Partners in trust

19/3/2025

‘Trusting blindly can be the biggest risk of all.’ (Pru Hobson-West)

Health and social care professions in the UK and beyond are facing unprecedented challenges. Time and again, I hear from clients – from senior leaders through to frontline staff – how they are struggling to cope with increasingly unrealistic expectations combined with hopelessly inadequate resources to meet the demand. The most common underlying questions they raise are, ‘How can I, we, sustain this?’ or, in a weary voice, ‘Is it possible to sustain this?’

There are multiple and intersecting underlying causes including political shifts in policies and priorities, underfunding in critical areas and significant staff shortages, including a shortfall in those entering the nursing profession. This is compounded by stress and burnout, leaving vacancies that add to the pressure on those needing to cover, creating a cascading effect. Add to that an ageing population with complex needs and escalating public demand.

That’s the macro-systemic level. Imagine now your friend, or relative, is admitted to hospital. You want to believe they are in safe and competent hands. Everything within you tells you to ‘trust the professionals’. It’s partly a learned cultural narrative. It’s also a way of defending ourselves against anxiety. After all, to consider the alternative is terrifying. It relieves us of responsibility and places it squarely in the hands of a system. That helps us to sleep better too.

So, I ask the professionals – ‘What do you say?’ ‘Firstly,’ they advise, ‘Show professional respect: staff often have years of studies, training and experience behind them.’ ‘Secondly, show human empathy: we’re often working long hours, understaffed and exhausted.’ ‘Thirdly, show personal agency: don’t imagine we’ll always know, notice and do everything that’s needed – that’s naïve. Work with us. Advocate for your friend or relative. That’s what we need too.’

16 Comments

Sophie Reid

20/3/2025 09:37:21 am

Hi Nick. I’ve worked in social care for 15 years. It’s tough but I still believe in what we do. Trust is a two-way street. We need support from the public as much as they need reassurance from us. Yes, systems are failing but that doesn’t mean people are. The best care happens when families and professionals work together, asking questions, sharing information and making sure patients aren’t just numbers on a list. We have to hold the system accountable but we also have to hold each other up. Thanks for posting this!

Nick Wright

31/3/2025 11:40:56 am

Thank you, Sophie, for sharing from personal experience within the social care system - and well said. Yes, I'm continually impressed and amazed by the compassion and resilience of people working in such challenging circumstances. I hope you are receiving the support you need.

Joan Wilkinson

20/3/2025 09:39:10 am

NIck, this is so true. I was in hospital last year. The nurses were kind but so busy. Sometimes they forgot my water. Sometimes they didn’t have time to help me to the toilet. My daughter stayed with me as much as she could. She asked the questions I didn’t think to ask. She made sure I was looked after. I trust the nurses, but I know they are human too. We have to help each other.

31/3/2025 11:43:11 am

Thank you, Joan - and for such a great example from personal experience. I'm pleased your daughter was there for you. It demonstrates well the power of healthy collaboration and advocacy.

Jade Patel

20/3/2025 09:45:04 am

Thank you for writing this Nick. I work 12-hour shifts with no breaks. I hold my bladder for hours. I hold dying hands. I hold families together. But I can’t hold this system up alone. Trust me? Sure. But also fight for me. Fight for funding, for safe staffing, for fair pay. Otherwise, we’re all drowning!

31/3/2025 11:47:29 am

Thank you, Jade, for sharing so honestly and painfully from personal experience. I hear similar accounts from health and social care workers in my own work too. It's harrowing. Thank God we have people like you in the system. I agree - we need to advocate for you too. The current situation is completely unsustainable. I hope you find ways and the support you need to take care of your own health too.

Alistair Wren

20/3/2025 09:48:28 am

Interesting post as always, Nick. The central tension in this discussion lies in the structural deficiencies of the NHS and social care system. Trust, while essential, cannot be unqualified. The crisis in workforce retention, underfunding and shifting government priorities means that safety is increasingly contingent on advocacy. Your call for 'personal agency' is notable but should not become a means of excusing the failure of institutions to provide adequately for both staff and patients. A long-term policy solution must include sustained investment, workforce planning and systemic reform, not merely a redistribution of responsibility onto the public.

31/3/2025 11:50:28 am

Thank you, Alistair. Perhaps it's a combination of greater personal agency (rather than being passive in the face of institutional hierarchies and pressures) and longer-term investment and reform in the systems as a whole..? I have some degree of influence over the former, and little sense of any influence at all over the latter.

Linda Davies

20/3/2025 09:51:35 am

I spent six weeks sleeping in a chair next to my husband’s hospital bed. I saw the nurses running on empty. I saw the mistakes, the forgotten medication and the mix-ups. Not because they didn’t care but because they were stretched too thin. I trusted them but I didn’t trust the system. So I stayed and I checked his charts. I asked questions. And when no one noticed his breathing had changed, I was the one who raised the alarm. They saved him, but only because I was watching.

31/3/2025 11:53:11 am

Hi Linda. What a great example from personal experience. I'm pleased you were there for your husband in that situation. I witnessed similar things happen when my father was seriously ill in hospital last year. The staff were great, but missed very significant things that affected greatly his chances of survival.

Marcus Ellwood

20/3/2025 09:56:03 am

Nurses? Exhausted. Social workers? Burned out. Patients? Stuck in corridors. But don’t worry, just 'advocate' a bit harder! Maybe if we clap again it’ll magically fix chronic underfunding. Maybe if we just believe hard enough, staff shortages will vanish! Until then, let’s just keep trusting the professionals while the government systematically dismantles everything that made them trustworthy in the first place. Keep writing this stuff Nick. It needs to be heard.

31/3/2025 11:54:06 am

Thank you, Marcus - that's a stark challenge and I feel your frustration.

David Mercer

20/3/2025 09:57:46 am

As a former NHS commissioner, I’ve seen how chronic underfunding, recruitment failures and unrealistic efficiency demands erode trust.

Blind trust in the system is dangerous but so is an adversarial relationship between staff and the public. Sustainable change requires political will, not just personal vigilance.

31/3/2025 12:03:00 pm

Hi David and thank you for sharing from a commissioner perspective. In the past year, I've witnessed some appalling incidents where senior leaders have displaced their own stresses and anxieties onto front line staff. It makes front line staff more anxious and stressed - which increases risks of clinical mistakes - which undermines public trust - which increases pressures on senior leaders: a vicious cycle. We need to find healthier and more sustainable solutions for the future.

Jan Marriott

20/3/2025 10:02:47 am

‘trust the professionals’. It’s also a way of defending ourselves against anxiety' So true Nick.

31/3/2025 12:05:24 pm

Thank you, Jan. Yes, in situations of high anxiety and stress, it can be a way of reassuring ourselves by telling ourselves what we want and need to believe. To believe otherwise would add to the anxiety and stress.