Brave New World - working towards values-based realism

Last Monday, I was a non-participant observer at our Integrated Performance Group meeting at our Trust, Greater Manchester Mental Health (GMMH). This is a new element of our re-engineered governance processes. It’s an approach that aims to make sure decision-making takes place at the most appropriate level of the organisation; in this case, the Care Group leaders. They form an important group of our senior leadership colleagues. Each Care Group presented on their progress to date, issues to be escalated and achievements to be celebrated. I was impressed with their depth of knowledge, their willingness to appropriately challenge each other, and their determination to make a difference.

To draw on the words of the Canadian Prime Minster, Mark Carney, it was a sign that the old order was disappearing. What I was witnessing was something new, fresh, and hopeful. Mark Carney also quoted Alexander Stubb, the Finnish President, and his approach to the current global uncertainty. The term he used in capturing this approach was ‘values-based realism’. The notion of being both principled and pragmatic. It is an approach that feels equally applicable to the increasing challenges we face in the NHS.

The past year has seen much turbulence, change and yes, uncertainty across all levels of the NHS. It has not been NHS England’s finest hour. Over the past 12 months, this turbulence has formed the backcloth to our recovery work as an organisation. One thing that has become clear over this time, is the need for all NHS Foundation Trust Boards to take ownership of the issues they face, find the solutions and be accountable for all their actions. To quote from Mark Carney’s speech once again*, we have become ‘middle powers’. As an NHS Foundation Trust, we sit between the Regional Offices of NHS England and the Integrated Care Boards of our integrated care system.

It feels like a good place to be. This was something I was able to explore twice last week. The first was at a small dinner party hosted by the wonderful folk at the Good Governance Institute (GGi). Andrew Corbett-Nolan, GGi’s Chief Executive was there in person. He is one of the good guys for sure. We were in Liverpool, at a restaurant on the Albert Docks. It was a great evening of good food and equally good discussion and conversation.

Although Jane wasn’t at the dinner, she travelled to Liverpool with me and watched the football. We stayed over, and spent a wonderful time the following day exploring Liverpool city centre. One of the things Jane wanted to do was visit the Walker Art Gallery, which had a special exhibition of Turner’s paintings. We weren’t disappointed. Next stop was to visit both the city’s cathedrals. Whilst they were both magnificent in their own right, we did prefer the majestic Anglican cathedral. Then it was back home and a late afternoon meeting with my Non-Executive Director (NED) colleagues.

The next day I was once more in the company of Andrew, albeit we were in a Zoom meeting. It was the first NHS Chairs and NED webinar of 2026. I was there to present a little of my experience of being a Chair at GMMH during our recovery journey. It was an opportunity to reflect on where we had come from as an organisation – not a place I ever want to return to – and where we are today. At one time, we were top of NHS England’s worry list. Thankfully we no longer occupy that position. The telling of my story revolved around a shared approach that both our Chief Executive, Karen Howell OBE and I had relentlessly pursued over the nearly two years that we have worked together. Our approach was and is centred around consistently promoting trust, authenticity, and transparency.

Building great leadership teams that bought into our three organisational priorities (recovery, reengineering of governance process and strategic aspirations) was where we were able to start to build trust. Nurturing neglected relationships, within the Trust and with partners, through consistently presenting one version of the truth helped promote authenticity. And finally, improving the quality and safety of our services, alongside financial sustainability, and good governance, ensured we remained transparent in all we did. At the meeting last Monday, I think I caught more than a glimpse of the difference such an approach can make, and I say a big THANK YOU to all my colleagues who have helped us get this point – the next phase of our improvement journey is about to begin.     

 

*I found Mark Carney’s speech at Davros inspirational, and I would encourage folk to try and read it in its entirety.

Stories to be told, and stories that require us to be bold

Last week, I was full of a head cold. Nothing too bad, but it meant I had a more slowed down week than normal. It also meant I had more time to catch up on my reading. I was so pleased to read of the Darlington nurses and their success at an employment tribunal last week. Common sense prevailed, and we should all be truly grateful the eight nurses had the courage to put truth to power. It was a great story, with a brilliant outcome.

That said, there were some really dismal stories around in the media last week. I find it difficult to believe that so many people are really interested in the Ramsey/Peaty feud or even the Beckham family feud, and don’t get me started on the banal Molly-Mae or Eamonn Holmes sagas. Tedious is the word that comes to mind.

Equally tedious, was the painful video of the dancing Meghan and Harry – I think I must have missed something along the way as this was a post, similar to several of the social media posts I saw last week, that used the caption ‘when 2026 feels just like 2016… …you had to be there’. In 2016, I was Dean of a large School of Nursing. During that year I presented research papers in Australia, Germany, Czech Republic and Hungary. I was there then, and I’m here now. So, what am I missing?

I haven’t, however, been to Venezuela. What a pathetic and wretched story we witnessed involving Venezuela and the US President last week. The Venezuelan opposition politician, Maria Corina Machado gifted her 2025 Nobel Peace Prize medal to Donald Trump. The fact that he gleefully accepted it made me think just what a sad man he is.    

