My Manifesto for the UK Post Brexit (part 4 – Health and Social Care)

Health and Social Care

The UK is facing an existential crisis, especially when it comes to healthcare. I think it is part of the reason why the Labour party are in such appalling disarray at the moment. When the nation state as we have known it is beginning to fall apart, what is the role of the state? The question comes into sharp focus when it comes to our beloved NHS. The financial nightmare facing the NHS is in the press everyday. How much of this has been orchestrated by a bureaucratic system that wishes to see its demise we may never know. But the fact remains, there is a whole lot of debt, an ageing population with increasingly complex health and social needs and a significant underspend in terms of GDP on health compared to most of the other ‘developed’ nations.

Although I believe that we will (and need to) see increased localism, especially when it comes to political participation and economic alternatives, discovering together entirely alternative ways of being and organising ourselves, I still believe in a more national approach to health and social care, as for me, one of the roles of leadership is to ensure provision for those most easily forgotten about or marginalised in society.

Obviously this subject matter is far vaster than a short blog can offer, but here is a starter for ten:

I would therefore increase spending on health in line with need and GDP. I would support moves through partnerships between health and education to encourage our children and young people, in particular, to exercise and eat healthily, therefore breaking some of the health inequalities we see presently in the years ahead. I would look to improve the overall wellbeing of society, as we know that both extreme poverty and extreme wealth is bad for our health. We need to talk about physical, mental, social, spiritual and systemic health. We need a 70 year vision for healthcare, not something that changes with the wind of each new parliament. People would be empowered to care for their own wellbeing and look after one another, because where people are connected to one another, they flourish more readily. I would not privatise the NHS, but keep it public, learning lessons from around the world, ensuring our systems are continually improving and accountable but providing kind and compassionate health and social care to everyone in our communities. I would amalgamate the health and social care budgets. I would invest in measures to improve the overall mental health of the nation by looking at the root causes of our unhappiness and disconnectedness, ensuring those who need psychological therapies and psychiatric expertise are able to access this. I would ensure our staff are appropriately paid and would create a culture of participatory leadership, where we care for the health and wellbeing of those who work in the system. I recognise that health is best provided in the local community and will support the growth of integrated care communities, like those in Morecambe Bay. General Practice is the bedrock of such communities and will therefore be funded appropriately. Communication training, led by patient-experience, would be compulsory. All training would be integrative, problem based and solution focussed (that could do with some unpacking – maybe another time!).

I would break the negative cycle caused by the economics of ‘payment by results (PBR)’ and create participatory shared budgets, breaking down the walls of competition between segments of the system that need to collaborate. I would create emergency care hubs, co-locating services that need to work in an integrative manor. We have to face the fact, that it would take an enormous cultural shift to stop people walking through the doors of the ED, so let’s work with it, rather than trying to change the tide. I would want to see the 5 ways to wellbeing as part of every work place environment. In hospitals, there needs to be a focus on faster discharges (something the dreadful cuts to social care budgets across our county councils will only worsen), working with community teams to enable people to be cared for in their own homes. We need a complete overhaul of our residential and nursing home sector, finding areas of best practice and raising the bar significantly in terms of how we honour and care for our elderly citizens. We need to have a philosophical shift in our approach to death – it is an emotive subject and I have vlogged on it previously on my other blog http://www.reimagininghealth.com People need to be able to die well, and far too often they die in the strange surroundings of a hospital, cared for by people they do not know, when they could have died at home or in their nursing home, surrounded by people who love them. If only we could face up to the difficulties of death, we would embrace it in a much more healthy way…..(again I recommend Atul Gawande’s book ‘Being Mortal’).

Is Another World Really Possible?

For those looking for a post about outer space and extra-terestialism, I’m sorry, you’re in the wrong place!

 

I’ve been thinking a lot recently about the possibility of another world, a different kind of future to the dominant story we find ourselves in at the moment. Much of my reading and wondering over the last few years has been about this: Is another world really possible?

