Over the past days, I’ve shared a short series of reflections on independence—what it means, and what it requires. Prior to that I wrote about how I came to know Mary Wollstonecraft, a founder of feminism born in the 18^th Century. This piece is a summary of my daily notes from the past 10 days.

My writing was inspired by the work of Mary Wollstonecraft, whose philosophy, despite being over two centuries old, feels strikingly current. Not just in theory, but in how directly it relates to the realities we continue to navigate as women in medicine, and in society more broadly.

A recurring concept is that:

Independence is not what we often think it is.

It is not resilience alone.
It is not confidence alone.
It is not something that can be achieved simply through individual mindset alone.

Instead, independence is about freedom.
And more specifically: the ability to live, think and act without being subject to someone else’s arbitrary power.

Viewing independence within this framework matters.

Because so much of the language we use around women - particularly in medicine - is still focused on the individual. We talk about confidence, assertiveness, resilience. We ask women to adapt, stretch, and endure. Become more confident, assertive, resilient.

But perhaps the more important question is not:
Are women strong enough?

It is:
Are we creating systems, cultures and environments where women are truly free to act?

As my daily reflections unfolded, it became clear that independence does not sit within the individual - it sits within the conditions around us.

Independence requires equality.

Not as an aspiration, but as a lived reality.

Equal pay.
Equal progression.
Equal voice.
Equal standing.

And where these are absent, dependence creeps into the gaps—shaping choices, limiting possibilities, and often going unspoken.

In medicine, this can be subtle.

It can look like holding back a thought in a hierarchical space.
It can feel like needing permission to speak, to lead, to challenge.
It can show up as over-accommodation, or quiet acceptance of norms that don’t quite feel right.

Many of us will recognise that space - the gap between knowing what is right, and feeling able to act on it.

And that gap is not about capability.
It is about power and inequality, and the structures that sustain them.

Another theme that runs through all of this is that independence is not something we achieve alone.

It is something that is built collectively, involving all, women and men.

Through the systems we design.
Through the cultures we tolerate—or choose to challenge.
Through the voices we make space for, and those we do not.

In medicine, we often value endurance. Quiet perseverance. Individual strength.

But independence, in the truest sense, depends on something else entirely:

Connection, community, and the active support of one another.

Who speaks in the room—and who is heard.
Who is seen as credible—and who is not.
Who is considered “ready”—and who has to keep proving it.

These are not neutral processes. They are shaped by culture as much as policy.

And if we are honest, many women continue to navigate systems where readiness is questioned more often, voices are interrupted more frequently, and progression is less straightforward.

Which means that change cannot sit solely with those individuals.
It has to be structural.
And it has to be cultural.

There is also something important to consider about the conditions that enable independence.

Too often, things like flexible working, parental support, financial security, and protected working environments are framed as optional “benefits”.

But they are not.

For many women, they are what make independence, a rewarding career, progression, authentic leadership, possible.

Without them, choice becomes constrained.
And dependence returns, holding back progress, limiting options.

So when we talk about freedom, we are not talking about abstract ideas.

We are talking about the lived realities of working lives.
Of careers shaped or limited by structures.
Of decisions made within the boundaries of what feels possible.

If we only think about this and do not act change will never happen.

These ideas do not need to remain theoretical. Change can happen through small, consistent actions.

When someone speaks up.
When someone creates space for another voice.
When assumptions are questioned.
When behaviours are challenged.
When support is offered.

These are moments that matter.
Collectively, they shape culture.

And culture, over time, shapes what becomes possible.

Across my daily reflections, one theme is consistent:

Independence is not something we achieve alone - and it is not something women need to earn through resilience or endurance.

It is something we build, together.

Through the cultures we all shape.
Through the systems we all question.
Through the ways we all show up - for ourselves and for each other.

In medicine, and in leadership, the environments we create determine whether women are able not only to succeed—but to act freely, speak openly, progress equally and lead authentically.

So perhaps the basis of our activism may be to:

Notice where you feel free—and where you do not.

To notice where the conditions required for freedom are not evident.

And then, where you can, take one small step - whether for yourself, or for someone else - towards creating a more equal, more supportive, and safer space in which women can think, act, progress and lead.

Become “A Force of Nature”.

A person whose energy, charisma, and determination are hard to ignore, deny, or resist. (Oxford English Dictionary)

Create a storm of change together.

We are not meant to do this alone.

Note: I will share a follow-up piece to this to bring this series to a close which will include prompts for reflection and action.

In the past few days I feel like I have come to know a woman who lived in the 18^th Century but whose philosophy and writing delivers a powerful and meaningful message for women today.

How I came to know Mary Wollstonecraft

Earlier this week, the TV was on in the background one evening. The programme was “A History of Britain: Episode 3 Forces of Nature”. My ears pricked up, Simon Sharma had just referenced a woman as “A One Woman Revolution” – I needed to know who this woman was.

The woman was Mary Wollstonecraft, whom I swiftly discovered was widely considered a founding figure of feminism. Born 1759; Died 1797.

Photo by Photos.com on FreeImages

Mary Wollstonecroft was born in 1759. Despite, or perhaps as a consequence of, growing up in a troubled family environment, Mary oversaw her own education, became well-travelled (including visiting France during the French Revolution) and established herself as a writer on human rights and gender equality. She died of sepsis following the birth of her 2^nd child at the age of 38.

Mary Wollstonecraft is famously quoted as saying:

Her greatest work was “A Vindication of the Rights of Woman” published in 1792 in which she described how the educational system of her time deliberately trained women to be frivolous and incapable. She argued that an education system that gave girls the same advantages as boys would benefit the whole of society.

Independence and Freedom

Both independence and freedom are themes which run through Mary Wollstonecraft’s writing. She described how in order for women to achieve freedom they must have the ability to think for themselves and act on their decisions. Both moral and civil independence [1].

Her concept of independence contained with 3 key elements:

1. Equality

Mary Wollstonecraft is said to be the first woman to write on the possibility of equal marriage, equal education and equality for women. Equality in all areas of life:

• Legal rights (property, income, security)

• Involvement with finances

• Social standing and voice

Without equality:

• People can become dependent on others

• Society becomes unjust

Independence is not just an individual mindset, it requires structural equality.

2. Freedom to think and act

Independence has two interlinked components:

• Independence of mind - the ability to think critically and use reason

• Civil independence - the ability to act on those thoughts

If either is missing:

• Women may know what they want but cannot act

• Or they may lack the tools to even consider alternatives

True independence = agency in thought AND action

3. Collective and collaborative freedom

Independence is not about being self-reliant - it is socially created and sustained.

• Society must be organised so that no one is subject to arbitrary power

• Both women and men must co-create laws, norms, and institutions

• Women must have a voice in shaping the systems that govern them

Freedom cannot be given—it must be collectively built and maintained, by women and men, equally, together

Mary Wollstonecraft in the twenty-first century

For many years the writings and ideas of Mary Wollstonecraft were forgotten and buried by the patriarchy however more recently there has been an upsurge of interest in her life story and her philosophy on equality. Below are examples of how her work has come to the forefront in the past 20 years.

Based in Newington Green, where Mary lived and attended church, a grassroots initiative, Mary on the Green, was created by Newington Green Action Group in 2011. Campaigning for a permanent monument to her legacy, their aim to make her life and work more accessible to local people.

And in 2013, on the weekend of International Women’s Day, the community of Newington Green witnessed the surprise appearance of a life-size, spray painted, stencil art work of Mary. Appearing on the side wall of the New Unity Church where she is said to have attended. The responsible anonymous street artist, working under his tag name Stewy, is known to contextually link a subject image to a location – what he calls ‘psychogeography’. The appearance of this ghost like figure provided a focus and spearhead to the local campaign for a permanent monument. [2] [3]

Sharon Rushton, wrote a great piece in the Guardian in Nov 2013 (“Mary Wollstonecraft, feminism, and the nature v nurture debate”) in response to The Great British Bake Off “female tears” comments made by Raymond Blanc [4]. In this article she cites the work of Mary Wollstonecraft as “way ahead of it’s time” and quotes Mary on her belief that women should be viewed as human first:

Alan Coffee, a social and political philosopher, wrote and published (2014) “Freedom as Independence: Mary Wollstonecraft and the Grand Blessing of Life”: a paper exploring 3 key themes of Mary Wollstonecraft’s writing on independence. [1] In summarising how Wollstonecraft articulates independence - having the capability to think for one’s self and being able to act in one’s own right - he concludes that:

“This approach is as relevant now as it was then.”

Finally, in 2020, following a long-running campaign the first ever statue commemorating Mary Wollstonecraft was unveiled in Newington Green, Islington. The statue, by Maggi Hambling, a silvered bronze sculpture of a naked woman emerging from the forms of other women, stands as a monument to “a rebel and a pioneer” in a city where 90% of monuments celebrate men. [5].

What is the relevance of Mary Wollstonecraft today?

What has stood out to me, whilst reading about Mary Wollstonecraft, was just how revolutionary her ideas were for her time. Simon Sharma was absolutely right, she was “A One Woman Revolution”.

The episode of “A history of Britain” which introduced me to Mary Wollstonecraft this week was titled “Forces of Nature”. If Mary Wollstonecraft was here today I believe she would urge us all to become forces of nature in our work for independence and freedom.

A force of nature:

A person whose energy, charisma, and determination are hard to ignore, deny, or resist. (Oxford English Dictionary)

I feel strongly that her blueprint remains unfinished.

We have made progress, that I won’t deny, but the “grand blessing” of independence, she described remains unevenly experienced by women in our modern world.

