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FAITHACTION NATIONAL EVENT EXPLORES THE ROLE OF FAITH IN SUPPORTING MENTAL HEALTH…
"You like austerity!"
This was the essence of a charge put to me recently. I was flabbergasted; then my accuser quoted one of my oft-used phrases: ‘faith is the first in and the last out’. I could see what was being said, but context is everything. In fact, I have been using that phrase for a long time to emphasise thelongevity, and to some extent, the reach of faith communities. One of the problems of the UK system is that much is linked to parliamentary cycles and spending reviews. Governments and minsters change, and with them the budget, which determines funding, changes too, thereby making long-term planning difficult. Of course, government and politics which are held accountable by the electorate is laudable. However, this system does not encourage consensus, as each administration seeks to exert its authority and tried to demonstrate difference. But the economic reality does not change with the election cycle and therefore forces a commonality of restriction on parties of every hue. Out of this reality, there is the possibility of cross-party agreement, even if it is unstated. The two areas that come to mind is with the DWP’s Work Programme and it’s similarities with the previous government’s Flexible New Deal, or the QIPP (Quality, Innovation, Productivity and Prevention) agenda for health of the last Labour government and the pursuit of efficiency of the Coalition.
So what does this do for the position of voluntary sector and faith-based organisations? It certainly is not a great time to be a medium-sized organisation, the VCS’ ‘squeezed middle’, subjected to reduced government funding or sub-contractor conditions, always requiring more for less; seemingly unable to determine their own destiny and having to make a decision whether to play a part in unpalatable programmes or to fold. In fact, it was this growing reality which led us in the FaithAction office to hold a workshop on social enterprise with Greenwich University in 20111. Our thinking here was that, with the pressure of cuts likely to affect the voluntary sector disproportionately, enterprise would give an opportunity for diversification of income as well as developing a surplus which could be used to support the aims of organisations.
Times of hardship can also be times of possibility. So, although medium and larger organisations reliant on public sector funding may face difficulties, there is perhaps an opportunity for more radical solutions. Stephen Timms MP often remarks to me that, if asked if five years ago what would be the response to hunger in the UK, few would have pointed to faith groups as a significant response. Yet, this is what has happened with food banks throughout the UK. This is not to say this is what the solution should be, just to point to the reality that food banks have sprung up in response.
We started looking at this change of climate in our response to Big Society, ‘How to eat an elephant’. The economic reality has presented need on the doorsteps of faith communities. It has meant we have had to face those around us in a way we had previously been able to avoid. The Olympics and the Jubilee also gave opportunity for commonality and connection, at the same time as concerns were being raised by individualised existence; epitomised as one of the root causes of the housing crisis we face, the raise in mental health issues, loneliness and unnecessary winter deaths of the elderly and the first detox clinic for ‘cyber-addiction’. A quick flick of TV channels will show you images of celebrity chefs bringing people together with the power of food, new housing designs bringing happiness, and unusually formed choirs bringing a sense of community. How much more is the potential in faith?
The extended family setting of faith reminds me of the saying, ‘God gives us our family, thank God we can choose our friends!’ I was recently talking to a young man who was chewing through the out-workings of his faith. He was talking about commitment to the people of his faith community, and what he expressed was that he understood the commitment was not just to the people he liked or naturally had some social connection with, but to everyone, including those who would not be naturally be his ‘friends’. It is this bedrock of faith communities which can stand as an alternative to a self-packaged life projected through Facebook profiles and selective interactions, rather the spontaneous interactions of family.
There is a greater sense of a ‘civic space’ where room is made for ‘service to the public’ and self-funded or partially public-funded projects are gaining prominence. The Together in Service (TiS) programme which FaithAction is leading for the Department for Communities and Local Government is an example of this partial funded programme. TiS has been set up to put a spotlight of faith-based social action, by providing match-funded grants of £2,000 and £5,000. To a certain extent, nothing has changed; if you can fund a programme yourself, you can do what you want, within reason and the scope of UK law. It’s just that the withdrawal of public funding and public services has left a space where people see a greater role for faith and community groups to play a role. Not all services can be replaced by the voluntary sector. In fact, that surely would not be right; we are tax-payers who pay all manner of taxes for services provided by the state. I do not expect any government radically reducing taxation to allow people to give to civil society instead. There has to be a twin track. There are services that voluntary sector organisations should compete to provide, there are many they should not, there are areas the state should not be involved in, and there are places that is only appropriate for VCS to be.
Phillip Blond of Respublica talks of the need for a new settlement2; by this, I think what is meant is a new understanding of what the role of the state should be, what the role citizens should have, and how faith-based organisations and community groups fit into this.
