3.10 Live special from CNWL November POD conference 2025

Guests live on stage talking about POD. Live special from CNWL November POD conference 2025.

POD at Central and North West London NHS Foundation Trust

Fiona Eastmond | LinkedIn

Transcript

Fiona 0:00

So welcome to a very special episode of Open PODpod. I did, thanks. I did promise Gareth that I would bring the thing that makes the noise at the start of the podcast, if you've ever listened to it, it's a very strange noise and it's a very strange thing. I get you to hold the mic? I am a big fan of Steve Beresford. So what brought us here? I'll introduce myself first I suppose. Yeah. Hi everyone. I'm Kayleigh I am the trust wide lead for the peer and lived experience workforce. So really thinking about peer support and I suppose within this context, peer-supported Open Dialogue. It's been a few years since I. Did the training. I was one of the first from our organization to go along and see what it was all about. And ever the skeptic and the cynical individual I am, I was thinking, here we go. This is the latest fad that, this is gonna be the newest movement and the way that we're gonna do things moving forward. And I'm a bit long in the tooth now of working in the NHS and receiving its services and yeah, went into that training with a lot of skepticism and left bedazzled and charmed and wondering why is that we haven't always been doing this. And it just makes so, so much sense. Yeah. And it's actually, I've been a little disconnected from the work for a while. Whilst things have been cracking on in Westminster and we've had your incredible, valuable input from the peer perspective. But actually to be here again today and to, hear about it and, see the way that things are moving forward has allowed me to just really feel hopeful and positive and has lit a fire in my belly again. Yeah, I'm excited to be here. Thank you. Fire in your belly. Always. Always. And I suppose, I see it as my position to the organization to be a critical friend actually, and to name where I have my reservations and, I still, I think it's important to say, have some concerns around how are we going to make this work within the confines of the NHS and, how much of the authentic, original model from Finland do we lose in trying to do that. But what I see is, yeah, moving forward in just a better way of working than treatment as usual. And I think the rest will figure out as we go and yeah, tolerating uncertainty. A big part of it, so thank you. I wonder if anyone else would like to come in and just, of course. So I'm up here literally because my autistic brain thought that was an open invitation when I realized that you've already got set guests, so that's totally fine. I might as well introduce myself while I'm here. So I was a service user and I was offered to basically do the peer training and I thought it was an amazing opportunity. And I've also had family members and friends obviously go through the system, so it's a pleasure to be on stage slightly overwhelmed, but I'm happy I'm here. But that's all for now. Add as we go along. Thank you Turanem. It's a pleasure to have you here. You are very welcome and you're very much allowed. And I very much did mean that to be a bit of an open invitation. Actually. I didn't expect everyone to come up, but it's lovely to have you here. Thank you for coming up. Anyone else on what brought us here? I am I'm the project manager, the project, and I've been on this journey right from the start. So pretty much when Gareth joined and started up the project, I was assigned to it. And to be honest, I had no clue what it was. And I know that I think a lot of people who aren't quite sure what it is, thought it was some kind of cult some kind of Gareth as the leader and us his disciples. So yeah, I was quite unsure of what it was all about. Had never heard of it. And then Gareth explained about it. But I think for me'cause I didn't just take it on as a project I myself have been in the system with a lot of mental health symptoms throughout my whole life. And that was why I took a change of career into the NHS. So when I heard about it, I could see how it could really work and could have been something that it would've helped myself and I probably wouldn't have had to go in and out. So I became very passionate about it. So I've been on this journey all the way through. There's been a lot of ups and downs, a lot of challenges, a lot of achievement and successes. I'm quite surprised we're all still here actually. After this after this three and a half years. And also what's nice to see is how many people are here and how many faces I've recognized throughout that journey, which has been so lovely to see as well how I think for a lot of these people as well, how passionate they are about it.'Cause some of the challenges I think we faced from a project side of things is obviously there was only a few of us on the project and doing it, and it was, it turned out to be quite a big project. There was a, at the start, a lot of people from the trust went on training at Cambridge. Myself included, there's about a hundred people. So obviously trying to reach out across the whole trust and keep the momentum rolling, it was very hard. And so it was, it was. It was quite a challenge to do that, but we had such limited resources. Then we obviously focused more on, on Westminster, which was a lot easier to focus in one area. But I think one thing I felt a bit bad for was all them people. I'd been on training, I couldn't obviously interact with all of them. I do know that a lot of them are still practicing in their own little areas, which is so lovely to hear. But it would've been nice if, we could have been able to work with them more as well. But obviously we were so stretched. I think having some more resource would've really helped with that. And I think just the sort of challenges around people being able to understand it and come