So, I said I'd left Twitter with a great (actually quite small) fanfare, but inevitably I had a look at recent comments re @rcp #AGM and @TheKingsFund report and so feel moved to comment. I was elected to council a year ago. The PA issue is hugely important, and it's clear that

“Leaders say they want transformation, engagement, innovation, creativity and agility … but their actions and the environments they create say otherwise: that what they actually value are the status quo, sameness, safety, certainty, busyness and consensus” Sonja Blignaut

“Short-term thinking repeated again and again doesn’t lead to long-term thinking.” Seth Godin

Agreed. Good access to acute care for older people has been hard won over the past 40 years in the UK. Access for those who need acute hospital care must be sustained.

Time to re share this perhaps? @ShaunLintern was asking us for ideas to give @wesstreeting on how to get the most from our health & care services. A focus on #Frailty is helpful in terms of getting the most value for every £ spent. The #Blueprint from @GeriSoc is excellent.

TLDR: while it’s easy to see why @WesStreeting and the public are dismayed at the state of the #NHS, there are signs of promise and fairly established solutions. We will have more to say on both as the Govt begins to set its course nuffieldtrust.org.uk/

We are building another great team to push forward on much needed work to address needs of biggest user group of healthcare, our older population. Come and work with us to ensure a healthier older population now and for the future!! @YoungGeris @wesstreeting @AndrewElder @j59dd

Change.

“Mass emails that demand clinicians to discharge older patients without proper assessment are not only disrespectful but also undermine the clinicians' role.” This has driven me potty over the years. Did they think we weren’t trying, before their email? It’s multifactorial.

“In the 1970s I worked on 'culture change' programmes. What a fool I was. I learned how behaviour is a product of the system. Change the system and behaviour changes. Culture change is free. If you work on the people in a command and control system it gets ugly.” John Seddon

Organisational systems - which leaders own - still incentivise and reward action, busyness, and reacting.

I tweet quite a bit - but this one is different and perhaps the most important I’ve ever written I hope it gets shared as much as possible, so new parents don't make the same mistake I nearly made (even as a dad of five, having worked in A&E for 23 years and someone who teaches about not missing a diagnosis because of cognitive biases). Our 6 week old baby is getting discharged today from @TheAlexBrighton @UHSussex after receiving the best possible care for meningitis. She is doing really well and as a family we can't begin to express our gratitude to all involved. The day she came in, she was not herself but nothing which particularly worried us. But my wife did her temperature, and it was over 38C. As she was under 3 months, it meant she needed to be seen in A&E ASAP. By the time we got to A&E she was really quite sick even though it was only 30mins after taking her temperature. I initially dismissed her signs and initially even questioned why my wife did her temperature. I had a cognitive bias, twisting my thinking to believing she was ok because that is what I wanted her to be, when she wasn't- a positivity bias. Please if you are worried about your new baby - be like my wife and not me, check their temperature, use your gut instinct and don't delay getting the help your baby needs. @M_R_F

Well done Adrian, not an easy job to comment on this. You were honest and appropriately concerned. As are we all. We should take responsibility for things within our power to change and never lose sight that patients should be at the centre of everything we do.

This isn't winter, this isn't one A&E, this isn't one system. It's everywhere, and it is entirely avoidable by prioritising safe & dignified emergency care. Stop blaming patients and driving "efficiency" and "redirection" - whole system approach is not just the front door...

A&E attendance for children 0-4 years ⬆️42% in last 10 yrs - mostly for minor illnesses, feeding probs, infant crying previously managed by health visitors🚨👶🏿👶🏼👶🏾 Cutting health visitors by ⬆️40% over the same period has been a false economy 🚨 ihv.org.uk/news-and-views/ne…

This is just appalling and demonstrates how this is politically driven mendacity supplied without question by @NHSEngland 100% designed to mislead. Physician is a protected title. @gmcuk @DHSCgovuk

I’m simply horrified to see @NHSEngland now literally breaking the law in how it misrepresents physician associates & other allied health professional - who are NOT doctors - to the public. These posters are from the Bradford District & Craven Health & Care Partnership. 1/n

When it comes to the denigration of the medical profession, primarily to the detriment of patient care & safety, I have low expectations of Govt & its quangos @gmcuk & @NHSEngland. However I am disappointed at the senior clinicians who sell out the profession after they climbed the ladder. Slow hand clap for: @NavinaEvans @NHSEnglandNMD @drcolinm to name but a few.

RT @jovanforclacton: Fancy seeing you here… 👀 #VoteLabour #Change