When I was a teacher, I remember hearing a parent exclaim, “I don’t discipline my children, that’s what teachers are for!” This showed a total abdication of responsibility and a sorry state of affairs; but I wonder whether I have a wrong view of what public services should do for me and what my role should be.
So do I like austerity? No, but I do appreciate that the circumstances we find ourselves in forces a new time of reflection.
Last night, my husband and I had a few friends over for dinner. He works in the banking industry and she is a teaching assistant. After dinner, we got chatting about work and how it’s going and I shared a little bit of what FaithAction is up to at the moment.
As I was chatting, I discovered that our visitors didn’t really know much about the voluntary sector and after a few minutes, our friend stopped me and asked ‘But why do you do it?’ He then asked about voluntary sector funding and I shared about how sometimes it is only for one financial year (if we’re lucky) and that means every February/March it becomes slightly uneasy! Now his question seemed more relevant!
I shared how I have seen members of FaithAction grow, develop and strive hard to serve the communities they work in. I’ve seen members go from no funding, to funding and back again. Even though it affects the staff, the service and passion is relentless. I’ve seen systems changed because of one person’s involvement and I’ve seen communities completely transform.
I then got asked ‘But why FaithAction – why can’t local authorities or central government run your programmes?’ There is something about the voluntary sector and particularly the faith sector which is different from any other mobilised ‘machine’. Daniel Singleton refers to Faith groups being the first in and last out, and we are that. We know communities, we know what’s happening on the ground and we know how to access people. At FaithAction, our aim is simple – we aim to support these types of groups and people; whether it’s training, funding advice, changing central Government policies or now with Together in Service we can offer grant funding.
Let us make a case for what you do. If you want to want to share about your organisation/services/projects and even the hard parts and the good parts please get in touch.
Following graduation from University of Manchester Institute of Science & Technology in 1970, Derek Markie pursued an engineering and management path for 20 years with 6 years at director level. In public life, he has had leading roles in local churches and voluntary organisations, and represented faith, public, and commercial groups to government at every level.
If we don’t share faith, how can we work together to bring faith’s contribution?
Like many who will be reading this, my faith is the most important thing in my life and the prime motivator for my efforts to serve others and our society. But in a world of many faiths where, for some, faith appears to be one of society’s problems, and for many more, it is declared meaningless, how do we justify our approach? What justifies FaithAction or others working in the faith-motivated social action “sector”? If my faith is so special, how can I ally with those of other faiths and what “unholy” compromises must I swallow?
I suspect I am not the only one who has faced these questions, but I suspect, like many, I have let myself off with answers that are just window dressing, rather than a deeper resolution required if this sector is to flourish. So let me attempt some answers and invite comment from others in the belief that we should agree the situation with one another. To fail to do so risks us proceeding blissfully blinkered, until a fundamental problem emerges and wrecks our endeavours. I believe the answer is important, too, for our various co-religionists who currently treat all joint or inter-faith working with suspicion and are not motivated to co-operate across faiths. I believe it is important also to declare once and for all to those who would wish it to be so: I do not believe we are taking the first tentative steps on a set of convergent paths – but we are learning better how to live together.
Perhaps it is best if I declare my position: I am a Christian from a broadly evangelical tradition and have progressed slowly to the point of view I now hold. But whilst I would continue to set boundaries for co-operation, I would totally endorse the idea of maximising it. The degree will vary. The closer the relationship of faith traditions, the less will be the limitations. I will be able to do more with fellow Baptists, and other Christians, than a wider group of mono-theists, and again more with them than with pan-theists, pagans or those holding atheistic belief sets. But I can do more with any of these than I can with those who are driven only by hedonism or purely economic determinism.
Our various faiths set a priority on created order, shared environment, common humanity, and, (apart from, perhaps, the most puritanical or fundamentalist extents of each of our faiths), the socially or culturally discerned limits of selfish expression that is public law and morality. Even those basics give us a lingua franca for working together for a common good, and raising concerns in an eternal context. For others outside of faith, many will claim to agree and travel with us, others will recognise a pragmatic value in our efforts and support us, but only those of faith or declared equivalent beliefs as prime motor will sustain equivalent effort, ethic and altruistic commitment.
