Induction week at Ashford and St Peter’s kicked off with what you might expect: a warm but formal welcome from the executive team. You sit there in a big lecture theatre, badged up, half awake, wondering what you’ve signed up for. But as the senior leadership began speaking, that familiar NHS feeling washed over me — structured, methodical, and genuinely supportive.
What exceptionally blew my mind during these first few days was just how deep the structure runs here. Ashford and St Peter’s isn’t just a chain of hospitals and clinics. It’s a self-contained ecosystem — a living, complex system with specialists and dedicated staff behind every imaginable aspect of care, safety, and improvement.
There were absolutely some familiar teams — ones that we also have in Iran. Infection control, medical education, occupational health, and workforce are universal concepts in healthcare. But what shocked me was the sheer level of specialisation here. Some teams exist to do just one thing — and there are three to five people doing it. In Iran, let’s be real, one person usually ends up doing the job of five “teams”. For example, I encountered teams – with green ipads in their hands – solely dedicated to pressure ulcer prevention, VTE assessment, dementia care, discharge coordination, safeguarding, and even patient flow. That’s not even touching the more abstract roles like the Freedom to Speak Up team (yep, a whole department for voicing concerns), Clinical Governance and Risk (monitoring audits, incidents, improvement), IT Training (not IT Support — just training), Simulation & Human Factors (soft skills and crisis teamwork), and Digital Health (the trust’s tech and innovation engine room).
Some of these I hadn’t even heard of before. It’s mind-boggling.
Now, don’t get me wrong — it’s impressive. The NHS is clearly built around layers and layers of safety, oversight, and specialised focus. And you start to understand how it’s grown into a system with over a million employees. Every aspect of patient care is being scrutinised and supported from multiple angles. But it’s hard not to think: too many cooks spoil the broth. Sometimes it really does feel like there’s a team to talk about a problem, and then a different team to talk about what the first team said. Meetings to plan meetings. Action plans for action plans. Coming from a system where the approach is often “just get it done,” it can feel like bureaucracy drowning out practicality.
Still, you can’t help but admire the scale of it all. The NHS is massive, complex, sometimes chaotic, but always trying. It’s easy to criticise it from the outside. Living and working in it, though? That’s when you really see both the beauty and the madness of it all.