along the journey with us. Obviously I know, we're still at a stage where some people are still not quite sure what it is. But I can definitely see more and more people are. Realizing how it can benefit the staff and the service users. So I'm hoping that, CNWL will come on board a lot more with that and we'll be able to really do more so we're not just focusing on one smaller area that we can offer out trust wide and bring everyone on board that's interested.'cause from doing our road shows, we found out there is a lot of interest elsewhere, so it'd be lovely to be able to work with everyone and not just focus it on small pockets. Yeah, it's good to hear. There's a lot of interest. Thank you. My microphones not working. Alistair's saying, can I come in? Hello? That's better. Thank you. Sorry Liam. I thought I'd just break up the linear kind of movement across the. The panel. So my name's Alistair and I'm Open Dialogue lead in one of the Westminster community mental health teams. Can I also just say how great it is to have an unexpected guest on the panel? I think that's really cool. We should do that more often. Um, So yeah that, that's my professional role. I'm also a dad of two small young children and I have at one stage in my life, been been a carer as well for a close relative who unexpectedly suffered a quite a severe episode of mental distress and spent many years in and out of hospital, which is where my own kind of. Story, I guess in, in mental health services began.'cause I was doing something totally different before and then I became a social worker. I'm a social worker by background. And I'm now working in one of the Westminster community mental health teams where Open Dialogue is is being trialed. And I've been there for about 18 months and it's been hard, it's been hard, it's been challenging. It's probably helpful to have a little bit of context. It's been a team with a fair bit of change. A couple of years ago, the there, there was a split when the social workers left the team, which is something that's happening in a lot of mental health teams up and down the country. So we lost a lot of staff members. And just before I joined there were a couple of deaths in the team as well. And then open, Open Dialogue came along and people were presented with this quite significant change. And it was difficult. Organizational change is really hard at the best of times, let alone when you are kinda trying to do it in a team that's facing a lot of instability. So it was hard and on reflection, I'm not, someone like me coming in who's very enthusiastic about Open Dialogue and who thinks it's the best thing since sliced bread. And then you can of meet people who are a bit more quizzical about it and a bit more understandably thinking, oh God, is this just the next change that we have to deal with. We're doing our jobs really well as most people are in very difficult context, a very difficult political context. And then somebody comes along and says, here you go. Here's this. A new thing that you need to do. So people were understandably, I think, a bit resistant and not expecting the team to go in that direction. So it was, yeah, it's been very difficult. Very difficult. But yeah things feel in a better place now. Dunno if you want me to talk about this now or later, but they feel better now. And it's I think part of that has been just allowing people to develop a sense of. Safety and trust with the work and allowing people to develop their own relationship with it in their own time. And it's got to the point now where instead of me going to people and pestering them to do Open Dialogue network meetings, people are coming to me and pestering me to do them. And that's the difference. And I dunno, maybe we can talk a little bit more about how that's happened at some point. Yeah. Thank you. Thank you for that. We'll talk a bit more, maybe a bit later about how it's feeling a bit better. I go next. Would you like to hello everybody. My name is Veronica Kammerling and I am a carer. I run my own organization eating disorders and carers, but I also work in psychosis. And I had two daughters out of my three children, had an eating disorder. My brother had schizophrenia, and funnily enough I heard about Open Dialogue years and years ago. It was a sort of muttering at a, at I think a carer's council meeting in CNWL. And then everything seemed to go dead and I never heard about it again. And then all of a sudden it popped up, ferocity and I started I was Val Jackson organized. I had a group called the Carers Champions, which I joined for Open Dialogue. And that was really interesting, set the scene of what it was all about. And I thought this really does work because eating disorders and carers is there to support families and to for the services to recognize. That really importance of what carers offer and how important they are in terms of recovery. Working as a team, is the one way to, in my view, to, to achieve your goals. So I was definitely tuned in to all of this sort of message of Open Dialogue and then it moved on quite swiftly to, I was there was a conference in, or Oxford Street and I can't remember whereabouts, but Russell was running it and I became more and more intrigued by the whole thing. And then the last speaker at it was Gareth. Who gave an amazingly moving presentation about Open Dialogue and I thought, you know what? This is definitely where I need to be in involved. And so it went from there on to attending meetings and getting more au fait with what Open Dialogue was. And then I had a really lucky break, and I shall be eternally grateful to Gareth and all at CNWL for asking me to come to the training in Cambridge in a university. You can imagine for someone who was thrown outta school, going to a university was definitely a very novel idea. And so anyway, I pressed on thinking, don't you know, you can cope with all this knowledge. Just carry on regardless. And there were