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Thursday 13 April 2023

I'd work in the NHS for free – it's part of who I am

By Matt Ross
Dr Rosena Allin-Khan MP at the London Eye, March 2023

Dr Rosena Allin-Khan still works regular shifts at her local hospital alongside her day job as Labour MP for Tooting. Now shadow mental health minister, she tells Matt Ross about Labour’s still-sketchy plans for the NHS, the impact of frontline staff shortages and why she backs striking nurses.

I’ve wanted to be a doctor since I was three, when I found out that my grandmother was blind; I wanted to make her better,” says Dr Rosena Allin-Khan. “But I grew up from a very poor background—single parent family, mixed race—in the Thatcher years, and I was made to feel that medical school was not something that I should consider aiming for.”

Raised by her Polish mum in Tooting, south London, Allin-Khan initially did badly in her A-levels. But she clung onto her dream, resitting her exams and completing an undergraduate degree before finally—funded by scholarships and part-time jobs—making it to Cambridge to study medicine. “I wanted to do emergency medicine, because that’s where I was going to meet the kids I’d been like: the ones who didn’t have a voice,” she recalls.

After training at the Royal London Hospital, she spent years in humanitarian roles abroad, before returning to the A&E department of Tooting’s sprawling St George’s hospital. In 2016 she was elected MP for Tooting, replacing Sadiq Khan after his victory in the London mayoral election. Yet the NHS remains at the centre of her life and her identity. “I still practice now,” she says. “My next shift is on Sunday!”

Since Allin-Khan qualified, however, she’s witnessed a steep decline in the quality of patient experience. “In 2005, it felt like we were offering a really excellent level of service,” she says; but by the time she returned from her humanitarian work overseas, “it had started to worsen—and now it’s unspeakably bad.”

Treating patients in cupboards

Successive Conservative governments, Allin-Khan argues, have failed to put in the money required to keep up with spiralling demand. “You can’t give people the quality of care they deserve when we’re examining people in cupboards,” she comments: staff “have been let down, and as a result are leaving in their droves; we have a huge workforce problem.”

That, she adds, “places a lot of pressure on managers, who are trying incredibly hard to keep services as gold standard as they possibly can”. She says the best managers she’s worked with are “those who understand what it’s like to work on the shop floor, as a clinician or nurse. That’s not the only route, but it’s easier to understand the pressures facing the people you’re managing if you’ve had that experience.” However, she’s careful not to appear critical of career managers, who “are integral to providing an excellent level of service,” she adds, “and it’s important that everyone who works in our NHS feels valued”.

When Keir Starmer became Labour leader in April 2020, during the first wave of the pandemic, he made Allin-Khan shadow minister for mental health. It was a shrewd appointment: her continuing work at St George’s gave her authority when facing Nadine Dorries and Matt Hancock across the despatch box, while the brief tapped into her personal mission to tackle poverty and its consequences. “The biggest drivers of poor mental health are adverse childhood experiences: social inequality, deprivation, poor housing, lack of opportunity,” she comments.

As she took on the role, covid was pushing an already-overstretched system over the brink. “The pandemic laid bare all the health inequalities that we already knew existed in our communities, but also showed where all the fractures were within the NHS. There was just no slack in the system,” she says. Many of those fractures lay in mental health services: ‘parity of esteem’ has never been more than “a utopia that we strive for,” she comments. Now, the economic situation is further driving up demand for mental health services: “We’re seeing the perfect storm,” she says. “We’ve had a quarter of all mental health beds cut since 2010. So the resources have shrunk, the need has grown; and as a result, we have a system that’s not able to cope.”

No quick fixes

In considering how to address these huge challenges in mental health, Labour’s “watchword is prevention”, she says. “That really is the key: a public health approach to mental health” and that demands action by organisational leaders in every sector and industry, and by every government body. “Mental health doesn’t exist in a silo,” she says. “There should be a place for positive policies for mental health in every single department: housing, [culture] when it comes to online safety, education, the justice system.”

To boost NHS provision, she says, a Labour government would end tax loopholes for private equity fund managers and VAT exemptions for private schools—raising the money to recruit 8,500 new mental health staff, provide specialist counsellors in every school, and locate open-access services for children and young people in every community. The goal is to guarantee access to mental health treatment inside a month, Allin-Khan explains, though that “will take an entire term to deliver: there are no quick fixes.”

To boost recruitment, “we have to make going into mental health an attractive offer—offering training, making people feel valued.” Meanwhile, action is required to support better mental health among NHS staff: “People were not prepared for the level and scale of death that they had to experience” during the pandemic, she says. “The greatest single cause of NHS sick days is mental ill-health, and we have to crack that.”