And this is why her words resonated so strongly with me.

They reminded me that independence is not a personal milestone to be reached through individual endeavour alone. Independence is a systems wide and social condition which is created both inclusively and collectively, together.

My final thought

When considering the words of Mary Wollstonecraft:

“Independence … is the grand blessing of life”

I believe we should think of this not a as statement relating to the current condition for women, but more as a reflection of what we are working towards. We are not there yet. Wollstonecraft’s blueprint has not yet been fully met.

And I am reminded that the work of creating real freedom, for women, and for all of us, continues.

The question we are left with is not whether individuals are ready to be independent - but whether the systems around them are ready to let them be.

1. https://www.jstor.org/stable/24542111

2. https://islingtonnow.co.uk/newington-green-graffiti-celebrates-wollstonecraft/

3. https://artcollection.dcms.gov.uk/artwork/18701/

4. https://www.theguardian.com/science/the-h-word/2013/nov/12/mary-wollstonecraft-gbbo-feminism-nature-nurture

5. https://www.bbc.co.uk/news/uk-england-london-54886813

The meeting

Dr A is a foundation doctor. She is reaching the end of her post, during which she worked hard to complete a quality improvement project (QIP). She’s been invited to present her QIP during the departmental meeting, at which her peers and the whole team will be present. You join the meeting just as Dr A is due to present.

Dr A is introduced by the Consultant chairing the meeting (Dr B), who enthusiastically refers to her as “The beautiful Dr A!”. Dr A gives a nervous laugh and looks very uncomfortable. She regains composure and goes ahead, presenting her work expertly and fielding questions from the team.

As Dr A draws the questions to a close, Dr B declares, “See, she is as clever as she is attractive!”

Again, Dr A looks uncomfortable, quickly sits down and makes an unusually hasty exit when the meeting ends.

Scenarios similar to this, in which inappropriate comments or behaviour cause an individual to feel uncomfortable, potentially unsafe, and almost certainly singled out, are not uncommon. Many of us will have witnessed similar scenarios in our working lives.

Many of us have our own stories to tell

I’ve written, and posted here on Substack, two personal stories of my own experiences of inappropriate behaviour. One in the context of a power imbalance (The Fabergé Egg Moment) and another of gender inequality and poor behaviour playing out in an interview scenario (Do You Like Shopping at Harvey Nichols?). These are not one-off or isolated incidents.

The national picture – what does the NHS Staff Survey tell us about how often NHS staff experience unwanted behaviours?

The NHS Staff Survey is one of the largest workforce surveys in the world and asks questions about the experiences of NHS staff working in their organisations. In 2025, 766,285 staff returned their survey responses, which equates to a 49% response rate, with the majority of responses from acute or community trusts.

Within the domain “We are safe and healthy”, 17% of staff experienced at least one incident of harassment, bullying or abuse from other colleagues in the past 12 months, and 3.51% had been the target of unwanted behaviour of a sexual nature in the workplace in the past 12 months, with this figure rising to 7.79% for medical and dental staff.

In “The Team Meeting” scenario you are placed directly into the meeting as a bystander. You could be another foundation doctor, a friend or peer of Dr A. You could be a member of nursing staff, working alongside both Dr A and Dr B in the clinical setting. Or you could be a fellow Consultant and peer of Dr B.

How do you think Dr A felt during the meeting? How did you feel when these comments were made? What would you do?

Do you have a responsibility to do something?

What is an Active Bystander?

An active bystander is usually described as “someone who witnesses a problematic, inappropriate, or potentially harmful situation and chooses to step in to help, challenge the behaviour, or de-escalate the event, rather than remaining a passive observer”. The term active bystander describes the person; “active bystander” is a noun. It is the name given to a person in that circumstance.

What is Active Bystandership?

By adding the suffix “-ship” to a word, this adds additional meaning, e.g. the position, qualities and skills of being an active bystander.

“Active bystandership is simply the power of third parties, through their action, to reduce harm.” Graham Goulden, lead trainer with the US Active Bystander in Law Enforcement (ABLE) Programme

Goulden describes how some view the term “Active Bystander” as an oxymoron - the pairing of the term “bystander” (a person in a neutral or indifferent state, who is not actively involved) with “active”. He describes how the passivity within the term can lead to feelings of shame, as there is no acknowledgement of the real and often complex difficulties of speaking up. Goulden states that, on the contrary, active bystandership is not passive and that it involves decision-making, taking responsibility and becoming an agent of change.

In order to enact active bystandership there is a requirement of an individual, firstly, to have an awareness of what behaviour is or isn’t appropriate, to be able to question and think about what is happening, how individuals are feeling and why they are behaving that way, and to then make a decision about how to intervene or offer support. This process of observation, thinking, decision-making and moral judgement is encompassed within the term “Active Bystandership”.

Goulden reminds us that:
“The dictionary portrays bystanders as people who ‘do not take part’ — as if they’re merely observers without power. But everyone who witnesses a situation has agency. They have two choices: do nothing or do something.”

Why is Active Bystandership important?

It is well recognised that by intervening and reinforcing that certain behaviours will not be tolerated, it is possible to shift the cultural dial away from unwanted behaviours and towards respectful and compassionate teamship. Intervention can also lead to prevention of escalation of harmful behaviours.

And there are consequences of remaining silent or doing nothing.

How to be an Active Bystander

Active bystandership is a key skill that can be both taught and learnt. It is something that doesn’t always feel natural to many people. Whilst you may recognise poor behaviour, making the decision to take action can be hard. For this reason, I am sharing a useful resource/infographic and some helpful tips. By familiarising yourself with available strategies and rehearsing responses, it can become easier to intervene when needed.

The ABC approach for initial assessment of the situation

Firstly, I recommend this helpful ABC acronym from the University of Cambridge “Breaking the Silence” campaign:

• Assess for safety: If you see someone in trouble, ask yourself if you can help safely in any way. Remember, your personal safety is a priority — never put yourself at risk.

• Be in a group: It’s safer to call out behaviour or intervene in a group. If this is not an option, report it to others who can act.

• Care for the victim: Talk to the person who you think may need help. Ask them if they are OK.

Having established it is safe to intervene, as a witness to “The Team Meeting” scenario, what then are the approaches you could take? Below, the “Four D’s” infographic covers how you can respond either in the moment or afterwards, either alone or with others, and any of these approaches may be appropriate.

The Four D’s

The infographic below gives some helpful tips on strategies for active bystandership.

Note: A fifth “D” is often suggested — “Document”. Make a contemporaneous record of what you saw and what you did. Keep to the facts. It is recommended that you share this document with the person targeted, allow them to decide what they wish to do with the record, and maintain their confidence.

The perceived challenges of Active Bystandership

Returning to Graham Goulden’s writing - he describes how active bystandership comfortably covers the range of bystander acts alluded to in the infographic above: delaying action (if too unsafe to intervene), distracting or delegating/helping indirectly, and direct action.

He reassures us that active bystandership does not require heroics or confrontation, and that sometimes indirect interventions are the shrewdest. He describes how people “overestimate how dramatic intervention needs to be and underestimate how ordinary, human-scale it often is”, and that this can lead to hesitancy in intervening.

The risk of comeback or consequence can weigh more heavily than the benefits of “doing the right thing”, but ultimately we need to keep circling back to the fact that by leaving poor behaviours unchallenged - by ignoring them - we are reinforcing them.

To return to “The Team Meeting” and what you would do

There is no “right” or “wrong” strategy, and your decision-making will depend on multiple variables. However, if you believe in the value and importance of active bystandership, then the following final tips will help you find the right response for the scenario — right response for both Dr A and you.

• If you have any doubt about a situation, check in on Dr A and ask her how she is feeling.

• Ensure that Dr A’s safety is the priority.

• Give control to Dr A; listen (without judgement) and maintain confidentiality.

• Use the strategy which feels safest for both yourself and Dr A — remember direct, in-the-moment action is not always required; indirect action can be as effective.

• Rehearse the phrases you feel most comfortable using - if you have rehearsed a phrase, it is often easier to use when you need to.

• Consider delegation or collective action - did a group of you witness the same behaviour, did you all feel uncomfortable, and can you take action together?

• Remain compassionate, both to Dr A and yourself.

• Know how to signpost Dr A to local support, policies and escalation processes, should she need them.

Remember that active bystandership can be applied to any scenarios, be they inappropriate gendered behaviour, sexual harassment, racism, ageism, ableism, bullying or discrimination, harassment or harmful behaviour of any sort.

The most important thing to remember is that active bystandership rarely feels straightforward. There is often uncertainty, discomfort, and “back of the mind” considerations about possible consequences. We won’t get it right every time but culture can only be changed by the decisions we make in these moments. Small actions matter as does our willingness to act. Collectively we can contribute to creating a workplace culture in which staff feel seen, safe to thrive and respected.

https://www.nhsstaffsurveys.com/results/national-results/
https://grahamgoulden.com/2025/10/06/why-getting-the-terminology-matters/
https://www.breakingthesilence.cam.ac.uk/prevention-support/be-active-bystander

Note: The scenario described in this article is fictional. If you witness or experience unwanted behaviour, please seek support from a trusted colleague, peer or friend. Refer to Trust/local reporting platforms, Trust/local policies and local/national charitable organisations for support and guidance. If in immediate danger, call the Trust security team and/or the police.