moments when I did feel slightly outta my depth if I was honest. Everyone was doing so PhD and I was just doing the easy bit about just tell us your views. And I thought okay, fine. Leading no, not on PhDs anyway. Which I'm quite good at doing as well, telling people what my views are. And anyway, and so I did that and I loved it. And then I had another lucky break at the end of the year. I found myself on the Westminster Older Adults team. So that was a terrific way of continuity to what I had just learned. So it literally followed on. So that one was very much remembering what you'd what you'd learned. And there I was practicing Open Dialogue and I have not found it very easy, partly because when I run a mentoring system and in that I, I talk which I'm also very good at. And so therefore, keeping silent is not in my remit all the time. And I have found that extremely difficult waiting for people to actually say something and then reply to that. And I'm still learning very, I'm very much in a learning curve. But I think the other thing I'd quite like to say about this morning singer I is that Russell and Steve Pilling completely encapsulate the importance of Open Dialogue and a listening. Hearing. And my daughter, my eldest daughter, said to me when she was very ill she said, look mom, you are not hearing. I said, I'm listening. I'm listening. Promise you I'm listening. No. The point is you are not hearing, and I've always remembered that remark and so that it really chimes with me that the absolutely fundamental importance of listening to where people have come from, what their lives are like, and then trying to join that up into a positive Open Dialogue approach. Did I go on a bit, Fiona? Oh, no, it's great. Thank you. I really relate to being very good at talking and finding it difficult to keep silent. So thank you. That's given me food for thought. Liam, I wonder what, what brought you here? Yeah, my name's Liam. I'm. From the Older Adults Westminster, Older Adults Team We had a very different journey. I think getting acquainted with Open Dialogue. It's not often that you are presented with free training, free residential training in Cambridge and have two days to decide whether or not to take it up or something similar. Two, two whole days, two whole or something like that. Yes, unfortunately Open Dialogue was rolled out about the same time that DIALOG+ was rolled out, so we couldn't work out why there was residential training for a year on DIALOG+ But it was a good time in our team to send people on and there was a core group of us that went on, including our manager. We were quite careful around choosing management, someone from nursing, from a psychology, et cetera. So we get a good representation and we all went to the first week in Cambridge. It was a bit woo. To begin with a bit woo. I think we weren't a hundred percent sure what we were doing, but started to see how it could be very helpful to our patient group. We work with older people, we work with their families all the time. All of our visits are in people's homes, so it lent itself very well to how we work anyway. And on the training we started forming relationships with other old adult practitioners, but also with Yasmin and other trainers who were experienced in setting up. So Yasmin set up the pilot in Kent. It was involved very heavily in it and setting up groups of people working in Open Dialogue in teams from the ground up. And the message that we got was, this is a model, got a certain way of working in your team. You do it the way you want to. And that's how we did it. We looked at our resources, we looked at what we could do, how we could start bringing Open Dialogue, not only into the clinical. But also into team practices. So our meetings, our MDTs, our supervision sessions. So we had a year of while we were still training of really working out the logistics of how it might look in our team. And so by the time the pilot started, I think we were in a good place to go take that forward. I think there's been some hiccups in terms of resources often and a little bit of staff change over, but otherwise, where we are now is so much better than where we were three years ago. I think the best evidence of that we've got so far is the feedback that we get from networks themselves. There's two. I think the networks are really important in terms of the feedback we get and I think you've heard a lot of feedback, good feedback about what people and how people experience Open Dialogue. But it is also from the staff themselves and how. Much more connected they feel to each other. We have intervision sessions. It's supervision sessions once a week in our team and people are staff on the ground are able to discuss and reflect on the difficulties that are happening day to day with networks, with patients with each other a lot of the time, which is an interesting discussion to be part of. But it's a safe discussion. There's no hierarchy. People feel that they're able to be themselves. And I think in terms of satisfaction, in terms of working in the team, I think that has just really increased hugely. We don't have a high staff turnover anymore. People want to stay. I think it's exciting to be rolling it out further on. Whatever happens in ODDESSI and I'm sure it'll be great. Not that we know, but it'll be great. But I think we've decided as a team that we really like this way of working and we will carry on working this way regardless of what happens. Yeah, sounds good. There we go. You'll carry on working that way, regardless of what happens. I think we have enough evidence for ourselves that this works for us and for our clients. And just to say, to add on to that, it's not just about that. We also have research that's starting very soon in terms of how Open Dialogue can be applied to and worked with people and networks living with dementia, which is not something, there's not a lot of older adult research in general, but