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’).

Naming the BEAST: Neoliberalism!

We really must wake up! There is a vile beast at work in our world, which has a name, but we don’t know it and we don’t understand it and so its power grows! It is ravaging the poor and breaking our communities. It wears the mask of freedom, but devours our lives. “The freedom that Neoliberalism offers, which sounds so beguiling when expressed in general terms, turns out to mean freedom for the pike, not for the minnows”. Do you get it? The vast majority of us are the minnows! It serves the predators, not the enslaved. It gives us just enough freedom to think we are free, but we have become captive to the greed and rampant consumerist individualism it instills. We must throw off the chains. We have to shake off our malaise. It is the very antithesis, or the exact opposite, of what Jesus called the kingdom of God. It is, in fact, the dominant political and economic philosophy of our day. All the major political parties drink deeply from its cup. The Labour party do not think they can win an election without it and its poison will destroy the NHS, education system and all other public services.   We need to know about it, understand it, be delivered of its power and reimagine some altogether different, creative and positive alternative ways of approaching life together, that will free us from its grip.

 

Please make yourself a good old cup of fair-trade or slave-free tea and take some time to read this in depth article from the very clever George Monbiot. As he writes: “it’s not enough to oppose a broken system. A coherent alternative has to be proposed.”

 

George Monbiot https://www.theguardian.com/books/2016/apr/15/neoliberalism-ideology-problem-george-monbiot

 

 

Reimagining the United Kingdom

imgresIt is no secret that I voted to remain in the EU. All 3 generations of my family, who were eligible to vote, also voted to remain (and my kids would have voted the same way, had they had the chance – under no parental pressure, you understand!). And yet, as my long departed Nanna would say (the one, who knew all the names of her grandchildren after her stroke, except mine, and called me, Edith!)…. “Well, here we are….”

 

Here we are indeed. I am disappointed and sad, but here we are. We have some deeply painful and complicated times ahead of us, but for those of us who voted to remain, what we must not do is retreat into a finger pointing woundedness that is willing to embrace the ‘other’ in Europe, but the reject the ‘other’ in the UK, who felt that Brexit was the way to go. No. In a world where we long for a positive approach to peace, for reconciliation under-girded by our first value to love one another, we must hold ourselves to account and dig deep to remember who we are and what kind of future we want to build together.

 

There are some really really important conversations for us to have right across the UK that will help us to face up to and heal the wounds we have exposed. Both sides of the debate over the EU have some significant hurts and many of them go deeper than a simple in/out referendum could ever address.

 

So, how do we engage together and have conversations with people from different sides of the dividing line about what kind of UK we might see develop? What might we reimagine together? Is there a hope of a Union left? Here are some things that I would like to explore in some upcoming blogs and see what conversations emerge:

 

imagesOntology – what?! Yep – in the end, so much of who we are and how we live, what we align ourselves with and how we would choose to shape our future together depends on this. Basically – why are we here? What is our purpose? We need to understand this at an individual and a corporate level. As I have suggested in my other blog (www.reimagininghealth.com) our health and wellbeing actually depends on having a life that aligns with this sense of knowing why we are.

 

Theology and Philosophy – what?! Yes – again, so much of our life in this nation and imgrescertainly our politics is under-girded by things people have/have not believed about God and his/her interaction with the world. Whether you are a person of faith or not, it is difficult to deny that for good or ill, the geopolitical worldview of the West has been hugely shaped by the partnership of church and empire over the preceding several centuries. This area of thought and study especially shapes our understanding of ‘Sovereignty’.

 

Economics – this is more obvious. How we choose to “order our house” has huge imgresimplications of how we then live in the world. David Cameron tells us there is ‘no alternative’ to the Neoliberal economic agenda with its reliance on the ‘benevolent’ free market, competition, privatisation, biopower and austerity. And whether the UK or the EU is the worst proponent of this, I’m not sure, but perhaps other options are available to us. Maybe we don’t need to have an ever widening gap between the rich and poor. Maybe we don’t have to have a London-Centric (or even with the emergence of a Northern Powerhouse, a Liverpool-Manchester-Leeds-Centric) economy. Does our economy always have to grow? If it does – what does this mean for the creation of a peaceful world or our ecosystems? Isn’t it high time we had a good hard look at what our policies are doing to the world we live in, or demand in terms of war and self-protectionism? I recently trained as an executive coach – I can tell you for sure, there are always options…..it is a lie to say that we have no alternative. We do. We can have a fairer society and perhaps it’s time for us to say to the corporate giants who threaten us that they will up and leave if we don’t give them enormous tax breaks and turn a blind eye to their greed, that we will find a kinder way of being without them. There are options open to us of renationalisation of some things, co-operatives, credit unions, gift economies, time banking and many other things explored by top economists, which the press give no voice to.