The limits to co-operation will inevitably occur in two areas – celebration and canvassing. I can celebrate with others in the Olympics or with my neighbours at a street party, but for me the most meaningful celebration is when I can praise my God for what is happening, and to do that with others, we need to share a closer understanding of God. I have worked with others on sharing art and music but even here there is a risk of confusion in my mind – do I share the same thoughts as others during Handel’s Messiah? – is participation in or attendance at a performance a declaration of truth in what is viewed or sung? – is the interpretation only in the mind of the beholder? At this point. my passion for collaboration finds its limits, and yet, as long as my inner thoughts are not compromised or my actions mis-perceived, I can share the moment with all and sundry.
Canvassing – or more overt evangelism on behalf of “faiths” – is equally fraught. I can say to someone, as a direct sequitur to this article, that I believe living by a faith opens up a fuller life. But I would be a liar if I suggested any faith would do, or that all faiths are equally valid, when I actually believe some to be blind alleys. I would be loathe even to suggest any faith is better than none, because I fear that some false lines would reduce the likelihood of someone finding what I believe to be the truth. So I would have to think very hard before agreeing to work for a group who wanted to “promote faith”. More widely, I find it hard to argue even this case without drawing on the unique insights of my own faith.
So much for a basis for co-operation; but what happens when our faith ambitions collide? It is common to hear the argument, often referencing the turmoil of the Middle-East or Ulster, that religion is the problem. I have to say that it has never been my experience and I would argue that unconstrained human passion is the problem, whether inspired by religion, romance, ambition or whatever. It is passion for what we desire or believe in which maximises our motivation and, if unleashed, can also blind us to the very things our actions then place at risk. Religious wars have been some of the most cruel; crimes of passion have even been partially condoned in some judiciaries on the basis that to do otherwise would be to limit a life-force. Our own society is facing massive moral turmoil as we at last promote individual rights above long-tolerated norms and social hierarchies in regard to sexual exploitation. Meanwhile, at the rational and ethical end of justice, I suspect for each of us there is another line that could be crossed. There is a point where our faith would demand the breaking of law, and we would assert the law of God as we see it, knowing full well that we must then accept the judicial consequences.
So, what is the basis for our co-operation across faiths? Surely, it is the shared view that we add a dimension to society, motivation, meaning, art… indeed to life, the universe, and everything… that very few would ultimately argue should be excluded. We raise both the ethical and relational qualities of debate and the humanity of practice. But we must beware. As soon as we begin to limit our own freedom to express the truths that motivate us individually, we risk a compromise too far that would make hypocrites of us all. To suppress those of others risks denying our common humanity.
We may not agree what the truth is… but we probably agree that it is the truth that makes us free.
“Resentment is like drinking poison and then hoping it will kill your enemies”
-- Nelson Mandela
What a great thing to be able to say you met Mandela – I never had that opportunity, but have met people who have. My wife has an uncle who did a photo shoot with Mandela soon after he left office, and as we have heard, he was struck by this gracious man who laid aside power.
However, rather than to talk about Mandela, I want to write about some of the things he came to represent and what I have found in others. The radical way Mandela responded to the wrongs that were done to him is his most powerful legacy. This reminds me of a hero of my own. Like Nelson Mandela, Richard Cole was born in an African Village, a son of the chief. After an eventful early life, he became a pastor in Liberia and Sierra Leone. When the civil war in the 1990s overran that part of West Africa, he was stuck in England where he had travelled to learn about agricultural projects. This was the summer of 1990, which was when I met him for the first time. In fact, my first memory of Richard was at a water park, at the top of a water slide, where he decided he did not want to go down the chute. It’s funny to think back of his timidity then, when this is the man who so readily went into rebel areas to rescue people in Sierra Leone.
There are many stories of Richard’s adventures in war-torn Sierra Leone; capture by rebels, attempted execution. The message from Richard’s life is one of forgiveness. He was asked by the authorities to start a home for boy soldiers. It was featured in a report by Jeremy Vine (BBC report). It is called the Nehemiah Project and is now run by Richard’s son, PJ Cole, with a leadership team of former boy soldiers. Richard’s approach was very simple: each boy taken into the home had an ‘induction’ where they stayed with Richard and his family for a week. Then they would be given a place at the home and each older boy had a younger boy to look after to foster a sense of community and responsibility.
Recently, Louise Casey – who heads up the Troubled Families unit for the UK Government – was asked about what interventions make the most difference for the most complex family cases in Britain. She was very clear that complex programmes and initiatives cannot replace the need for ‘love and care’. The approaches that result in professional distancing and jargon, cannot make up for genuine empathy, care and love.
The close proximity that Richard set up with his induction process, was put to the test when one boy arrived at the home, who had been one of the rebels who had killed Richard’s own grandfather. As we can all understand, this was not an easy situation but Richard yet again tapped into his faith, to enable his to forgive and accept this boy alongside the others in the home.
