Consent, Divorce and Brexit

images-1Sometimes people change their mind, especially when new evidence comes to light! For example, in the medical profession, the process of consent stays open right until the operation is about to take place. It would be ludicrous to tell someone they have to go through with a leg amputation, even after it’s been discovered that their leg is in fact healthy and savable, simply because the consent form is signed! I think Brexit feels like that, except in our case, we are the leg and we’re about to cut off the body to which we are joined! Or we could compare it to a couple being forced to go through with a divorce, with all the pain involved, even after they rediscover that they are really great together, have believed lies about each other, and will both be worse off without each other. Yes – they may have some things to work through and they may need to totally reimagine their relationship, but to force the divorce through just because they were going through a rough patch, might be hugely regretful. I think Brexit feels like that – a very sad outcome to what could have been a totally different kind of conversation.


Yes, I accept that there are things about the EU which have made many across the UK find it difficult to want to stay in a relationship with her. But we’ve been led to believe some things about Europe which are wholly untrue and our vision got really clouded. When we step back and recognise all the good things about the relationship, knowing that it isn’t perfect and would still need a lot of work; mediating a reimagined future is so much more preferable than what a divorce is going to mean. And sometimes, it’s only after you call something off that you begin to realise that it isn’t a break-up that you want, it’s just a different kind of relationship. We are literally about to make an unbelievably terrible mistake, but it’s not too late to change our minds. 


Unknown-1Let’s be honest, through the unraveling scandal of Cambridge Analytica et al. we now know that Brexit was NOT the result of a “democratic process”, and the idea that we now can’t change our minds, (even though the evidence is clear of how bad it will be), is beyond ludicrous. Yes, it’s true, we were told it would be a once in a lifetime vote, and that not leaving the EU will break people’s trust in our political system – but last time I looked, there wasn’t loads of faith in it anyway! The leave campaign broke the law in terms of what they spent, told many lies, and hard though it is for us to face up to, used immorally targeted psychological manipulation to get the vote they wanted, driven by hyper-nationalist media moguls. And so NO, we don’t actually have to take the result and live with the dire  consequences. It is time to stop this madness, say sorry to our European friends and renegotiate a New European Union that works for everybody. Clearly there are some huge problems, which is why we are seeing the rise of the far right across the continent. Many people feel un-listened to. Europe has forgotten how to create a positive story of the future and so we are retreating into narratives of fear and separation. But, rather than leave, what we need to do is come together with a bolder and more positive dream of what it means to be in Union together and then we can begin to face up to some of the really complex issues we face at a global level.  


images-2We’ve been worried that being part of the Union means that we are losing our own national identity. It doesn’t mean that at all! Have you seen the Dutch fans at a football match?! When I married my wife, I was still me, she was still her, but we also became something new together! The EU really doesn’t limit our sense of individual nationhood, rather it expands our sense of partnership! We’ve believed that that the union prevents our ability to make good and sensible laws, but this simply isn’t true! Rather, the EU upholds human rights and helps us to embrace ‘otherness’. Europe and the European Union is extraordinarily amazing, but it absolutely needs to modernise, change and embrace the positive new power movements which are emerging. In the bloodiest continent on the planet, we have managed to live at peace with each other for over 70 years, and more than that to have become friends with each other. 


Compared to many nations in Europe, we are not as amazing as we might like to believe. We have one of the highest levels of poverty, some of the least happy people, the widest inequality gaps by an absolute mile and some of the lowest spending on public services. We have the highest property prices and rents in Europe and significantly declining productivity. To top it all, we have the worst pension deal. This is not the fault of the EU, but of the economic systems we have championed but which the rest of Europe have been more careful about monitoring.


imagesSo, leaving the European Union will help us how? £350 million extra a week for the NHS
or social care, or education, or policing? Nope. A better deal in life for those living in our most economically deprived areas? No again. Will we be safer? The police chiefs tell us not. Will our borders be more secure so that we can control all the immigration that we are told is the root of all our problems? Well no, and although immigration is a complex issue, Brexit is not the answer to it and we need to resist a rhetoric of fear, division and hate. . Might we create division across a well-healed Irish border? Yes. Will we potentially lose loads of manufacturing jobs across the North? Yes (just look 
at the new manufacturing deal Japan have struck with the EU). Will many of our businesses suffer heavy losses? Yes. Will the NHS struggle to recruit workers when our workforce is already hugely overstretched? Yes. Are there likely to be food shortages and will food become more expensive? Yes. Are we more likely to see the break up of the UK? Yes – and what of our great sovereignty then?! England is a very small place on its own! We need to wake up!Unknown



I know, we had a referendum and the ‘remoaners’ lost. But we are all about to lose so much more if we actually go through with this madness. We don’t just need a people’s vote, we need some humility and some hope that we can restore the damage we have done to our friends across the continent and together face the huge complexities in front of us over this next century – climate change, the refugee crisis, the plastic in our seas, water shortages and so much more. We cannot face these things alone as isolated nation states, but together, in union, we can! So, enough with Brexit! Let’s stop this now and find a new way forward together. #togetherwecan










Misconstrued Sovereignty

iu-5We are hearing a lot about ‘sovereignty’ these days, especially in the current debate about Europe. We are particularly told by the ‘brexit’ campaign that leaving Europe will give us our ‘Sovereignty’ back as a nation. We will be able to make our own laws and do things the way we want them to be done. And yet sovereignty usually means the empowerment of the few, something that absolutely must change.


