So we can't just say, we can't, because there's only one person that can after that ward for two nights.
And you've mentioned about how at the beginning, how we responded during COVID.
So I'm just thinking about that part.
I'm wondering what your thoughts are there, and I'm not expecting you to come up with some sort of amazing solution, because that's obviously quite complex in itself.
So I'm just asking what your thoughts are and to hear a bit more.
Yeah, I suppose my initial thought when you were asking that is, who do we define as in the team? because I think that if we think, if we take your example of the person left in charge of two wards, that if the team is defined as the ward team, i.
e.
the nursing team, then that's quite a limited ability to respond to the situation that people find themselves in, in terms of if we've got vacancies within that team, if we've got people who have done 12 hour shifts already so they can't stay, and people have lives outside of the health, their work.
But if we widen that sense of team to not just the nursing team, but, the medical teams that are involved, the therapy teams that are involved and the managerial teams, and we start to say, it's a collective responsibility to make sure that patients, are having the resources available to support them.
Then we get into different types of conversations about what is it that we need to be doing.
I think if we draw parallels with the board.
So, the board should be operating as a unitary board, and what that means is that every member of the board has a responsibility for all aspects of the organization's activity.
So, the, balancing the board, the budget is not just the responsibility of the finance director.
It's as much the responsibility of the director of nursing as it is the finance director or the director of estates or chief people officer or whatever titles people are holding.
And that's the same with quality.
And safety.
So if the quality and safety often gets positioned in the portfolio of the chief nursing officer or the chief medical officer, but they only play one part in ability to provide quality of care.
and so actually there is different types of conversations that need to happen about the trade offs that if we balance the budgets.
What does that do to our ability to maintain quality? And how do we as a board take collective responsibility for that? And that plays for me all the way down the organization.
So when I was a general manager, I was very clear that I needed to understand what the quality of care was, and the ability of the clinical staff to meet those that meet those demands.
And my role was to do everything I could to enable them to provide the best care possible.
It wasn't just down to them.
I played a part in that too.
So I think That's why I think in terms of when you're thinking about team, we can become quite siloed in the way that we think about these things or the way that we respond and think, okay, well, I've got to sort this out as the nurse, or you've got to sort that out because you're the nurse and that's, in the nurse's remit.
Whereas my challenge is, no, healthcare is a team activity and that involves patients and families as well.
And saying, so here are the situations that we've got, here are the risks that we are being presented with.
What do we collectively need to do to mitigate those risks, rather than just leaving it to one, one part of the team.
So I think that would be my response to what you're saying, and I do feel quite strongly about that because I think often, and this is what I wrote about in my thesis, that sense of responsibility is often taken and positioned as purely the responsibility of the clinicians.
And the clinician's ability to respond to those things is limited, and they need other members of the team to do their bit and take responsibility for that.
Thank you.
And that collective bit, that's what I was trying to say earlier on when I was talking about the leadership and the word was just eluding me there, but collective leadership is so important and having that collective team, so that person has If that situation happens and obviously it's happening and we just need to be aware that it's happening, actually what can we put around that rather than just saying it is your responsibility and if something happens in that night shift then that person goes home and then they live with that responsibility as you said you know years on they're holding on to that responsibility to be able to do something and if they're on their own.
How can I go to somebody else and say, well, what, what do I do in this situation? What can I do? And actually what happened the other day was, and this is how I felt, I think there's a real responsibility.
And I like that bit, how you put that, bit about the board, that everybody actually has a responsibility for everything rather than being, well, you're the finance manager, that's your job.
And I'm the nurse on the board tonight.
That's my job.
Actually, everybody needs to say, well, All of it is our responsibility and we need to work together.
So it's quite a difficult thing to achieve.
So I just wondered, you've obviously got a lot of experience over the years.
Have you got an example of somewhere where you've seen this sort of working well, or a good example that you might be able to share with us of this type of working or something going well, please? Yeah, Many examples in different places.
I think one, one that comes to mind was when I was working in one organization, in a board role and, the Care Quality Commission had come in, to do a inspection and they'd raised some concerns, and they were talking about Whether the service was going to be rated as inadequate, and of course, that's very distressing.
It's distressing the thought that patients aren't getting the care that you want them to get.
It's distressing that staff, despite working, under difficult position, in difficult circumstances, are then the feedback and the assessment of them is that they're inadequate.
And at the same time, it's important that we do have a mechanism in which we're able to assess quality and respond to it.
But the response Often, in terms of CQC, I was talking about where these things get located, they often then also get located with the chief nursing officer, to, oversee the quality agenda.
The chief exec, when we got the results, we had an executive meeting and the chief exec was very clear.
This is not just the responsibility of.
The, person, I won't say the name, but, the person concern, this is our responsibility.
So what are we as an executive team now going to do, to support the staff and address the issues that the CQC have, identified and, asked, the chief nursing officer, because it was in their portfolio, what do you need from us? What do you need from your colleagues? So that, we are playing our part in this.
So for me, that's a very clear message that this is not just down to an individual.
I think often we can individualize things.
Your leadership can be perceived as a sort of individual leader, the hero.
Whereas actually it is a collective response.
