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.

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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).

Devotions upon Emergent Occasions: The workforce

This is the second post in a three part series.

In line with John Donne’s original ‘Devotions upon Emergent Occassions,’ Temitope has outlined his own devotions to adhere to as the NHS enters a period of ambiguity. In his first post, Temitope touched on his vision for a primary and community care system that will adequately accommodate service users despite mounting pressures. As a medical student, he outlines here a more personal devotion. 

“No man is an island, / Entire of itself, / Every man is a piece of the continent, / A part of the main.” – John Donne, Meditation XVII

I have spent this commission working as part of the Workforce Sub-Group. Having carried out several interviews, the picture of the conditions facing those working in the NHS has been made clear to me. The NHS workforce is being asked to do more with less. It is an incontrovertible fact that real terms spending on healthcare is falling. It is also the case that demand for health services is rising. This means staff have fewer resources to deliver more care. This has had a real impact on professionals’ work-life balance. For example, an NHS survey found that 59% of staff worked unpaid overtime every week. As a future doctor myself, I would like to be renumerated for all the work I do after having spent six years paying fees for university. I don’t think that’s an unrealistic expectation.

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It is worth remembering that productivity in the NHS is already really high, higher than other sectors in the UK economy, despite the areas of inefficiency.

The wellbeing of healthcare professionals needs to be reprioritised if the NHS is going to be sustainable in the future. Doctors and nurses have a significantly increased risk of suicide when compared to the general population, to which the conditions at work must contribute. In 2013, 10,383 people (5.5% of all leavers) left work in the NHS in England owing to unsatisfactory work–life balance. It is widely reported that staff burnout is endemic in the NHS. Doctors in these conditions cannot work to the standards they would like, and, more importantly, to the high standards of which they are capable. The impacts on patient care of unsafe and unsustainable working conditions cannot be overstated. Systemic changes, beyond staff yoga and mindfulness, are required to preserve the NHS workforce for the future.

In 15 years time we should have a health service that recognises Donne’s most famous sentiment, that no man is an island, and that this means caring for patients and for staff are linked. We need an NHS with the best working conditions possible, that allows staff to take vital rest breaks at night, that has no endemic staff shortages. Expansion of medical school places is just the beginning. Higher Education England has released a rough draft of a workforce planning strategy, and I hope that in 15 years time a more finalised version is being implemented. Safer staffing levels, achieved through a combination of encouraging doctors to come from abroad, allowing allied health professionals to become doctors through accelerated courses and conversions, facilitating more refugee doctors to retrain, and “growing” more doctors here in the UK, will facilitate better working conditions in the NHS.

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). Edited by the social media team.

Devotions upon Emergent Occasions: Patient Care

This is the first post in a three part series.

The original ‘Devotions upon Emergent Occasions’ was written by John Donne in 1623, during a bout of serious illness. He believed himself to be close to death, and so he offered his thoughts on the end of life, rebirth, as well as imagining sickness to be a divine visitation. The NHS, too, is undergoing a period of intense distress. We have lived through an unprecedented series of events: the 2016 junior doctors’ strike; the continuing “humanitarian crisis” in our A&Es; louder and louder cries for more money, for a cross-party approach, for a Royal Commission. There have even been demonstrations outside St. Thomas’s Hospital, King’s College Hospital, and in the streets of Devon amongst several others all over the country, with more planned. Brexit has also heaped uncertainty on the NHS: as yet there are no plans for £350 million a week; nurses are leaving in droves; and the feasibility of cross-Europe collaboration in medical research remains unknown. It is clear that we are facing an “emergent occasion” in 2018.

So, to my devotions:

“And so our Health is a long and regular work” – John Donne, Meditation I

 Primary Care needs radical change if the NHS is going to survive. It is Primary Care that performs the essential task of optimising health by intervening early. GP practices are the first point of care for a person facing illness.  Yet the numbers of GPs are plummeting practices are merging, patient lists are getting longer and longer. In my first visit to a GP practice as part of my degree, we were told how a new housing development, for more than a thousand households, was being built within the catchment area. The staff there were worried about how they would cope in the future: waits for an appointment at that practice are already growing, while other practices have  close their doors to new patients.

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Sexual health and community care are also under pressure. This BMJ article beautifully illustrates the forthcoming cuts to sexual health budgets in England. London has recently achieved the UNAIDS 90-90-90 targets for HIV, but this is not a passive achievement, it is an active one. The resource stream is flowing in the wrong direction and innovative practices in sexual health, such as SH:24, are not available to the same extent across the UK. It is imperative we recognise primary care for the vital service it is, and reflect this in the way we allocate resources. If you invest upstream, you prevent a lot of problems downstream.

I’m excited by the vision of the future the 2000 Days Project sets out. While I may not agree with limiting this primary care utopia to just 2000 days (the first and final 1000 days of life), I strongly believe in recognising the interaction between medical illness and the social determinants of health, such as poverty and race. A holistic primary care service that could signpost individuals to social interventions like Parkrun, or Sure Start Centres, as well as to medical therapies like counselling, could support people to stay healthy throughout their lives.