Allin-Khan’s Care for Carers campaign, launched in 2020, called for “timely, quick access to care and treatment” for all NHS and care staff. Other support to improve wellbeing can also help, she believes, but it must fit the realities of working life in the NHS: “There’s no point having pilates available for an hour a week if staff can’t get off the ward.”

“We've spent a lot of time talking to people in the sector, really understanding where the needs lie. It's not about flashy buzzwords and machinery. It's about people; we just don't have enough of them.”

Not enough people

Pay is, of course, another crucial factor in the NHS crisis; Allin-Khan has—as far as her front-bench responsibilities permit—expressed sympathy for striking nurses. “You’re part of a family when you work in the NHS; you’re so proud of what you do,” she comments. “People have missed weddings; they’ve missed funerals; they’ve cried themselves to sleep at some of the things they’ve seen. To not go to work and to stand on a picket line is the toughest decision you could take, and you do not take that lightly. So for the government to hope that the appetite for striking abates because of public pressure… they’ll be waiting a very long time.”

In other policy fields, she sticks tight to the party line. Asked about the inequalities in today’s social care system, for example, she responds that “we don’t have a policy on that at the moment. What I can say with certainty, though, is that the burden placed on families needing to care for their loved ones—many of whom have to choose between heating and eating; who’ve given up their jobs—is horrendous.” In her constituency surgeries, she adds, people express fears that their life savings will disappear into care costs. “These are real issues that people are concerned about,” she says. “We understand that.”

Asked Labour’s view of Integrated Care Systems (ICSs), Allin-Khan pivots back to staffing. “The priority is about having a workforce that can treat the patients, care for our vulnerable and really do the job,” she replies. “We’ve spent a lot of time talking to people in the sector, really understanding where the needs lie. And it’s not about flashy buzzwords and machinery, particularly in mental health. It’s about people and staff; we just don’t have enough of them.”

So how would the party address the rising demand baked into the UK’s demographics, improve integration with social care, or strengthen providers’ focus on prevention? “We need adequate investment in our workforce; we currently don’t have enough carers for our vulnerable elderly,” says Allin-Khan. “Without growing the workforce, the structural issues are less relevant because you can’t deliver the services you need.” On ICSs, she says only that “these are the sorts of things that we’ll look at and address when we’re in government.”

As with social care, Allin-Khan’s uncertainty reflects the lack of an established party policy. So a broader question: how would Labour find the right balance between regional autonomy and central intervention to drive up performance? The solutions lie in having the “people running the system and using the system at the front and centre of what happens, as we’ve just done with the draft Mental Health Bill,” she replies.

Allin-Khan sat on the Bill’s pre-legislation joint committee, “and to decide policy we had experts from the colleges and charity sector; patients with lived experiences; the Care Quality Commission—all the major stakeholders at the table,” she explains. “That’s the approach that works incredibly well: getting everybody round the table and making decisions with the people who are going to be delivering and using services”.

It’s a gift to work in the NHS

Our time is up: Tory MP Andrea Leadsom is knocking on the door of our Portcullis House meeting room. But as we head for the exit, there’s time for another question: what’s Allin-Khan’s view of the rules on MPs’ second jobs? “For MPs like myself, who do something vocational where you’d lose your license [if you couldn’t practice], you should be able to continue,” she replies. “Because it’s a gift to be able to work in the NHS.

“The first question I asked, when someone suggested that I throw my hat into the ring to stand in a by-election, was: ‘Would I still be able to continue doing shifts?’,” she continues. “And if the answer had been ‘No’, I never would have done it. Because for me, that’s who I am; it’s a huge part of what makes me me. If second jobs were banned, I would do shifts for free—just as I did many shifts during covid for free. And I still practice my humanitarian medicine: I went to Ukraine to train doctors in the first week of the war; I’ve been to the Rohingya camps; I’ve been to the Syrian border and Palestine, all while being an MP. For me, that advocacy is very important.”

Second jobs shouldn’t detract from MPs’ ability to serve their constituents, she suggests, but “I’m lucky: I can do my shifts in what would be my family time, at nights or weekends.” This comment, absolutely heartfelt, neatly illustrates Allin-Khan’s utter commitment to her vocation.

And what, if this government lasts another two years, is the outlook for patients and staff? “Bleak,” she replies. “I don’t expect my next shift to be any better than the last shift I did, and there are very few quick fixes that I can see that could make any difference. So I have no faith in the current government to deliver for our NHS.

“Moreover, I don’t truly feel as though they care,” she concludes. “I think what they’re trying to do is put sticking plasters over what is a gaping wound—and that never works.”

Photos: Mark Weeks

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