 

And then we have more surface issues. What about our relationship with Europe and the rest of the world now? Surely we aren’t going to believe we have some kind of Empire-like influence in the world anymore? The British Empire and Christendom are both over! So, now that we don’t have them and we’re not part of the EU – what kind of partnerships do we want with other nations?

 

imagesAnd what about education? Is it OK that there was such a massive split in how people voted according to what they had achieved at an academic level? Are we developing academic snobbery? Are we developing education systems where there is an understanding of important issues like the one we’ve just had a referendum about? If it wasn’t for our dinner time conversations, my kids would know nothing about the EU – but thanks to Michael Gove, they can tell me about subordinate clauses and modal verbs! There is something very wrong with that.

 

5517007247_63d55ac8f5_m[1]For healthcare – we already know that the Brexit campaign told us a complete lie about how much extra funding would be available to the NHS. But here we are! Given our current economic policies, it is difficult to see how our Nation’s favourite brand will survive. You cannot believe in an ever shrinking state and increased privatisation and continue to have the best and fairest healthcare system in the world! This is why we need greater participatory leadership and truer representative democracy!

 

Ecology, peace-making and so much more need to be the discussions around our kitchen tables, on our walks and in our cafes and pubs. Enough of the hypnosis by our media! Let’s find each other again, heal our hurts, listen, seek to understand and together find solutions for how we are going to live in this world. Here is to a future of love, hope and peace. I will explore some more of this in the coming blogs.

Christmas Number One?!

A few months ago, I was moved by the Syrian Refugee crisis to write a song. I sat at my piano and played some chords and imagined what it must feel like to have to flee the place you call home and to throw yourself on the mercy of strangers. I let myself feel the pain that many Syrian people must feel as they see the walls being built around the borders of Europe, a continent which only a few decades ago was tearing down the Berlin Wall but is now erecting barbed wire fences.

 

So, this song emerged. I recorded a little youtube clip. A friend of mine, Claire UnknownAskew (who plays drums on the track) heard it, played it to some producers (Sugarhouse uk) who generously offered to record the track for free. The amazing charity that is World Vision then heard it and it was agreed that we would release this single as a way of raising money (100% of all the money from singles sold will go to World Vision) for Syrian Refugees this Christmas.

 

I don’t know if there is a better narrative for a song in this season. The song of a refugee, fleeing home due to powers beyond their control, only to find there is no room for them…..

 

On one level, I would love the NHS to get to the number 1 spot for Christmas; I definitely don’t want x-factor to get the spot! But, what if this Christmas, we decided to spread the word as far and wide as possible and help World Vision raise a huge amount of money to help those stranded, cold and homeless. The single only costs 99p – less than most of the bottled drinks we will consume this Christmas. I have no power at all to make this happen, but it would be amazing if the Syrian Refugees could be this year’s Christmas Number 1!

 

So here it is. “Will You Love Me?”

 

https://itunes.apple.com/gb/album/will-you-love-me-feat.-claire/id1063998040?i=1063998267

Changing the Healthcare Conversation

Here is a slightly impassioned stream of incomplete and imperfect thoughts about the future of healthcare……I hope it stirs some conversations……

Political Parables – The ‘Other’

I recently participated in an extremely enjoyable conversation about ‘The Parable of the Good Samaritan’ and how we read it/it reads us today. (Read or watch below).

Luke 10:25-37 English Standard Version Anglicised (ESVUK)

The Parable of the Good Samaritan

25 And behold, a lawyer stood up to put him to the test, saying, “Teacher, what shall I do to inherit eternal life?” 26 He said to him, “What is written in the Law? How do you read it?”27 And he answered, “You shall love the Lord your God with all your heart and with all your soul and with all your strength and with all your mind, and your neighbour as yourself.”28 And he said to him, “You have answered correctly; do this, and you will live.”

