Iman

My mum's back seized up for the last time in 2017. Twenty-three years of cleaning office buildings before dawn, hauling vacuum cleaners up stairs that never had lifts, bending over desks that were built for people half her height. She couldn't afford private physiotherapy, couldn't take time off for NHS appointments that were booked three months ahead. I watched her move through our Harlesden flat like she was carrying invisible weights, and I knew what I wanted to do with my life.

I finished my physiotherapy degree at Brunel in 2018. My dad drove me to graduation in his minicab, the one with the torn seat that he couldn't afford to fix. He told me he was proud, that I would help people like Mum who never got help when they needed it. For two years, I worked in private clinics in Marylebone and Hampstead, learning how to treat people who could pay £80 for a forty-minute session. But every patient I saw reminded me of the people who couldn't walk through those doors. The real work was waiting for me in the NHS.

In early 2019, I started applying for Band 5 physiotherapist positions across North West London. I sent applications to North West London NHS Trust and Central and North West London NHS Foundation Trust. The automated responses came back quickly, but they all said the same thing. Both trusts had frozen recruitment. The HR department at North West London was direct when I called: "Budget constraints from NHS England mean we cannot take on new staff this year." At Central and North West London, the workforce manager told me: "We have twenty-seven unfilled physiotherapy positions, but Treasury spending limits prevent us from recruiting."

I didn't question it. It sounded reasonable. The NHS was under pressure, everyone knew that. Money was tight, everyone said so. I applied to smaller practices instead, but they all wanted NHS experience I couldn't get. The circle seemed complete: I couldn't get NHS work without NHS experience, couldn't get NHS experience without NHS work.

I decided to make myself more competitive. In late 2019, I contacted Health Education England about additional training in musculoskeletal physiotherapy, the specialism that could have helped my mum. The response came from their workforce development team: "Treasury spending limits mean we cannot fund new training cohorts this year." Again, I accepted it. The government was being careful with public money. That's what responsible governments did.

I took temporary work in a private clinic in Wembley, close enough to home that I could help with Mum's care. The clinic saw construction workers with back injuries who paid out of pocket because they couldn't wait for NHS appointments. Warehouse staff with repetitive strain injuries from shifts that never let up. Office cleaners like my mum, whose employers offered no occupational health support. Every day, I treated people who were paying for care that should have been free at the point of use.

In 2021, something changed my understanding completely. A friend from university was working as a receptionist at Northwick Park Hospital. She mentioned, almost in passing, that the physiotherapy training centre there was barely half full. I thought she meant applications were down. When I visited the next week, I discovered something that made no sense.

The training centre had 40 empty places on their postgraduate courses. Fully equipped treatment rooms sat unused three days a week. I walked through corridors lined with exercise equipment, ultrasound machines, and assessment tables that no one was learning to use. The course coordinator, Dr Sarah Mitchell, showed me around. "We have qualified applicants," she told me. "People with the grades, the motivation, the clinical experience. But we have no funding allocation from Health Education England to fill these places."

I asked her to repeat that. "The people exist," she said. "The equipment exists. The teaching staff exist. But there is no funding to connect them."

I stood in that empty training room and felt something shift. If the people existed, and the building existed, and the need existed, what exactly was it that there was no money for? The government that prints the pound had chosen not to spend the pounds that would put these students in these chairs, learning to treat the patients who were waiting for care.

I started asking different questions. Why were there twenty-seven unfilled physiotherapy positions at Central and North West London NHS Foundation Trust while there were forty empty training places ten miles away at Northwick Park? Why was the Treasury setting spending limits as though pounds were a finite natural resource, when the Bank of England creates them with keystrokes?

I spoke to other physiotherapy graduates who were stuck in the same loop. Qualified people working in private clinics or taking agency shifts because permanent NHS positions were "frozen." Meanwhile, NHS waiting lists for physiotherapy stretched longer every month. The constraint was never the availability of trained staff or the existence of clinical need. The constraint was a political decision to limit NHS spending as though the UK government might run out of its own currency.

I used to accept the excuse that "there was no money." I hear it differently now. The government that prints the notes and mints the coins told me it could not find enough of them to train the people who were standing right there, ready to work. The real question was never about money. It was about whether the people existed, whether the skills could be taught, whether the materials were available. They were. All of them.

The excuse was not a fact. It was a choice wrapped in the language of impossibility. It is the same logic as a household that says "we cannot afford it," except a household does not issue its own currency. The government does. The limit was never the money. The limit was the willingness to spend it into the places and the people who needed it.

Now I work agency shifts across North West London, filling gaps in a system that claims it cannot afford to fill them permanently. Every ward I work on, every patient I treat, every colleague I meet confirms what I learned in that empty training room. The resources exist. The need exists. The only thing missing is the political will to connect them. And that is not my failure, or my generation's failure. It is the failure of an ideology that treats public investment as a burden rather than as the means by which a wealthy country delivers care to its people.