2.3 Claire Murdoch- a name not a number

Claire Murdoch, Chief Executive of Central and North West London NHS Trust (CNWL) and national director for mental health, brings her wealth of experience and insight to Episode 3. Claire has a lively discussion with Amanda Bueno, Gareth Jarvis and Fiona Eastmond focusing on the importance of fostering meaningful connections and facilitating healing within the community. Listeners can expect to gain valuable insights into the principles and techniques of open dialogue, as well as practical strategies for implementing them. Claire's candid real-world examples provide a compelling narrative that both educates and inspires, making this episode a must-listen for anyone interested in promoting mental health and well-being through open and empathetic communication. Tune in to discover the transformative power of authenticity with Claire Murdoch on OpenPODpod, the CNWL podcast about Peer-Supported Open Dialogue.

Transcript

Fiona: 0:09

Welcome to Open POD pod,

Amanda: 0:11

This is season two of our podcast, so I'm Amanda Bueno, and I'm the practice development lead at CNWL to embed open dialogue across our team. So that's the idea, to make sure that There is a joining up between the theory and the practice. That's my aim.

Fiona: 0:30

I'm Fiona Eastmond and I'm a deeply creative and very easily distracted person who loves helping people.

Gareth: 0:37

Hello everyone, I'm Gareth Jarvis, I'm the medical director of the adult mental health services at Central and Northwest London, and I've been interested in open dialogue since I trained in it just over seven years ago, and have been looking. To find ways to bring this to the NHS and broader practice wherever I can ever since. we're hugely privileged, that you've given us some time today, Claire, so thank you very much. for agreeing to be interviewed for the podcast. for those of you who aren't familiar with Claire Murdoch, she's a 40 years, and she has been the chief executive officer of Central and Northwest London NHS Foundation Trust for, Is it getting close to 20 years now, Claire? And the National Director for Mental Health. and, and so, a hugely influential figure in terms of mental health in the UK. And with the these podcasts, Claire, are really meant to be a free resource, to the people who are training in open dialogue at the moment within our trust. But also sort of widen that for people who are interested in how change happens and how can we bring about a change as, as significant, as open dialogue in our context. And we are looking to really have a conversation with you today to think about that together. but I've given you sort of all your official titles. Who, who are you as Claire, as the person

Claire: 1:56

Yeah, well, thank you, Gareth. And what a pleasure to be participating in this podcast. so I suppose Clare the person is quite a lot. That nurse, that worker in the NHS, that person who has thought about Mental health professionally for over 40 years. I guess that is quite a lot of who I am. I think I tend not to think of you have work and then you have your real life. For me, work is my real life. But, you'll be pleased to hear that in addition to my working real life, I'm also mum of two boys who are two men who are 26 and 29 years old. And they are a great, joy to me and big privilege and even greater joy are my two dogs Trevor and Colin, two cocker spaniels, one is 14, the other is three and I guess my family, I'm one of six children, I've got lots of brothers and sisters, nephews and nieces and even great nephews and nieces and I suppose if I had to sort of pull out, a last joy. It would be the community choir that I sing in on a Saturday morning, which is for me a great way of connecting to a creative side of myself. And I love it because our musical director takes control of everything and we just have to turn up and sing, which is fab. But, I suppose that's a little bit about me. I'm also a self declared chronic, optimist. So, my pint, pint glass 99 times out of a hundred is half full. So that, that's a good thing. It can also be really irritating for people that I'm so very resolutely positive, but at least I've got awareness. and I'm deeply committed to social justice and equality in all of its forms. And, you know, politically. very serious about everybody having a voice and all members of our society being important, equally important.

Amanda: 3:51

my goodness. Can we scrap this? I want you to be my best friend, Claire. So I'm a, I'm a, that's it. I'm in love with you. I'm a mother of dogs. I'm a permanent optimist. I drive Gareth and everybody else mad about social justice and embedding this kind

Claire: 4:05

Ah, there you are.

Amanda: 4:06

all the time. you know, I love singing. I sing in a church choir, although I'm Jewish, because of the passion for singing. So it's like this, let's not talk about the transformation, I just

Claire: 4:17

Yeah,

Amanda: 4:18

I just want to have a drink with you, yeah.

Claire: 4:20

be telling me you live in Muswell Hill next,

Amanda: 4:22

Well, funnily enough, my, funny you should say that, I'm just buying, placing, just bought a place in, Cockfosters, and might as well have to drive through from where I am at the moment. But, I mean, being as you said about your passion for social justice, etc. The trust in, as I understand it, the NHS in general has gone through a plethora of different transformations. Which ones would you say? Have made a difference.