I left DEMEC* 2025 my mind buzzing with thoughts of leadership, humanity and the challenges of practising and leading in an increasingly AI‑enabled world. A powerful and thought‑provoking plenary delivered by Professor Jamiu O. Busari had left me profoundly moved. Prof. Busari’s exploration of rhetoric, emotional intelligence and what it means to remain deeply human in the face of disruptive technology stayed with me long after the conference and was a key driver for me undertaking an “Empathy for Educators in Healthcare” course.

What did I hear which struck so deeply?

Rhetoric and Meaningful Communication

Professor Busari spoke about rhetoric as more than persuasion, describing it as grounded in credibility, trustworthiness, authority, tone and style. He framed this discussion of rhetoric through four key concepts:

• Ethos – the speaker, their credibility and character

• Pathos – how we create connection, including empathy and sharing of stories

• Logos – reasoning and evidence within our communication

• Kairos – the context of the conversation, timing of the moment of communication

Together, these elements shape not only how messages are delivered, but how they are experienced and understood.

Leadership, Humanity and Technology

Humans need connection, empathy and trust. In the face of AI and disruptive technology, profound leadership is required. Professor Busari described our mission as developing “smart minds and warm hearts.”

He spoke about the importance of remaining:

• Emotionally centred

• Patient centred

• AI empowered

• Technologically fluent

The Reality of Lived Experience

The reality of many lives today includes cognitive overload, a high risk of burnout, and patient expectations that are both high and variable, alongside differing levels of readiness for AI.

• Being smart means thinking critically and using AI intelligently

• Being warm requires empathy and emotional intelligence

Our leadership style should therefore include personal humility alongside professional will. We need to embrace the five elements of emotional intelligence to navigate this complexity.

• Self-awareness

• Self-regulation

• Empathy

• Motivation

• Social skills

AI will never be able to provide pathos — the emotional impact that comes from genuine human connection.

Instead, there is a risk that AI contributes to information overload, emotional strain, increased complexity and pressure.

Remaining Deeply Human in an AI World

A key question posed was: How can we remain deeply human when using AI?

Suggested responses included:

• Redefining purpose

• Developing critical consciousness

• Encouraging critical dialogue and understanding

• Exploring algorithmic empathy

• Acknowledging uncertainty

• Developing human–machine decision-making

• Reinvesting time into human connection

• Leading with warmth and kindness

Human Leadership in an AI World

In a human–AI world, kindness and empathic purpose matter. There must be connection between new and old ways of working, supported by critical appraisal and dialogue. Smarter minds are effective. Warm hearts are meaningful and attune us with our communities.

In a rapidly evolving technological landscape how will you nurture and protect the empathic purpose of your connections with the people you provide care for?

*DEMEC stands for the Developing Excellence in Medical Education Conference

Attribution statement

This piece is a reflective synthesis inspired by a plenary delivered by Professor Jamiu O. Busari at the Developing Excellence in Medical Education Conference (DEMEC) 2025. The reflections above draw on notes taken during the session and are offered as personal interpretation rather than a verbatim record of the talk. AI was used as a tool to support organisation of my hand written notes. No additional content was added by AI. Content is derived from my notes or text added by myself.

A week ago I posted an article “SuppoRTT - a vital programme for resident doctors returning from a break in training #1”. I shared a story of how difficult returning to work after a break can feel and how the SuppoRTT programme can be implemented to improve the experience of resident doctors. The structured steps involved in SuppoRTT were outlined in the article.

Application of this process can make a real difference. Dr Roisin writes commented on SuppoRTT with the following words:

“I’ve just made full use of SuppoRTT after returning from my second maternity leave. It was great - a pre-return return to training day covering well being, deanery contacts, working LTFT and SIM, followed by 3 weeks of enhanced shadowing before I started on the rota proper. Still feels wobbly getting back in the swing of Paeds reg-ing but so much better than it could have been.”

In this follow-up article I am sharing 3 checklists which can be used by resident doctors and supervisors to aid supportive and meaningful discussions when planning a return to training:

1. Mi-PREPS Checklist - a general checklist for a return to training conversation

2. SpiRiT Checklist - a speciality focused checklist to aid conversation focused on speciality knowledge and skills

3. My pre-return checklist - a personal checklist for resident doctors to use to support personal planning for their return to training. A place to note key actions which they feel they need to keep track of or complete.

Note: Please refer to your local SuppoRTT guidance for detailed information, policies, available courses, key contacts, and the appropriate point of contact for any queries.

To close

Responsibility to ensure the SuppoRTT process is applied within a Trust is shared by both the resident doctor and supervisor and so awareness of the process is vital as well as ensuring the process is implemented equitably across organisations. Engagement, by resident doctors, with SuppoRTT is an expectation, as is facilitating SuppoRTT by supervisors.

In my experience as a SuppoRTT champion the one single most important intervention is usually the pre-return meeting at which point there is discussion and agreement of a structured yet compassionate return plan. I hope these checklists are helpful in enabling these supportive conversations. If we want to retain a healthy and diverse workforce SuppoRTT is essential.

Link to NHSE SuppoRTT information: https://www.hee.nhs.uk/our-work/supporting-doctors-returning-training-after-time-out

My return to training experience – 2003

In 2003 I returned to work, as a medical registrar, after a 9 month period of maternity leave. At the time I had 2 young children, a 9 month old and a 2.5 year old toddler. I was peak “baby brain” and sleep was a distant luxury.

Re-adjusting back to work was a struggle, within a 24 hour period I was expected to flip straight back into “Med Reg” mode with no updates, re-orientation or induction back to the workplace. I was no exception, this was the norm.

I was hanging on to being able to cope at work, and manage at home, by a fragile thread. Exhaustion, anxiety, lack of confidence, guilt feelings about returning to work, pressure to “just get on with it” all weighed heavily. Those days and weeks following my return felt like a lonely place.

I considered leaving clinical medicine, I applied for a 9-5 role with a private company that ran commercial pharmaceutical trials. I was invited to an informal meeting with a senior manager from the institute. His manner was far too familiar which raised a serious red flag based on previous experiences. I politely withdrew from the application process and decided to stick with the “Med Reg” job - better the devil you know - the desolate fatique and busy out of hours duties feeling like the better option at the time.

Burn out wasn’t a term used in 2003 but I suspect that I would have met the criteria - a state of physical, mental and emotional exhaustion. I remember being so tired that I would try very hard to arrive in clinic half an hour before my list started so that I could sit quietly, eat my lunch in peace and then rest (often on the examination couch) for a few minutes before the clinic started. I don’t remember being asked how I was feeling. Or feeling that it would be OK to share how I was feeling with my colleagues.

However, someone must have noticed the signs of strain because a meeting was arranged for me to have a “chat” with a kind female senior educator. I don’t recall who arranged the meeting, being told why the meeting had been arranged, what we discussed or what the outcome was.

All I can remember is breaking down in tears, feeling broken and shattered by my return to training experience. Things improved from there, primarily I feel as a result of being given the opportunity to talk to someone who understood something of what I was feeling. I wasn’t alone.

I’ve had 3 children and 3 experiences of returning back to work with no structured process of support. This history has driven my ambition to try and improve experiences of those following me. In 2019 I was delighted to be appointed as the Trust’s first SuppoRTT champion, a role funded by the national roll-out of the NHSE SuppoRTT programme.

Over the past seven years, I’ve had the privilege of supporting many doctors as they navigated their return to training. It’s a period that can feel daunting and stressful - stepping back into clinical work after time away can present new challenges, uncertainties, and there is a need for structured approach to navigating the transition.

That’s where SuppoRTT fits in.

What is SuppoRTT?

SuppoRTT is a nationally funded return‑to‑training programme for resident doctors who have had a break from training for more than three months. The programme was introduced by in 2017. Although the specific acronym SuppoRTT (Supported Return to Training) was created by Health Education England, equivalent support is available across all four nations. The resources I’m sharing are based on my experience as a SuppoRTT Champion in an NHS Acute Trust in England.

What are the aims of SuppoRTT?

To provide a structured, safe and supported return to training for any doctor in training, regardless of the reason for their break, including:

• Parental leave

• Out of Programme (OOPR, OOPC, OOPP, OOPT, OOPE)

• Sick leave or phased return

The programme aims to ensure returning doctors are clinically competent and fully supported, with access to structured planning, enhanced supervision, and any additional courses or support they may need. I often explain that SuppoRTT is fundamental in terms of both patient safety and resident doctor health and well-being.

Who is eligible?

Any doctor in a training programme who has had a break of more than three months is eligible. This may also include doctors joining a training programme directly after a break of the same duration.

What is provided within SuppoRTT?

Whilst details will vary across regions, the key elements of SuppoRTT include:

• A structured process of 3 scheduled meetings between resident doctor and supervisor to discuss and agree a bespoke return plan

• 10 days period of enhanced supervision on return to training

• Refresher courses/SIM training/workshops

• Access to coaching/mentoring

• Access to a Trust or School SuppoRTT champion

• Training for educators on the SuppoRTT process

SuppoRTTed Return to Training Resource #1

This resource is designed to guide you through the SuppoRTT process in a simplified, easy‑to‑follow way. It highlights key meetings and important points to consider. It can be used alongside local Trust or regional NHSE guidance.

Note: Please refer to your local guidance for detailed information, policies, available courses, key contacts, and the appropriate point of contact for any queries.

What about returners who are not doctors in training?

Whilst SuppoRTT is a programme specifically funded for doctors in training, the principles of supportive conversations, planning and enhanced supervision can be extrapolated to returners in other roles or professions. Trust HR policies will vary but most will include a return to work meeting following sickness absence or maternity leave.