I think this is a new area and I think we are really keen to see how that might work for a patient group that isn't really looked at a lot. Yeah. So yeah, so there's exciting stuff happening, but I think for us, the evidence on the ground is enough motivation to keep going. Thank you. Yeah. Sounds very positive. I'm hearing a lot coming from all different sort of directions, but the story seems to be, it was quite hard and has been quite tough, but things are getting better currently. Can I just pick up on Liam's point about feedback?'cause of course, because I think that's, so that's been so important in terms of the the journey, I hate using that word, but the journey of our team is the feedback that we're getting from from people and their networks. I think Russell alluded to it earlier in his when he was speaking this idea that you get feedback from people talking about. How they've never been listened to before in the way that they feel they have been when they're doing Open Dialogue. And it's, I dunno, it's almost become a bit of an Open Dialogue cliche. I remember hearing kind of similar stories when I was doing my training and thinking this must be like Open Dialogue propaganda. But it's real. And it happens and it's happened in my experience repeatedly. I'm thinking of a particular case that I was working on with one of my colleagues. And this was a person a woman in her thirties who had multiple admissions over the past few years. And quite a history of having one meeting with professionals and then disengaging and, never coming back. And we did our first meeting with her and, she was in tears. She was in tears. She was saying, I've never been, nobody's ever listened to you like like you've been listening to me. And that wasn't, because of me personally or my colleague, it's because of the model. And she was in tears and I was in tears and my colleague Tamara was in tears and she was asking us, you know, when can I come back? When's the next meeting? And this is someone who's just been, yeah, just never would've said that before. And our staff pick up on that. And it feels good. It's obviously good for the people, but it's good for for the practitioners as well because,'cause it feels good. Yeah. Thank you. It feels good. I'm wondering Turanem, From hearing how things have been going.'cause I haven't seen you for quite a while. I was the, one of the mentors on the training that you were in. And you were one of our service user representatives, which is such a clunky way of saying amazing person that was invited in to do the training. And so we were there. So I was there as a mentor and a peer person. And you were there as well. And I just wonder, hearing from everyone having said all of these things about how it's been difficult, it's been uncertain how has tolerating that uncertainty been for you? what brought you here in terms of training thanks. Yeah, it's really interesting for me because my experience was, in terms of the difficulty, the opposite, I was I was so happy and I felt so lucky and privileged. I think Veronica said to be given the training and I was like, oh wow. This is something I learn, like new skills to learn. If nothing else, I'll get new skills to learn. And as a service user had done a lot of engagement work. I like to make good trouble, so I thought, oh, this is gonna be a good opportunity to make a bit of good trouble. So I went with a very open mind and a very open heart. The difficulties I did see was when I was with my sort of staff colleagues,'cause I, so to speak, didn't have any skin in the game, right? I could go back and just engage with my services as a service user and it was almost irrelevant. But it was good to know that okay, there's movement happening and there's new things and there's new models that are happening. And maybe one time in the future if I don't get to use it, somebody who's had troubles like me will get to benefit out of that. And at least I get to inform that in some way. But, so for me it was really at times very painful to see the difficulties that staff had to go through and the kind of tussle and the thing and the difficulties out that they had to go through. And it was I think that was the hardest part for me in terms of after the training, the other difficulties has come along. Was that as a. Sort of service user peer. It was the kind of, there was a hope to involve us more and use our skills. And also you've tried, you've put so much, everything's sometimes put down to a cost. My philosophy is there's things cost more than just what a monetary cost. But I was like, you put so much you invested in us so much so use us. And I'm very happy to be used in that way. But it just went a bit dead in the water and there was no follow up. So that, the difficulty I had,'cause I was like, I also wanna contribute, to, to the system that I'm part of. So I think that was one of the difficulties, but obviously good to be coming to the conferences and learning in that way. Yeah, so I think that's what I experienced. Oh, sorry, last point. Just remembered. And I think the other difficulty is,'cause I'm not. Obviously I'm a resident of CNWL, but not Westminster because so much of the focus has been in Westminster, and excuse my language, as a Brent resident, I feel like a bit of a bastard child out there, and we are not getting the services. So I would love, as a Brent bastard child for more services to be pushed out into the other parts of CNWL. You have my blessings, so please do that. Thank you. Thank you. A micro reflection from me is that it was wonderful to have you on the training your lengthy experience as in service, user involvement and things like that. I don't think any of that could have prepared you for what, how tough the training actually was. But but it was it was wonderful to have you there. And I do hope that there'll be some kind of role in the future. That's all I have is hope. Yeah. I suppose I might talk a