The Student Blog

Final Reflections

In the lead up to the unconference, I was filled with a sense of excitement about finally reaching the culmination of months of hard work. Now that it has come and gone, I will deeply miss the diverse group of high-level thinkers whom I formed bonds with during countless meetings that were filled with lots of laughter and even more debate.

The prospect of the Student-led Health Commission immediately peaked my intrigue. I have been interested in healthcare since I was a child and regularly visited the hospital to manage my asthma. My curiosity was sparked from reading the books and posters that surrounded the many doctors’ offices.

Image from HSJ, Debunked: Myths about NHS Managers

That curiosity led me to volunteer with St John Ambulance for 6 years and to begin to further research into health services.  I vividly remember reading Dr Bach’s article in Times Magazine, “The Day I Started Lying to My Wife”, and it really stuck with me. It was an emotional story journaling an oncologist’s suffering as his wife battled through breast cancer. Through his series of blog posts during his wife’s treatment, I gleaned a deeper insight into the difficulties he faced, both as a husband losing the love of his life and as an expert in the field of her disease. His article sparked a particular interest in cancer but also to better understand the type of experiences faced by healthcare workers.

Image from The Kings Fund, Priorities for the NHS and social care in 2017

I took on the role of sub team manager for the NHS workforce group because I am passionate about  an NHS workforce’s that is effective when their emotional welfare and quality of life is considered. Our team analysed the precarious balance between workforce well being and patient care to develop recommendations that ensure the sustainability of healthcare services. Our primary idea was to improve flexibility in terms of re-specialisation and career transition in the NHS, as well as a new approach to recruitment which replaces the existing rigid tick-box culture. Our team was surprised by the extent to which the experts at our policy lab agreed with our initial radical recommendations, such as medical apprenticeships in the future, and gradually we fine tuned our recommendations from visions into implementable ideas.

We believe a functioning NHS relies on a happier workforce who are encouraged to provide the best possible treatment because they feel appreciated, and have a healthy work-life balance. I sincerely hope all the recommendations we envision will become a reality over the next 15 years’ time, but it will only be possible with continual public awareness and, perhaps most important, a political will to change the health and social care system.

Nathiyaa Thevananth is a 2nd year Chemistry undergraduate with a passion ranging from baking to chess. She hopes to one day volunteer in a Buddhist monastery in Nepal. Edited by the social media team. 

They came to see how a third world health system looks like

Last year I took part in the Public Health Summer school in Mexico City. I visited clinics, hospitals as well as participated in interactive Public Health workshops with the aim of comparing the NHS to the Mexican Health System. I clearly remember walking down the corridor of one hospital and overhearing a radiographer whispering to her colleagues “they are English medical students who came to see how a third world health system looks like”. I was surprised by this comment. Indeed during my visit I encountered facilities that were below standards and observed shortages of the most basic medical supplies and vaccines. However, I also observed the prominent use of effective preventative practices at the primary care level.

For instance, when shadowing frontline staff in a primary care clinic I noticed that every female patient, regardless of the reason for their visit, were checked for proper technique to self-screen for breast cancer and if patients performed incorrectly the practitioner or the student ran through a demonstration. Every patient was weighed and their BMI calculated, every person flagged with a high BMI were made aware of the risk factors linked to overweight/obesity, and diet / exercise regiments were explored.

In my opinion, our NHS should learn how countries such as Mexico prioritise preventative care in clinical practices, to alleviate strains on health services and to  get serious about our own prevention (as they have already suggested). This is especially important now that there is a steep increase in demand and financial constraints.

There is so much our government could gain from how other health provision in low-to-middle income countries deal with these issues. For instance, in December 2015 a BBC News article stated: “Imagine your doctor knocking at your door to give not just you, but your whole family, an annual health check-up” … Guess which country is providing this service… France? Germany? Did you say the US? No, it is Cuba.

The Cuban health system is known worldwide for its excellence, despite extreme financial and resource constraints caused by the US sanctions imposed for over half a century. In 2014 it was praised by Dr Margaret Chan, Director-General of the World Health Organization (WHO) and by Ban Ki-moon, Secretary General of the United Nations. Cuba acknowledged their funding and resources limitations and re-aligned their political priorities. The Cuban healthcare system is based on preventative medicine. Moreover, Cuba has managed to universalise health coverage and achieve results similar to developed nations, hence why Dr Chan  urged the world to follow Cuba’s example in this field by replacing the expensive and ineffective curative model with a preventative healthcare system.