Claire: 4:46

Yeah, well, I suppose if I span my career, I would go back to beginning my nurse training 40 years ago in a very, very big Victorian asylum where I was told by a really influential consultant psychiatrist in my first week of being there that I would hear a lot of stuff and nonsense about the hospital closing and he wanted to assure me I never would. And then by the time I was a ward sister back in that same hospital, I was asked to speak at the closing ceremony of said hospital. So that was a huge transition and, it's entailed some really moving things. I, you know, I'm really pleased to have trained, so long ago now, because I think. And to have seen that transition, because I do remember patients who, people who'd been in hospital for decades, suddenly, moving out into housing, supported housing and lives in the community, and things as simple as, I remember being reduced to tears, I think I was a matron by this point, but, hearing about a patient who had only had hospital blankets and things like that, suddenly going out to choose a duvet and a duvet cover. And curtains and the color of that, that their room would be in their house and just choices that had never, never been possible. I think that whole era and the shift to where we are now has been a huge, transformation in ways we don't fully appreciate because. Well, not everyone's worked in mental health for 40 years, so why should they? But I think there have been many others. I think another really big point of transformation for me in my career was the introduction of crisis home treatment teams when I worked with John Holt, the, Australian, psychiatrist who came over to England and worked in Birmingham and then came and worked with me in Camden and Islington. And my job was to work with John Holt to introduce proper crisis home treatment teams. To that trust. And that really was the first time in my career in terms of acute episodes or crisis, when we were able to seriously challenge, I think, as nurses and

Fiona: 7:00

Bye. Bye.

Claire: 7:07

when you needed to come, how long you needed to stay, and actually in very many cases there really were genuinely better alternatives. In some cases not hospital best place, but I think that was quite a transformation both in services but also in how I saw mental health.

Amanda: 7:31

noticed in my efforts to challenge the system as it is, can be very difficult, because the system as it is seems to operate in many ways from a place of fear for the professional, a place of risk, a place of fear. And I wonder if we took that sort of, You always give the expert perspective out the hierarchy in that way from another person's life. Because nobody can be expert in another person's life in any event. I wonder what you think the essential components would look like. What would we be left with if we didn't need to be experts in people's lives? What would we be left with?

Claire: 8:08

that's a huge question, isn't

Amanda: 8:10

I never said this was going to be easy.

Claire: 8:12

no, nobody said it was. I mean, I guess. So I don't want to deny our expertise. I think we have an expertise. Can that expertise change and become different? Yes. So I think we can learn new things and new expertise and some of what we need to learn. Although to be honest, I would say we need help from our regulators and others if we're to truly unlearn some behaviors and relearn or learn new ones. so I think being really great listeners and better actually at understanding what makes somebody tick. What, what gives them joy? What do they want for their lives? Not what do we want for their lives? I, I, I think being really good listeners and walking a journey with someone is an expertise all in and of its. self. And I think if we were to let go more of the risk assessment and the framework of thinking about deficits rather than assets, and choice in its broadest sense, not a narrower sense, I think that would be, and, you know, it's, I've seen examples of it, of where it can be really transformational for the individuals who we want to work with and whose lives we want to improve.

Amanda: 9:31

Mm. You've given me such a beautiful answer that if you were there, not only would I want to have a drink with you, I'd have to stop and hug you.

Claire: 9:38

Oh, Crikey!

Amanda: 9:42

would, I, I would because, because it's, it's very much a core part of our Open Dialogue is our listening training, which somewhat interestingly is also coming from Australia. So like you, I've also teamed up with an Australian, but I think it's really interesting because it is the core of authentic listening and being alongside. It's the first step. And it's, you know, and it's something that we're doing and we're actually doing it as well and having the honor of doing it in your trust in situ, in, in some of the most difficult areas, you know, so in, on the wards and in MCAS and so on and so forth, we're going to be training people and embedding it in action alongside our patients. So that's what I'm trying to do to close that gap between the learning and the doing, and try it on in person with patients. Okay.

