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A day in the life of Dr Akanksha Mimi Malhotra, Vice President of the RSM Respiratory Medicine Section

I’m spending this academic year as a clinical fellow seconded to the Health Foundation, providing clinical input to the public health and health policy work taking place there. The work is quite a contrast from a year ago, when I was working as a core medical trainee in the intensive care unit at St Thomas’ Hospital in London during the first wave of the Covid-19 pandemic.

Working as a clinical fellow

I’m one of a group of 30 junior doctors at various stages of clinical training who are members of the National Medical Director’s Clinical Fellow Scheme. It’s run by the Faculty of Medical Leadership and Management and sponsored by Professor Stephen Powis, the National Medical Director for NHS England and NHS Improvement. The scheme has given me a unique opportunity to spend a year developing my interests in medical leadership, health inequalities and health policy before starting my specialty training in respiratory medicine in October.

I’m part of the Improvement Directorate at the Health Foundation, which is an independent charity committed to bringing about better health and health care for people in the UK. The focus of my work is the role of the healthcare sector in improving population health and tackling health inequalities. I really value this opportunity to contribute to something I’m passionate about.

Having moved around England quite a bit during my childhood, I got an early sense of the huge differences in social and built environments from postcode to postcode. During university I came to understand that these factors are conceptually called the social determinants of health and include things like housing, education, employment and access to healthcare. An interest in and understanding of health inequalities became unavoidable when I started working as a junior doctor. You see different outcomes for patients with similar conditions, differences in the way patients are able to respond to the advice and treatments given, and whether or not they will be able to self-manage at home because of other stresses in life.

The NHS as an anchor institution

One of my main areas of work at the Health Foundation is looking at the role of the NHS as an anchor institution. Anchor institutions are large public sector organisations, such as hospitals, universities and local government, that are rooted within the local community. For a hospital, being an anchor institution means that in addition to its main role of providing acute medical care, it also purposefully embraces other responsibilities in order to tackle inequalities, and to improve the health and wellbeing of the local population more broadly.

Covid-19 galvanised many institutions, including the NHS, into more purposeful anchor action. Over the last few months I’ve been involved in convening and facilitating a series of conversations with leaders across the UK representing health, local authorities, higher education and the voluntary sector. Our aim was to understand how anchor action was being used to respond to the impact of the pandemic; and to determine the opportunities, challenges, and future priorities for anchor action within the healthcare system.

As a result of this work I co-authored a long-read article that summarised insights from these conversations into nine key lessons. These lessons hope to guide existing and emerging anchor leaders within the NHS. At the heart of this effort is the need to maintain momentum from the pandemic, and purposefully tackle inequalities and co-produce with communities.

Daily life

While working from home is a big contrast from working on a busy hospital ward, the Health Foundation has made it a very open and sociable experience. Virtual meetings are camera-on and we’re encouraged to meet new people through Randomised Coffee Trials – where you meet a new person for a virtual coffee every month who you wouldn’t come across otherwise. For me this might be someone from the corporate communications team or a data analyst who doesn’t have any overlap with my work. It’s been great and makes you feel like you’re part of a family too.

My days are made up of a mix of meetings with people I’m collaborating with, sessions where I’m providing clinical perspectives to specific projects and helping to host or facilitate conversations with external stakeholders. More recently, I have also really enjoyed supervising a medical elective student. I then have to find time to actually do all the work generated by these meetings so I have to be very organised – a colour-coded diary makes all the difference!

I’m also involved in attending, contributing to or hosting workshops and events to understand what’s happening in different spheres of the health sector. I’ve recently hosted an event with the new UK-wide Health Anchors Learning Network with a focus on how lessons from anchor action can be practically implemented, and also contributed to the panel discussion of the RSM’s climate change webinar on respiratory health.

Looking ahead

I’m excited to be going back into clinical practice as an academic respiratory trainee in October and I’m keen to build on my knowledge and enthusiasm for public health policy that I’ve gained from working at the Health Foundation this year. As medics we’re often working in a little bit of a bubble and the experience of working with people who are passionate about health and healthcare but who aren’t clinicians has been fascinating and has certainly broadened my horizons. The opportunity to meet with senior medical leaders, such as the Chief Medical Officer Professor Chris Whitty and my current supervisor Dominique Allwood, and learn from their leadership journeys has also been really inspiring.

If I had an extra hour in the day…

… I’d light some candles, put on some music and start painting some cards for my friends.

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