tiny little bit just myself about how training was for me. I also was in Cambridge. It was an amazing four weeks. I found it utterly transformative. It was pretty incredible. And since then it's been a bit, it drops off a cliff edge after the end of training but I think a lot of people experienced that, but I don't necessarily think it has been one of the gifts, actually, I said this to Darren a little while ago, that the training to start with was quite scatter gunned. If you'll excuse the pot, I can see Gareth's nodding. It was quite scatter gunned. And I said that it was a bit like throwing seeds all over the place and then hoping that some would grow. And I think some have and I don't necessarily think that the scatter gun approach was, is gonna turn out to be wholly a bad idea. But I could, I could stand corrected of course. Fiona, I just wanted to, it was reflecting on the training,Turanem, Fiona and I mentored on your cohort. The Cambridge training was very different. We were on residential, it was safe. In group we could connect with we had some interference from day-to-day work. Not really a lot because we could turn our phones off, but on the, this cohort which was coming in, living in the same city coming for a day, going home. What I noticed is how, the training is challenging. It asks a lot of yourself. You have to engage with a lot of your own. Your own hangups, your own beliefs, the things that affect you, your red flags, those sorts of things. Alongside that was day-to-day clinical work and issues that were coming in from the team. People weren't really t from a lot. And I can see a few people in the audience now who I know were impacted on by day-to-day stuff that alongside the training they had to manage. And you're in a group of people where you are being more vulnerable, you are talking about yourself a lot more. You're talking about the difficulties of work and then the difficulties of work come in. And I think, and I'm looking at Yasmin here, I can, I think us as mentors, but more the trainers took a lot of heat from the people on those trainings because of the tension between trying to do a training that was intensive. Also try and keep work going. While they weren't there, but they were also there. It was not easy. And as a, even as a mentor we could see that, I think. Yeah. And I think that's gonna be one of the tensions going forward in trying to roll out Open Dialogue into existing teams. And I know the Ken, the Kent project with Oesi, teams were trained up from the beginning. They were Open Dialogue exclusive. But when you're rolling out a new model, a new way of working into a team that has existing structures and processes and caseloads, the tension is quite a lot. And I think that's where things like resource allocation of time, external support becomes much, much more important. Because I think in the cohort that we worked in, I think we could see the impact of not having enough of that. Yeah. It it hasn't been the smoothest ride, but I feel like our hearts have stayed in it and I can see lots of people in the room that I trained with and that I've worked with. And I think a lot of what Open Dialogue does and is relies on believing that it's gonna work and then putting the extra work in, often without any extra resource. Which makes it even more important I think, to, to care for ourselves in the work. But luckily Open Dialogue I think has that built in within Intervision. And I just wondered if anyone wanted to. Comment on how they've personally changed or found their work or other parts of them to have changed, talking about systemic change. How about the changes within ourselves, if I may? I've been a peer worker for a number of years prior to going and doing kind of the Open Dialogue training. And I think for me it was eye-opening that I expected to be able to go in and do a lot of that self-reflection that roster talks about really naturally, because that's part and parcel of what I do. But I think for me, it, and having to do some of that work around our own family systems and sharing with clinicians, I suppose for me was a real, I guess a sobering moment in that actually I work alongside clinicians and practitioners every day within in the context of my role. And yet there was something about that vulnerability and sharing in that space that. Actually, I think it's important to name brought up for me that there's still a lot of distrust there. And I think, not just through the Open Dialogue training itself, but through many years of working in services and actually getting to work alongside clinicians as human beings and getting to know them as my colleagues and my friends. And I suppose, I look around this room today and there are a lot of people here that I recognize as just being real rock stars in this organization actually. And I feel, really hopeful for the direction of Open Dialogue when I see actually the people that we've got in this space pushing it forward. We've got change makers and we've got, radical individuals that aren't happy to sit within a system that's broken and isn't working the way that it is. And that fills me with a lot of hope. So I think, for me this did a lot of reparation for some of the. Harm that had been caused to me by services and some of that distrust. And, the amazing colleagues that I got to train with, there were only six of us initially, and four of them were doctors. And when I saw that, I thought, oh, here we go. And now we go for meals together. And, it's, I suppose for me that has been a real, yeah, a huge benefit of this is just shared humanity and remembering that irrespective of titles and qualifications and years of clinical practice, actually at our core, we are all human beings. And I think Open Dialogue really allows us to be human beings in a space together, which, someone like me makes me feel very safe. And it allows me to stop feeling like I have to speak the language of my clinical colleagues