Claire: 10:39

to make us be. Less task focused and more person centered. It was when the care program approach was introduced. And I do remember everyone going, Oh, what's this new thing about the care program approach? and everybody actually having individualized plans and things like that. It seems ridiculous. That was 40 years ago. I do still think we have a way to go. I think. I think some practitioners and for some people that we work with, we really do get it right. and it's very special when we do because that's why everybody comes to work. We love getting it right for people and that it's an incredible feeling. but I think. It's still very difficult for people to be truly person centered and to listen and to think creatively with people and those that love them, and less task focused. And I, you know, I do think as a Chief Exec, we have to consider really carefully how much of, how many of the tasks are truly value adding. So I hear a lot about the bureaucracy and jobs we give people to do. that may add really very little value to a person's, a patient's journey or a service user's journey. So I think we do have to think about not just training the individuals, but what can we strip away from what we ask them to do that's non value adding that will free them up a bit. So I think we all have responsibilities and enabling this transformation.

Amanda: 12:05

And I think we are doing it in that Gareth and I, he knows how much respect I have for that, he's gone back into practice one day a week. and I've also gone back into practice as such with the home treatment team and at MCAS and on a ward, because it's very difficult to see those edges of where the bureaucracy and where the SOPs are all a bit sort of. mundane and unhelpful unless you've tried them on and you can really experience it alongside people. But I don't know, Gareth, you've probably got more to say about that.

Claire: 12:37

Okay.

Gareth: 12:43

one of them was, my ears really sort of pricked up when she was saying that she got to work with John Holtz when Crisis Teams first came across because, one of my sort of major jobs, that I had as a consultant, I, I took on the Crisis Team in Haringey at a time when it was going through a really, a difficult phase. And, I kind of sort of jumped into it feeling like do I really know what home treatment is meant to be about? And so I went and did my archaeology and I went back and I was sort of trying to sort of uncover sort of where did all our our standard operating procedures come from and all these rules the team seemed to be following of were they set in stone? Were they core to the model? Do we have to do it that way? And I went all the way back and and looking at the stuff from John Holt itself, it's really interesting that actually systemic practice, thinking about family. was right there, right at the core of the model, right at the beginning. And then the more I had conversations, because it was around the same time I started to train in open dialogue, within sort of about six months of having joined that home treatment team. And so my perspective shifted on that. It was really interesting. I started having conversations with lots of different home treatment teams across the country and they'd all gravitated away from that systemic practice. And I just thought it was really interesting, actually, that it seems to happen time and again. We keep putting out this ambition and this value that we want to be inclusive of family. We want to be inclusive of the people who are really important to someone. And yet our teams find it really hard to hold themselves in that place and that space.

Claire: 14:06

I find that really interesting because I'm thinking when I worked with John in Islington first, and then I came to CNWL, and we set up our crisis home treatment teams, first of all, in South Kensington, and then we rolled it out to North Kensington, South Westminster. But when we first did, we, it was It was thrilling because we had the opportunity of doing something from scratch and really thinking about what were the components of a really great, home treatment team. And I'm sure his name was Paul Polak and he was American. I'm sure that's who it was. And we brought him across from America. And he was a massive systems thinker and worker and certainly in his services in America. And I've forgotten which state it was now, but he even had lots of landlords and landladies who would, who people could live with, who perhaps had more major mental health problems. So not just live in supported living, but live as part of families. but he really spent a lot of time with our teams at that point, doing lots and lots of culture change, practice change, and helping them think about using a system and working with those around people and in their real lives, not lives as our patients, but lives as themselves. and.

Amanda: 15:27

Yeah.

Claire: 15:29

that some of that could have gone because we, we fill the work of our teams with task, not person somehow. and I have high hopes for the MCAS because again, it's new and I really want to take the longer period of assessment that MCAS

Fiona: 15:45

to

Claire: 15:45

affords us. So not quite the four or 12 hour assessments that have to happen in a busy A& E.

Fiona: 15:52

background on

Claire: 15:54

Which is often so inhospitable for our service users, but also for staff to really think. I'm hoping that MCAS will bring in family members, others, community supports. as part of the assessment that happens there in making a decision with somebody about whether it's hospital or home and what that, what home looks like and what needs to be true or in place for the latter to work for them. But yes, I'm sure it was Paul Polak. I should have looked up before this,

Amanda: 16:24

I

Claire: 16:25

before this webinar actually, but he was an amazing man who just, I was absolutely sold on his work and what we needed to do.

