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’).

Talking Health and Wellbeing with the Rising Generation

I had the privilege of facilitating a conversation in our local high school with a bunch of students of differing ages and backgrounds. The head teacher at Carnforth High is an amazing person and her vision and holistic view of education is inspirational – it was a real privilege to spend some time at Carnforth High. The two main questions: “What does it mean to be healthy? And what would this school/town be like if it was healthy?”

We then had a further discussion about how we might make those dreams a reality and they also helped me understand more about what they perceive some of the barriers to be (nearly all systemic). It was really stimulating to be part of it and gives me lots of things to report back to our Health and Wellbeing Board. Here are some of my thoughts/reflections immediately following it (I was quite excited…..)!

The Complex Commodification of Healthcare

Not the most eye catching title, but bear with!

I’ve been thinking quite a bit about what on earth has happened and is happening to healthcare, particularly in the UK, but globally, also. My musings are being particularly influenced at the moment by the writings of William T Cavanaugh, Georgio Agamben and Michael Foucault. More from WTC and GA another time (when thinking more about healthcare and the nation state)….

Foucault, speaks of biopower, i.e. the commodification of life itself, so that even what would have been considered within the private sphere of our lives, is now the fodder of the economic machine. Truthfully, healthcare has become utterly commodified and in such a complex way that we find ourselves entangled in a sick web and it takes some major diagnostic work to make sense of what is happening.

Firstly, the system of healthcare has become commodified and is itself driven by economic greed. I have yet to find any clinician who thinks that the top down reorganisation of the NHS in the UK at the hands of Andrew Lansley, (but started by the government of Thatcher and most certainly compounded by Tony Blair’s team) has been in any way a good thing. It has cost literally billions of pounds, and has led to and will lead to more private companies, limited by shares, owning and running the health care services. This is driven by the EU-US trade agreement and is based on an utterly flawed philosophy that competition will improve patient care. Except, it won’t. The problem is that share holders don’t give a toss about the needs of the chronically sick or the marginalised poor. Rather they want to protect and guarantee their ‘income’. So health care will worsen. The WHO recently stated that the NHS is the best health system in the world and yet our government has thought it best to dismantle it! The claim is that the system is costing too much money! The thing is that the NHS is and has been ‘in profit’ for a long time. It isn’t run badly. All the cuts that are being made (which the Tories won the last election by promising they wouldn’t make) are in part due to the fact that many corporations are paying such little tax, and also because we have such an utterly corrupt banking system. The reason that successive governments have not stood up to the banking sector or these corporate giants (and are now cutting public services instead of challenging them) is because they are not really the government! The banks and the corporations are (well they are not either, but they act as though they are)! That is why the healthcare system itself is becoming more commodified! At a corporate level it is simply fodder.

Secondly the patients have become commodities. Do not be deceived. We have a healthcare system based on a Pasteurian philosophy of healthcare. Kill the disease. You are a commodity. Your children are a commodity to the advertising companies, cheap supermarket trash and fast food chains, which are driving up childhood obesity and diabetes, whilst we take exercise out of schools. You are a commodity to the pharmaceutical industry and when you reach 40, if you’re not there already, you will be offered a free NHS health check, which will tell you that your BP, Blood Sugar and Cholesterol are too high, so you will shortly be needing some medication to control it all. But here’s the thing…..it’s mainly too little, too late. What happens in our early life far more affects our health in older age. We need to be majorly cheerleading the promotion of healthy living to our kids, especially our young women, as the health of your mum whilst she is pregnant has a huge impact on your future health, far more so than drugs you take after your mid-life crisis. You are also commodified by the breakdown of the welfare system. We don’t have time or money, apparently, for you to be off sick. We need you back in work to get the economy going. You will notice that most therapies are being extremely cut back – we don’t have time for you to get really healed, we just want you functional……

Thirdly, there is the commodification of the health-workers. Burn out, low morale, tired and flagging. The pressures are mounting and we are not taking care of our staff, and the sad truth is, it will get worse and not better. One reason is that we are becoming increasingly self-centred and demanding as people, due to a multiplied sovereignty in our history, which leaves us feeling like we have the right to behave like mini-emperors. Another is a kind of learnt helplessness due to the breakdown of community. A third is the anxiety driven nonsense we find daily in our media, a kind of chicken-licken hysteria about every mild ailment. And fourthly, there has been little foresight or planning to think about where on earth our workforce is going to come from if we don’t train them. We have a 50% trainee doctor shortage in the Emergency Departments. We will shortly have a national shortage of over 30000 GPs (and yet the government is promising 7 days a week cover, 8-8, just incase you want to discuss your piles on a sunday afternoon), but little thought is given to exactly where we will magic the workers up from. And if we take them from the EU? What then of healthcare in those countries? Ah yes…..multiplied sovereignty, we don’t really care. That’s why we continue to complain bitterly about the health services in this country, and yet we have the same population as South Africa, and ten times as many doctors. How do like them apples? Try being grateful!

