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.

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.

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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.