The discussion of privatising the NHS is a hot and ongoing topic, and some believe that privatisation is the answer to under funded services. The WHO considers the Cuban health system, which is exclusively in the hands of the public sector, a great example of a how to deliver services when resources are limited. This is because inefficient medical care provision does not merely result from limited resources, but rather demonstrates the importance of political will to protect the health of the population.  As Dr Chan noted: “Societies that have the least inequality have the best health outcomes, regardless of the level of spending on health. In other words, money alone does not buy better health. Good policies that promote equity have a better chance.”

Image from Advance Lifestyle Medicine, Dr Rooke’s Journey. http://advancedlifestylemedicine.com/?page_id=13

 

Synthia Enyioma is a King’s medical student with a previous degree in Biochemistry. Her past experiences and interest in entrepreneurship prepared her for her role on the Commission as sub team manager of the ‘normovation’ team and manager of the ‘unconference’ on 16th March.

Out of the hospital, into the streets

credit: http://www.grammar.zone/out-of-the-frying-pan-into-the-fire/

We know that being homeless is not healthy, and yet those experiencing homelessness face many barriers in accessing adequate healthcare. One main area that needs to see change is the practice of discharging people back onto the streets. The average homeless person has a life expectancy of 47, compared to 77 for the rest of the population– so even though an elderly person and a homeless individual have similar body clocks and share similar vulnerabilities, their treatment remains different: the former can access intermediate care and out of hospital/community care, while the latter are discharged with no place to recover properly, increasing chances of re-admission. I believe we need a layered approach which delivers appropriate care, changes complex systems, and encourages a cultural shift.

Homelessness is not only a housing issue, but also caused by psychological factors, which means we need to think beyond accommodation or medicine, and more about building healthy relationships and independence too. Social prescribing can be one way to achieve this. Hospitals and primary care services can act as gateways for those who are homeless by signposting to housing support, educational or employment help and social activities. The NHS Five Year Forward View suggests we build stronger partnerships with the voluntary sector, and we can work with voluntary organisations and their volunteers, supporting them with the right funding and training so that they can still operate independently and provide guidance to patients we refer them to.

credit: https://www.curriculum.gov.sk.ca/webapps/moe-curriculum-BBLEARN/FullResourceList?id=62 

We can also work towards integrating community care, local authority support and voluntary sector organisations. Fostering these partnerships can create a smooth process from admission to discharge and can develop intermediate care between hospitals and hostels. Projects in Liverpool and York Southampton and Cornwall have shown the successes of staff training and creating links between nurses, hospital outreach workers, and charities to share responsibility over patient health and after-care for those who are homeless.

We need to see more integrated care models to end the “Kafkaesque nightmare of bureaucratic buck-passing” amongst financially strained hospitals, local authorities and social services.   For example, the Pathway model which includes a care plan supported by nurses specialising in homeless health and mentors with experience of homelessness, has led to improved outcomes for hospitals and patients, and cost savings of around £100,000.

Underlying all of this is the stigma that surrounds homelessness. This is a cultural shift needed not just in the NHS, for example staff should be trained for ‘psychologically informed’ services, but also throughout society as a whole. Tabloid and political propaganda criminalise homeless individuals and portray homelessness as a lifestyle choice, while childhood factors and mental health causes remain ignored. This reinforces prejudice and depicts those who are homeless as ‘undeserving’ of healthcare.

The NHS is ‘of the people, by the people and for the people’, and we expect this means responding to all people, including those experiencing homelessness. We know that an integrated care system helps people recover properly, alleviates pressure on A&E, and reduces costs. We need strong, meaningful, long-term changes, not temporary reactions.

Rough sleeping is predicted to rise by 76% in the next 10 years. As we imagine ways to futureproof our NHS, we must consider what we want this future to look like and it is clear to me that care of homeless individuals is an issue the NHS will need to work on closely and collaboratively.

Sonali Nundoochan holds a First Class Honours in International Relations from King’s College London and is interested in policy and research regarding health inequalities. Edited by social media team.

Leadership for everyone

I have always held the strong belief that you have to be the change you want to see. But I am also conscious that sometimes people are in circumstances which makes it harder for them to enact that change, due to more restricted choices, less resources or maybe a lack of confidence in themselves. It is this desire to contribute to change and support others to access opportunities to improve their outcomes which led me to mental health nursing.