in order to be heard and understood. And actually it's something about, no, you can come and talk my language a little bit and we can talk the same language as the people that kind of share this space. So yeah, it's. It's something for me about flattening that hierarchy that I didn't realize. I felt actually quite as much as I did despite a number of years of doing this kind of work. Yeah. Thank you. Actually, Fiona, can I add to that? I echo course everything that Kayleigh says, because I think for me, I've worked on lots of different projects and I've never felt so passionate and so happy doing a project. I've had a lot of ups and downs and things happening, but I always find I bounce back and I'm really motivated. Whatever setbacks we have, it's always Nope, we're gonna carry on. We're gonna persevere, we're gonna get through this. And I've never really felt like that before. And also. This will probably sound a bit cultish. I feel like we're all like a family and there is no hierarchy. You wouldn't have had me sitting on a stage like this in previous roles.'cause I always would've felt oh no, like I can't do that. And I don't feel like that at all. I do feel really safe in the project. I feel I can be very open. I feel like that we're not just using Open Dialogue with service users. We all use it ourselves as well in our roles. And like I said, there's definitely no hierarchy. I feel like I can just speak openly to anyone I work with regardless of what position they are. And as I've said, I've never had that before. So I can definitely see how it can benefit staff wellbeing. Because nearly all the people I've worked with, we've all been on this journey right from the start and we've all persevered through a lot of setbacks and a lot of the time I wouldn't see that people would start to leave or lose motivation, but I feel like we all just bounce back, which obviously shows there's something else about it for us all to keep doing that. Thank you. Yes, listening towards, there's a lot of what I agree one agree with, I think one of my worries is that the enthusiasm I'm hoping doesn't evaporate and if the whole Open Dialogue gets watered down and I'm not being negative, but I was, I was asked to bring what I saw as challenges and I do feel that a bit actually. And whether it will become very difficult to begin to get everybody involved in a sort of hierarchical position as well. So you've got to take everybody with you, which is a very, quite a difficult thing to do. And I was listening in it to how Steve was outlining it. That, that is one of my worries, I think, but in, it's a gift to carers. That's all I can tell you. They, I mean it, this is, they will be so pleased that they've been involved and not quite Open Dialogue in my own life. But collaborative care with my two daughters was very much to the fore and in particular my eldest daughter, where a lot of time and effort went in to change our relationship. The outcome of that was that she got into recovery and therefore Open Dialogue can only be the icing on the cake for me. And it's, I just can't talk more enthusiastically about it. Thank you. I was just considering, and I was wondering what you were thinking about this of asking if anyone has any questions for any of you. Would that be okay? Because as we're talking away, there might be some burning questions that they'd like myself or the panel or anybody else to answer. Thank you, Gareth. So I'm a GP and I've been listening with intrigue and delight, but I wondered about how you experience or how your, the people that you have been supporting, or both as a carer and a peer support worker, then feel. Then going back to their GP who has 10 minutes and is awfully doctor centered and sometimes slightly abrasive perhaps. Not personally, hopefully. But how's that interface with primary care? If you are talking about whole movement, what about the cradle to grave people? Can I just answer a little? So in our team, we have a GP liaison nurse who's Open Dialogue trained and who works. It's a limited project at the moment, but who works with a couple of GPs I think are north or south in Westminster. And I think is identifying networks early on. I think the move more generally is to look at, finding networks in trouble earlier on before they present to service or they present to our services. So we've been rolling out limitedly a Open Dialogue within that context. And I think the feedback we've had from GPS has been very good. Again, it's GPs have limited time. It is a bit like a meat factory in terms of, one after the other. But with the liaison side of things, that's interfacing much more with the GPs, they can identify people quickly. We can then get in and actually assess and see and bring them on alongside. I think that's not just an Open Dialogue move. I think that's more generally where things are headed in terms of intervention based care. But I think Open Dialogue fits in very nicely into that. Yeah, I'm not sure that's answered your question, but I think that's just where we are in terms of GP relations. Yeah, you could also join a network at the invitation of, the person. Obviously I've yet to find a GP that said they had the time to do that, but that, that's another way of interfacing. I've certainly had situations in which we've had people join network meetings electronically, and the iPad's been propped on the chair. These are things that do happen when people have limited time and they have, and they can't come from A to B and I genuinely believe that 10 minutes of a GP's time in a network meeting, even if it's through some kind of electronic device, would still be incredibly valuable. So I just personally, I would encourage creativity in being able to join in with things. Come and just be a network member because you, you bring that polyphony and sometimes even just to listen and be there will be very important for the network, especially if you've been a family GP