Complicated, huh?

So we and our health are commodified. So what? How does knowing do anything except add to our already felt sense of powerlessness?

Well, we have some choices and some options.

We can choose to subvert the system wherever possible.

We can create some exciting alternatives.

We can protest.

We can radically love Andrew Lansley

We can vote out this government at the next election, though we must press for a new way of doing government, and allow our selves to completely reimagine how we do life.

We could have a revolution.

We can treat patients as sacred beings and refuse to treat them as commodities.

We can treat workers as gifts and not use them or abuse them.

We can be thankful that we have the best health system in the world and change our attitude somewhat.

Revolution

Ok, I can’t sleep. I’ve been needing to write this for ages. I know my voice is small and I live somewhere in the north of rural lancashire in the UK, but I want to add my voice to the growing song that is rising in the hearts of the multitude. We need a revolution and we are in the midst of one, but we don’t fully know it yet. It is stirring in our hearts, the yearning for something truly and radically different. Russell Brand gave voice to it, in his interview with Jeremy Paxman. You can see it on youtube.

I watched question time the other week, and I nearly threw my shoe at the television. I was filled with such indignation at the lack of real debate.The ‘right’ and the ‘centre-left’ may as well be saying the same thing, the odd difference in policy, but a maintaining of the status-quo. We cannot and must not allow the wool to be pulled over our eyes. We cannot and must not allow ourselves to be hypnotised or enslaved in our thinking and believe that things cannot and will not change. Part of my job description at the moment is to try and help save/cut 70 million pounds from the health budget for the Morecambe bay area. Save 70 million pounds! I ask you! When there are billions of pounds in off shore tax havens?!

You see we do not dream of a future in which we allow competition and greed to drive us. We do not dream of a future in which our african children starve to death or our afghan brothers are killed by our european ones. We do not dream of a future in which our children are commodities, eaten up by an economic system that pitches them one against another. We do not dream of a future in which we value our children by their grades and devalue education to the degree that we measure success by literacy rates at the age of 16. We do not dream of a world where healthcare is about profit and the ones who need it most cannot access it. We do not dream of a world where we continually rape the earth of her resources and leave an unsustainable planet. We do not dream of a global economy in which the rich are protected and given more and more privilege whilst the ‘feckless poor’ are punished and scapegoated. We do not dream of a world in which girls are slaves within a sex industry. We do not dream of a world in which there is such disparity between rich and poor. We do not dream of a world in which we spend trillions of dollars on war because we have such a skewed idolatry of nation states. We do not really believe that war will eventually bring real peace. We do not dream of a world in which billions of dollars are siphoned into tax-free havens so the rich can build their super yachts and we have to cut back our public services to the extent that the only other alternative on the table becomes to privatise everything and increase yet more competition whilst sacrificing our very souls. NO!

We dream of something different. We imagine a very alternative future to the dominant reality of our time. We hope for something far more beautiful. We are in a change of eras and we must not be scared. We must not be silenced and we must not give up. Something is stirring in our hearts and we must let it stir us more into love and action.

Can you imagine a world in which we didn’t send young men and women off to war, but instead trained them to rebuild cities that have been devastated, like Damascus, or taught them to irrigate deserts so that streams would flow there and there would be no need for starvation? Can you imagine a world with multiple economic systems based on gift in which the primary drive was giving and receiving instead of buying and selling? Can you imagine people living where they want to, not only where they can afford to? Can you imagine excellent healthcare available to all people everywhere, not just in the rich, developed lands, but given freely to all who need it? Can you imagine a radical overhaul in how we create energy? Can you imagine a government which doesn’t dominate or control and isn’t in the pocket of multinational corporations, but rather serves the real needs of the peoples and partners with other governments to ensure everybody has enough, through a sharing of resource and ideas? Can you imagine businesses which are not driven by greed, but by the needs of the communities around them? Can you imagine laws that really free us to live and breathe and have our being, but protect the most vulnerable rather than exploiting them? Can you imagine education that celebrates difference, creates a genuine love of learning and inspires the next generation to go even further in love and creativity? It’s not beyond our imaginings! It is the longing of our hearts. It is what God gave life to us for……to love, to create, to heal, to steward, to tenderly care for, to enjoy.

There are many solutions to explore. There is much co-creating to be done. We must end the commodification of human beings and the earth and treat one another and the land as friends. We must resist the temptation towards violence and hate. We can dismantle the old oppressive systems whilst building together a wholly different future. Do not be put off by a seeming lack of answers. If we ask the questions, more questions will come! And from more questions, we will together discover some answers we hadn’t thought of before. The earth is calling for it, our hearts are longing for it, the spirit groans for it. It is time. It is time for a deep and long-lasting revolution of love.