Amanda: 16:34

I

Claire: 16:34

With

Amanda: 16:35

of that. Yeah. Well, I'm, as I'm a systemic psychotherapist and I was always trained to be a system thinker. So sometimes I drive them a little bit crazy, Claire, to be honest, because somebody is wanting to do something and I'm like, you know, and thinking about the wider, repercussions of the whole puzzle all the time going, no, you can't just do that. That's too small. You have to build the foundation. You have to build the scaffolding. So sometimes I just get on with that. I'm like, no, no, no. You have to put the scaffolding in or it'll fall down. So I have that constant thing, but I think the MCAS is also something that Gareth and I have discussed a lot and it's close to our hearts to put some transformation in. I mean, I would say a key point that I would love to see if you do have a magic wand there, I can't see on your desk. So I'm assuming you've got one. Maybe it's in your handbag, I don't know. Just get, get the damn thing out, because I need it. Is, could we make the MCAS? I think it needs to be self, self, referral to be honest with you Claire. I would love to see at least that, so that people didn't need to go into a hospital to have something that is more therapeutic. And it seems time consuming for it to start off in the sausage machine. Got the, have you got the wand, please?

Claire: 17:44

thought people could refer actually, so I do need to have a look again because certainly in its early days, people could self refer and could walk in and that was hugely possible. So, I don't know, Gareth, has something changed?

Gareth: 17:59

well, I'm going to go away and have a little look because it should be a self referral and we always said that that's what it was meant to be. So,

Fiona: 18:10

So,

Claire: 18:12

Well, I definitely think we have to look at it. because, and in fact, in the early days, some people were referring themselves and actually were very appreciative that the service was there and that they could, and the team were very pleased with some of those outcomes. So I think we do need to go away and just have a look because certainly as services develop, unless you're really. constantly vigilant. they change without it being a conscious decision that that's what's best. It can be an almost by default decision. I mean, it's why it's actually really hard listening and watching and observing and always thinking. It's because if you stop for a moment and don't assume things will stand still and be be tomorrow as they were today kind of thing. There's a, I always describe it as it always feels like there's magnetic pulls that can take control of things unless you do. And that's hard work.

Amanda: 19:09

It is hard work, and also I think you're absolutely right, often people say to me, well we always do it like that, and I'm like, so, but why do you always do it like that, what is your, in fact Gareth, I, I had the pleasure of meeting Gareth when he was in charge of the home treatment team, Claire, and I started then when, I mean I do love, I love what you did, I always repeat it but I don't care Gareth, it was wonderful, because every MDT meeting started with a name and then a diagnostic label, Claire, and I said, Surely we should start with a context of what's gone on for someone instead of whatever their label is. That's not the way, because that reduces somebody's ability to think about them, their family, their wider unit, their them as people, et cetera. And Gareth just sort of walked out of his office casually. I was very new there then with the wiper board and just wiped off the whole Rove diagnosis. He went, you mean like this? And I was like,

Claire: 19:59

Okay.

Amanda: 19:59

yeah, I kind of do. Thank you very much. And, you know, and then I remember the other arbitrary thing. I walked in, I said, I have to leave. And he said, why? And I said, because you want me to be a bad therapist. He said, what are you talking about? And I said, well, they are apparently not in a terrible crisis anymore. And I'm not allowed to work with them. So. I'm not going to be a bad psychotherapist for you. Go hire a bad psychotherapist. And he wheeled in a separate little whiteboard and said, there you go, that's Samantha's boards, put her clients on there. She can work with them as long as she wants. I was like, okay, this is easy.

Fiona: 20:30

go

Claire: 20:32

yes. Yes.

Amanda: 20:33

Exactly. Yes, he does. So he's got that, but I do always check in with him. I want you to know I'm not that naughty.

Gareth: 20:40

I

Fiona: 20:41

going

Gareth: 20:42

guess a question I had knocking around my head, Claire, is that you've seen a number of changes come and go in the NHS over the years and obviously, so Amanda and Fiona and I are all sort of quite passionate about seeing a change, like open dialogue come in. What, what have been the ingredients for the changes that have stuck the, the changes that have been successful and, and, and carried on? What have you noticed over the years of the ingredients for.

Claire: 21:06

Gosh, yeah, they're great questions. I mean, I suppose the changes that stick best are ones that start from a great foundation, i. e. that make sense, that have some degree of authenticity and values based about them. If you want something to endure, it absolutely does need to make sense. sense. It needs to be of value and of worth. I think, and I'm loathe to say this, but I do think that individuals and teams make changes stick. They really do. Now I'm only loathe to say it because I

Fiona: 21:44

going

Claire: 21:46

if there's a really good change that it hangs too heavily off of one person. It needs to be teams and the wider system that make it stick. So whilst I don't want any individual ever to underestimate the difference that they can make and should make, obviously the great power of that is in a team and then having a set of

Fiona: 22:06

Okay.