for a very long time because you do almost become a member of the family, the GP. I always think. It's such a good question. Can I just jump in quickly? So a lot of the work that we do, we get to a point where we need to have a professionals meeting and a lot of our professionals meetings in now framed within the Open Dialogue framework and so the invitation would be with a person's permission to bring the GP into that. You wouldn't have to attend every single network meeting, but you could just be there for one professionals meeting, which has been expanded. It's not just a professionals meeting. it's a Network meeting and include family and the individual. So I think the invitation could be there for GPs or any other professionals involved that social workers, anyone outside of the system and be part of that, depending on who the person at the center of concern felt it was important to bring in. It's that flexibility and mobility again. I think, and it's down to relationships again between the GP and the and the service. I don't have a question. I just want to contribute to that. What I think is a fantastic question and I wanted to suggest that the flexibility of the Open Dialogue world would expect us to go the extra mile, not the GP, to go the extra mile. So we, when we try to facilitate that, we would very much work around what times are you available, what, when are your 10 minutes? What is the best medium? Do we need to come to yours? We sometimes have meetings at GP practices and invite GP to just pop in for as much or little time as they have. So it's the onus is on us using our freedom of doing things whatever way works for the network. I would say it's not you guys who have to join us, we have to go join you. So thank you. Hi there. Rashmi Patel and I'm from Kensington, Chelsea CAMHS. And it's, I guess my question might be to Liam we are trying to roll it out in CAMHS and there's not a lot of appetite at the moment, but obviously really essential. So I just wondered, we could have a long conversation, but in terms of any kind of key points you might help us with in terms of setting off in terms of setting up a service where at the moment there isn't a lot of appetite. Oh, dear Li, I can only say how it worked with us, which was to start small with a couple of people. It's a strange model to communicate, to give evidence about how it works to people who are not involved. I think for us the most helpful way of introducing it was to get people involved in the actual network meetings, so we started small, we had a couple of practitioners, a few in our team and then started introducing it to other members of the team. They would shadow. I think what's important for what was very important is to get who's the key players in the team. I think management is really important, and it's the clinical leads as well. It's people who have influence, who can get things moving. If you can get them on site and you don't need a lot, you need sort of 25% of the team, whatever, to be trained, oriented, engaged, that will then generate enough interest and momentum. That's what we've found. I think if you go in with a stick, you will lose the team. They're not gonna be interested. It's not that kind of model. I think it needs to be something that is built from the ground up and built slowly and built with an invitation. Come and see what it's like. At the moment, so our intervi supervision sessions with the supervision sessions for people who are doing network meetings we had supervisions going on for a year or so with just practitioners with the rest of the team being outside of it. The divide was very clear that people who were not involved, who hadn't experienced, they would hear about it, but they wouldn't know what it meant. And for them to take it on board was very difficult. And what we did is open it up for everyone in the team just to get a sense of what it was like. And that was enough to get them interested for more people to go on the training and then to develop that momentum within the team. You can't go in with a stick. It has to be done slowly. And I think identifying who's important within the team, that can actually get, also it's management's important, but also do you have support from higher up to able to do something like that, to give you the flexibility, give you the space maybe to give you a little bit of extra resource. I think that's what we did. That's what worked for us. Experiencing it is the key I think for us and for me as well. Once the woo the cultish weird bit went out the door as soon as I had my first network meeting. Or, in my experience my first network meeting, and saw how it worked. Yeah. So can I just ask whether you, are, you were talking from a clinician's point of view or did you have were, do you find that families were resistant to it as well? No. No. So actually we are, I am, I'm talking from a clinician's point of view. I think what it is it's a lot of, it's just resources isn't it? But I have managed to get a psychiatrist on board and so I think, we are slowly starting to do the work with the two of us and Gareth is very much on board in supporting us as well. So I think we have made some shifts but it'd be really nice to network with people who've gone through the journey. I think that's what I'm saying. Thank you. Probably time for one last question. Russell and I had a discussion of this other day, is a welcome call out and for developments for children and young people and for reasons I won't bore you with it didn't meet the criteria, but I think in CAMHS services we should think seriously about doing a proper evaluation. Okay. You, I'm just, Gareth, while you're running with the mic, I'm also just gonna come in on that point. But we've got people from all over the trust that have been trained in this approach and that, often even members of our workforce battering my door down desperate for opportunities to practice. And so I think, where