When Sadiq Khan was elected Mayor of London in 2016, Rosena Allin-Khan was flitting between working as an A&E doctor at St George’s Hospital in south London, being a Labour councillor nearby in Wandsworth, and pushing two toddlers around in a pram.
Allin-Khan only stood for the council in 2014 because someone else had dropped out and Labour needed a “paper candidate” – otherwise known as a no-hope candidate – to fill the ballots. She won by a handful of votes in a then-solid Conservative ward.
So when Khan vacated his seat as Labour MP for Tooting in south London in 2016, Allin-Khan hadn’t even considered that she could take his place.
“Local activists thought I should throw my hat in the ring, and I thought they were, quite frankly, mad,” she tells Spotlight over a video call. “But I decided to go for it, because it was my area and I wanted to call out some of the injustices and speak for my community where I was born and raised, and where I was now raising my family.” She won the seat and has held it ever since. In 2020, she also joined Keir Starmer’s shadow cabinet as mental health minister.
Allin-Khan grew up in Tooting, in a working-class household. Her Polish mother and Pakistani father were both musicians. They later separated, and her mother worked three jobs to support Allin-Khan and her brother. After doing poorly in her A-levels, the shadow minister missed out on studying medicine and took medical biochemistry instead. She excelled and went on to study medicine at Cambridge University, funded through scholarships.
“I had no plans to be a politician whatsoever,” she says. “My upbringing and the way that I was forced to grow up led me to have very strong Labour values. It was the Labour Party that made it possible for someone from my background to go to medical school.”
Alongside her political responsibilities, Allin-Khan still does A&E shifts and worked on the front line during the Covid-19 pandemic. The polymath has inherited her parents’ musical streak too. She sings, plays the violin, piano and saxophone. She also trains as an amateur boxer and has worked as a humanitarian doctor across the world, including in Myanmar, Palestine and most recently Ukraine. Working abroad showed her “how unequal life was across the globe”, she says, and spurred on her political activism.
Most people would think Allin-Khan was mad to juggle a high-pressure NHS job with parliamentary and ministerial roles, as well as being a parent. She often ends up doing hospital shifts late at night or squeezing multiple shifts into parliamentary recess. While I do wonder when she sleeps, she tells me that her jobs are complementary.
“When I became an MP, it was very important to me that I wouldn’t have to give up my clinical practice,” she says. “[It] enables me to have a really informed experience – the two jobs have a synergistic effect when it comes to my advocacy in parliament.”
Allin-Khan is speaking to me virtually from what looks like her bedroom after a frenzied rearrangement of an in-person interview the day before. She had been delayed in parliament due to an opposition-day debate on the mental health crisis. Casually dressed in a hoodie and Abercrombie & Fitch T-shirt, she has the relaxed and amiable demeanour of someone with far less responsibility, and a much smaller workload.
She is not all approachability and smiles, however. After an accidental mispronunciation of her name, she corrects me – “it’s Ro-zen-a, not Ro-zeen-a” – in a manner that betrays mild irritation (and implies the mistake is a regular occurence). The day before, she directed exasperated comments at the Tory MP Andrew Bridgen in the Commons after he asked her to “apologise” for backing Covid lockdowns. She told him she would take “no lectures” from someone who “proudly sat” in a government that “oversaw hundreds of thousands of unnecessary deaths”.
Having worked through the pandemic as a doctor, Allin-Khan was understandably angered. There’s no doubt that Covid-19 caused extreme loneliness and isolation, she says, but she believes the greatest impact on people’s mental health was the “extreme loss of life and the inability to say goodbye” for patients and their families, as well as the psychological effects on NHS staff.
“Nobody was trained for this,” she says. “I’ve worked in war zones; I’ve worked in huge natural disasters; I’ve seen children die; I’ve worked in genocide areas. I thought I’d seen a lot. But I was so deeply traumatised by it [the pandemic].”
