Having spent six years as a doctor in the NHS, I left. I left because I felt I needed to spend my time improving (and not just frustrated with) the state of the nation’s health care delivery systems; and I could not see a way to do that with any level of significance in the role I was in.

It took me only a short time away from clinical medicine to stumble upon what seemed like an entirely other civilisation outside of, but intricately related to, the world of the NHS. I was shocked to discover charities, foundations and other organisations whose primary and often sole aim was the improvement and development of the NHS - the institution that I had been employed by for all of my working life.

A little while later I found myself working for one of these organisations. There were departments, teams, programmes, initiatives, everything one could think, carefully designed with the aim of making the NHS a better place for patients… but also for staff!

I was shocked; shocked that I was so completely unaware that there existed a whole world completely outside of my line of sight. As I became exposed to the wider arena of health care improvement (policy, programmes, research etc.), it also became increasingly apparent that there lies somewhat of a disconnect between this world and the ‘average’ NHS employee. It is encouraging therefore, to see the Health Foundation working towards connecting the worlds of policy (it produces reports to influence those in power) with the front line of NHS practice (it funds numerous improvements projects supporting teams on the front line).

However it goes to show how insular life in the NHS can be.

As a junior doctor I spent on average 10 to 11 hours in the hospital each day (more during my on-call shifts). Life pretty much consisted of work, exams, the obligatory audit etc. There was little time and mental space outside the ever growing list of patients waiting to be seen, to consider in any depth the kind of  systems that exist in and around but strategically supporting life within the NHS. I had become skilled and knowledgeable in my role as a doctor, but for the most part, was disconnected from and unaware of, the wider context that determined so much of the world in which I worked. There was an even greater disconnect from feeling able to use my working knowledge to influence such a world.

I’ve likened it to what I can only imagine it feels like to be released from prison. Within prison you know only of the limited daily goings on of prison life. You become proficient at life ‘on the inside’. In prison you are very likely completely unaware of, and lack any appreciation for, the systems and people working to support you; without knowledge of the legislation being decided to improve life for you; no knowledge of the surrounding cities, towns and infrastructure of which you are a part; no knowledge of the advance of thought and ideology toward you and around you; ultimately no knowledge of the fact that you are not alone. Just as in the NHS beyond the physical hospital walls, this lack of knowledge is in itself, imprisoning.

If we are to merge these two worlds, I think two things need to happen:

  1. The world of health care improvement (initiatives, funding and support) needs to somehow reach out in a less fragmented way to a wider section of the NHS; the policies that are developed, and the quality improvement initiatives that are undertaken, need to intersect with more of the NHS - something which programmes like the Q Initiative is seeking to achieve. The ‘average’ hospital employee needs to feel the weight of the wider apolitical support systems around them. Organisations have to find a way to direct our help and support to not only the thriving Trusts but (I feel most crucially) to the struggling ones. 
  2. Work life within the NHS (particularly within hospitals) must be designed in a way that encourages the average (there’s that word again) hospital/NHS worker to have an avenue to use their expertise (about what works and what does not; what is needed and what is not) to influence and affect the systems around them. Examples of where this is happening can be found in the Health Foundation’s Power of People Film Series.

This can only result in a more empowered workforce, more productive initiatives and ultimately, more efficient and higher quality care for patients.


Glasha trained as a physician at King's College London GKT School of Medical Education, before going on to work as a doctor in the East of England. She is currently working with the Strategy Team at the Health Foundation.


Aisha Lewis

Often I feel that those in the trenches are locked into their own world and many times, through no fault of their own, are unaware of the wider world around them. Bridging that gap is very important. In this case health care professionals may not even know not only what questions to ask but who to ask. How are these organisations ensuring now that the information gets down to the healthcare professional (doctors, nurses, admin staff, etc.)? Maybe they should also be reaching out to the various schools of medicine to ensure that those who are newly entering the field are also aware. I imagine all of this is part of the eventual goal Q Initiative etc.

herine menya

Indeed efforts that push any set of practitioners towards a greater sense of interconnectedness and community life have the capacity to improve not just the quality of work done by each practictioner but even more important individual inspiration and motivation.

Dave Pao

Glasha this is great. I started doing a PhD in design because I had to escape the NHS for half the week (I am a GUM/HIV Physician). My research is in the visual design of EPR and, as if by magic, it's main focus has ended up being its impact on clinician wellbeing (autonomy, purpose, mastery). The often empty propaganda of 'patient first' has to be coupled to looking after healthcare workers. It's a brutal system the NHS, for those who work in it - we have to be wary of the health of the system when the health of its workers is so poor.

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