Category Archives: Random Thoughts

The Powers

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This last week I was sat in a meeting with several maternity service users and a splattering of health professionals and managers of varying sorts. We were talking about the enormous deficit that is in our health budget and therefore some of the difficult options that are ahead of us. The government likes to call these options “efficiency savings”, everybody else knows that we are talking about cuts to services.

I always start my presentations by talking about the difficulty we find ourselves in, how we got here (a massive national debt, which all nations are in because our entire economic system is built on debt and none of it is real and they just keep on printing more money to solve it, made far worse by people who get massive bonuses and a >£2billion reorganisation of the NHS that no one wanted or asked for, which had we not had, we would now not be needing to make so many cuts!) and what our options now are.

I then offer a revolution, and other than a few smiles and the odd chortle, no one seems to think this a realistic or viable option….But, if we didn’t reinvest in Trident, or if we did charge greedy corporations appropriate levels of tax, then we wouldn’t need to cut services in the NHS.

Anyhow, I then talk about the fact that no decisions have been made and that we are genuinely in a process of listening (something the government really didn’t do before inflicting this reorganisation on us) and wanting to come to a place of collaborative agreement. But I am fast learning two things. The first is that nobody wants the thing they really care about to be cut or refashioned in any manner. They understand that safeguarding their piece of the pie means that others will miss out, but they don’t actually want to make any sacrifices – I understand that. I also understand more clearly that isolated health budgeting doesn’t work……more on this anon….

The second and starkest realisation I’ve had though is just how dreadful the new legislation voted in by parliament really is.

http://www.bbc.co.uk/news/health-26531807

You see, the Secretary of State for Health now has new powers, never had before to close any services or hospital he/she deems fit, not if they are performing badly, but if it makes better financial sense to do so…..And this is where the rubber hits the road in our public consultations and discussions with patients and service users. If we don’t come up with a solution to cut our services (oh sorry, I mean make efficiency savings – memo to self – stop referring to “efficiency savings” as “cuts”), with the public in some sort of agreement (although they won’t be, because who wants their services cut?!), then what will happen is the government will simply do the following:

They will tell us our sums do not add up, they will tell us that savings/cuts must be made, they will get rid of those of us who are trying to reach a point of agreement with our service users and they will bring in their own board aka Monitor. Monitor do not have to consult with anybody, they will simply cut/burn/slash whatever is deemed necessary and their decision cannot be challenged or overturned!

This is nothing other than bullying. It is what Georgio Agamben talks about when he refers to ‘The State of the Exception’ and with this grim stick of threat held up behind us, it makes our work of trying to reach a collaborative agreement on the redesign of services completely impossible. What are we to do? The challenge is here: how do we subvert the system, making it absolutely clear that we do not play this game, and yet submit back into the system so as to allow love to win the day.

The Powers have shown their strong arm. But they have forgotten that there is a power far more ancient and far more beautiful…….life laid down love……love always wins and it will win in the end in the face of all oppression.

My Aunty Judy

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My aunty Judy is a heroine of mine (one of many incredible and strong women in my life). She is an example of a life poured out in love for those around her. She is a district nurse, working in rural north Yorkshire in the North East of England. I heard a story about her recently which inspired me and challenged me deeply.

I found out that Judy was visiting a certain patient of hers, who has a severe and chronic airways disease, unable to even leave the house due to her level of breathlessness. Judy went to this lady’s house and had never seen such squalour. The lady was too disabled to do any cleaning herself, and therefore none had been done for ten years! So, on the following day, when Judy could have been a having a well deserved rest, as she already works well over her allotted hours, she went and cleaned this lady’s house from top to bottom. The “system” had turned a blind eye to this lady’s needs, but Judy knew fine well that with the amount of dust and fungus in the house, this lady stood little chance of improving her breathing at all. No extra pay, no thanks from the lady, but rather a disciplinary hearing from the management powers, for going beyond her remit! But the lady now has a clean house, because Judy was willing to be a toilet, forgiving the system for its failings, cleaning up the mess and releasing more life in the process.

To embrace kenarchy is to embrace humility.

But when she’s not nursing, she is caring for children with severe mental and physical illnesses in her own home, to give their parents some respite. And when she is not doing this, she is often trekking halfway across Europe to help her eldest son who is setting up an eco-backpackers place in Bulgaria! And amongst all of that she cares deeply for her 4 other children and their families and her own mum, my Nanna, who’s health is seriously declining. Talk about going the extra mile!