She recounts how she helped a 27-year-old dying woman’s three children see her via an iPad, because families couldn’t visit hospitals. The woman was pregnant and had suffered complications from Covid-19. Her baby was delivered by emergency caesarean on the intensive care unit. Allin-Khan remembers the children shouting “Mummy, wake up, you’ve been asleep too long.”
“That floors you,” she says. “It was the anger [I felt] every day, going home from my shift, asking myself the [same] question and knowing the answer – could so many of these deaths have been avoided?”
On its 75th anniversary the NHS is still under enormous pressure. There are huge workforce shortages and backlogs of appointments and elective surgery. The latest NHS England vacancy statistics for March 2023 show a shortage of more than 40,000 nurses and 8,500 doctors, while, according to the British Medical Association (BMA), 7.4 million people are waiting for treatment, up from 4.4 million in March 2020.
What is it like being a doctor right now? Working in A&E is “soul-destroying”. Allin-Khan tells bleak stories: suicidal young people who can’t access mental health; there’s nowhere safe or private to examine someone with bowel cancer symptoms; children are sleeping on waiting room floors.
“This is Tory Britain, where we examine patients in cupboards,” she says, flatly. “Whether you’re a nurse, doctor or healthcare assistant, you’ve gone into a profession because you care and want to deliver the best for your patients. It’s crippling, and we’re losing the workforce.”
NHS staff strikes are ongoing, with unions demanding double-digit pay rises and solutions for the severe workforce shortages, which they say are putting patients at risk. The Royal College of Nursing is asking for a 16 per cent pay rise while the BMA, which represents most doctors, is asking for 35 per cent.
While the shadow health secretary Wes Streeting has previously said strikes are “not in the best interests of patients [or] the NHS”, Allin-Khan is clear about where her loyalties lie. “If I was a full-time doctor and not an MP, I don’t see any reality in which I wouldn’t be on strike, shoulder to shoulder with my colleagues,” she says. “No nurse or doctor goes on strike willingly. You have to be so worn down.” She adds that the biggest impact on patient care is not strikes, but consecutive Conservative governments that have “set out to destroy the NHS through underfunding and under-resourcing”.
The government published its Covid-19 recovery plan last year, which pledged to spend more than £8bn by 2025 to reduce waiting lists, £5.9bn to invest in new beds, equipment and technology, and £7.5bn to discharge patients from hospitals into social care settings. It also published an emergency care plan this year, which promised to boost capacity in A&E through 800 new ambulances – including 100 specialist mental health vehicles – and 5,000 more hospital beds.
Last week, the government published its long-awaited NHS Long-Term Workforce Plan, laying out a three-pronged “train, retain and reform” model to tackle worforce shortages. This includes doubling medical school places, increasing GP and adult nursing training places, and incentivising experienced doctors to stay in the NHS through more “flexible” working patterns. It also includes reforming training, through introducing medical degree apprenticeships, and supporting medical schools to move from five- or six-year degrees to four-year programmes.
In May, Labour published its own NHS plan. It includes training 7,500 more doctors by doubling medical school places, 10,000 more midwives and nurses, and 5,000 more health visitors. While Allin-Khan acknowledges the importance of technological advancement, ultimately, she says, “it’s not about shiny machines – it’s about people. And people in the NHS just want to feel valued.”
One problem with both political parties’ plans noted by doctors is that increasing medical school places doesn’t fix the mass exodus of clinicians from the profession, which has left specialist and experienced roles empty. Allin-Khan says Labour would set out to make now-depleted specialisms such as GP and emergency medicine “attractive again” through better training opportunities, access to suitable jobs, and more support staff and resources.
Both Labour and the Conservatives have mooted the use of private providers to clear the NHS backlog. Streeting has spoken openly about how the private sector could be used in the short-term to help the NHS “reform” and ease the crisis. Critics, such as the BMA, have warned this could create a “two-tier” system in which richer people have better access to healthcare. The union also worries it would ultimately drain NHS resources, as doctors would earn more in the private sector and a profit motive could lead to an excess of unnecessary tests and procedures.
