Tag Archives: love

Complex Very Complex

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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):

http://www.dailypost.co.uk/news/health/baby-care-shake-up-more-north-6720586

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….

At What Cost?

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I was handed a book this week entitled: “People over Capital” (the co-operative alternative to capitalism) and I’m looking forward to reading it on my way to Toronto later next week. The back cover starts with these words: “Economic turmoil, rampant inequality, austerity politics, climate chaos. Capitalism is clearly failing and ordinary people are being forced to pay the price. Faced with such deep-rooted problems there is real hunger for alternative ways of organising our economic systems.”  Increasingly I am becoming aware of the effect of what Foucault calls “biopower” or the commodification of life itself.

The film UK Gold has highlighted with insightful and expository brilliance the true relationship between the UK ‘democratic’ government and the corporate giants. If we’re not careful, we turn a blind to the cost of the cuts and the immense toll that the squeeze is really having on the little people. Whilst literally billions of pounds are being siphoned off into tax havens to bolster the super rich, we are making unbelievable cuts to our public services and welfare systems. The heartbreaking truth is that we are paying for this, not only financially, but people are being eaten up like bread, fodder for the economic machine that is destroying the very life we are made for. I know of two people in the last few days who sadly took their own lives under extreme pressures being placed on them as they tired to serve the public good – one a police officer, the other a social worker…….

I have blogged about ‘revolution’ and the need for something utterly and life-givingly different to what we have now, but I maintain that even in the face of the pain and sorrow, stress and strain that many find themselves in, the answer has never been and will never be violence. There is another way, and it is the way of love. We must love those who perpetrate these crimes against humanity. Our only hope is to forgive the wrong we are suffering and so find a better future for us all. How do we ‘turn the other cheek’ when we feel smacked in the face by an uncaring system that would squeeze the very life out of us for the sake of keeping the economy going? How do we give of ourselves lovingly in the face of such opposition and uncaring greed? How do we dance to a different rhythm than the dominant marching beat that sets it’s metronome to the whims of ‘market forces’?

Now is the time for creative experiments, like those of William Penn, before his sons sold out to greed and dominating hierarchy. These are days to love our enemies until there is nothing left for them except to love us back, as Martin Luther King demonstrated. We are in a moment of extraordinary potential. We must not rush, but take our time to let new hope, vision and pragmatic ways of reorganising ourselves to germinate within us. Kenarchy is about emptying out power, laying our lives down in love for one another, prioritising the dispossessed and radically renegotiating our relationship with money (sacred economics). We can remain as we are but the stark ongoing cost will be destruction, demoralisation and death. Or we can put on love, forgive the past, learn from it and embrace the future. It will cost us everything, but our hope is one of life.

Kenarchy – the beginning of a series

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Yoda_SWSBI was watching ‘The Empire Strikes Back’ with my eldest son a few days ago – love that film. There’s a brilliant bit in which (for those odd ones of you, who aren’t into Star Wars) Yoda (the Jedi Master) is training Luke Skywalker to become a Jedi. Luke catches a glimpse of the future and asks Yoda what will happen. Yoda tells him that the future is always moving, and so it is difficult to see. We live in a moment in time, when so much of what we have taken for granted until now is crumbling around us. The ‘rich west’ is no longer the great power that it once was. The globe is changing. Free market capitalism is failing, democracy is being revealed to be the child of empire that it really is and the nation-state project isn’t working. Yet, at a time when everything is shaking, and uncertainty taints our sense of stability I feel a deep hope that there is a future, which though uncertain on one level, due to the dynamics of human interactions, complex choices and external pressures beyond our control, could be one in which the peace and love that humanity longs for, could be more real.

There’s a guy, I like a whole lot! His name is Walter Brueggemann. One of the things he says is that “we must be unafraid to subvert the dominant realities of our time.” There are things, which we assumeWalter Brueggemann to be true, things deep in our psyche which we hold fast that are not really in line with what it means to be fully human. These mindsets, fit into three main categories – firstly, our paradigm, or worldview, secondly our praxis, politics or how we live and thirdly our personhood, or how we see ourselves. If we don’t face up to some of the ways we think and challenge those things then maybe the future is inevitable……

Over the Christmas period, I always love listening to Handel’s ‘Messiah’. I especially love that famous piece from the book of Isaiah, found in chapter 9 v 6 and 7. It says: ‘For to us, a child is born, to us, a son is given. And the government will be on His shoulders. And He will be called Wonderful Counsellor, Mighty God, Everlasting Father, Prince of Peace. Of the increase of His government and of Peace there will be no end.’

Jesus was born at a moment in history when Caesar Augustus, the first emperor to call himself the ‘Son of God’ was in power, in Rome. He comes onto the scene telling people to ‘Repent, for the Kingdom of God is near’. Repent, change the way you think about God, the world, the way you live and who you are. Think differently about the future and what is possible.