To close

Responsibility to ensure the SuppoRTT process is applied within a Trust is shared by both the resident doctor and supervisor and so awareness of the process is vital as well as ensuring the process is implemented equitably across organisations. Engagement, by resident doctors, with SuppoRTT is an expectation, as is facilitating SuppoRTT by supervisors. If we want to retain a healthy and diverse workforce SuppoRTT is essential.

In my next article (A Simple Guide to the SuppoRTT pathway #2) I will share two further resources which aim to promote supportive conversations between educators and returning doctors and a final checklist designed with the returning doctor in mind. #SuppoRTT

Link to NHSE SuppoRTT information: https://www.hee.nhs.uk/our-work/supporting-doctors-returning-training-after-time-out

Last weekend I saw EPiC (Elvis Presley in Concert), directed by Baz Luhrmann the film uses never-seen-before archive footage to narrate Elvis’ early life/career story, particulary leading up to his 1970’s residencies in Las Vegas. Described by critics as a “truly epic concert documentary (which) restores some joy into “The King’s” legacy”, “gets closer to the pop enigma” and “manages to feel profoundly intimate” I was looking forward to what these “close-up” glimpses of “The King” may reveal.

I was 9 yrs old when Elvis died. Something about him or his music must have made an impact on me because I clearly remember feeling a little heart broken at the time. I kept the Sunday Times supplement which was dedicated to his memory, titled: “The King is Dead”. It was a precious item to me. I am fairly sure I still have the copy in a box in my loft. My fervour has diminished and nowadays I wouldn’t class myself as an Elvis fan, but nostalgia piqued my interest and I did know someone for whom the memories would be strong and who would definitely enjoy the film.

And so I invited my dad on a cinema trip to see EPiC, he was an original, genuine, Elvis fan. He tells a story of how as a young man he stayed up all night with his late best friend listening to Elvis albums and sharing six bottles of “Double Diamond” beer. Those days are long gone but the story and image it conjures gives a tiny glimpse of who they both were and what was important to them in the heady days of their youth – companionship, music (Elvis’ music) and beer!

Empathy and Compassion

I want to pause here to talk about both empathy and compassion. I hope, if you continue to read to the end, you will see how this all links with my cinema trip.

The Cambridge dictionary definition of empathy is “the ability to share someone else’s feelings or experiences by imagining what it would be like to be in that person’s situation”. There is a growing evidence base for the clinical benefits of delivering empathic healthcare. Compassion and active listening are key features required of effective empathic care.

Compassion is a strong feeling of sympathy and sadness for the suffering of others and a desire to help them.

Empathy and compassion are often discussed together, they are closely related. The reason being that it is imperative we are able to understand and resonate with someone’s situation, history or emotional state before we can proactively deploy compassion. Compassion, meaning an active emotional response which drives a desire and action to help someone, to lift the burden of their suffering and relieve distress.

Recently The In-between Doctor posted an article which, by sharing stories, perfectly spotlighted the need for empathy and its application whatever the background, history, problem the patient presents to us – the real case stories calling on us to use empathy to drive compassionate care.

Where is this going? What is the relevance of a trip to the cinema, Elvis, a story of 2 young men enjoying music and beer together and The In-between Doctor’s article?

Men with Broken Hearts - the monologue

The stand-out moment of the film EPiC for me was set on stage, in Las Vegas, Elvis in full stage costume, sweating, pausing within his performance, holding the screaming audience in silence as he read off a single, slightly crumpled, sheet of paper, the following words:

“You never stood in that man’s shoes or saw things through his eyes or stood and watched with helpless hands while the heart inside you dies. So help your brother along the way, no matter where he starts for the same God that made you, made him too, these men with broken hearts”

The words were taken from the song “Men with Broken Hearts” (written by Hank Williams in 1950), the lyrics strongly urging for humility and grace.

“You have no right to be the judge
To criticize and condemn
Just think but for the grace of God
It would be you instead of him
One careless step or a thoughtless deed
And then the misery starts..
These men with broken hearts”

The spoken lyrics were delivered like a soulful preacher, Elvis then followed with:

Walk a mile in my shoes - the song

Seamlessly switching into singing a cover of “Walk a mile in my shoes” (by Joe South (1970)) this song was the perfect follow on to the monologue, with the opening lyrics holding the same heartfelt message:

“If I could be you, if you could be me
For just one hour
If we could find a way
To get inside each other’s mind

If you could see you through my eyes
Instead of your ego
I believe you’d be
Surprised to see
That you’ve been blind

Walk a mile in my shoes
Walk a mile in my shoes
And before you abuse, criticize and accuse
Walk a mile in my shoes”

My research into this song revealed that the same truth appears, decades earlier, in Mary T. Lathrap’s poem “Judge Softly” (1895) a poem which references narratives of Native American tribes and is said to be the inspiration for Joe South’s “Walk a mile in my shoes”. Key phrases from the poem:

Judge Softly - the poem

“Pray, don’t find fault with the man that limps,
Or stumbles along the road.
Unless you have worn the moccasins he wears,
Or stumbled beneath the same load.

Just walk a mile in his moccasins
Before you abuse, criticize and accuse.
If just for one hour, you could find a way
To see through his eyes, instead of your own muse.

Take the time to walk a mile in his moccasins.”

Bringing it back to present day

As I sat in the darkened cinema, what struck me deeply, was how those lyrics, spoken and sung many years ago conveyed a message of compassion, kindness, empathy and understanding, which is equally relevant today: the need to apply empathy over judgement, a plea for compassion and understanding. These are not new concepts.

And if we can practice with empathy, we will understand our patients better and be able to treat them better. I wonder, the next time my Dad is admitted to hospital, will anyone ask him about what has been important to him throughout his life, listen to a story or two about who he was before he became a patient, understand what is important to him and which memories and pastimes sustain him. Will they see the person, try to see things through his eyes and imagine walking a mile in his shoes (or slippers).

Because if they do, if they dig deep enough they may hear a story about two young men, staying up all night, listening to Elvis and sharing six bottles of “Double Diamond”.

“The King” may be dead, but the message Elvis delivered - of empathy before judgement - is one healthcare, and society, should never forget.

Three months after publishing my first article on Substack, I reached a point that felt like a milestone. I have to admit – when I created my Substack I had no plan. A quarter of a year has passed – I wondered if there were common themes emerging, habits forming, what connections I had made and whether looking back may help me moving forward.

I wanted to pause and reflect on the journey so far. Not in a data driven analysis, but more an old-school reflective exercise: what have I been doing, why did I start, what am I learning, and what might I do differently? I hoped that stepping back, looking at themes and reflecting, might help to connect my “Substack experience” to learning and perhaps offer a sense of direction for what comes next. I’ve been conscious of feeling unsure of my niche and perhaps something in me hoped this exercise may reveal my USP or conversely open my mind to the idea that liberty in writing without a niche may actually free me from any writing anxiety.

Using AI as a Reflective Tool

As part of that reflection, I decided to explore the use AI to support the process. Much discussion is had on the utility of AI (and I’m not discussing this here). In this exercise I asked AI to look across what I had already written. I asked for a thematic analysis of my articles, posts, and restacks — patterns, recurring ideas, stand out lines, and closing reflections.

The analysis didn’t tell me what I should be writing or how to write. It gave a summary of what I had been writing.

What came back startled me.

“I don’t see a single argument being made.”

There was no cushioning here – no balancing praise. AI had clearly not had the training on using “the sandwich” technique to deliver feedback. It felt blunt, even critical. I had read so many Substack pieces that carefully constructed, robustly defended, and confidently declared an argument. Had I really spent three months writing without making a single argument? Had I missed the mark entirely? Was I failing by not stepping forward with evidence and conviction?

Then came the second line.

“I see a conversation unfolding.”

I started to feel more positive, a more promising follow-up to the negative feedback. An “open sandwich”.

Writing as Conversation

I had to think what actually is a conversation?

It’s an exchange of thoughts, feelings, ideas, observations, and opinions. It has a relational element rather than being purely factually analytical. I am at home with conversation, and so I felt this was a fair and reassuring summation.

Looking back, I can see that my writing does circle around familiar themes for conversation: the experiences of women in healthcare, gender equality, belonging and community, authenticity, and moments of everyday joy. The AI analysis grouped these into five overarching areas.

Theme One: Thriving, Not Surviving

The first was thriving, not surviving. This mirrors my recent series of notes, Women Thriving, Not Surviving in Healthcare, and so was not unexpected. I aim to mirror my personal views in my writing particularly the view that survival should not be the benchmark for women in medicine. Resilience alone is not the answer; creating conditions that allow people to thrive should be the goal.

The analysis noted that my writing is “not written with anger, but with steadiness – and that matters”. I recognise that. Creating respectful, safe spaces does not mean avoiding reality. Respect and difficult conversations can co-exist. Creating spaces in which people feel able to speak up whatever the topic they wish to raise is a behaviour I hope I intentionally model and support.

Theme Two: Belonging as Personal and Political

The second theme was belonging. I write about belonging as both a personal necessity and a political act. We all need to feel we belong. It becomes political when we actively challenge exclusion and negotiate inclusion, with the aim of creating equality and a sense of being “at home” within a community or system.

I feel this is evident in my writing about gender bias in recruitment, equal pay in the NHS, and in my affirmations of other women’s voices through restacks and notes. It is also evident in challenging myths – such as the idea that women do not belong in health tech – by drawing on lived experience to highlight the value of skills like empathy, systems thinking, and change management.