Allin-Khan is quick to clarify Labour’s position on privatisation. “Wes couldn’t be clearer that ‘over his dead body’ will the NHS be privatised.” While she would not support using private providers to clear the mental health backlog because they “fail patients and generate even worse outcomes”, her view on physical health is more nuanced. She offers a real-life example – a grandmother who came to A&E with a cancerous lump too late and whose grandchildren would now need to enter foster care. “People like that are being failed,” she says. “If they can get the operations they need, while bringing waiting lists down and having their lives saved? Of course, there is a place for that.”
Mental health is one of the most crisis-ridden areas in the NHS, particularly child and adolescent mental health services (CAMHS). There are currently 1.6 million people waiting for treatment, including 400,000 children, and nearly a quarter of patients wait more than 12 weeks to start treatment. Many are pushed to emergency services: mental health patients waited 5.4 million hours in A&E last year.
Emergency departments are poor environments for people experiencing a mental health crisis, says Allin-Khan: “It’s cripplingly frightening for somebody having an acute psychotic episode to be in A&E with people throwing chairs, someone having a cardiac arrest, noises going off and bright lights.”
An investigation from the House magazine recently revealed that CAMHS is a postcode lottery, with average waits for a first appointment varying between ten days and three years. In 2021-22, nearly a third of children’s mental health referrals were closed, resulting in no treatment. Allin-Khan says she sees young people attending A&E who are suicidal, with CAMHS doctors rarely available to assess them, and “younger and younger” children come in with eating disorders and self-harm issues.
She thinks the Conservatives have “failed” children through a lack of resources and funding, but also by neglecting to address broader inequalities, such as housing, income, racial disparities and domestic violence, which all impact mental health. For example, black people are almost five times more likely than white people to be detained – made to stay in hospital – under the Mental Health Act 1983. The act is currently undergoing reform, but the government is “dragging [its] feet”, Allin-Khan says, following a cross-party committee’s recommendations that she was part of.
“Adverse childhood experiences are the single biggest driver of mental ill health,” says Allin-Khan. “Mental health shouldn’t exist in a silo. It’s got to be a cross-government approach. Labour plans to increase the mental health workforce by 8,500 people, and move more care into the community by launching “open access” mental health hubs for young people, and placing specialist staff in schools. This would speed up referrals while lightening the NHS burden, says Allin-Khan, and steer towards “prevention”, which she says is at the heart of Labour’s NHS strategy.
Government plans for mental health appear to have been sidelined. Last year, the then health secretary Sajid Javid pledged a ten-year plan, but this has since been scrapped and rolled into a “major conditions strategy”, which will tackle multiple issues simultaneously. “This is the problem with mental health,” says Allin-Khan. “It always feels like the poor relative to physical health. One of the huge issues that we have is stigma. People are afraid to admit that they’re struggling because mental health is never given parity of esteem with physical health. When we scrap things dedicated to it, we’re saying it’s not important – it’s not valuable enough.”
Inevitably, psychological well-being has fallen to the bottom of the pile for many patients too. GPs are so stretched they can only offer short appointments that tend to focus on physical problems. Greater investment in the workforce would reduce pressure on GPs and allow them to perform their jobs more holistically as “family doctors” again, with more time to spend with patients.
“It’s very difficult to have that relationship now,” says Allin-Khan. “The longer you wait for mental health care, the sicker you become and the more it costs the economy to treat you. It’s a false economy not to invest in mental health.”
This piece first appeared in a Spotlight special print edition on the NHS’s 75th anniversary. Read it here. The online version of this article has been updated to include the publication of the NHS Long-Term Workforce Plan, which had yet to be released when the supplement went to print.
[See also: Why adults should put their phones away]