Housing letters – the dilemma (a poem)

Rebecca Quinn is an inner-city GP, who occasionally encounters the sublime amongst the daily grind of people that she had the privilege of calling her patients

So often we are told that writing letters for patients is ‘not NHS work’ and therefore we must levy a charge. We are also told that housing letters make no difference. Yet an argument can be made that a letter does make a difference – one that perhaps is not easily quantifiable, but one which does validate someone in need, at a time when to be heard is of vital importance to their sense of self worth.

How many of us shift uneasily when charging for a few lines on headed paper? How many of us allow ourselves the possibility that from our vantage point as general practitioners, we may have had our focus so sharpened by years of walking alongside our patients that we might see the benefit of a letter where bland policy cannot? This poem challenges us to examine the tension between our inbuilt desire to help and the constraints in which we must practise.


Housing Letter.

I know this name.

Behind it stretches a journey from

One country to another, carrying burdens.

The syllables that shape it are punctuated

with family friction and hidden shame.

I know this name-

The pain itself the congealing kind,

Resistant to cure. Hercules himself

Would buckle. This man floats stranded

Buoyed by tablets – so many colourful corks

On a wild, wild sea.

So when he tells me that his world has contracted

Into two streets, a sofa and the bus to the surgery

And that he looks out of a place of endless grey

I do not think:

Benefits advisor, social prescriber.

I do not think:

Counsellor, dose increase, or switch and taper.

When he asks for a letter to validate his need

I do not think:

This is not NHS work.

I think of all the reasons a man deserves a home.

I think of the terrible rawness that makes a man weep.

I think of wounded birds, and how hard it is to set a broken wing

And that a letter

Is such a little thing.

He leaves with it tucked like a rose in his breast – no charge-

a folded symbol of dignity and control

a proof to the authorities that he was worthy of being heard.

Tentative proof that we do not yet do trade

in compassion,

that priceless lode that still runs true

through the brittle rock of our NHS work.


Featured image: Taking to a brick wall, by Andrew Papanikitas, 2023

The BJGP is the world-leading primary care journal. At BJGP Life we add multi-media comment and opinion for the primary care community.

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