Yesterday was Good Friday. A day when we remember the cruel and appalling death of a man who claimed to be the Son of God.  A man who touched the untouchables, healed the sick, gave dignity to prostitutes and embraced the dying. A man who set a trajectory for the equality of women and the rightful honour children should receive. A man who welcomed strangers and prioritised the poor. A man who dared to say to religious powers that God is not far away and unknowable; and to political leaders that top-down dominating hierarchy is only based on fear and control. A man who in essence gave us the foundations for true democracy (as Robert Schuman says), where we do not seek that which is best for ourselves, motivated by self-preservation; no, we learn to embrace the ‘other’ and show brotherly and sisterly love to all.


imgresThe cross is not about the need of an angry Sovereign God to be appeased, but rather the love of God utterly dismantling humanity’s understanding of what it means to be sovereign. So much therefore for ‘Sovereign decisions’ that disregard the need of our fellow humans. So much for the desire to be self-ruling and governing.


In our household today, we have been thinking together about all that Jesus took upon himIMG_0368.jpgself on the cross. Not just our own ‘Sovereign’ ways of behaving with a capital S, the thoughts and actions that demonstrate our own need to be in charge, but the things we do as humanity collectively that bring such destruction to ourselves, our relationships and the world we live in. We wrote many things down on scraps of paper and pinned them to a wooden cross (words like selfishness, greed, the arms trade, nuclear weapons, starvation in a world of plenty etc). And then we burnt the whole thing, representing to us the way that his love consumes and overcomes all of these things. It is finished. That old understanding of Sovereignty is done with. True sovereignty is to walk in the way of uncontrolling love (Jay Thomas Oord) and has nothing to do with violence, debt, control, power games or self-preservation.


When christians speak of the ‘Sovereignty of God’, we must be careful to understand what we mean. God is not sovereign in the way humanity classically attributes sovereignty. His sovereignty is of a completely different order. The word sovereign is unhelpful when thinking about God. It attributes all kinds of disturbing characteristics that do not belong to him at all. We must find better language that is not entangled with such confusion, or alternatively allow the word ‘sovereignty’ to be entirely redefined.
And so, when we want to make our own individual ‘sovereign’ decisions, or as a nation IMG_0371.jpgwish to do so collectively, we could perhaps think more carefully about what will happen when we act in a ‘sovereign’ dimension toward others….As english people, we are going to struggle with our own sense of sovereignty, because we have had the biggest empire in the world and have a long history of grand monarchy. At Easter, we could do worse than to reflect on the humility and grace of the cross and allow our hunger for autocracy to be utterly undone.

Complex Very Complex

A brilliant midwife, whom I hugely respect, posted this link on her Facebook page recently (if you don’t have time to read it, it details how North Wales is going to lose its special care baby units, so babies needing such care will be transferred over to England):

When we lose local services it causes a sense of anger and disempowerment. What about not being able to give birth in your local area, if you have a complex pregnancy? What if a mum’s baby is taken miles away from her for special care, only hours after having a caesarian section and it is a few days before they are reunited? What is the impact of this on the mental health of the mum and child? What about partners who can’t afford to keep travelling 40-50 miles to visit mum and baby and have to look after the other kids? What about the loss of jobs to the local economy and the sense of belonging that having things available in the local community can bring? What about the dangers of being transported to somewhere so far away to receive specialist care? It seems like a dreadful and unloving thing to close local services.

Sadly, it’s not that straightforward…. I thought it was, until I became the lead clinician for maternity for Lancashire North CCG. When looking to provide services for an area we have  a backdrop of three key factors to consider: 1) Safety, 2) Affordability, 3) Accessibility.

1) Safety: Research suggests that survival rates of babies with complex needs are higher in specialist tertiary centres, which deal with such problems far more commonly. Travel times from studies seem comparatively safe. Women, who have complex pregnancies have better outcomes in more specialist environments. The equipment is better, staff are more specifically trained and due to seeing and dealing with very poorly babies and mums more often, the care is better and survival is higher. Currently, the UK has some of the worst maternity and neonatal data in Europe and there is a hope to change this. I am grateful that none of my children needed this kind of care when they were born. I was also grateful, that if they had, I happened to live in Manchester where there is some of the best care available in the UK. But there is a difficult question for those who live more rurally (as I now do). If your pregnancy is complicated and you need more specialist obstetric input, or your baby needs highly specialised care, do you want that care to happen locally with a team who may not have lots of experience in that specific situation, or would you rather be transferred, potentially some distance, but be able to receive more expert care and have better long term health outcomes?