Claire: 22:06

I was going to say architecture, but things in place around the team that make it easy for them to do the right thing. And that, that vigilance about stripping things out that are not value adding. I mean, I think it was, it was many years ago when that whole phrase fidelity to the model came in. It was when. We had the National Service Frameworks a few years ago. I think it is worth knowing what fidelity to a model looks like. So what's your model? And what was being done? What does being true to it need? I think training. Personally, I've over the years come to think that you're better training whole teams in something than you are. Well, it depends what the training is, but if it's a meaningful transformational change, I think I've learned that you can pull individuals out, they can train, but if they're going back to a team that's the same old team, they can burn out really quickly. They can feel defeated really quickly because, there aren't. more people in a team, that think the same way or understand the constructs or, what you're trying to achieve. I think money matters, you know, so understanding what the financial basis for something is and is that sustainable is important, does make a difference. I guess above all it's having a great model that people believe in, are trained in, that's valued.

Amanda: 23:23

Yeah.

Claire: 23:23

People investing at a team level as well in things that they give up really easily in the NHS in my experience. So I think one of the first things to go on a busy inpatient ward is maybe the team supervision.

Gareth: 23:34

Mm.

Claire: 23:35

Like people would never not do the drug round, would they? They would never not do the drug round. You'd never not have a ward round. You'd never, there were some things you'd never not do, but there are some things that do, it may have changed a little since it used to drive me. Absolutely. When I was a ward sister, I was so determined that we wouldn't, for example, have our team meeting. So I think it's knowing which are the components in a change that help you sustain it. And which for me sort of supervision, training, the ability to think about it is key. Otherwise you just get swept along in busy, busyness. And others around you understanding what you're doing really helps. So that can be slow and difficult. Because if you're not careful, people think they're rather special and they're not special. And it never ceases to amaze me that if we're not careful, even in the NHS, where we sort of like to think we're thinking always about the greater good and what's best for patients. I think we too, if we're honest, can quickly revert to what we know and Don't always want others to be special, but we should always want others to be special and changes to be special. It's just, we need to be special too. So it's how you value it and give people the space to think there's worth in valuing what we're doing. I do remember once wanting to call my ward a name, not a number, going all the way back to that institution and the battle that ensued until, and we compromised in the end, we wanted to call our ward Oak Ward and the administrator said, well, you're on Ward 6, so you're Ward 6. which interestingly was a Chekhov play about an institution anyway, but that's another thing. but we wanted to be Oak Ward and they wanted us to be Ward 6 and there was a battle, a real battle ensued and it became ridiculously important to us to have a name, not a number. And the sorts of things would be phoning reception of this big hospital and saying it's Oak Ward here. And then saying, there's no such ward in this hospital and hanging up or sending our pharmacy box off to get restocked every day and putting Oak Ward on it. So they knew where to bring it back and it coming back with Ward six on it, us putting posters up outside the ward every day saying Oak Ward this way, and then being ripped down. And it went on for such a long time. And in the end, I suggested to the administrators that we could be Ward six

Fiona: 26:00

to

Claire: 26:01

we were allowed to be Ward 6 Oaks. And when the administrator phoned me to tell me, I was just surprised to find I cried. And I, you know, I just, and it's, but that's been a big lesson to me as well about

Fiona: 26:13

And,

Claire: 26:15

to what matters to people and humanise things. It does small, seemingly small things can matter as well. So creating space for the small things, if they're important in any system, I think.

Amanda: 26:28

I couldn't agree with you.

Claire: 26:29

to endure and survive.

Amanda: 26:31

couldn't agree with you more. I mean, I'm giving a lot of thought to the MCAS, you know, if it moves, etc. And when we've got more opportunity to flavor it in a sort of more of a therapeutic way and like having like a nice cup of coffee, you know, something that is not. derogatory, a nice proper mug for everybody that comes in, you know, something warm, homely. It should be more like a home, an ability to have places to talk privately, and, and sort of little things, like you say, the little things really, really matter very

Claire: 27:01

Oh, I think if we want to just, look, so MCAS, great example, it's new, so it can be what it wants, you know, within, obviously within reason, we know, we know what it needs to be as part of a wider system, but having a decent, I don't know, an espresso machine there or whatever, having good fruits, nice fruits

Amanda: 27:21

No, just carry on. Fiona, make a note of this. Claire Murdoch has just said I can do what I like with MCAS. Okay, and

Claire: 27:28

an espresso machine in there.