29 But he, desiring to justify himself, said to Jesus, “And who is my neighbour?” 30 Jesus replied, “A man was going down from Jerusalem to Jericho, and he fell among robbers, who stripped him and beat him and departed, leaving him half dead. 31 Now by chance a priest was going down that road, and when he saw him he passed by on the other side.32 So likewise a Levite, when he came to the place and saw him, passed by on the other side. 33 But a Samaritan, as he journeyed, came to where he was, and when he saw him, he had compassion. 34 He went to him and bound up his wounds, pouring on oil and wine. Then he set him on his own animal and brought him to an inn and took care of him. 35 And the next day he took out two denarii[a] and gave them to the innkeeper, saying, ‘Take care of him, and whatever more you spend, I will repay you when I come back.’ 36 Which of these three, do you think, proved to be a neighbour to the man who fell among the robbers?” 37 He said, “The one who showed him mercy.” And Jesus said to him, “You go, and do likewise.”

Footnotes:

  1. Luke 10:35 denarius was a day’s wage for a labourer

The Holy Bible, English Standard Version Copyright © 2001 by Crossway Bibles, a division of Good News Publishers.

Or Watch it here:

UnknownIt’s a parable so well-known now, it is easy to let its impact completely wash over us. For me, it and the preceding dialogue poses 3 hugely political issues (by that I
mean how we live alongside our fellow humans) rather than party politics, which I consider to be an utterly defunct system which will not deliver to us the future we are calling for. (Having said that I recognise some people feel called to change it from within, and I am particularly excited to soon embark on the wonderful Caroline Lucas’ new book, ‘Honourable Friends?’)…….

The 3 issues are as follows:

1) With whom does your allegiance lie? Jesus’ challenge is straight – Love the Lord your God with all your heart, soul, mind and strength i.e. are you about loving God and walking in the ways of love or are you about serving Caesar or religion or an oppressive regime or a particular leader or a nation-state or flag?

2) Who is my neighbour? Who is there around me that I could be helping, but am not? Who am I too busy or too important to help, to stoop down to, to embrace? Who might inconvenience my schedule or delay my journey? Who might infect me or make me feel ‘dirty’? Who am I struggling to spend myself on behalf of? And yet, who is the unexpected person doing that for me?

images3) Who is the ‘other’ that offends me? I was watching one of my favourite TV shows the other week – gogglebox – absolute genius television! One of the reasons I love it is that it gives me hope that TV, rather than simply nullify our pain, numb us to the real issues, pacify and hypnotize us to carry on business as usual, can actually inspire some conversation, cause to engage with the ‘other’ and maybe even challenge and change our perspectives! One of the shows the goggleboxers were watching, was one about a man I have in all honesty had quite a low opinion of – Nigel Farage. It was a show about him as a person, rather than his (odorous) policies. It challenged me deeply. Nearly all of the people watching him, started out with quite a low opinion of him, but came out the other side seeing him much more as a human being. It is so easy to dehumanize the ‘other’, to ridicule those we don’t agree with and create the great ‘us and them’ divide. But the challenge of Jesus is so stark in this parable. Who is the one you despise? See, they are a human being like you, and maybe not so awful as you might think. (Not an excuse to not debate awful ideas btw!).

I wonder, as we look to the future across Europe, how helpful the vilification of individuals and people groups is? Will it give us a new, love based politics? When we really allow ourselves to imagine the future, I mean really imagine it, does it involve more separation and division?

I wonder, if Jesus told this parable in the UK today who he would cast as the ‘Good Samaritan’? Maybe a male taxi driver of Pakistani origin from Rochdale? Or a school girl from London who has some sympathies for some of the ideas of IS? Perhaps a member of the EDL? PLEASE don’t mishear me. I am not for one minute suggesting that those who did the despicable acts in Rochdale, or those carrying out heinous and barbaric crimes in the middle east, be that IS (or the nation-states bombing the middle east) are “good samaritans”. But if we are not careful it is possible we tar too many people with the same brush. Interestingly, we wouldn’t have an NHS without the 11% of all our staff and 26% of the doctors who come from overseas. Maybe we (who is the ‘we’ – the UK? Europe? Humanity?) are richer together and if we allow ourselves to discover interdependence, we will find some love from very unexpected places and find ourselves embracing those we once thought “beyond the pale” (originally a phrase meaning those in Ireland who lived outside the British boundaries…..)?