 

I know people have asked this question for generations and for some it has meant creating an alternative story, outside the dominant system in the hope that others will join it. For me, this is obvious in certain religious and political institutions. The same yearning has also led to many wonderful people movements (suffragettes, civil rights, gay rights etc), inventions and change. But nearly always, these catalytic shakings result in commodification and assimilation into the status quo. My good friend, Martin Scott, has written some very helpful and thought provoking things about the nature of people movements of late and I especially like the observation he makes about how such movements rise and fall. First of all they are ignored, then they are ridiculed. When ridicule fails and the movements become more threatening to the powerful elite, the strategy becomes one of hostility and when this fails, they are colonised. Colonisation leads to control.

 

The danger for any people movement is the acquisition of power. This is based on the old adage that all power corrupts and absolute power corrupts absolutely. For me this is held fast by the current reality of the dominant system that holds its power through the triangulation of control through violence (particularly seen in the state of the exception), debt and law (both religious and political, especially when is oppresses or stifles creativity and freedom). But, another good friend of mine, Roger Mitchell, contests that love itself is the most powerful force in the universe and love does not have to be corrupted. If love is the prime choice before power, then power becomes subordinate to love and another world becomes possible (see ‘The Uncontrolling Love of God’ by Thomas Jay Oord).

 

Another world is possible, but my perspective is that it is only possible for it to be ‘recreated’ from within it. And that involves our eyes being opened to new possibilities and a determination that love must be our prime choice. Once we decide that we are first and foremost about love, it leaves nobody at all on the ‘outside’. It has a different set of priorities to those of the dominant form of power. It involves a new way of being together. Our systems can be transformed once we personalise them and realise that we are part of them. For me, this is the heart of what the christian narrative is all about (ignored, ridiculed, treated with hostility and then colonsied). It awakens the possibility within us, as individuals, communities and nations, of another kind of world, not a separate world within the world. A world where God is not mysterious but known to all as the One of Love, who does not dominate or control but gives love and life freely; not in some Utopian, hippy-like dream, but in the gritty reality and pain of every day life, pouring itself out from the choice of love. This kind of love does not demand uniformity, but calls us deeper into a place of union, a real belonging to the family of humanity in which our choices, values and behaviour become aligned with the hope we carry for the future. Once we decide that our underlying and first value is love, the possibilities ahead are very exciting!

 

 

Political Parables – Free Market Economics

Unknown First of all, I listened to an awesome radio 4 show this week, which is part of a brilliant series called “Promises, promises: A History of Debt”. This week’s short program was entitled: “The International Politics of Debt” and serves as a good backdrop to challenge some of our world-view before embarking on this next parable, which to be honest, interpreted through the lens of Freire and Herzog, blew my mind! Have a listen: http://bbc.in/18eAr6m The parable in question is that of  “The Parable of the Talents” (Matthew 25:14-30; Luke 19:11-27)

Matthew 25:14-30 English Standard Version (ESV)

The Parable of the Talents

14 “For it will be like a man going on a journey, who called his servants[a] and entrusted to them his property. 15 To one he gave five talents,[b] to another two, to another one, to each according to his ability. Then he went away. 16 He who had received the five talents went at once and traded with them, and he made five talents more. 17 So also he who had the two talents made two talents more. 18 But he who had received the one talent went and dug in the ground and hid his master’s money. 19 Now after a long time the master of those servants came and settled accounts with them. 20 And he who had received the five talents came forward, bringing five talents more, saying, ‘Master, you delivered to me five talents; here I have made five talents more.’ 21 His master said to him, ‘Well done, good and faithful servant.[c] You have been faithful over a little; I will set you over much. Enter into the joy of your master.’ 22 And he also who had the two talents came forward, saying, ‘Master, you delivered to me two talents; here I have made two talents more.’ 23 His master said to him, ‘Well done, good and faithful servant. You have been faithful over a little; I will set you over much. Enter into the joy of your master.’ 24 He also who had received the imagesone talent came forward, saying, ‘Master, I knew you to be a hard man, reaping where you did not sow, and gathering where you scattered no seed, 25 so I was afraid, and I went and hid your talent in the ground. Here you have what is yours.’ 26 But his master answered him, ‘You wicked and slothful servant! You knew that I reap where I have not sown and gather where I scattered no seed? 27 Then you ought to have invested my money with the bankers, and at my coming I should have received what was my own with interest. 28 So take the talent from him and give it to him who has the ten talents.29 For to everyone who has will more be given, and he will have an abundance. But from the one who has not, even what he has will be taken away. 30 And cast the worthless servant into the outer darkness. In that place there will be weeping and gnashing of teeth.’

