Robert Nisbet – At a Drop of Another NHS Hat: The Health Clinician (and Patient) Cometh!

We are pleased to welcome a post by our newest editor, Robert Nisbet.

The Beryl Institute defines the patient experience ‘as the sum of all interactions, shaped by an organisations culture, that influence patient perceptions across the continuum of care’. Through a number of benchmarking reports and research projects the Institute demonstrates that actions by most organisations are primarily tactical, which pose challenges to achieving true systemic impact and lasting change. This highlights the need for organisations to think more strategically about their patient experience goals and to let this strategy influence their business objectives and decisions on how clinical care should be delivered.

Thinking through some of the challenges of effective patient engagement in their care and treatment, I quickly drifted into the memory banks of my childhood and in particular family Sunday lunch times. Silence was strictly observed at the table to ensure that the BBC’s Light Programme ‘Family Favourites’ (best remembered by its later name ‘Two-Way Family Favourites’) was not interrupted, as it crackled from a Bakelite wireless that sat like some shrine on the sideboard.

Silence, though, could be interrupted if a Flanders and Swann song was played, to enable us to accompany the well-acclaimed duo. Their songs of the ’60s were linked by contemporary social commentary; ‘a witty and educated diversion‘ as Kenneth Tynan, critic for the Observer, commented.  Flanders and Swann’s concerts toured first with ‘At a Drop of a Hat’ and, on return to the UK after their European and American tour, ‘At the Drop of Another Hat‘.

To prevent any further drift into my recall of the ’60s, the Flanders and Swann song ‘The Gas Man Cometh’ is a timeless piece of insightful commentary into the habits and culture of many organisations and services. Flanders (with Swann nodding his agreement), fresh back from across the pond, would press upon their audience their observations that ‘wandering around things have come to a pretty underpass here in England while we’ve been away. It’s small wonder to us that satire squats, hoof in mouth, under every bush‘. The purpose of satire is to strip of the veneer of comforting illusion and cosy half-truth, and as Flanders and Swann practiced ‘to put it back again’. Of their ‘respectable songs for responsible people’, ‘The Gas Man Cometh’ is best known for providing a ballad of unending domestic upheaval.

Recognising that my reworking of the songs lyrics are no match for the talents of Flanders and Swann, I hope that they still convey the same style of satire that duo applied to situations of everyday life; in this case the challenges faced by the NHS. Moreover, I hope that I do not offend any individual whose profession or ‘craft’ is referenced below. If you wish to sing or play along, click here.

The Health Professional Cometh
‘Twas on a Monday morning
The GP came to call;
The medication wasn’t working – I couldn’t go out at all.
He tore of all my clothes
To try and find a vein,
And I had to call a Nurse in to put them back again.
Oh, it all makes work for the NHS to do!
‘Twas on a Tuesday morning
The Nurse came ’round;
She pulled and she stretched and she said, “Look what I’ve found!
Your joints are far too tight but I’ll put it all to rights.” Then picking up a leg [pop] put my knee right out.
Oh it all makes work for the NHS to do!
‘Twas on a Wednesday morning, the osteopath came round.
He called me Mr. Nesbit, which isn’t quite my name.
He couldn’t reach the knee without sitting on by back, so I called the physio in.
Oh it all makes work for the NHS to do!
‘Twas on the Thursday morning the physio came along.
With her lotions and braces and her merry…phy-sio song,
She popped my knee back in…it took no time at all,
But I had to get a psychiatrist in to come and assess my needs.
Oh it all makes work for the NHS to do!
‘Twas on a Friday morning the psychiatrist made a start.
With questions and theories he covered all my past.
Every nook and every cranny,
But I found when he was gone.
He’d made so depressed that I lost the will to live.
Oh it all makes work for the NHS to do!
On Saturday and Sunday they do no work at all…but alas I sat in A&E.
So, ‘Twas on the Monday morning that the GP came to call.

If we are to engage the patient with a better experience of their healthcare this requires a radical transformation in the way healthcare institutions and professionals serve their patients. Likewise, we need to assist patients (if the circumstances permit) to recognise and take responsibility for being active participants in also changing their ‘role’. Noting that professionals, and their family members, are not immune at times from having to be ‘patients’ themselves.

The necessary change is being spurred by recent legislation coupled with an overwhelming entourage of policies, guidance, commissioning and payment models designed to reduce costs while improving outcomes. These efforts centre on the idea that improved communication and engagement equals a better patient experience and real cost savings. The work of the IMH alongside a wide and informed network of research and evidence-based practice is playing a crucial and influential part not only in the debate but in the ‘making it happen’ zone.


Organisational cultures, professional comfort zones, the long tradition of patient ‘passivity’ and the ‘fairy tale’ belief that the NHS will always be there, sets an incredible challenge. Cuts, reconfigurations, mergers and acquisitions in health and social care services are providing, and will continue to provide for some time, regular items for the news media.  Is there sufficient time to achieve what we know can make vital difference to how we plan and deliver services or will the ‘Gasman still cometh‘ until there is no one to answer their knock on the door?

If by reading this article you have become a little disheartened – then cheer yourself by watching another rendition of the ‘The Gasman Cometh’ (new page)!

Robert J. Nisbet.
Robert is a member of the IMH and by ‘trade’ a social worker. He worked in post-sixties Britain in a variety of mental health services, and these days he provides programme management support for the East Midlands Adult Safeguarding Board.
He blogs at
Tweet: @NisbetRock


1 Comment

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One response to “Robert Nisbet – At a Drop of Another NHS Hat: The Health Clinician (and Patient) Cometh!

  1. First of all I loved your excursion into Flanders & Swann! I think it requires a degree of participatory wellness on the part of me the Patient for the making it happen part to carry through and what is missing currently is the presence of proactive opportunity that is timely for the engagement of that wellness when it first emerges, so that it can be worked with proactively and enable a successful restitution, rehabilitation – and dare I say it, recovery? Our stories are a saga not only of missed opportunities but also of no opportunities whatsoever, which is the tragedy of permitting people to cut services which jeopardise whole futures and throw our Present into such disarray. False economies are rife in the current political landscape and we lean very heavily on the ‘well’ to argue our case – when our compos mentis status is so glaringly called into question.

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