Theme Three: Learning From Women Who Came Before Us, For the Next Generation

A third theme focused on learning from women who came before us. When I wrote about this, in the Women Thriving, Not Surviving series, I wanted to emphasise that history and shared memory are not theoretical concepts; they are practical guides. The suffragettes, for example, are not distant icons but examples of women who organised, collaborated, and persisted together. Their message – “Always and always facing towards the light” – feels less like a slogan and more like a compass, something that can be passed from one generation to the next.

The analysis noted my interest in reciprocal learning: learning from each other. That “observation” takes me back to one of the reasons I started a Substack in the first place – to create a vehicle to inspire, motivate, educate and connect. To share but also to gain and grow.

Theme Four: Accumulated Impact and the Long View

The fourth theme was accumulated impact and the long view of a career. My writing may touch on stages of our careers, particularly transitions and the idea that careers are not linear. I write about the accumulation of skills, insight, and confidence that are gathered along the way – embracing each career stage as a season with its own lessons.

AI analysis suggested that this aspect of my writing was particularly aimed at mid-career women. I’m not sure I agree. I would like my writing to reach a wider audience, particularly early career doctors, perhaps as a kind of “letter to my younger self”. I’d also like my writing to inspire allies and I hope there is/will be content which is relatable to both women and men. However, I suspect that I cannot entirely disguise the fact that I am a late-career woman. My perspective, and in turn my writing, inevitably may reflect that.

This raises an unresolved question for me:

If I remain fully authentic, do I naturally speak most to those closer to my own stage of life/career?
Can I write with authenticity and connect to a wider audience than mid‑career women?

What resonated strongly with me was the observation: “that there is reassurance in the writing, rather than urgency. A sense that nothing has been wasted.”

Theme Five: Creating Spaces, Not Just Critiquing Systems

The final theme focused on “creating spaces, not just critiquing systems”. This was described as one of the most distinctive features of my Substack: the fact that “alongside the writing sits practice.”

My work with women’s networks, gender equality and sexual safety groups, and as a SuppoRTT champion allows me to listen to lived experience, engage in data driven conversations, and write from a place grounded in practice as well as personal experience. Through the Leicester Women in Medicine network I am involved in building opportunities for connection, support, and growth, and my writing aims to share ideas and model conversations which arise from these real-life practices.

Slowness, Steadiness, and Success

In conclusion the AI analysis stated:

“It is slow, relational, day to day work.”

That description does not offend me. I have written before about being a “slow processor”, about deliberative thinking as a strength. I am content to work towards cultural change gradually – day by day, month by month, year by year.

Perhaps the line that stayed with me most (and I admit, I was most happy with!) was:

“The Substack reads less like a platform and more like a room you’ve intentionally arranged, where people are invited to sit down and exhale.”

Ignoring the critics who will say the AI platform has learnt how to “intuitively” respond to my questions – if my writing does offer someone a pause, a moment to sink into a comfortable chair and reflect, then I would consider that meaningful success. As I wrote elsewhere: Success is alignment – between who you are and what matters to you. Let your definition of success grow and evolve with you.

So, What Have I Learned?

In Substack I have found a place to curate ideas, opinions, stories, experiences, and observations – and in doing so, to begin conversations with people I would never otherwise have met. I have really enjoyed and valued this. Writing on Substack can contribute to changing culture and to the politics of belonging: challenging power structures, naming inequity, and creating connection and community. This I find rewarding and I feel there is purpose.

I also learned that AI describes my writing voice as quiet. I deliberately omitted the “q” word from the quotes included in this article – in doing so I felt this was a quiet act of activism. Because, whilst I may be a quiet person, and my writing may be quiet, the conversations themselves need to be heard clearly and loudly.

As Lucy Knight, features writer at The Guardian, said:

“Why should women shrink and shut up?”

To finish – the closing lines of the analysis:

“If there is a single message running through it all, it might be this:
The way you want to work – and live – matters.”

The way you want to work – and live – matters.

Note: this article does not aim to either support or dismiss the use of AI. We will all engage with AI to different degrees in our lives. I was curious to use AI to create the thematic analysis and it has helped me to think about my writing and experience of Substack since joining in January. All content from the analysis is highlighted in bold.

Introduction

Over the past two weeks, I’ve posted a series of bite‑size reflections gathered from the LLR Women’s Leadership Conference held on 10 March - insight drawn from conversations, collective wisdom, and the lived experiences of women from many areas of healthcare.

This article brings those notes together in one place. It is a tapestry of shared experiences: the challenges, the moments of courage, the communities that strengthen us and thoughtful suggestions. The starting point for the daily notes series was one of looking forward and focusing on positive intentional actions we, as women in healthcare, can consider or our allies can support and get behind. Not every note will resonate with everyone, some notes may strike a chord, some may not feel relevant. However, my hope is that everyone can find something in this collection of notes that resonates with your experience, brings clarity or comfort, or simply reminds you that you are not alone and that your needs matter.

Women in healthcare deserve to thrive.

What follows are 15 daily reflective notes to supplement your professional growth.

Thriving, Not Surviving

Many of us reach a moment in our careers when we realise we’ve spent too long simply getting through the day. Surviving becomes the default.

But we deserve more than endurance.

Thriving begins with a simple truth: how we feel matters profoundly.
When women feel seen, valued and safe, culture shifts — one interaction at a time. Thriving also requires self‑kindness and curiosity:
What helps me thrive? What small change can I make today to create space for it?

The Quiet Power of Accumulated Impact

Every role you’ve taken — the chosen ones, the unexpected ones, the ones you grew into — has shaped your leadership.

Impact builds slowly and quietly through stretch, curiosity and courage.
You don’t need a title to have influence. You already have it.

Pause and notice the skills, experiences and insights you’ve gained so far. Then ask:
What experience might come next?
Every step adds to your bank of accumulated impact.

Opening Doors

Some people open doors.
Some hold them open.
Some walk through with confidence.
Some build whole hallways just so others feel safe to approach.
And yes, some close doors.

Leadership is not about guarding thresholds. It is about creating possibility.
A quiet encouragement, a timely “I believe in you,” a moment of sponsorship — these small gestures open doors.

Who could you open a door for today?

Finding Your Professional Tribe

Healthcare can feel deeply isolating — especially for women navigating leadership, the juggle of caring responsibilities, or transitional seasons.

Your tribe — those who lift you, champion you, and understand your reality — is essential.

Belonging fuels resilience.
Connection is a form of care.

Reach out to someone who feels like part of your circle. None of us is meant to do this alone.

Reclaiming “Give to Gain”

The phrase “give to gain” can feel uncomfortable for women who already give so much.

So let’s reframe it.

Giving can be:

• encouragement

• mentorship

• sponsorship

• wisdom

• honest conversations

• opening opportunities

And the “gain” might be collective or individual: confidence, clarity, courage, momentum.

And sometimes the person you most need to give to… is yourself.

Lifting Women in Real, Practical Ways

Lifting women isn’t theoretical — it’s tangible and everyday.

It looks like:

• sharing our realities honestly

• centring women’s health: menopause, perimenopause, maternity return, fertility

• giving credit freely and carrying responsibility generously

• acknowledging the juggle

• recognising that “having it all” doesn’t mean doing it all at once

Support doesn’t need perfection. It needs presence.

Boundaries as Courage

Boundaries are wisdom — not withdrawal.

For many women in healthcare, boundaries feel like a push against pressure, expectations or culture. But they are essential for sustainability.

Wisdom might look like:

• leaving on time

• letting go of perfectionism

• having “good enough” days

• allowing a ball to drop without self‑criticism

• releasing the pressure of presenteeism

What boundary do you need to honour in the week ahead?

A Note to Your Younger Self

If you could sit with your younger self, what would you tell her?

Women shared:

• “It’s okay to get things wrong.”

• “You don’t need to carry this alone.”

• “You are allowed to take up space.”

• “You don’t have to worry so much.”

• “Allow yourself to drop a ball.”

What sentence would you choose — and what might shift if you lived by it now?

For Women Without Children

Discussions about women in leadership often centre around motherhood, but this can unintentionally exclude or overlook women without children.

A few important reminders:

• Your challenges are valid.

• You owe no explanations.

• Your priorities are legitimate.

• Respect is non-negotiable.

• All paths deserve dignity — chosen or unchosen.

Every woman carries a story. Every story matters.

Redefining Success on Your Own Terms

Success isn’t linear and it isn’t defined by job titles.
Success is alignment — between who you are and what matters to you.

It can include:

• purpose

• fulfilment

• values-led decisions

• flexibility

• the courage to change

• long-term sustainability

Let your definition of success grow and evolve with you.

Supporting All Women with Intention

Support cannot be passive — especially for under‑represented groups of women in healthcare.

Meaningful support includes:

• calling out inequity

• diverse voices in decision-making

• reverse mentorship

• deep listening

• purposeful opportunities

• moving beyond tokenism

Solidarity requires intention, not assumption.

Learning from the Women Who Came Before Us

The women who fought for our rights were relentless, hopeful and courageous.

The Leicester Suffragettes’ motto continues to resonate:
“Always and always face toward the light.”

We honour their legacy when we use our voice, our courage, and our leadership to create space for others.

Progress happens when we move — together.

Women Belong in Healthtech

The myth persists that women don’t “fit” in tech. But the skills that matter most — empathy, curiosity, problem‑solving, collaboration — are strengths many women bring naturally.

These are leadership skills.
If healthtech sparks curiosity in you, trust that instinct. There is space for you there.

Creating Safe Spaces for Women to Grow

Safe spaces don’t appear by chance. They are created with intention.

They enable women to:

• ask questions

• make mistakes

• voice ambition

• build trust

• take risks

• grow with support

Safety is the soil from which confidence grows.

