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The rules in healthcare that nobody teaches you - but everyone follows.

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  Busyness = Value Exhaustion = Contribution Pressure = Legitimacy Suffering = Loyalty You might not hear these said out loud, but many of us act as if they’re true. How many of these have you seen this week—or done yourself? • Staying late to “just finish one more thing” • Apologising for being off sick • Taking quiet pride in “just getting on with it” None of this is accidental. These beliefs are reinforced every day—through praise, through culture, through what gets noticed and what gets overlooked. So, people adapt and over time, it becomes the norm. From the outside, this can look like a strong work ethic. A culture that delivers. But I would argue that it’s short-term thinking, because there is always a cost. Exhaustion becomes baseline, compassion fades and cynicism creeps in. So, what if these rules are wrong? Busyness ≠ Value → Clarity and prioritisation create more impact. Exhaustion ≠ Contribution → Sustainable clinicians contribute more over time. P...
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24 Hours in A&E - What that really means today.

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When 24 Hours in A&E first aired on Channel 4 in 2011, the average length of stay in a UK emergency department was just over two hours. In 2026, “24 hours in A&E” is no longer a television concept. For many patients, it is a painful reality. NHS figures show that last year alone, nearly half a million people spent more than 24 hours in A&E. Just this week, BBC News shared the story of a 77-year-old lady ( I waited 46 hours in A&E on a plastic chair, says Skegness woman - BBC News ).  Forty-six hours . It’s hard to imagine what that must have felt like: discomfort, fear, pain, hunger, cold, a creeping sense of abandonment. What is perhaps most sobering is how little shock such stories now generate. We may be becoming desensitised. But we also need to talk about the staff who were there. In a department where waits stretch beyond a day, every clinical space is full. Trolleys line corridors. Ambulances queue outside. There is no slack in the system — only ...
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“Needs Healthier Staff”: An Essential Strategy for Fixing NHS Performance

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  The UK spends billions every year training, developing, and recruiting staff for the NHS. This eye-watering amount grows year on year. So, are we getting value for money for this huge investment and is the NHS performing well? When we think of NHS performance, we tend to look at metrics such as waiting times or access to treatments. These numbers make for grim reading. In Accident & Emergency, for example, only 70% of patients in Scotland are currently seen and sorted within four hours—down from 95% a decade ago. But what do we mean by ‘high performance’ in healthcare? Is it hitting a target, or is it delivering safe, compassionate care day after day? Trending upwards however is NHS staff sickness absence. Scottish Government data show that 6.4% of NHS Scotland staff are currently off sick—that’s over 10,000 people. So, we have a more expensive service, with deteriorating performance, delivered by sicker staff. Performance, it seems, is inseparable from staff wellness. ...
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Trouble with Self-Discipline? A Modern Problem with an Ancient Solution

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'I just can’t seem to help it!' is something I hear often in coaching. Whether it’s checking your notifications or 'just one more' chocolate, the impulse feels familiar. In a world of dopamine loops, doom scrolling, and 15-second video distractions, self-control is under siege. Like a muscle that isn’t used and becomes flabby over time, our self-discipline can waste away if not regularly exercised. The opposite holds true too: self-discipline isn’t a fixed trait, it’s trainable. But unlike motivation, which comes and goes, self-discipline is consistent and reliable. It’s the scaffolding that holds behaviour change in place. So, how can we train and develop it? This same question was considered more than 2000 years ago by Greco-Roman philosophers known as The Stoics. They recognised how crucial self-discipline was for thriving and happiness in life, along with “virtues” such as wisdom, justice and courage.  As the philosopher Epictetus said, “No man is free who i...
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Wellbeing Washing: Why Token Gestures Are Making Things Worse

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    “Made with Organic Cotton!” screams the flowery advert headline, trying to obscure the fact that the rest of the clothing production line has harmed the environment. This tokenism from companies is known as “greenwashing”. In healthcare, we’ve learned to sniff out tokenism quickly — and nowhere is this more obvious than in how some organisations approach staff wellbeing. Bowls of fruit in the staff room, sporadic resilience workshops, or reminders to “take a break” in the middle of an unsafe staffing crisis… these are often less about genuine care and more about optics. Welcome to the era of wellbeing washing. Wellbeing washing is what happens when employers attempt to look like they’re supporting staff — without putting in the hard yards. The result? Distrust, cynicism, and a growing resentment of the very word “wellbeing”. One of the most damaging misconceptions is that wellbeing is some sort of luxury — a “nice-to-have” rather than an essential component of a fu...
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Can You Heal Without Leaving? Recovering from Burnout While Still in Healthcare.

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  Can You Heal Without Leaving? Recovering from Burnout While Still in Healthcare. At a recent networking event, a fellow emergency physician told me he’d just returned to work after recovering from burnout. But when he looked online for stories of others who’d come through it, he noticed something striking — almost no one who’d recovered was still working in clinical practice. Which raises a difficult question: is it even possible to heal properly while still inside the system? Or is leaving the only real path to recovery? A useful analogy here is the drowning man in a river who, kicking and gasping, just makes it to the riverbank, shattered and exhausted. After catching his breath, would the man be foolish to simply jump back in again? There seem to be two sensible alternatives here: 1) Stay on dry land entirely, or 2) If you go back in, wear a lifejacket — and try to stay in shallower waters. The reality is that talk of burnout amongst those working in high stress, high r...
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Artificial Healthcare. My A&E shift in the year 2045.

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  We can't see the future, but can predict what it might resemble based on current reality and trends .  This work of fiction is entirely based on my own thoughts and understanding of what the future might look like for healthcare practice in the UK. The patient references are entirely the work of my imagination, but like all good stories, are based on an element of truth. So, read on and find out what’s happening in 20 years’ time…  "Welcome to The Emergency Department!" - a detached, computerised voice cheerily states as I walk through the door into work. I'm 70 now, but still have to resist a childish urge to tell this smug voice to sod off.  Yes, I should retire and that would be lovely, but since the collapse of the NHS – and my pension with it – I won’t be able to hang up my stethoscope for a while yet. My work ID badge still says ‘NHS’ on it, but this stands for “Network Health Solutions”, the name of the private healthcare company I’m employed by. Headi...
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