Richard sadly died of cancer in 2006, but it’s a testament of his work that those who had been taken as children into the rebel army forced to do horrendous things, are now part of the future of Sierra Leone.
For a significant part of December, I have been on Jury Service. If you have ever performed this civic duty, you will know that there is a lot of waiting around. It is a curious situation, to be stuck in a room with near to 200 people waiting for something to happen. When I first arrived, I thought it odd that there were jigsaw puzzles around the room, but a week in, I started to consider jigsaws, crosswords and philosophical conversations with strangers a norm. Against our initial reserve, friendships and interests are shared; the commonality of boredom causes people of all backgrounds to connect. People obviously are enjoying connecting with different sorts of people, and who can say who will remain in contact after this 2 week stint? It is so unusual in the UK today to get such a cross-section of society, not only in the same place, but talking. Of course, the other place for this connection in a more permanent fashion is through faith.
This community of connection is just one of the many things that faith groups provide, even without understanding the significance for those in their faith community. Let’s just look at one example: mother and toddler groups. For those parents who have been through the life-changing experience of having a baby, whether they have been diagnosed with post- natal depression or not, the regular opportunity to meet with others to get out of the house is often under-valued. Yet this often helps people recover from mild post-natal depression or prevents the onset. When this becomes a cross-generational opportunity for connection with retired people attending the group as well, the benefits expand greatly.
It often seems that the issue of appreciation of what faith groups do is one of language. I often press faith-based organisations to adapt their language (but not necessarily the activities they are doing) so that those in different sectors understand what they are contributing. We need to look at the ‘shop window’ of faith and make sure those looking in can see what faith communities do, expressing it in a way that is not lost in religious jargon. This in many ways is behind the Friendly Places work we have been doing (along with a Friendly Places pledge that we are currently consulting about). In this work, we want to highlight whole area of hospitality that many faith communities exhibit as a matter of course, particularly highlighting and promoting faith as a welcoming place around Well-being and Mental Health. We want to support, share good practice and extend what faith communities are doing already around this area. For example, we are connecting with friends at Livability around the work they are doing around Dementia Friendly churches.
One of the ways to help wider society value what faith-based organisations do is to measure the impact of our work in a way which is understood and appreciated. Particularly in the area of measuring the impact on mental health, FaithAction has been helping members utilise the Warwick Edinburgh Mental Well-Being Scale (If you are interested in this work, please contact Hannah.firstname.lastname@example.org). We are also working in partnership with NCB to run a series of workshops on measuring impact, looking at how to best demonstrate social value to commissioners. These events will be taking place in London on February 25th and Birmingham on March 13th and can be booked here. If there is to be recognition of what faith contributes, it needs to be communicated in a way others can understand.
The most frustrating thing can be when you hear of a project which is rightly receiving plaudits for the effect it is having on a particular community and yet the work you are doing is of greater significance or depth, but you are not able to articulate in the public space. To faith groups I would say, you are often ‘better than you think you are’.
So what’s the ask?
1. Tell us what you are doing (sign up on the Together in Service Fellowship, we can highlight your work www.togetherinservice.net)
2. Measure your impact
3. Keep doing the good works that you do
We know that you have great case studies and good ideas.
Over this year we have sent out invitations to contribute to national consultations and feed into the work that we’ve done around working with local authorities, public health and volunteering. Thank you to everyone who has responded to these call-outs – it is vital that your voice and experiences are fed into national level decision-making and we appreciate the time you've taken to respond.
With this in mind, at FaithAction we want to give you an opportunity to influence government and policy makers, and to raise the profile of your projects, through our work over 2014-15.
Take a look at the themes listed below and let us know:
Any examples of good work you are doing in these areas
If you can identify areas where you would like increased support or an opportunity for learning or training.
Please email your responses to email@example.com by Monday January 20th 2014.
I found myself watching a romantic comedy the other night. It's one I have seen once or twice before. Although this can be a painful experience, as I knew what was going to happen, I started to see the contradictory ideas in the film. I think these are common to this genre.
Some of the characters were talking about when it was appropriate to say 'I love you' in a new relationship. In fact, there was every expectation that sleeping with someone can happen very early in a relationship, but you should not say you love them for quite some time, maybe even years.
This would make sense, in a film like this, if relationship, commitment and family was not so significant to the film in other ways. What often happens is the film pivots on a change of perspective. Main protagonists start falling for each other when they are confronted with the community and family the other belongs to. Essentially, the person they saw before is now seen as a whole, and what is the attractive is the whole package. The human emotion - the love and commitment - is the attractive part, not so much the sexual encounter.