What one small action could you take to create that safety for someone else?

One Intentional Action

If you take just one thing from this series, let it be this:
Choose one intentional action today.

It might be:

• sponsoring or mentoring another woman

• creating space for yourself to thrive

• taking one step towards a new goal

• recognising your own strengths and impact

Commitment doesn’t have to be formal.
A single, well-timed conversation can change someone’s trajectory.

Sometimes the most transformative words we can offer — to others or ourselves — are:

“I believe in you.”

Closing

Women across healthcare continue to navigate complexity, pressure and change -often juggling caring responsibilities - and yet the extraordinary leadership, compassion and resourcefulness we bring can often be under-recognised, unsupported and squashed by a system which was not designed with women in mind. Whilst we may be seeing some evidence of change, we need to continue to ensure that work to address gender equality issues remains a priority and our opportunities to progress are equal for all.

My hope is that these reflections remind you that everyone deserves to thrive. And that these notes strengthen your belief not only in the power of the community of women around you, but most importantly, in yourself.

I believe in you.

We Say NO: Why I Chose to Share My Story

The NHS Trust I work for launched a We Say NO campaign encouraging colleagues to report sexual misconduct and inappropriate workplace behaviour, promoting a safer, more respectful environment. I strongly support this campaign, and as part of the launch I shared a story from earlier in my career—a story I had previously shared with only one other person.

Why Share Stories?

Storytelling is an age‑old human tool that allows connection, understanding, empathy and the possibility of enlightenment or change. The narrative told often links events and emotions, introduces a human element or character, and illustrates a meaning or theme.

“Stories have a transformative power to allow us to see the world in a different way than we do if we just encounter it on our own. Stories are an entry point to understanding a different experience of the world.”
— Clare Patey [1]

Why Do I Share Stories?

I am driven by my own experiences, and those of my colleagues, to improve the working lives of women in medicine and the wider NHS. Storytelling as a means of informing and leading to change feels intuitive to me. It suits my nurturing and empathic nature.

Why This Particular Story?

Sexual misconduct within the medical profession has been widely publicised and has led me to reflect on times in my own career when I have been placed in a position where I have had to say “no” or would have valued the support of others to help me say “no”.

The launch of the We Say NO campaign felt like the right time to share this story. I’m sharing it in the hope it may resonate with someone, spark change, and lead to a better working environment for colleagues.

Where I Come From

I grew up in a northern town, educated in a state comprehensive school, and I was the first pupil from the school ever to apply for and study medicine. I’m telling you this to give context.

My education, whilst good, had no real extra‑curricular element. My focus was on achieving my A levels—there was only one thing I wanted to be: a doctor. At the time, I’ll be honest, keeping up with current affairs and obtaining a “well‑rounded” knowledge base did not feel like a priority.

Like most of my peers, my extra‑curricular activities centred around relationships, fashion, alcohol, music, clubs and adventuring in the nearest big city. This definitely benefitted me in terms of becoming independent and confident.

The Story

I was a medical student undertaking research during an intercalated year. I had been invited to attend a national conference to present my research work; it was a new experience, and I was excited. This was an amazing opportunity. Included was an invitation to attend the conference dinner, which was being held in a noteworthy building.

When it came to the evening of the dinner, I joined the group who were going to be seated at our table. I had never met most of them before; all were much more senior than me, older than me and predominantly male.

Whilst enjoying drinks before the meal, we were making small talk, and I was looking forward to a formal three‑course meal in a beautiful historic venue. One of the most senior individuals in the group turned to me and said:

“Did you know they have Fabergé eggs here?”

With food on my mind and, to be quite honest, having never heard of or seen a Fabergé egg, I replied:

“Oh, are they on the menu tonight?”

Whilst this could have been taken as a witty response, it was quite evident I had no idea what a Fabergé egg was. He then went on to “educate” me. I’ll come back to the significance of this exchange.

The dinner was delicious and, when the last course had been cleared, I excused myself and left. As I walked back to my hotel room, I became aware that someone was behind me—one of the men from our group had followed me, and on reaching my room, he asked if he could come in with me.

He was probably 20 years older than me, and that evening was the first time I had ever met him. I was shocked that he should ask this, said “no”, and I quickly entered the room and closed the door.

I often think: What if I had hesitated? What if I had felt unable to say “no” due to the power imbalance of a medical student versus a senior, or for fear of career repercussions? What if he had been more forceful? What made him think that this was an acceptable way to behave?

At the time, this type of behaviour was accepted by many as part of “conference culture”—swept under the carpet—and remaining silent could feel necessary to progress your career. There were no sexual safety campaigns, guardian services, reporting processes or women’s networks. Sexual safety was not discussed in the same way as it is now.

I said nothing about the incident afterwards, but I never forgot how it made me feel.

What Was the Significance of the Fabergé Egg?

I believe that the Fabergé egg exchange spotlighted the power dynamic between us: stark differences were laid bare—age, seniority, gender, privilege, education. In that moment I became vulnerable.

I didn’t recognise it at the time, but I do remember feeling embarrassment—shame that perhaps I should have known what a Fabergé egg was—excluded from a club of people who knew all about them, and “less than” those around me.

And the person who followed me back to my room? It was the senior who had asked me about the Fabergé egg. Whether consciously or unconsciously, I believe he made a judgement about me and formed a view of how he could behave towards me in that moment.

I do, however, believe that my background and formative years also saved me. I was brought up in a family with a strong sense of right and wrong. I was a middle child between two brothers. I’d learnt to look after myself as a teenager; I was “streetwise”. I’d developed a determined confidence. And in that hotel corridor, a combination of strong family values, my middle‑child traits and teenage survival skills gave me the bravery to say “no”.

I felt I had taken ownership of the power myself by courageously changing the possible course of events that evening.

Closing Thoughts

Experiences such as this have galvanised my drive to improve workplace culture. We need to be clear that these behaviours are not acceptable and to empower staff with the courage to say “no”. A recent joint report from the BMA and Surviving in Scrubs found that 41% of female medical students had been the target of sexual harassment or assault at medical school. Thirty years on from the experience I have shared, it’s clear that the problem continues to exist in UK medical education. We have a responsibility to ensure that a safe and respectful workplace culture exists for all.

Storytelling is one tool I can use to make a difference.

I choose to do this because it feels like the right thing to do.

I have no expertise apart from my own experience.

“One day you will tell your story of how you overcame what you went through, and it will be someone else’s survival guide.”
— Brené Brown

If you have been affected by issues raised in this post please talk to a trusted colleague, friend or peer and seek support from NHS Trust support services or from charitable organisations.

[1] https://www.health.org.uk/features-and-opinion/features/the-power-of-storytelling

[2] https://www.bma.org.uk/advice-and-support/equality-and-diversity-guidance/gender-equality-in-medicine/sexism-and-sexual-violence-towards-medical-students

Reflecting on recent conversations about sexual safety and protecting the NHS workforce from sexual misconduct, one message is clear: there is only one type of appropriate and acceptable behaviour — behaviour in the green zone.

There are no grey areas.
Everything outside the green zone is unacceptable.

Why Amber Matters: Early Behaviours Can Signal Risk of Escalation

It is vital to recognise that amber‑zone behaviours can be precursors to red‑zone behaviours. These, often considered, low‑level behaviours should never be ignored.

Addressing concerns early — through timely reporting and meaningful action — can:

• prevent escalation

• reduce repeat incidents

• support an open, transparent, safe workplace culture

Individuals who experience sexual misconduct must know that:

• they are safe to report

• they will be protected

• those responsible will be held to account

Policy and Legal Changes Shaping NHS Responsibility

In 2023, NHSE introduced the Sexual Safety Charter, outlining expectations for NHS organisations (covering areas such as training and education, reporting mechanisms, support processes and policy). Its aim is to eradicate sexual harassment and abuse across healthcare, improve staff safety, and inform future staff standards for NHS Trusts.

Two recent legislative changes also strengthen protection:

Worker Protection Act (in force from October 2024)

Employers must actively take reasonable steps to prevent sexual harassment of employees.

Employment Rights Act (in force from April 2026)

• Reporting sexual harassment will be classed as a protected disclosure, ensuring staff are protected from detriment and/or unfair dismissal.

• “all reasonable steps” duty, a move forward from “reasonable steps” to prevent sexual harrassment (in force by Oct 2026)

• employees will no longer be able to be silenced by non-disclosure agreements or confidentiality clauses

These frameworks mean Trusts can be held to account for inaction. Much of the implementation will sit with HR leads, EDI leads and People Partners/Employee Relations managers — but the responsibility for creating a safe culture is shared.

What Can We Do

Even without formal roles in this work, we can contribute meaningfully by:

• supporting colleagues and signposting to support/policies if needed

• raising awareness

• modelling good behaviour and being clear about what is and what isn’t acceptable

• championing values that support a healthy, safe culture

• calling out poor behaviour when it is safe to do so

• using anonymous reporting routes if needed

• reviewing organisational data such as the NHS Staff Survey/National Education and Training Survey (NETS)

• asking questions of leaders responsible for this area

Small actions, taken consistently, can shift culture.

Activism and Allyship

We can all choose to be activists — even in small ways.
Activism here could mean:

• deliberately raising awareness

• intervening when needed

• questioning systems or those in power to create positive change

Allies amplify change

Allies create a force multiplier, helping to achieve more collectively than individually. They bring diversity of approach, allowing under-represented voices to be championed, strengthen belonging, and deepen empathy and understanding within groups.

Together, activism and allyship can drive actions required for cultural change, safety, dignity, and respect in our workplaces.