Yet she has learnt the secret of rest and refilling in the midst of it all so that she doesn’t burn out. She has found the secret that God is really with her as she serves others. This is where God is found – with those who are in need! She has learnt about unforced rhythms of grace.

No job is too small for us, no person too unclean to be embraced and no task is beneath us. This is the kind of love that transforms the world.

Devolving Power from the Centre

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Earlier this week the UK parliament voted that the secretary of state for health will have new powers to close any hospital in England, should he see fit. There are a couple of caveats attached. Firstly, the local people will apparently have ‘a say’ and the local commissioning boards of GPs will also have to agree. How much of ‘a say’ local people will really get is yet to be seen and how much pressure will be exerted on local commissioning boards to tow the party line we don’t yet know.

What this highlights yet again is the complete lack of joined up thinking that happens around healthcare and the wider economy. It also reveals how utterly disempowering central government really is. How can Westminster decide what the needs and wants of the city of Leeds are, for example? What do they know about the non-economic impacts of closing a hospital? I’m not arguing that all hospitals should stay open, and there’s a good chance that some may well need to close. But it cannot be a decision from on high. Nor can it be an isolated decision. It’s too complex for that.

I find great encouragement from the knowledge that there are several towns and cities in the UK where ‘a people’s assembly’ is emerging. There are some stunning examples of this in Nottingham, Leeds and London. Across a city such as these ones, there are webs of networks and interconnected relationships that represent thousands and thousands of people. I had the utter privilege recently of spending some time with John Battle, a recently retired MP from Leeds. He carries a wealth of wisdom in understanding how to engage people from across a city to participate in key decisions. He was explaining to me that in a people’s assembly, there are representatives from many groups across the city. Each person can speak on behalf of their group and report back to them for further discussion. It’s an incredible way of involving a huge proportion of a city in a discussion.

In Nottingham, for example, at the time of electing the new police commissioner, over 1200 people, representing a vast number of networks, gathered from across the city to have a facilitated conversation about what they would hope for from their new commissioner. They were then able to ask questions to the four candidates, and were able to set up a system of accountability for the eventually elected commissioner back to the people. The commissioner understood in no uncertain terms that he was there to serve the city and the city understood that it was there to partner together with the commissioner for the welfare of the communities living there.

A facilitated conversation gives voice to everybody and sets no-one up above another. Leadership becomes about facilitation rather than dominance and control. When we talk about closing a hospital or a maternity unit or a school in an area, it is often said (as in my previous blogs) that there are some very complex things to consider. This is absolutely true. The problem is that we don’t share the complexity, we leave the decisions to so-called experts (who are at best having a good guess), and then either make them heroes or scape-goats!

National budgeting doesn’t work when it comes to healthcare. Local budgeting in isolation doesn’t work either. It’s all well and good to campaign to keep a hospital open, but we do actually live in a world of finite resources and people and so if we keep the hospital, there may be other tough cuts to make. We have separated out huge aspects of budgeting that really belong together. That is why a people’s assembly in a town/city/region doing the complex task of participatory budgeting is a possible way forward. It isn’t actually that difficult to get people together and budgets aren’t that hard to understand. I know so many people who have extremely tight and complex budgets to manage when it comes to their own households and they do it with finesse. Multiplying the numbers up, ain’t that tricky.

When a town/city understands what it’s budget is for a year (or longer) and the people can decide what the priorities need to be I think the results could be amazing. Firstly, there might be genuine partnerships formed across cities to work in more innovative and creative ways. Secondly, there would be greater engagement and social responsibility. Thirdly, there would be less waste. Fourthly there would be emerging partnerships of gift (rather than competition) between cities for various resources.

Some argue that in such a situation, the most needy and therefore least empowered in a city could miss out. This happens currently in the national setting. For me, this is where leadership comes in. Leadership is not about riding into town to shut a hospital here, or rename a school into an academy there. Leadership is about emptying power out and reassuring all that they are already empowered. It is also about helping protect and promote those who could potentially be down trodden or forgotten. It is giving a voice to those who feel voiceless and oppressed by the dominant systems. For me that would mean promoting and protecting the needs of women (for whom there is still an incredible amount of injustice), children, asylum seekers and refugees, the marginalised poor and homeless, those with physical and mental health needs and prisoners.

Power needs to be devolved from the centre to the margins (just as Gordon Brown MP stated this week). And once the power is more regional it still needs to be continually emptied out so that communities find and serve one another, so that cities become gifts to one another and we find that the order of the house (economics) is the responsibility of all.