Firstly, He challenges the paradigms of the day. Who is this Messiah you wereimgres expecting? You wanted a warrior? Oh, different kind of warrior am I (I’d love it if Jesus spoke like Yoda!). What do you think it means for this Messiah to be called ‘the human one’ by the prophet Daniel? Who do think God is? You think God is a Sovereign Dominator who needs all to submit to Him? “No”, says Jesus, ‘if you have seen me, then you have seen the Father. I and the Father are one. And I have come as a servant, one who pours out his life for others.” Caesar, the one who calls himself Son of God, has not even begun to understand the nature of God. Jesus declares himself to be God and shatters any other understanding we may have.

Secondly, He challenges the politics. He prioritises those most forgotten and marginalised in society. He is the champion of children, he breaks cultural taboos and promotes women. He goes to the poor and the sick. He associates with those of disrepute. He champions the foreigner and the refugee. He declares a new Houses of Parliamenteconomics in which you either serve money or you serve God. He devalues money to be a resource not a ruling power. He stands in the shadow of temple mount, and declares that ‘if you have seed as small as a grain of mustard seed, you could say to this mountain (this whole system established over centuries, which has ended up oppressing and suppressing people) be thrown into the sea, and it would be done.’ At a time when the romans were establishing ‘ecclesia’ as the ruling councils of their cities, Jesus establishes his ‘ecclesia’ made up of a mixed bag of the un-elite, whom he wants to learn how to steward the resources of a city for the good and peace of those who live there. He comes to a contested city, Jerusalem and declares that we are to love our enemies and turn the other cheek…….Shane Claibourne has recently written a phenomenal piece on what Jesus would say to the NRA, in the Huffington Post and it is worth a read.

Prodigal SonThirdly, He calls us to see ourselves differently. To be those who carry light into dark places, hope beyond hope to those who have lost their way in disillusionment, peace to those who are torn apart and warring, love to those filled with hate and grace to those who are broken and rotting. He calls us to recover our humanity, to become like him, the human one. To be those who forgive and so find forgiveness and freedom. To be free from all that which makes us less than human (aka sin), that which destroys ourselves, relationships, other people or the planet.

And so, in challenging the paradigms of the day, the politics (and economics) and even the person as to what it even means to be human, he challenges the powers. It turns out, the powers don’t like it. And so they kill God! And as they kill him, instead of smiting them all, Coventry Crosshe declares forgiveness, he sucks up all the ‘sin’ into himself, like a cosmic sewer, and then declares all things new. A chance to start again. A chance to live and hope for something other.  You see, the powers never counted on resurrection, but love wins! It is, as Aslan calls it, the deeper magic. Love is stronger than death. And so the one who is love, defeats death and brings life. Then He gives us the substance of Himself, the Holy Spirit to fill us and help us and calls us to follow Him, to the same radical, life-laying down love that holds no fear of death because in Him is life in all its fullness.

But something terrible happened. In the 4th century, a theologian called Eusebius and the Emperor Constantine worked together on a theology, or way of thinking about God, that led us to believe that GodConstantine is not just like Jesus, he is, rather, like an angry emperor that wants to dominate other people and have them all come and bow down. So church and empire got into bed together to try to create peace through dominance and created a mish-mash of children, including the Nation State, Western Democracy, Free Market Capitalism, Communism, but none of them come close to the radical Kingdom of God that Jesus spoke of. Too often christians have aligned themselves with these things, rather than having railed against them. Too often, christians find themselves yearning or harking for the ‘good old days’ of the ‘christian nation’. There is no such thing. A nation is not ‘christian’, just because it seems restrained, or has the ‘right’ kind of laws in place. The days of ‘christian dominance’, or christendom, are over. We cannot go back. The context we find ourselves in now, is completely different. It is the future that calls us forward. That does not mean a society cannot be transformed, but top down dominance is not the way of Jesus!

Empire, in any of its forms has nothing to do with Jesus or his life-laying down kingdom of peace.

My friend, Roger Mitchell, honorary research fellow at Lancaster University calls this emptying out of power – ‘kenarchy’, a word coined from the greek – ‘keno’ to empty and ‘archy’ power. It is this that I want to explore more in the next few blogs and what it might be like if we were to embrace this way of life more fully.

What if to have a ‘God complex’ was not to misuse power but to be servant-hearted and to be a one who facilitates and makes room for others so that they can become fully what they can be? What if we were those who chose collaboration and partnership instead of control, manipulation and dominance through competition? What if business, The Futurehealthcare, education, government, finance, media etc were based on these kind of principles? What stories might be told to future generations? My challenge this New Year is to realign my mindsets again with those of the One who is Love. My allegiance is not to any flag or nation-state. I believe our hope for the future comes from embracing an altogether different paradigm, politic and personhood. It is peace I hope for, and peace I pursue and that is going to mean some radically different choices for us as humanity than the ones we are currently making. This year, I resolve to choose life.