On a happier note, was an old story from Japan that had a reprise last week. This was about the introduction of blue LED lights at many of Tokyo’s railways stations. Apparently, the blue lights are said to create a ‘calming pause’, which results in subtly influencing mood during moments of distress. Since they were introduced over 10 years ago, there has been a dramatic (84%) reduction in suicide incidents at these stations. Literally lifesaving.

Not lifesaving, but there was a ‘life changing’ story that caught my eye last week. It came from a Dr Alex George. Apparently, he is a famous ‘Love Island’ star and a former A&E doctor who has been diagnosed with Attention Deficit Hyperactivity Disorder (ADHD), aged 30. Now I don’t know what a ‘Love Island’ star might be, but of course I know what an A&E doctor is; however, it was the notion that getting an ADHD diagnosis had changed his life that intrigued me.

Now, like me, you can’t have missed the number of ADHD related stories in the news over the last few weeks. There is clearly a challenging issue facing both the NHS and individuals like Dr George. Last December, our somewhat politically ambitious Secretary of State for Health and Social Care, Wes Streeting, launched an independent review into what seems to be an ever-increasing demand for assessments and treatment. Many adults and children can wait an average of eight years to be assessed and even longer for treatment. The government’s ADHD taskforce warned late last year that the people with ADHD, who have not been assessed, often struggle with education, work and social relationships. They put the hidden costs of such delays at around £179bn a year as a consequence of crime, educational underachievement, drug and alcohol misuse and mental illness.

The Guardian newspaper last week reported that NHS spending on ADHD services will be over budget by some £164m by April this year. It is perhaps no wonder then that Wes Streeting’s independent review has also been charged with considering whether there is any evidence that there might be over-diagnosis of this condition, and by implication, other mental health problems. For me, this is a story that has been nagging away in my mind for a while now.

Somehow, here in the UK and especially over the past 12 months, we seem to have conflated mental illness, autism, learning disability, and all kinds of neurodiversity into a single undifferentiated set of problems. Clearly this is not right, and such reductionist conceptualisations don't serve people living with any of these problems well. Like the Darlington nurses, I have now started to articulate my concerns at a local, regional and national level. I’m pleased to report I’m getting some very positive responses – hopefully, we will, collectively, make a difference. Everyone, whatever the diagnosis or societal label they are given, deserves to have their individual needs recognised and met.  

Improving neighbourhood resilience for better health and wellbeing one step at a time

I love to walk, and  I walk everyday One of my favourite walks is from Fleetwood to Lytham. We live halfway between the two towns. The walk is just over 12 miles long. You can walk along the promenade or on the beach for most of the way. If the wind is with me, I can walk it in three hours, but usually it takes just under four hours. I sometimes vary the walk, by taking a bus to Lytham and walking back to Fleetwood. It’s easy to do this as there are many great pubs selling food and drink in both places. If you are visiting Lytham, I can recommend the Queens Hotel on the front. At the other end, there is the fabulous and famous North Euston Hotel.

The North Euston Hotel is still a rather grand building. It was designed by Decimus Burton. It is a semicircular building, built in 1841. I have never stayed there but I think every bedroom will enjoy super panoramic views over the Wyre estuary, Morecambe Bay and the Lake District. The hotel got its name from being at the end of the railway line that started at Euston Station in London. It was a gentler version of the now defunct HS2.

The hotel was, at one time, said to be the jewel in Fleetwood’s crown. Sadly, these days much of Fleetwood is showing many of the physical signs of a deprived northern town. Much of the once thriving deep sea fishing industry has disappeared, and one of the other big employers, ICI, closed its doors in 1992. The main employer now is Lofthouse’s of Fleetwood Ltd. They make the menthol lozenge Fisherman’s Friend, which although very popular worldwide, seems to have a special place in the hearts of folk from Japan.

The steady decline in industry and the increasing unemployment of the town’s population has adversely impacted on the health and life expectancy in the town. Back in 2016, a local GP, Mark Spencer, and NHS Practice Manager, Karen Boylan called a public meeting (held at the North Euston Hotel) to see what could be done to improve the health and wellbeing of the town. Healthier Fleetwood, a not-for-profit organisation, was formed. This aimed to support and improve the physical and mental health of Fleetwood folk by connecting them to each other, and to services and voluntary groups across the Fleetwood community.  

To me this initiative is very much an early example of what can be done through place-based, and neighbourhood approaches to promoting good health and wellbeing. It works through addressing more positively some of the underlying social determinants of poor health. There is lots of evidence that tells us people who are supported to take greater control of their own wellbeing and take an active role in the decisions that might affect them, have better health outcomes. Indeed, the number of people with Fleetwood postcodes seeking appointments at their GP practice and/or attending Blackpool A&E department has consistently reduced year on year since 2019.