there's not appetite within your particular team or service potentially borrowing that appetite and people that are really keen to keep that practice live and still going. And I think, yeah, there needs to be a way for us to network that across the organization because there's so much resource that isn't being tapped into. So I just, yeah. Wanted to make that point. Yeah. Thank you for that. Thank you. I think my contribution is actually in two parts. First of all, just to. Reiterate on the point that I think is the GP who highlighted that. Is there any room for Open Dialogue within GP surgeries? My view is that,'cause I'm also a liaison person based at the GP surgeries, whilst we welcome the notion of Open Dialogue, I'm also, I did Open Dialogue by previous trust having come to CNW brand In particular, I think the challenge that we have in GP surgeries is the rigidity. Sometimes even if, when you want to be flexible enough to operate in such a way that you are accommodating to the patients that we see, we find it so difficult even just to negotiate beyond the 20 minutes. So I think systematically there is a lot to be done in order to be able to allow us to operate in an open dialogical way. And also even if we are to have those GPs come in, I don't think the 10 minutes would be enough because within the Open Dialogue approach, we do have to sometimes tolerate uncertainty. And person can sit in for 10 minutes and if that's what they have and they have other appointments booked for them, I don't think it would actually be viable. So my contribution to that is if we could be flexible enough from I think systematic or rather from the top, if we can allow that, then it would definitely work. And also just so it doesn't die down, like it doesn't, somebody says it doesn't fizzle out. It is a good approach. We love it, we've worked with it. But we also want, maybe I would address this to Russell, if we could have a refresher. For some of us who have done it before, it'll be helpful as well to have it a refresher and then we are raring to go and restart it again. Thank you. A refresher. I think that's probably all the questions that we've got time for. I just wanted to come back and ask if there's anything more that anyone else feels moved to add, especially after the questions and go on. I just can't help myself. I think this is what I like. Open Dialogue so much. I just love a chin wag. I think for me, just to think about, some of the points that I've raised around, me being worried about how is this really going to fit within the NHS and. I guess I wanted to name that I've invited along some colleagues today from local authority, and I really think that there is a home for Open Dialogue within that and within social care actually. And as we move towards neighborhood working and actually getting out into the community and meeting people where they're at, I suppose I just wanted to add that, please do impress this upon local authority and discuss this because it feels like that, that to me feels like a natural home and I'm one person with one opinion, but I guess I, yeah, I wanted to name it, you put a microphone in my hand and I am going to, I'm going to give my opinion, but yeah, that to me just makes sense. And I think particularly as we move towards that neighborhood working, and I know in Hillingdon already, the Civic Center is becoming a hub. And I just think this is an approach that, that makes sense where we can genuinely get out into the community and meet people where they're at. And I would love to see us collaborating with local authority more as an NHS provider. So I would too. Say my piece and turn my mic off now. Thank you. I wonder if we could join the two questions and the thoughts that coming from GPs and wondering how we can work across those if it feels like some kind of boundary that we're crossing, like a wall that we need to jump over. That it's not just systemic and is beyond hierarchical. Perhaps hubs are the answer to that kind of thing. And I, it just it reminds me of a quote"when I find stones in my path let me be water" uh, let me be water, that just came to me out of absolutely nowhere. I wondered if anyone, it's amazing. I'm a comedian now. I wondered if anybody else had any further final reflections. Nothing. This is what happens in Open Dialogue. Things just come That's it's true. Lovely images that you've vocalized. Yes. Suddenly just in my head, it was just there. And I think that the the laughter hopefully reflects just a little bit of relaxation and just being human beings together on the stage. Alistair, Veronica, Liam, Nina, Kayleigh and Turanem. Thank you so much. Oh, did you want to say something more? I had some reflection. Oh, please do. I'll try and be quick. So I think one thing for me is as a late diagnosed neurodivergent person, so I'm autistic and I've got A-D-H-D-I would just be interested in the research and going forward how if people are known to be neurodivergent, how they found the model.'cause for me it's very, it's very instinctual and it's because it's very clear and the fact that there's no hierarchy, which, yeah, I've got lots of sort of pathologic demand avoidance, so that drives me crazy. But, so things like that really affected me. So I found that the fact that it's much more, it's intuitive and it makes sense and it comes to me very naturally as a autistic person. Just be interested in that and maybe something to think about going forward. We've got the research and things like that. I want a quote as well, there's a quote which something along the lines as"The person who plants the seed doesn't get to sit in the shade of the tree." So I'd like to think, especially Gareth and everybody else here and all the staff, like you've all planted the seed and hopefully future people, future service users, and future staff get to sit in that shade and just, benefit from that. So thank you. Oh Turanem. I was really moved by that. Thank you.