Footnotes:

  1. Matthew 25:14 Greek bondservants; also verse 19
  2. Matthew 25:15 talent was a monetary unit worth about twenty years’ wages for a laborer
  3. Matthew 25:21 Greek bondservant; also verses 232630
English Standard Version (ESV)The Holy Bible, English Standard Version Copyright © 2001 by Crossway Bibles, a publishing ministry of Good News Publishers. I have sat in so many different church contexts over the years and heard this parable taught the same way. “Use your talents/gifts/money for God, because God doesn’t want you to waste what He’s given you. You are supposed to multiply it and increase it and use it for His glory/for good/to show others His blessing…..” But, hang on a minute. What if we turn this parable on its head? What if Jesus is not casting God as the master, but he is again directly speaking into the societal set up of the day? What if this master is in fact a ruler in an agrarian society, with a governing class beneath him, a section of merchants, retainers and priests with a few artisans thrown in underneath that and a bunch of unclean/degraded/expendables at the bottom of the pile? If this is so, (and I’m not sure the master fits the bill in terms of who Jesus is revealing the Father to be), then what might the parable mean? Is it possible that the radical person is not the one who doubles the money of the “unjust ruler”, who reaps where he doesn’t sow etc etc? Rather, could Jesus be highlighting the one who choses to challenge this way of life, that in effect keeps the ruler rich and powerful, or gives increase to the ones who are willing to increase their wealth through defunct systems of usury, to be the real radical/irritant/one of another kind of Kingdom? It’s not to say that God doesn’t want us to use gifts he’s given us for the benefit of others…..but maybe that’s just not what this parable is about. Too often, the parables of Jesus are used to uphold and justify a certain way of doing economics and perhaps we don’t want to engage with the hard-hitting realities of what he might really be saying…. If we assume that this master does not represent God, then what might a modern-day reading of it be (also given the context of international debt)? Maybe something like this: For it will be like the CEO of a big chocolate company, who went to the Ivory Coast to ensure a good flow of chocolate into the West and ever expand his chocolate empire. He called three of his most entrusted leaders to himself, and asked them to ensure more chocolate at a lower price. He set one of them, with the most experience over 5 factories, the next one over 3 factories and the last one over 1 factory. The first two set to work, thinking about how they could make more chocolate for less money in order to keep their boss happy and the business functioning well. They knew if they did well, they would secure their own future in the company and good income for their families. Understanding capitalism, they came up with a cunning plan. They decided the best way would be to get cheap or even free images-2labour. So, they enslaved children from the surrounding area and nations with families who were too poor to keep them, and put them to work in the fields, picking the cocoa, or in the factories at the grinding machines, under terrible and dangerous conditions, in which many of the children died or were abused by hard task masters. images-1The last of the workers, saw what the other two were up to and it made him sick to the stomach. He refused to enslave children in this way and couldn’t understand the motivation of the CEO. He chose to pay people a fair wage, keep their working conditions good and have strong morale amongst his team. The CEO returned. He was willing to turn a blind eye to the methods and was full of praise for the ‘business acumen’ of the first two. He paid them well, ensuring his ‘fair trade’ logo and set them up over even more projects to continue achieving brilliant results. The other guy was out on his ear, sacked from the company with no right of appeal. Confused and dismayed, what was he to do? End his life? Beg for his job back and act the same way as the others? No, he continued Unknown-1to try to live a life that restored people’s humanity and hoped for “the more beautiful world our hearts tell us is possible”. So, who is the radical carrier of the Kingdom of God here?