I need to work out what the next goals are. I’ve never had ambitions to drive a porsche or own a mansion with a gym and jacuzzi or anything like that, and I don’t have a goal for turnover or numbers of employees, or to take over the NHS. I just want to do good work that is free at the point of access for those who need it, with people I like around me. Not that I wouldn’t like to win a big contract, just that its never been on my radar.

I’ve had a great summer of slowing the pace and reclaiming life since the end of July. I’ve made a real effort not to bring work home, and for the last 6 weeks I’ve been going to the gym after work and doing the school run more often. But that rests on doing very little court work, which feels like I’m not working enough!

Its weird having health things too, as I’m usually so resilient. I’ve got ocular hypertension (the precursor to glaucoma) which has meant a lot of eye tests, and I also need some medical investigations, but it has been hard to prioritise me time. My friends and colleagues from the forum reminded me to value being a mum as ‘worthy’ and ‘work’ too. They are right that I need to give myself permission to prioritise me a bit more, and accept good enough rather than perfection (which I think I do with therapy delivery, but don’t with other aspects of the business).

It made me think about my drive to overwork. I think its a family story. My mum has been a hard worker (early consultant CP, head of service, in an era where mainly men attained that rank). My Dad was a creative person who had a lot of time off with ME-like symptoms when I was a kid. My mum’s mum was a hard working single mother in an era where there were not really single mothers, and remarried unhappily but wished she hadn’t (and probably impressed upon my mum at some level the value of supporting yourself and marrying for love). Plus my heritage is as an immigrant squared – my great grandparents/grandparents were persecuted Jews who earned their way up from nothing when they fled from Russia to South Africa, and then my parents came to the UK and built a new life. There is a high value on the opportunity for a good education and the value of hard work. There is also a very high value on parenting – my mum took a 5 year career break to have kids and I feel bad for not giving the kids enough priority.

When I take on too much it is difficult being emotionally available when it matters most (for family) when there is work stress and heavy stories and overload sapping your resources. It is something I will pick up in my peer supervision. I’ve also emailed the management coach I did a few sessions with to set up another session. But I did want to be open about the fact that being outside of the NHS makes this stuff harder. The seductive thing about self-employment is that doing more -> more income and better reputation, so it isn’t like a salaried job where you can say I’ve done enough to fulfil my contract. My mum says court work glitters, in that it offers money, influence, an intellectual riddle, a role in the theatre of the court process. It is hard to say no to. But I think that’s just icing on my workaholic cake.

I’ve got lots of exciting links building for me personally, which give me optimism (meeting with DfE LAC lead on Monday, two book ideas, four keynotes/talks to good audiences in new year and a helpful new connection in health economics with an interest in my adoption research and useful links to tap). I’ve also been trying to read about successful entrepreneurship and thinking a lot more about what my big goals are. I’ve decided I care less about being a provider of therapy than I do about changing thinking and practise to improve the lives of vulnerable children and families. I want to help answer the big questions about how to know who needs fostering as opposed to adopting, who needs residential care and what defines an effective placement, what risk and resilience factors affect placement stability, what works for families on the cusp of care. I want to write books and papers and speak at conferences and influence government policy. These are ambitious goals, but not impossible if I don’t get bogged down with taking on other stuff that is on an individual scale.

But I’ve had to bite the bullet and look at redundancies for the diabetes project. Everyone is telling me that this is just business and the state of the economy and not to feel bad. And I know that if I was managing an nhs team and they told me the budget was being cut and two posts have to go I’d manage to put these two posts forward and get on with it with my identity intact as a decent person. The difference here is I feel there is no-one else to blame, and the nature of being the business owner means I’m making people redundant out of choice to preserve my own income (or allow some in the first place). And that sucks and hits at some of my own schemas. I didn’t promise people permanent jobs, but I had started to hope we could create them, and it feels tremendously sad that we didn’t.

On the good side, it always feels better once you’ve ripped the plaster off. It’s horrible to have to let people go, but on the other hand gives me a better base to think what I really want to do in future. That could be take up a job or travel abroad or go into academia or go back to some sole trader court work or providing consultation and therapy. My only real commitment is to a month more court work and a few conference talks and I’ll have a trickle of court work income for at least the next year to subsidise whatever I choose. So I feel like personally I’m okay, which is why I feel so guilty, as it seems like a selfish decision.

I’m starting to feel like the court work has made me feel quite burned out. It is fine to hear a grim story once a month, but four times a month for two years has been too much, and I’m tiring of the petty haggling over invoices. And that’s before the final round of fee cuts kick in. Given the business side hasn’t been as productive, and I don’t want to take on therapy myself, that leaves me the options of going into a primarily research role or returning to a clinical post within an organisation. I’m starting to browse NHS jobs and consider the consultant grade posts with children and families more positively, but I need to be careful that this isn’t just a rebound fling.

Meanwhile a few small positive opportunities have come in for the business that make me wonder whether what I want is someone experienced who can take on the delivery of the business for me, and perhaps pick up some court work, either on commission or as a contractor, whilst I take some time to explore my options…

Addendum: As painful as it was, reducing the salary bill has made everything feel less burdensome. I’ve gone through all the finances with the accountant and can see that I’ve managed to pull out of the dive ahead of catastrophe and held back enough funds to earn a reasonable income this year. I’ve also had lots of positive feedback from training and consultancy I’ve done recently and got re-enthused about the research aspect of my work. A children’s home has commissioned me to do some training, consultancy and outcome evaluation for them and we’ve got the opportunity to bid for some “widening the impact” funding for our diabetes project this month, and are likely to go and present it in the USA at a conference in the summer. I’ve also spoken to an amazing guy who is a very senior accountant but interested in the economics of social issues who might be able to link me up to some useful people. I’ve had a couple of good people enquire about contracting to do the therapy work here. I’m even thinking again about finishing off my adoption risk and resilience research and submitting it for publication somewhere, maybe as a book. I want to stretch my brain again, and that is the topic closest to my heart.