So, I was delighted to read last week, that Dr Mark Spencer has been appointed to Chair the Pride in Fleetwood funding Panel. The town is set to receive £2 million each year for the next 10 years, funded by central Government. How the money is spent in revitalising Fleetwood’s public spaces, high street and other community assets will be determined by local residents. I love the idea of trusting the residents of Fleetwood’s communities to use this money to build upon the great work of Healthier Fleetwood. Mark Spencer will bring a wealth of experience, knowledge and energy to the role. I’m sure with his leadership, the funding will be transformative. Whilst similar funding approaches won’t always be possible in other areas, the model of local people determining what best improves their health and wellbeing is surely replicable and desirable.

There is no doubt that we need to see a shift away from individuals and communities always being reliant on others for help and support. There is a place for that of course, but it shouldn’t be the first response to life’s challenges and problems. Individuals and communities need to learn how to better support themselves and others around them, and to be much less dependent on the State to provide solutions and services.

Such a change in approach to how we live our lives, will help bring to life the ambitions in the NHS 10 Year Plan, particularly preventing poor health earlier than we do now; and where care is required, moving services away from  hospitals and closer to people’s homes; and harnessing the opportunities provided by new digital technologies to transform how and where people access their health care and social care support. We can all do something to help improve our health wellbeing. I walk, but there are many others ways to improve your health and wellbeing that are both simple, cost nothing, and are easy to do. Why not find out what works for you and take that first step on your improvement journey of a 1000 miles.

Believe in being courageous, compassionate, caring and pickle juice

It’s almost hard to believe that a year has passed, since I sat down to write my first blog of 2024. This is blog No. 856. Although I don’t really make New Year resolutions, I am resolved to try and carry on writing and posting my weekly blogs, every Sunday, for the next 12 months. So, thank you to all of you, who have supported and read my blogs, and I hope you will continue to do so. Amongst all the celebrations, carol singing, eating and drinking and family and friends catch ups, there has certainly been much to read and think about over the Christmas period.

One of the stories I read came from a long-standing NHS colleague, and pioneer of the #earlyrisersclub, Kenny. He told the story of him and his late husband Phil, in particular their last five years. Back in 2020, Phil was diagnosed with T6 spinal cancer, and early treatment had left him with permanent paraplegia. Together, they developed #TeamBelieve as a way of telling the story of their journey. Phil died in September last year, but it was only as 2025 was ending, that Kenny felt it was the right time to share one last post of the #TeamBelieve story. Apologies for the alliteration, but theirs is a story of courage, compassion and care.

Kenny and Phil had been together for 34 years. Like everyone who experienced the loss of a loved one last year, Kenny is now facing a future that will be very different from his past life. My mother died last year. My parents had been married for nearly 69 years. Although my father has done remarkedly well since her death, the change in his life has been profound.  

Kenny had no choice about where he found himself at the start of 2026, but January is traditionally a time of the year where people do make choices, sometimes referred to as resolutions, about how to live their life. Now we enjoy the presence in our lives of not one, but two, Gen Z young ladies. They do make resolutions, and goodness they are organised in how they frame these. One has created an eight-themed set of resolution categories. It was the stories of how many Gen Z folk are looking to improve their lives in 2026 that provided me with much amusement over the Christmas break.

You will, I’m sure have seen of the stories as well. I particularly liked the notion of gargling with the pickle juice from a jar of pickles. Apparently, it’s a great source of electrolytes. I just want to know what they do with the pickles. It also appears that beetroot juice is making a bit of a comeback too (it is meant to reduce high blood pressure).

Of course, we can’t neglect the Nootropics (yes I had never heard of the these before). These are supplements, which allegedly improve your cognition, concentration and reduce stress. They come with some great names too. However, I don’t think your local Tesco will be stocking ‘Lion’s Mane’ or ‘Ashwagandha’ any time soon. Call me cynical (or just an old grump), but I’m not sure a daily dash of ‘Lion’s Mane’ is actually going to help someone understand, and deal with, whatever is causing them stress in the first place.

However, I may be a little frivolous in my observation there, as there is lot we can all learn from the Gen Z folk. They are, after all, a generation whose mental health and wellbeing has been adversely impacted by the consequences of global turbulence, wars, a very sustained cost of living crisis and of course, a disruption to their education resulting from the Covid-19 pandemic. Against this often-challenging backdrop to their lives, Gen Z folk have clearly recognised the critical importance of building and sustaining healthy relationships with others, as a way of protecting and maintaining their mental health and wellbeing.

They actively work at nurturing such relationships. Emotional intimacy is as important as physical intimacy. Easy words to write, but I think more difficult to translate into practice. It is also easy to see why. Gen Z are ‘digital natives’. They are the Instagram, Tik Tok generation. Navigating an online persona and online interactions with real world ones, can be challenging. However, they are showing us it’s possible to do so. And it’s not just about beetroot juice or Lions Mane supplements. It’s about holding on to, and living lives that promote those values and behaviours that were so evident in Kenny and Phil’s story: being courageous, compassionate and caring within all our relationships, and of course, being kind. Kindness matters, always. Wishing everyone a wonderful start to the New Year.