Entering in to the degree and the world of the NHS from a new side, I was confronted with huge challenges but also great potential and continuing evolvement. The role of the nurse is a perfect example; over time nurse positions have expanded to include more responsibilities and autonomy, which has meant an increase in opportunities, such as nurse led clinics, increasing numbers of nurse prescribers and a strategy set out by the National Institute for Health Research to improve awareness of the Clinical Research Nurse role. Similarly, the patient’s role has evolved,  and there is a growing recognition  that patients are experts by experience, hence they should be supported to take a leading role in their own care. This evolution sees the opportunity for old hierarchies within healthcare to fall away and for a more sustainable organisation to grow in which collective leadership is fostered. Collective leadership involves a flow of power within teams so that leadership is shared and power is easily shifted to whoever is best equipped to lead in any given situation. This requires a culture change and presents challenges, as roles are negotiated and balance is sought. But it also offers exciting possibilities to develop leadership capabilities across the whole team.

photo credit: https://www.bing.com/images/search?view=detailV2&ccid=YbsdCQJM&id=9F61D2A3AC4276820933CE7DC0E705C75FDA8E7D&thid=OIP.YbsdCQJMejJ16EsHbo_powAAAA&q=patient+nurse+partnership&simid=608047769289033247&selectedIndex=7&ajaxhist=0

Evidence based co-design  is an example of an approach to share leadership with patients, because it recognises them as part of the team, as experts in their own care but also a vital source of knowledge to help inform the care delivered for others.  My hope is for the landscape within the NHS to shift to better incorporate the principles of collective leadership and collaborative work with patients,  so that patients are seen not only as people we have a duty to care for but also a duty to learn from.  Increasing the scope of collaborative work removes boundaries and improves the ability to think creatively and from different angles.

This is the change in the NHS I want to be part of.

photo credit: https://www.bing.com/images/search?view=detailV2&ccid=OgMJtqu9&id=0B2D2396A74875F7BC4ABB58B21D4B62FA249952&thid=OIP.OgMJtqu9ozckErk9V1ggPwHaJk&q=change&simid=608018567750157969&selectedIndex=6&ajaxhist=0

Anna Doyle is currently in the mental health nursing degree at King’s College London, after completing a BSc in Criminology and Social Policy. Edited by the social media team.

Devotions upon Emergent Occasions: Politics and the NHS

This is the final post in a three part series.

Previously, student commissioner Temitope laid out two devotions that focused on improving patient care and resolving expected staffing complications. In this final post he makes an argument for the NHS to have more autonomy in it’s decision making. 

But we have a Hercules against these giants… that is, the physician” John Donne – Meditation IV

Health and healthcare have always been, and always will be, political. It is a political choice to provide care free at the point of use, according to clinical need and not ability to pay. It is a choice that generation after generation of British people has continued to make. And we celebrate it too – most famously in the London 2012 Olympics opening ceremony. Recently however, health as a site of political struggle has become contentious.

On the 23rd of October 2017, hospitals were formally obliged to ensure that all those who received free care were entitled to it, by carrying out passport checks, or other checks on the residency status of patients. Prior to this, a Memorandum of Understanding between the NHS and the Home Office meant that patient data could be scrutinised, not by healthcare professionals, nor for any clinical purpose, but with a view to detect any undocumented migrants using the NHS and to subsequently deport them from the UK. Dissuading people from seeking healthcare will always have negative consequences to the health of the population at large. Moreover, it is unclear exactly upon whom this obligation falls: doctors aren’t trained to take payments from patients, and doing so takes time away from performing clinical duties.

photo credit: http://java-latte.blogspot.co.uk/2015/08/file-locking-example-in-java.html

The British Medical Association, the union for doctors in the UK, has expressed concerns at the introduction of these regulations. The BMA has also called for the end of indefinite immigration detention in the UK, citing the well-documented mental health implications this practice has. The workers of the NHS have repeatedly used their voice, be it via the BMA or the Royal Colleges, to lobby the Government for better conditions for the health system and for society at large.

This is a task for all of us. It’s time to bring the NHS back into our hands, working to our agenda, for our future. Over the course of the last election, Yougov found that 84% of people support the nationalisation of the NHS.Demos, a cross-party think-tank, found that the NHS is one of the top concerns for young people today. The JR4NHS campaign recently won concessions that Accountable Care Organisations, which represent a radical restructuring of the NHS, cannot legally be implemented without national public consultation. It’s up to us to take every route possible, from expressions at elections – both local and general – to other means, to show the Government what we believe in, to develop a culture where it’s unthinkable for politicians to defy or subvert our wishes for our most treasured institution.

After ‘Devotions upon Emergent Occasions’, Donne made a full recovery from his disease. The NHS should have every opportunity to repeat his success.

Temitope Fisayo is a medical student at King’s College London and a writer. He is a member of Students for Global Health (formerly Medsin).