1. Today I have spent some time reflecting on yesterday and on my time in the NHS. I spent 10 years, 1/3 of my life with the NHS. What changes could occur begin to curb the divide?

2. My initial thoughts are that the board should have a set amount of hours spent on the front line, seeing what happens, understanding the challenges and speaking to staff, almost like CPD. Listening, consulting. They should have substantial experience of the nhs practices.

3. Mandatory training should be implemented to hear real stories. Stories of excellence, stories of pain. These should be updated annually.

4. Each year every member of staff should shadow another, from another department. Not a friend - somebody they don’t know. A couple of hours, share practice.

5. Shared learning should not just be local it should go across trusts. I need to think more on this.

6. Whistleblowing hotlines should be available and completely anonymous. Often freedom to speak out champions have worked at the trusts for years and people are still fearful of retribution. Investigations of poor culture shouldn’t be carried out by the team in question.

7. CQUINs/targets these need a reform. Targets shouldn’t be put on areas where the subject is patient choice. I.e smoking cessation there should be no financial penalty because you can’t MAKE somebody stop.