Rights, Choices and “Free” Healthcare

Today I took part in a really fascinating hypothetical discussion forum with women from across North Lancashire. We looked together at the “right” of choosing to have a Cesarean Section instead of a vaginal birth when there is no clinical indication at all to have one. We also discussed the “right” of having a home birth against the advice of clinicians and current, sound clinical guidance. Unsurprisingly it sparked some good debate but it is this kind of conversation and indeed much wider ones that are vital if we’re going to continue having a National Health Service in the UK that is accessible to all, safe in its provision of care and sustainable for the future.

images

ukhumanrightsblog.com

The human rights agenda, if we are not careful, becomes a platform for each of us to act in a way that leaves no regard for the impact of our decisions on the ‘other’ (be that professionals involved in our care, or other people who will now have less choice available to them due to decisions we have made). But we must differentiate between choice and rights as they are not the same thing. In maternity services, a woman has the right to excellent maternity care in which she makes shared decisions with her midwife and obstetrician. However, does a woman have the “right” to demand care which is way outside of what is clinically safe, or to demand a much more expensive treatment option when there is a lack of evidence that she truly needs it, especially when resources are limited? Tough questions! The truth is, she does , of course, have that right. But a more difficult question is whether or not it is then within the gift of the NHS to then provide that kind of care.

So, for example within maternity, let’s take home birth. Two of my 3 children were born at home and it was a beautiful experience (says the man). It is really important that this choice is offered as widely as possible on the NHS. However, there are certain situations in which a home birth becomes extremely risky to the mother and unborn child and the clinical evidence really backs this up (see NICE guidance). So, as an example, a woman who hasimgres previously given birth and had a massive haemorrhage afterwards and in a subsequent pregnancy has gestational diabetes, obesity and a twin pregnancy would not be advised to give birth at home. For the best outcome of a healthy mum and baby the evidence would suggest that this birth would be better under closer supervision than can happen at home. However, what if she takes all this information in and still demands a home birth as her “right”? Well, currently, she would come to a shared care agreement with her midwife and obstetrician, come to an understanding of all the risks involved and have a home birth. And there is a huge part of me, as a feminist, that loves this. It is her own body and her own baby and she can make informed choices. But the cost implication of the time and resource taken from what is an understaffed and overworked midwifery service might then mean that very few other home births can happen in the week or two surrounding her due date and puts the clinicians under significant stress. So, the woman makes the choice to hold onto her “right”, but the impact on others is that their choices are now more limited.

So too with Cesarean Sections on demand. I understand the fear of some women about going through labour and various other reasons for choosing a section. The conversation is not about removing the choice for those who really need it, but the current rates of 25-27% of all births through C. Section is not sustainable in the long-term (nor is it supported by the Midwifery 2020 document). The NICE guidance has been interpreted very liberally by some obstetricians who do not want the hassle of saying ‘no’ and commissioners have in some places not been clear enough about what their own guidance is. But, vaginal birth is natural and safe and perhaps we need to see it as the norm for every woman unless there is a clear clinical reason (be that physical or psychological) as to why that can’t occur.

The tough question facing those who commission services for the NHS is whether or not choices should become more limited in certain situations so that the gift of the NHS can continue to be sustainable in the future for all. If choices were limited in order to protect everyone’s rights to free and excellent maternal care, it is not that women could not then go against guidance, but they may either have to go through an appeal panel or pay for the kind of care they want themselves……ouch (especially as this won’t be equitable for all).

Much of this comes down to good communication skills. I have been really heartened to imgresspend some time with AQuA (Advancing Quality Alliance), who are helping clinicians learn how to use better consultation skills to really share decision making with patients. It is based on a model of care which we use a lot in General Practice called “Calgary-Cambridge” (more on this another time). But it is vital that clinicians communicate choices better and come to shared decisions with their patients, so that they understand the impact of their choices both on themselves and their loved ones, but also on the system itself and therefore other people. We cannot have a situation where people can simply demand whatever they want without any thought of the implications and so good information sharing is vital. Equally, we cannot continue with patients being forced down one path of treatment or not understanding the choices available to them due to poor communication or a lack of humility on the part of the clinician. The clinical-patient relationship is a partnership.

If we are going to develop a new love-based politics, our own “rights” must also take into account the needs and rights of others.