Amanda: 27:30

in the can.

Fiona: 27:31

got my pen out, and I'm writing it

Claire: 27:32

there's fresh fruit every day and nice snacks.

Amanda: 27:36

Yeah, make it somewhere that you want to be. Make it somewhere homely. I mean, and the other part of this Open Dialogue training that we've been really conscious about is making sure that the community also is alongside in the philosophy of what's needed and the GP practices. So we've got wonderful collaborations that are going on in our pilot borough of Westminster. Really strong, special collaborations, that I'm very proud to have brokered and they continue. Because I, it was one of those systemic thinkings, Claire, that I thought, actually, if we make it so cool to be in hospital and be able to have lovely conversation, people aren't going to want to go home. Because they're going to get what they need, and that's actually, to a degree, what's happened in Harrow. Because they haven't built the community around. So they're starting to now, they're really putting it in. But it's to have that relationship, so that we're all speaking the same language from primary, secondary services. So I think we can offer some continuity, I

Claire: 28:34

really matters. We, our trust board always starts each board with, a service user and someone who's working with them coming to the boardroom and, They tell us their story or what they'd like us to know and it's important to us because it brings the board into the room in the right way. It starts every meeting with what's most important which is the service we deliver. But at the last one, our last meeting, we had a gentleman He wanted to tell us about some difficult experiences and it's pub, it's, it's put in the public part of the board. So this is out there, but he, he wanted to tell us about some difficult experiences. It sounds like he was psychotic and when it got unwell, got very unwell. but he started off by describing himself as a football coach. the link that he'd made while he was an inpatient. was with a chap that actually I think the local authority run, but into the local football club, into Brentford. And he said that guy has saved my life. And what he wanted to talk to me about then was not just what goes on at the football sessions, but how he's now a coach himself, the sorts of groups that are run and what he is going to give and do next. And I just thought, yeah, we have, we have to be able to. It's back to your diagnosis point. It's back to people in reaching from the community and thinking about how they help us build bridges with and for a person, back to life outside of our clinical settings. However lovely we make them, they still will be a hospital setting or a clinic setting and you can make them lovely. But that's not where all of life runs. It's, it's the bridge back to where the rest of your life can be. I just love the fact that this chap introduced himself as a football coach. And we were thinking, Oh, right. We're going to hear from a patient now. Nope. We heard from a football coach and a father and et cetera, et cetera. And he told us straight what had not worked for him and what, what was working for him now. And that made me really thoughtful about those vital relationships with the wider community and community groups.

Amanda: 30:50

really struck by the beginning of this, we were talking about the edge between the personal and professional. I'd written it down as thinking it was something I was curious about with you personally, Claire, and I'm really struck by it's because you're so personal. In the way you are that, that you equally have got that beautiful magic and humanity within the professional.

Claire: 31:13

Well, thank you. I suppose I look back at my nursing days and I can remember something from many years ago where we were caring on my ward for a young woman. She was only 17 on an adult ward. I'm going back. 35 years now, but we had a call to say that her sister had been murdered in Germany and the police were coming to tell her that afternoon that she had lost her sister. And this particular young woman could, if she became very upset and she was super tall and super strong young woman, if she became very upset, she would tables and she just had to externalize it. So we knew that she was going to be told this terrible news and, it was instinct. I allowed myself to act on instinct. So after the police had gone, the inevitable started to happen.

Amanda: 32:06

So,

Claire: 32:07

And, She could do real damage to herself and others, so this wasn't, you know, and I just was able to grab her hand, as a ward sister this was, and make her run with me in the garden, and these were huge gardens, and I just kept screaming at her to keep running, and in the end she was saying, I've got to stop, and I was like, no, you're not stopping, you're not stopping, till I say you can, and then we both flopped. under a tree, both exhausted at that point. and then she was able to cry. And I just, I remember things like that from my days in practice. And I often ask myself, do we still make opportunities like that available to staff colleagues to really, because I don't suppose that's in any nursing manual. And I guess today people might get into trouble if they grabbed someone and shouted at them and made them run and run and run. I, I just knew that was what this young woman needed and I, I suppose I'm really thoughtful about what does it take for staff to really be able to use their judgment in a way that's all about the person they're with, even at a point of real crisis when the person they're with perhaps can't even articulate what they want or need. And you've just got to think, I'm going to trust my judgment enough now to do something a bit different.