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). Edited by the social media team. 


Empower us to make a change: Perspectives from the frontline

Some may mistakenly misconstrue the purpose of this commission to replace and improve the negative aspects of the NHS; ‘out with the old, in with the new’. Instead we have chosen to find ways to bolster and support what is great about the NHS, and a major aspect of this is the workforce of the NHS. Recently the extreme working conditions of healthcare staff have been under scrutiny, as shown by the Junior Doctor Strike, and the Scrap the Cap campaign,  and highlighted previously by my colleague Haider. And yet despite these conditions as well as the negativity construed by the media about the future of the NHS, the staff continue to work tirelessly to continually triumph by doing what they do best; delivering care to the UK.


This is why we conducted a survey for frontline staff, a survey designed by us to be both user-friendly and constructively gain insight into aspects of the jobs of frontline staff, or soon-to-be, which currently seem to cause extreme effort. We want to know how we can enable frontline staff to improve their jobs and the care they deliver; so the purpose of many of our questions is to gain insight into current perspectives. Questions such as ‘Have you ever had an idea to change an aspect of your workplace?’ ‘If yes, what did you do with the idea?’ to assess the ease of implementing innovation within the NHS, whilst questions like ‘Do you think your working place culture supports innovation and adapts to change easily?’ evaluate the receptiveness of the NHS to change.

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The survey was shared through social media, forums and physically distributing hard copies in order to capture results from the widest possible audience. The ethical process was laborious, and the survey is in no means robust form possible which is unfortunately outside the scope of this commission, but it has been worth the effort to yield results which demonstrate the current situation.

Our survey showed that 85% of frontline staff had had an idea or an innovation. However, there was a multitude of responses which showed that the implementation of these ideas was hindered due to lack of funding, which may be expected, but also by lack of time and low workforce morale. Reflecting on the responses it was clear there was a lack of willingness to adapt the workplace to accommodate innovations from the frontline staff, which I feel is nicely summarised by a responder: ‘Nobody on the frontline feels they have the power to make change’. The survey opened my eyes to the NHS’ current receptiveness to ideas directly from the people who work tirelessly, and highlighted that in order to address barriers to innovation, we, as a Commission, must also address workforce conditions. The survey has been instrumental in directing our report, it is our hope that we can find ways to address these problems so that the NHS workforce can be supported to continue their work that Great Britain has experienced for the last 70 years.

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Grace Pinn is currently a nursing student at King’s College London who is interested in using her nursing degree to implement effective health policy later down the line. Edited by the Social Media Team. 

New avenues for creativity

As I write this blog, the world has just entered into 2018. Reflecting on 2017 and my personal experiences with the Student-led- commission, one word comes to mind: WOW!

What a year 2017 has been. I entered medical school with an idea to better health for everyone by improving the healthy living standard of those disadvantaged in society. I never thought this process would need a great deal of creativity, something I felt I lacked but realised came naturally once trained to do so. So, this blog will focus mainly on applying creativity and change in the NHS, and health in general.

Commissioners in training (from left: Sonali Nundoochan, Osama Suwar)

The NHS is an outstanding institution with well-renowned achievements and was described as “one of civilisation’s greatest achievements,” by the Chair of the British medical association in 2013.  However, at the same time it can be argued that the NHS has not adapted to the fast-changing environment that defined the present and future generations i.e. technology and social networking., In my opinion, it hasn’t adapted to the new world that we live in today.  Although considerable effort has been made to design tools which improve patient involvement and feedback in the NHS, such as patient participation groups in GP practices, decisions are still dictated from above. In simple terms; it is run by those whose perspectives do not reflect the average service user, in my opinion at least.

This is why creative ideas and strategies that challenge the status quo need to take effect in the NHS. In a way, the structure of the NHS needs to flip on its’ head, and becoming a bottom-up service that relies more heavily on people on the front line. By this, I mean patients and front-line staff alike. A more democratic National Health Service. The public need to have trust that decisions that are made on their health are made by people that understand their situation.

The world has changed. The NHS needs to look for solutions and employ a different way of thinking, by moving its’ entire service to one that is based around prevention of disease. To do that end, we need a more proactive and robust health service that understands that understands its’ service users and what makes them tick. And this is where creativity and technology that has advanced our society in so many ways need to be deployed in the NHS.

At one policy lab, participants used fictional scenarios to find creative solutions to help ‘Sharon’ manage her depression.

We need to change how everything is structured and support individuals to take control of their health by mobilising communities and enhance their social and health capital. This can be done by creating platforms or networking opportunities for patients, which provide space for innovative ideas.  There are some signs the NHS is targeting solutions for specific groups, but not at a quick enough pace, such as devolving powers back to the community where patients can have more of a say and input locally. This way the NHS becomes more resourceful by using the social/health capital of communities to help advance good care.

Osama Suwar is a medical student at King’s College London with an interest in health policy. Edited by the social media team.