Note: if these issues have affected you please speak to a trusted colleague, peer or friend and seek support from the agencies available via your NHS Trust or charitable organisations. I appreciate this is a complex topic and my post does not aim to cover it in entirety, rather to share a reflection of recent discussions which may provide a starting place for change.

Rethinking What It Means to “Coast”

To coast is to proceed without great effort. In many workplaces, effort is equated with productivity, ambition and value. Being busy is often seen as a marker of success, and striving for exceptionality has become an expectation of modern life. In some careers, and medicine is no exception, exceptionality may be viewed as an expectation. Yet there are moments in our careers when we need to change pace — moments when consciously choosing to coast is not only appropriate, but necessary.

Can we coast without jeopardising our professional identity or reputation?

Although coasting is often framed as laziness or a lack of ambition, this is a relatively modern interpretation. As André Spicer notes, “In the past, being relaxed and not burdened with too much work was a sign of status.” Acknowledging that you are coasting — even privately — can bring feelings of guilt or shame. But hearing a senior leader describe coasting as one of her own strategies was a turning point for me. I realised I had been coasting too, and instead of feeling embarrassed, I felt validated.

My epiphany: coasting and progression are not opposites. They can coexist.

Conscious coasting does not signal failure, disengagement or a desire to “check out” of your role. It can be a strategic, healthy and career‑enhancing choice.

The Case for Conscious Coasting

Sara Daly describes coasting as “taking a breather” — surfacing for air so you can keep going.

Conscious coasting is a temporary, purposeful choice, not a long‑term passive habit, apathy, complacency or avoidance.

It is a deliberate recalibration of energy — a way to sustain long-term performance, protect wellbeing and create space for growth.

Kristi Andrus reframes Sheryl Sandberg’s Lean In philosophy by reminding us that careers have seasons: “In some seasons, you lean in… in others, you coast and conserve your energy for important reasons.” Conscious coasting is about agency, boundaries and sustainability. It can even be a period of deep personal development, offering space to learn, reflect and reset.

For those juggling caring responsibilities, burnout, fatigue or life transitions, coasting can be a lifebuoy — a form of self-preservation that empowers long-term success.

Strategic Coasting: A Positive, Intentional Approach

Rachel Feintzeig describes “strategic coasting” as doing your job well while intentionally directing your energy toward core work and away from discretionary or “above and beyond” tasks. This is not disengagement — it is conscious energy management.

Strategic coasting can also be a valuable tool when facing a career crossroads. It allows you to “lean out” temporarily so you can sustain a long-term career without burning out or making reactive decisions.

How to Coast Successfully

There is no universal formula, but the approach should deliberate. Understand that you may not be able to switch into coasting immediately but that it is OK to strategically plan for a coasting season. Focus on the purpose of this career season, and on the positives it brings.

Principles for effective conscious coasting include:

• Be intentional — know why you are coasting and what you hope it will achieve.

• Prioritise your core work — maintain high quality in essential tasks.

• Redirect energy away from non-core work — be selective about what you take on.

• Focus on quality over quantity — excellence in fewer areas is still excellence.

• Play to your strengths — choose tasks that align with your capabilities.

• Use time management deliberately — protect your boundaries.

• Minimise non-essential meetings and travel — reduce unnecessary drains on energy.

• Delegate where appropriate — especially when it supports others’ growth.

• Be open with leaders or mentors — if comfortable, explain your approach and reasoning.

What Leaders Can Do

Leaders play a crucial role in normalising conscious coasting. They can:

• redefine what “effort” means within a culture focused on upward trajectories

• champion coasting as a legitimate, strategic behaviour

• create space for supportive, compassionate conversations

• recognise that sustainable careers require varied seasons, not constant acceleration

Knowing When To Move On

Conscious coasting should be time‑limited, even if the exact duration is unclear at the start. Regularly reassess how you feel and what your circumstances require. Some people find coasting uncomfortable because it contrasts with their usual pace; for them, it may be a short-term bridge across a challenging period.

Signs it may be time to stop coasting

• you are no longer learning or maintaining relevant skills

• apathy or boredom is creeping in

• your ambition feels dulled or your professional identity is weakening

• you feel a renewed desire for challenge or notice yourself seeking new opportunities

As the senior leader put it: “You’ll know when the itchy feet get too much that you’ll need to move. Don’t do it before then!”

Moving Into the Next Season

Transitioning out of conscious coasting can be as intentional as entering it.

Strategies for pivoting back into the next season

• set a timeline for shifting energy toward new opportunities

• identify skills, courses or training that will support your next step

• look both upward and laterally — growth isn’t always vertical

• start small if you feel anxious — choose a manageable project to rebuild momentum

• reconnect with mentors or supervisors to share your plans and seek guidance

Closing Reflection

As a woman in medicine, I have experienced many career seasons. I now feel comfortable acknowledging that I am consciously coasting — and that this current season has value. Emily Lamia captures this beautifully: “.. let’s all give ourselves permission to strategically coast at work when we need to. In the long run, it may actually help us achieve new levels of success personally and professionally.”

Each year The Fawcett Society campaigns on Equal Pay Day - the point in the calendar when, because of the gender pay gap (GPG), women start working for free compared to men [1]. The date is calculated using data from the Office for National Statistics. Last year Equal Pay Day fell on November 22^nd 2025. In the UK the GPG is currently 10.9% [1]. In 2024 NHS England reported a mean GPG of 11.4% [2]. NHS Trusts with 250 or more staff are mandated to publish their GPG report annually. A search of this data for 2024 suggests a wide range in reported mean GPD from 1.2% – 36%, with many NHS Trusts reporting figures between 15 – 25% in 2024.

The GPG measures the difference between men’s and women’s pay and is usually expressed as a percentage of the men’s pay. Eg, a 50% GPG means men are paid twice as much as women. Mend the Gap: The Independent Review into Gender Pay Gaps in Medicine in England was published in 2020 [3]. Analysis undertaken for this report showed a GPG of 24.4% for (mostly hospital) consultants, 33.5% for GPs and 21.4% for clinical academics with the main reasons for the pay gap being: hours (women are more likely to work less than full time (LTFT), grade and experience (senior positions are more likely to be held by older male staff with LTFT working impacting on women’s career trajectories into the senior/higher paid roles) and additional payments (historic legacy of clinical excellence awards, allowances and additional payments/premium rate working, eg, locums and waiting list initiatives). Importantly, NHS Employers “Bridging the Gender Pay Gap” reminds us that we should consider a wider narrative when looking at pay gaps and gender inequality, including intersectionality [4]. The report cites data from the BMA and NHS Staff survey highlighting issues of sexism, sexual harassment and assault and health inequalities.

Given the current published NHS GPG data you would expect NHS organisations to be actively campaigning alongside The Fawcett Society on Equal Pay Day – using the opportunity to raise awareness of inequalities in pay. November 22^nd 2025 provided a perfect opportunity to highlight pay inequality, take action, promote best practice and champion the female workforce. Sadly, a Google search revealed no NHS communications directly related to Equal Pay day on November 22^nd 2025.

Gender Pay Gaps are driven by lack of female representation in the most senior positions, systemic barriers to career progression and for black and minoritised women, disabled women and mothers the gap is wider [1]. The NHS workforce is made up of 75% women. Women are working across all pay grades however there is a greater percentage of women working in Bands 3 – 5 roles (74.5 – 76.5%) and the lowest percentage of women (49%) in medical/dental leadership roles [2].

As NHS Women we need to take every opportunity to campaign to end the GPG. For too long society and systems have expected us to be “ladylike”* and silent. Women have been made to feel they should keep in their place but, to quote Lucy Knight (features writer at The Guardian), “… why should women shrink and shut up?” [5]. Equal Pay Day should be a call to action to empower NHS Women to occupy space, take action and be heard. Activism, however, does not have wait until the next Equal Pay day in 2026 – we can all start to make a change from today. From initiating a conversation with a colleague, joining a Trust Women’s network, championing our female colleagues, reviewing your organisations GPG data or raising this with your CEO, our actions, small and large, will make a difference.

Kath Higgins Nov 26^th 2025

*Oxford Learner’s Dictionaries definition: “ladylike” describes behavior as polite, quiet, and socially acceptable for a woman. https://www.google.com/search?q=oxford+dictionary+definition+of+ladylike&rlz=1C1GCEA_enGB1136GB1136&oq=oxford+dictionary+definition+of+ladylike&gs_lcrp=EgZjaHJvbWUyBggAEEUYOTIHCAEQIRiPAjIHCAIQIRiPAtIBCjE0NjI0ajBqMTWoAgiwAgHxBTQXAUaWbr2B&sourceid=chrome&ie=UTF-8

[1] Women are being shortchanged! Equal Pay Day 2025 https://www.fawcettsociety.org.uk/equal-pay-day-2025#:~:text=Latest,to%20help%20make%20it%20happen.

[2] Diversity Pay Gap Reporting 2023/24 for NHS England https://www.england.nhs.uk/long-read/diversity-pay-gap-23-24-nhs-england/#:~:text=What%20was%20our%20gender%20pay,unlike%20the%202021/22%20figures.