It needs to be a collective response.
So I think that's a very good example of somebody modeling that.
And I think the same at a clinical level, a situation, many situations I found myself in.
But I remember being in a situation, having to go to a court which was incredibly distressing.
And a situation that I had to manage, which had arisen because other people hadn't done stuff that they.
Needed to do for all sorts of reasons.
I'm not here pointing fingers, but things that hadn't happened.
But it just happened that I was the one that turns up at the point at which all those things, came together and had to deal with it.
And going back to the base and talking to the team leader.
Who was incredibly supportive and then getting a call from colleagues in, another team who hadn't done what they needed to do to apologize that I had been put into that situation.
So, it was a recognition that actually there are many things happening that different people can or can't do at different times, but it's not just you.
It's not down to an individual.
I mean, there are obviously situations where an individual might do something, adverse, but generally it's much more that this is a team response that needs to be thought about.
It'll probably take us into a whole discussion around human factors, I'm sure, but recognising that team and what I really like there, as you've spoken about, that question that came up is what, Do you need, and we've heard that more and more as a focus like need and demand around sort of our service users or patients or the people that are coming along for that care, what do people need rather than waiting for that demand, but actually thinking about that for our, for the people that are providing the care, our staff.
Do you need actually to support you? And we might not have everything straight away, but I think just recognising that rather than making people say, I demand that I need this to be able to do my work.
So it becomes a different sort of question, just feeling that that's open and recognising when it's not there.
And I think that's a really nice response that you've given.
So thank you.
Yeah, it's interesting that thing about, what do you need, both for, patients or users of services as well as the staff.
But also I think there's something about, and what is it that I am able or not able to give in response.
And I think it's important to recognize that sometimes we might not be able to, respond with what people are asking from us.
And to say, okay, so if I can't do that, is there anybody else who can do that? Or what is it that you can do for yourself if the services can't meet that need? And I think there is this need for a much more honest conversation about what is possible and what isn't possible because if we keep trying to say yes we can do these things when we can't.
I think it's disingenuous.
I think that it creates more distress because there's an incongruence between what people are, saying that they can do and knowing that they can do, which adds distress.
It also then affects trust because patients will be saying, well, you said you'd be providing this, that, and the other, and now you're not.
Because you can't, and it also creates an unhealthy expectation.
So people will rely on something where maybe they need to find their own ways to respond because you're not going to be able to meet those needs.
So I think we need to have much more adult adult conversations with people.
often it comes from a good place because people, we're steeped in trying to reassure or trying to, support people.
But if the infrastructure and the capacity isn't there to be able to do that, I think we need to have more honest conversations with people about that.
And that is at political level as well as, clinical practice level.
Yeah, and I think goes all the way through every aspect to be fair.
So whether it's the support worker through to that advanced and consultant practitioner, but as you say, that higher level as well, where those conversations need to go on.
Yes, and I think recognition at board level.
So, the level of distress that sometimes is felt, at board level is not recognised.
People, they've got very difficult jobs, often being asked to deliver on incredibly, competing priorities.
And actually a recognition of what it's like for them is also important.
They're human too.
And that's probably where that wider team and that support and those honest conversations would support them to feel that if the people that they're supporting feel supported by them and then offering that support back again.
So that's sort of working together and.
And making that team something that's much wider rather than these people go off to talk about something and come back and tell us what you're talking about is actually these people are just trying to help us and thinking about how you do that, creating that support for everybody.
So.
I'm aware of time now, so thank you for everything that you've shared.
You've shared so many insights and thoughts, way beyond what I'd imagined from reading your article.
So you've really brought a lot of life to that, about what needs to happen and what we need to think about from that.
So to me, that was such an important thing that you'd written stone.
So thank you for bringing that to life.
What I'd like to ask now is, is there anything or any key messages that you'd like, to say to people for them to take away that you think are important or that would be useful? I think that, we were talking about the article, so one of the other authors, Elaine Maxwell, Elaine, like myself, has done a lot of work, studying in the social sciences.
And I think that when we were thinking about healthcare, it's both a biomedical and social science activity.
And I think giving value and recognition of what our colleagues in the social sciences can help us with in the way that we provide care and the way that we organise care, I think is really important.,
and I think that understanding that social context in which care is delivered is a critical, skill and, area of knowledge that we probably need to spend a bit more time with.
The reason I'm saying that is making me think about I gave a talk recently to a bunch of registrars, resident doctors, and they were talking about often that the pressure in their training is to understandably learn the sort of anatomy and physiology and pharmacology, etc.
And that often, the lectures, which are about sort of communication, human relations and stuff.
often get less priority, and perhaps not even attended.
And then as they qualify and are working in these social systems, trying to make sense of what is going on and how to respond to it, I think it is very difficult for them.
And I think we owe it to our health professionals and other colleagues to really understand that we work in social systems, and understanding and.
Have access to the evidence and research in that space.
Thank you.
So thank you for that, I think that wraps it up really nicely.
It is a biomedical and a social science, and we're working in social systems So thank you so much for joining me today.
It's been an absolute pleasure.
So thank you.
Welcome.
It's lovely to speak to you.
Thank you.
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