Amanda: 33:28

Well, in some of these podcasts we've talked, and you said you're a singer, and we've talked about not just the notes, but the spaces in between, and I'm, I'm really thinking about what you're saying, Claire. It's almost like in that instinct. is the felt feeling, which is a huge part of Open Dialogue and what we say. It's that emotional, like, I mean, I've had it at the moment with the home treatment team, where we, for some reason, have been sitting there and doing a prayer at the end. Because this is what this client is benefiting from. She said, I love your prayer at the end. And I'm weaving in the conversation from the thing, but I'm just like Heavenly Father and I'm doing a prayer. It's, it's beautiful and it's, it's in the space in between like music. It happens in the notes. You can't have music, can't have the singing without the breaths and your run sounds to me like a, a giant breath of instinct and love actually. It comes from a place of love, doesn't it?

Claire: 34:23

a way it does, it just identifying with the pain that young woman must have felt at such a young age. And with all of her quite serious mental health problems, you know, how was she processing, or could she process it? And perhaps she couldn't, which is why the dining room was being, shall we say, disrupted. And I could just see someone going to get medication, which wasn't wrong, because she could, you know, that wasn't necessarily a bad thing. I just thought there must be a better thing, given we almost needed to stop her physically so she could perhaps begin to process what she just heard. And it wasn't in, it was an instinct. In fact, I won't keep telling stories about 100 years ago when I was a nurse, but these were big important lessons for me, which was one chap on a ward that I was on as a student nurse. He was quite catatonic, barely moved, hadn't spoken for years, had a routine. He was called Lenny. And, I used to periodically get Lenny to come and sit at a piano with me. I can't play the piano, but I would hit a note on this piano and he would hit a note on this piano. So I felt there was a, and then there'd be a space and then I might. hit a note than he would, and then slowly he would hit a note so I would, and it never got beyond just gentle one note, but it felt, I don't know, I really felt that we were, there was something there. He never spoke, and

Amanda: 35:48

were communicating. You were communicating. Silence.

Claire: 36:10

in his eighties. But he had died and it was three o'clock in the morning and everyone was asleep and I was really sad and I sat there with this great tome of notes thinking it's now time to read about Lenny. Because in those days you were taught not to read the medical notes as a student nurse, you were taught to get to know the person. But I remember reading, I know, you were literally told as a student Don't read the notes, but I thought right, it's time to get Lenny's notes down. So I did this huge tome at 3 a. m And right back at the very beginning It had Lenny was admitted to this hospital age 14 years of age with a diagnosis of moral deficiency And the key offence was, stealing sheet music. And I just remember sitting, you know, crying into, into the office. But I suppose it's that thing about in the spaces and just trusting, being able to trust your instincts sometimes, which as a professional, so important to create the spaces where you can develop that as well. And I think. Staff colleagues find that really hard in a very

Amanda: 37:22

Well,

Claire: 37:22

NHS, don't

Amanda: 37:23

think it's permission. We need permission from our line managers, et cetera, to be able to do it. I mean, I said to Gareth a long time ago, I said, I don't read the notes and he went, it's all right. Nor do I, because it's about going in and feeling the space. I'm just conscious of time and Fiona is definitely sitting here. Do you have anything you particularly want to, that you'd like to bring to the conversation?

Fiona: 37:45

Well, there's just so much really, and I think that you said what was in my mind a second ago actually, Amanda, about permission, and I wanted to say something about, what is sometimes called air cover, and I think that there's, that the NHS and the globe have been through such a recent trauma, and I think we've had, it's been a long while since institutions closed down, and it's been a long while since I think we've lost Space in Between, you know, which kind of really brings me back to the title of our very first, episode, one of the titles that we had, which was The Space in Between. And I'm wondering, and I want to ask you, Claire, is how do you think that we might get that space back?