2) Affordability: Currently in the UK, the litigation budget for maternity and neonatal care takes well over 40% of this whole budget area. They are also hugely expensive specialities. We would all love to have highly specialist units on our doorstep or at least fairly local. But we have to face to some difficult facts that we have a lot of hospitals in the UK, which are extremely expensive to run and we can’t afford them all to be specialist centres for everything….We don’t have the staffing levels needed for this and with the way we currently do economics and due to our strong culture of blame and litigation when things go wrong, we don’t have the money. We have also hugely over-medicalised birth as a process. The Midwifery 2020 document implores us to help birth become a more natural process again, to take out too much over involvement and encourage (more affordable) midwifery led units and home births…..We could also train our midwives and health visitors (and even surgeons) to higher levels of expertise, as they have done in Scotland…..Complex cases could then be handled in larger regional centres…..

3) So, when we talk about accessibility (and for me this is especially important for the marginalised poor and for those for whom mobility is a real issue), we have to have that discussion in the light of safety and affordability. We also need to factor into our budgets the need to help those who can’t afford travel and child care…..

This doesn’t stop with maternity and neonates. Only yesterday we have also seen the Health Secretary, Jeremy Hunt, decide to close large parts of Mid Staffordshire Hospital and redistribute services elsewhere, after the recent scandal involving substandard care. We are seeing ED’s closing and will see many more such ‘reorganisations’ happening.

I believe that leadership can be self-emptying and loving and sometimes hard medicine does not always feel like love. Personally, however, I feel that the way Mr Hunt acted was neither self-emptying or loving but rather dictatorial, bullish and driven by a very different ideological objective.

We do have some significant challenges ahead and there are some changes to our systems that are necessary in order to provide the most excellent and loving care. It will take some serious re-imagination and the breaking down of some current mindsets we hold.

Not that my opinion really counts for that much, but for what it’s worth, some of my ideas would be as follows:

I really believe in participatory economics (sounds fun, eh?!). There has been a lot of rhetoric about devolving of budgets and allowing local health boards to make decisions about how money is spent. Firstly this isn’t really happening, as any time a decision is made on something the ‘powers that be’ don’t like, they come and crush the idea and tell the boards what to do instead, with the threat that they will replace the board if they don’t comply! Secondly, it doesn’t go anywhere near far enough and it lacks integrity because there is no joined up thinking. If local people are going to make decisions about their local economy, then it must be the whole and not just a part. Currently we spend an enormous amount of money on treating disease (or preventing it through vaccinations), but nowhere near enough on promoting health in our communities. Isolated budgeting doesn’t work and we waste an enormous amount of time and resource. We know that maternity care and neonatal care are being made so much more complex by our astronomically rising rates of obesity and diabetes, but we’re not putting the money into the places that could help turn this tide. We are also not collaborating between areas like health and education but are rather putting them in competition with one another, which is genuinely crazy. So, if the people of North Wales want an amazing special care baby unit near by, which provides brilliant care, they could decide to do so, but there are cost implications on other services, and cost implications on keeping up the expertise of staff and giving them enough time and exposure to complicated scenarios to know how to handle them efficiently…..So, less learned helplessness, and more engagement…..

Within that, we need to watch out for selfishness and all wanting our own rights. For me there would need to be priority care for children, women, the marginalised poor (especially including destitute asylum seekers), prisoners, the elderly and the mentally ill.

I also believe in gift economics. Towns and cities within a region can gift things to one another. This is already happening in healthcare and could happen more and in many other fields. For example, in North Lancashire, Blackpool has a gift of cardiology and cardiac surgery. It is a regional centre of excellence. There was initial resistance and concern about losing and moving local services but survival outcomes after heart attacks and many other conditions, both in terms of mortality and morbidity (how well you are afterwards) are far better across the region. Preston has a gift of neurology and neurosurgery and again provide excellent care. We don’t all need to have everything. Learning how to work in partnership and collaboration is key.

We need less of a blame culture. We need more compassion and understanding when things go wrong. Even if all the complex care is put into regional specialist centres, things will sadly still go wrong at times, mums and babies will still be poorly and die sometimes and nothing will change this……so some would ask, is all the reorganisation therefore worthwhile?

The redesign of our current systems is necessary and complicated. Sometimes, in the face of the economic beast and within the suffocating nation state environment, we can feel hopeless of change and helpless in our learnt disempowerment. Foucault says that we’re not really disempowered…..we just think we are. Revolution doesn’t have to be violent and bloody. Revolution can occur when enough people chose to engage, to love and to become the change they want to see…..

In the mean time, my plea would be this. Let those who are making tough decisions do so out of love and goodness, and not look to make healthcare profitable for private company share holders. Secondly, let those who don’t make decisions be kind to those who do….