Stephen Twist - NHS insight from a former Governor

16/07/2026

In addition to the Parking Steering Group, today I attended the CDDFT EPR Digital update session on e-outcomes, currently under trial in dermatology. A novel digital upgrade enables clinicians to enter patient discharge information via EPR through a tick-box template which generates follow-up information and arrangements. It is a small step, but very encouraging - especially considering my previous posts and proposals for smarter discharge information.

15/07/2026

Meeting with Will Thompson, Head of Facilities tomorrow (Thursday) as a member of the Car Parking Steering group (clever name) - to review and feedback on recent changes since ANPR cameras were installed at hospitals UHND and DMH. Save for the inevitable complaints about high charges and difficulty in finding a spot, any positive suggestions ahead of the meeting are welcome.

08/07/2026

TEAMS with Hayley Wardle, Chief Finance Officer, looking at the County Durham and Darlington NHS Foundation Trust discretionary capital budget for 2026/7 of £13.75m and how priorities for spending are reached. It is clearly an unenviable balancing act to determine which project is 'ready to go' and whether it can be achieved within the timescale.

28/06/2026

One of the energising elements of attending CDDFT courses is to meet and speak with fellow managers and staff. So it was at the 'NHS Engagement for Managers' event last week, where we looked at leading by example, handling feedback and responses consistently, and generally enabling and engaging our peer workforce.

A few observations about training methods that perhaps may lend themselves to an update?
1. For courses involving managers, is a 'lecture method' necessary? Reading from PowerPoint excludes learning by guided and moderated discussion, especially if the slides are so detailed that content is inaccessible.
2. Does this less-interactive method of learning perpetuate 'management think', forfeiting an opportunity for the organisation to learn from its staff's real-time experiences?
3. With superb AI now being embedded in the NHS, why isn't a preparatory 'AI read' sent to attenders, so that attenders are informed and the attended event may be more interactive?

25/06/2026

Neuro diversity training yesterday with CDDFT. 14 members of staff booked, 4 cancelled - and only 4 of us attended (29% turnout). It follows that just over two thirds of staff who were expected to take part in Trust-funded training, failed to show. When it comes to their appraisal, will they admit that they have avoided the training? Should their line managers know that they failed to attend, and more significantly, failed to notify the trainer?

25/06/2026

Trust's legal costs: £603k
Settlement update, 18 June 2026): £187,833.58
Est. internal/management/backfill costs: £250k–£450k (assumption based on scale of tribunal)
(Note: any costs award against the Trust - likely on the Threshold test - have not been included in this estimate)

➡️ Estimated total cost: ~£1.04m – £1.24m
Using a fully loaded Band 5 nurse cost of ~£38k–£45k p.a.:
➡️ Equivalent to 23–33 nurse‑years of employment

Assumptions made in this calculation:
Internal costs reflect senior management, HR/legal time, and staffing disruption (not publicly reported).
Nurse cost includes salary + on‑costs (NHS employer contributions)

Even on cautious assumptions, this single dispute represents the equivalent of a small ward’s nursing workforce for a year or more—a stark illustration of the opportunity cost of protracted litigation.

In December 2024, as an elected Trust Governor, I asked the Trust about their risk assessment. This was their reply given by the designated non-executive director, still employed by the Trust as a director:
'On the point you make about governance I am afraid I have to disagree with you and I believe this is a management issue that is being dealt with by relevant executive directors in an appropriate manner. I am sighted on this as is the board.'

23/06/2026

Have you tried emailing the NHS? Have you found yourself at the wrong end of silence - a simple request gone unanswered - an observation unacknowledged? If this is your experience I would like to hear about it. Whilst on the topic of responses, rather than your email being ignored, would you prefer an intelligent reply from AI that gives you the information you seek or answers you question?

11/06/2026

In the quiet hours after death, our eyes begins to lose their clarity. The surface that once let light into our world now turns opaque. For a short window—less than a day—that clarity may be preserved. Something extraordinary is still possible: you could pass on the gift of sight that you no longer need.

As Chair/moderator of County Durham and Darlington NHS Foundation Trust's Organ and Tissue Donation Group, on 3 June I attended the Northern Region Spring Collaborative arranged by NHS Blood and Tissue (NHSBT). Did you know that the UK pays about £1,200 per imported cornea from the USA and Spain, whilst (with your post-mortem donation) one of our acute hospitals could probably meet our region's requirements? Check your donation registration now.

27/05/2026

https://www.nature.com/articles/d41586-026-01625-2

Researchers hope to build a facility with thousands of robots capable of performing experiments independently by 2040.

17/05/2026

On 12.05.26 I attended the Environmental Systems Research Institute (ESRA) UK annual conference to learn about the use of ArcGIS (geographic information systems) to resolve multi-dimensional geospacial problems - and its use by health authorities, Police services, Network Rail, the Co-Op and the National Trust. ArcGIS enables real-time assessement of what has happened, what should be happening - and what is actually happening, giving predictive data for planning the next decision.

Register for the Esri UK Annual Conference on 12 May 2026, the UK's largest GIS event. Discover the Power of Location.