Claire: 38:28

I think it's really difficult, but me, it's less about having loads of free time because that's never, that's not realistic. It's not happening. We won't have that in the NHS anytime. I was going to say soon. I would say ever, but it's about thinking about the time we do have and how we create pockets or opportunities for quality space. So that's why for me, the team supervision space was always so important on a busy ward because it was about now we're going to sit on our hands and think together about what's going well or what's. Not. I also think those spaces can come in the small moments and how we use them as well. I'll never forget a nurse during a cardiac arrest at the Royal Free many years ago. she was a staff nurse. I was a student nurse in this poor town. chap did die, but I somehow found myself supporting her in this cardiac arrest, and I shouldn't have done it. It should have been a much more experienced nurse, but she had me, and I wanted to run away, and I was trying to pass the bits of kit, and I will never forget her, because I passed her something, and she could obviously sense I really wanted to run away. I was scared and felt incompetent. But she managed to squeeze my hand as I passed her something. And it was a, what, a nanosecond of a squeeze. And that fortified me, it allowed me to stay there. It was a way of saying, I know. And you're doing well. And so I think for me, sometimes the finding the space won't always be about that protected hour or things like that. It will be about a mindset that looks for opportunity to find empathy for each other, that looks for opportunity to tell somebody they've done. Just on something that you really appreciate or that you've noticed or, and, and sometimes it's about a way of being as opposed to creating great big chunky bits of space. I do think there's something like open dialogue. It's really important. We create the space for training, that we create the space for less experienced people to think about what they're doing and be able to talk about that. I think you create space as well. If you ask your service users for genuine feedback. That space, in a way, because you're sitting still and genuinely saying what's gone well, or what's not working for you, or how did I do, or what should we do differently? I don't know, the sorts of questions. That's a form of In a way, creating space because you're, you're engaging a different bit of your head, which is all about the, how am I doing and what might I do differently going forward. And, I will just say, I give this example quite often, but things, when my dad was dying in intensive care.

Amanda: 41:16

I'm going to

Claire: 41:17

And, that intensive care nurse, highly skilled, highly, you know, you have to be, and you're busy in intensive care as well, even though it's one on one, there's always something to do if you're a patient. And I came in the morning after father's day and dad was still unconscious in intensive care and all his father's day cards. gone from the foot of his bed

Amanda: 41:38

be talking

Claire: 41:39

and I, and I'd left them carefully there the night before and I said to the nurse, where are my dad's cards, six children's cards at the foot of his bed? It was really important they were there in case he opened his eyes. And the nurse said, Oh, they're here. I was just reading them to him. Wow, that was using the evidence. Yeah, no, but using the evidence base of hearings, one of the last senses to go when you're dying. She didn't need to find words that my dad would find meaningful because we'd written them for her and not in a million years would there be a KPI or a protocol that says, you know, once a day read something touching to your patient from his Children. She just. obviously felt as a busy nurse and the way she approached her job that it was okay to sit and read to my dad. And so I do think that we, we should Much more, we should ask staff to ask forgiveness, not permission. They shouldn't need forgiveness, but really don't ask permission. If it feels right, if it's good for patients, ask forgiveness. Honestly, really not, not permission. And I, I think creating the culture, the climate, a set of tools, training, a mindset in a team that allows you to do that has to be the answer to Service users, their families and you, the professional feeling you're doing something worthwhile. It just has to be. I did very quickly when you were asking a question as well, because it was driving me. I was like, have I got this completely wrong? But Paul Polak. absolutely was a social systems psychiatrist in America who was really well known and was John Holt's inspiration for the home treatment teams. I had to just very quickly have a look to make sure and that's who he was and he was an amazing chap. creating spaces can come in big chunks of time and set pieces of time where we, with consciousness and awareness, say we're creating space now. And that's valid, quite structured, but actually I think it also comes from a way of, a culture and a context, in how we allow people to do their work and how we allow them to think a bit more freely. so it's a way of thinking as well as protected time. Some of the most powerful things that affected me as I was training were in the small spaces as well as the big ones.

Amanda: 44:06

Wow, I think that's a wrap, isn't it? That is just beautiful.

Fiona: 44:10

I

Gareth: 44:10

it's just wonderful, wonderful words of wisdom and experience, Claire. it's been a real privilege to, to have the conversation with you today and, thank you.

Claire: 44:20

Well, thank you to you. Thank you to all of you because it could not be more important if we're really committed to mental health. If we're really committed to people, then it couldn't be more important that we think about and act consciously around them. what it is that people need and want and whether that's our staff colleagues or the people we're working with. and so I really appreciate the opportunity to talk just very honestly and frankly, and you know, it's a privilege. And at the end of the day, I'm one person and there are many, many other brilliant one persons out there and collectively, we can make quite a difference. So thank you for the work you're doing.

Narrator: 45:01

And that's it for this episode of Open Pod Pod. Join us for the next episode.