[3] Mend the Gap: The Independent Review into Gender Pay Gaps in Medicine in England. https://assets.publishing.service.gov.uk/media/5fd893a7e90e076631fb2286/Gender_pay_gap_in_medicine_review.pdf

[4] Bridging the gender pay gap, NHS Employers, 2025. https://www.nhsemployers.org/publications/bridging-gender-pay-gap

[5] ‘Too loud’, ‘too messy’, ‘too much’ … why should women be expected to shrink and shut up? Lucy Knight https://www.theguardian.com/lifeandstyle/2025/jul/20/too-loud-too-messy-too-much-why-should-women-be-expected-to-shrink-and-shut-up

Imagine yourself, mid-interview, for a 5 year registrar training post, a post which would transform you from junior doctor to Consultant specialist, and you are asked “Why do you want to work here – is it because you like shopping at Harvey Nichols?”.

It was the late 90’s, I was in my late 20’s, and I had completed my senior house officer training in a large teaching hospital. Prior to that, whilst at medical school, in a different city, I had graduated with Honours and intercalated both a BmedSci and a PhD. I was easily as credible as any other candidate interviewed that day. The senior panel member who asked me “the Harvey Nichols question” had a reputation for being “a character” and it was at this interview that we first met. Before he asked “the question” I was already feeling anxious about how he may behave.

I have always found interviews challenging. I am not naturally intuitive or spontaneous; I am comfortable to admit I am a “slow processor”. My strengths are in careful reflection, with logical analysis to form a considered conclusion – deliberative thinking. Coupled with this I have a natural tendency to honesty and an aversion to lying including what may be considered a “white lie”. Struggling, in the moment, to understand context there is tendency to avoid telling an untruth. The above may be considered autistic traits. I have never undergone a neurodiversity assessment but I recognise these traits in myself and importantly also the strengths and benefits they bring me, an analytical thinker who advocates for fairness, offers reliability and application of attention to detail.

And so when blindsided with “Why do you want to work here – is it because you like shopping at Harvey Nichols”, not a question I had prepared for, I responded by simply stating “Yes, I do like shopping at Harvey Nichols”. And that was the truth, I was in my mid-20s, I had disposable income, I enjoy fashion and, yes, I did like shopping at Harvey Nichols. This is the singular question/response that I remember from that whole interview and so it’s difficult to give an objective assessment of how it went overall.

I was not offered the post, I was told, very kindly, by a different panel member, that I should have answered that question differently. I should have ignored the Harvey Nichols reference and told the panel, how I was the perfect fit for their department, and how their department was the perfect fit for me. But I didn’t, I froze, and I truthfully answered the question that I was asked. I’ve moved on now, quite literally, via a different training programme, in a different city with different colleagues and I have a fulfilling and thriving career. And so why am I returning now to “that question”?

I haven’t actually thought about “that question” for some time but recently I was thinking about triggers or turning points in my career particularly in terms of experiences which have galvanised my commitment to work related to gender equality in medicine. This experience came to mind and on reflecting back with some years behind me I felt it illustrated perfectly the importance of fair and structured processes when it comes to interviews and appointments.

I would argue that this interview process was not fair or structured. I suspect that “the Harvey Nichols question” was not part of a pre-agreed set of questions which every candidate was asked. My feeling is that this question was unfairly directed to me as young woman presenting in an expensive trouser suit, heels and long blonde hair. The BMA report that 67% of women, who responded to their survey, which informed the BMA Sexism in Medicine report, felt that their gender had a negative impact on their career progression [1]. Forty-seven percent of women who responded said they felt that they were treated less favourably by senior doctors because of their gender. One of the actions suggested within this report, is for transparency and monitoring of how career-enhancing opportunities are allocated. This could include reviews of interview panel composition (in terms of diversity), panel members completion of EDI training, questions used (job related and values based), consistency in process and consideration of any required adjustments (which should be identified at shortlisting stage) as well as outcomes.

NHS Employers describes values based recruitment (VBR), an approach which focuses on recruitment of individuals whose values match those of the recruiting organisation [2]. In order to fulfil VBR panels must avoid biases, there must be a consistent approach to questioning and the process should be fair and objective. Panel chairs are encouraged to manage panel dynamics. It is incumbent on any panel member to speak up if the process deviates away from this approach.

In recent years there has also been a move towards sharing interview questions ahead of the day. This approach allows a fairer recruitment experience and is likely to be particularly beneficial for neurodiverse candidates or applicants for whom English was not their first language. It offers an unbiased process which may lessen anxiety and allow a more deliberative response.

My question to you is, are you absolutely sure that values and fairness are prioritised in your appointment processes - and that “Harvey Nichols questions”, or equivalent, are gone for good?

1. https://www.bma.org.uk/advice-and-support/equality-and-diversity-guidance/gender-equality-in-medicine/a-joint-pledge-to-end-sexism-in-medicine

2. https://www.nhsemployers.org/articles/values-based-recruitment

In 2004, an article in The Observer described a bold government plan to introduce state subsidised emergency childcare provision for working mothers [1], the brain-child of backbench women MPs canvased for ideas for an election manifesto ahead of the 2005 general election. The scheme would involve both state registered child-carers and private agencies and childcare tax credit could cover the costs, opening up impromptu childcare options to poorer families and promising a national emergency childcare service “as reliable as the NHS”. The Department of Education and Skills were already consulting on a “light touch” system to vet and approve childcare workers to make it easier set up the emergency childcare provision.

My response back then

On reading this article I felt conflicted - whilst elements of this proposal had potential to help - support for shift workers or during holidays - there were elements which concerned me – the “light touch” approval of carers and the inference that parents/carers would leave their ill child with an unfamiliar carer in order to continue working. There was no reference to developing or strengthening workplace policy which may support working mothers to provide essential care when needed. I felt compelled write to The Observer [2].

“For most working women with children in childcare, the scheme for emergency childcare that you report is nothing more than a ‘nice idea’ created by people who know how to make the government appear sympathetic to working women but who are not in touch with their day-to-day lives.

I am a mother of two pre-school children, I work for the NHS as a hospital doctor and I know the consequences of unexpected leave due to illness of a child. My first priority is to my children and if Tony Blair thinks I will leave them with a complete stranger when they are ill then he is wrong. Perhaps for families with older children there may be a role for such a scheme but for the growing numbers of mothers who return to work when their children are young it would be much more useful to invest money in encouraging employers to adopt flexible and innovative roles for working mothers.”

Fast forward 22 years

I now have 3 children, the 2 referenced in my letter above are adults and I have a third child soon to celebrate their 18^th birthday. I have not witnessed the birth of a national emergency childcare service. Like many, I have juggled emergency care between myself and husband, taken time off at short notice and worried about the impact on patients, the team and my career. Wrestling with the dilemmas - which parent is going to stay at home, how ill is “too ill” for childcare, will taking time off jeopardise relationships at work or career prospects?

Where are we now?

Women make up the majority of NHS staff. Seventy-six percent of the NHS workforce, in England, is women [3]. According to the Office for National Statistics of all women born in 1977 16% had not had a child by the age of 46, the assumption then being that 84% had had a child, with two child families being the most common [4]. There will also be parents through adoption or surrogacy and those who care for foster children. Families can be complex with parents co-habiting, living separately but sharing the caring role or lone parenting due to various circumstances. My perspective is from that of a married woman but I recognise that amongst NHS staff carer/parent roles will be defined by an individual’s circumstance which in turn will impact how carers respond to childcare emergencies.

A universal state-funded emergency childcare service has not been realised. The current government’s plans for childcare and early education make no mention of an emergency childcare service [5]. The 2004 proposal may be viewed as political rhetoric, soon forgotten after a successful 2005 election outcome. If we cannot rely on the government then we must look to employers to lead the way with workplace policies which meaningfully support staff at times of crisis.

What should we expect from our NHS organisations?

Government statutory rights state that employees have the right to a “reasonable” amount of time off work to deal with an unexpected emergency involving a dependant [6]. This may include a child becoming ill or injured, involved in an incident at school or an unexpected breakdown in childcare provision. Payment for this time is discretionary. There are no limits to the number of times you can take time off for emergency care assuming the frequency is not affecting your ability to undertake your role. Importantly, an employer should not treat you unfairly for taking time off or refuse you reasonable time off. NHS Trust policies are modelled on these statutory rights. Support offered via policies may vary but will mainly be in the form of emergency leave allowance, discretionary pay or short term/temporary flexible working arrangements, such as, shift changes, remote working or compressed hours, put in place to cover emergency events. Policy documents need to be clear and accessible to all. They should be jargon-free, easy to find, and compliant with the Accessible Information Standard. Fair and consistent application of supportive policies is a necessary life-line for many parents and carers who work in the NHS.

Twenty-two years ago, I wrote to The Observer, then a mother of two, unwilling to leave my sick children with strangers. Those children are now grown-up. The proposition of emergency childcare feels like a distant memory. For many NHS staff, who are parents and carers dealing with an emergency childcare event, the struggle continues and the stress and anxiety remain real. Employers must be pro-active, prioritising family-friendly policies which support staff in crisis. The well-being and retention of staff – and the future of the NHS – depends on implementation of policy rather than promise.

[1] https://www.theguardian.com/uk/2004/aug/01/politics.children

[2] https://www.theguardian.com/news/2004/aug/08/letters.theobserver

[3] https://www.kingsfund.org.uk/insight-and-analysis/data-and-charts/nhs-workforce-nutshell#:~:text=Create%20a%20chart-,Who%20makes%20up%20the%20NHS%20workforce?,staff%20to%203%25%20of%20doctors

[4] https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/conceptionandfertilityrates/bulletins/childbearingforwomenbornindifferentyearsenglandandwales/2021and2022#:~:text=1.,the%20calculation%20of%20fertility%20rates

[5] https://labour.org.uk/updates/stories/labours-plan-for-childcare-and-early-education/

[6] https://www.gov.uk/time-off-for-dependants