It is not the statement of ‘love’ which is the problem, but the uncommitted un-covenanted liaison which creates insecurity and lack of peace. It is here that the rom com reflects and promotes a failed aspect of society today. The gush of attraction is not shown up for what it is, just a gush. Community comes from a basis of strong family and committed relationships.
Strange then that the problem and solution are implicitly embedded within the film. In a way, no one learns from the tale.
When we were treated to the press conference in the garden at No. 10 in May 2010, I was lulled by the ‘together in national interest’ statements. There were various pundits talking about how Clegg and Cameron got on well and that it did not seem too hard to pull a coalition agreement together made of common desires.
The Conservatives’ back-benchers were looking increasingly unhappy with their position, and the Lib Dems - although practically in favour of coalitions, as they want some form of PR - had a nasty shock that it could put them in power alongside the Tories. Even with all that, the Government has been quite stable, but has it been a different sort of government? Has it operated in the national interest? Has it been just and cared for the weak, whilst keep the nation safe from threats internal and external?
The benefits reforms were always going to be difficult. The New Labour government was unable to achieve this and found it easier to side-step the issue. However, the changes related to Universal Credit and the ‘bedroom tax’, on top of shortages of appropriate accommodation, particularly in London, seems to be creating issues which were not there previously, or at least not to the extent they soon could be.
So, what is our role in all this? I think that as part of the greater voluntary community sector (VCS), there is a role for faith-based organisations to point out where policies are having a detrimental effect on people, particularly those who are least likely to have sufficient voice. In most sacred texts, there is a commission to protect the poor, the widows, the orphans and the aliens. These may not be the majority, and this means that we stand up for minority causes, which is a must in a democracy. Otherwise, we are swayed by populism, just like a mob.
So, what of Universal Credit and the ‘bedroom tax’? There is a need for the system to be reformed, to be made more efficient, and for work to always pay. The complexity of bureaucracy has provided a place for many people. However, Universal Credit will mean that claimants potentially have larger amounts of benefits pass through their hands on a monthly basis. They will not have been given any real guidance on budgeting and managing money, and the attraction of payday loans will be greater. This could mean that those who have managed well on the old system will now find themselves in difficulties, and it will be because of a lack of skills rather than a reduction of funds. Surely, this is an unintended consequence?
The issues around housing have caused a surge of support for minority parties such as BNP, and they are dominating MP’s surgeries in London. With more local authorities buying properties outside of their own borough and shipping people to other parts of the country, this is a problem, the repercussions of which will affect us all. I have been interested in the lack of sympathy that some have for people having to move out from their home areas. Some of those I spoke to outside of London said that it was common for children to have to move away to find work, etc. But, of course, this is still a voluntary move; although the removal from home community is still difficult. The real issue I see is one of hopelessness. East London boroughs are already moving people to seaside towns. People are taken away from the economic possibilities of London to the economic inactivity of depressed seaside locations. So, if it is not of economic benefit, is there a possibility that this is a ruse to remove London of the unemployed and working poor, a ‘cleansing’ of sorts? It is a solution as such but it seems weighed against being redemptive. This sinister conclusion probably would not even come to mind if the 50p tax rate had not been dropped and Michael Gove’s education reforms did not seem so obviously aimed at skills and to favour grammar-style middle class dominated schools.
Maybe the role of faith and VCS is to drive the economic viability of those areas where people are being deposited. There is a role to challenge injustice and to bring hope. Our task may just be beginning.
In this guest blog, Marion Janner, director of Star Wards, talks about the role that volunteers can play in mental health wards.
Mental health wards are tough places to be a patient but surprisingly enjoyable and satisfying to be a volunteer. There are a range of wards, some for particular populations e.g. young or old people, mothers and babies, and others providing specialist support for people with particular mental health needs e.g. eating disorders, while secure units have more intensive support and security for people with higher risk. Wherever a patient is, they are going through exceptionally difficult emotions and the unusualness and inevitable isolation of being hospitalised compounds matters. But volunteers can transform people’s days!
Volunteers are welcomed on most wards, as their role and relationships are very special. They bring an energy, kindness and independence which patients cherish, and staff really appreciate the extra attention and experiences that patients get. There is a huge need for volunteers from local faith communities on mental health wards, whether there is an explicit faith component to their involvement or a different focus. Many patients find their spirituality is especially important to them during an emotional crisis, one which takes them away from home, family, friends and their local community. This can be intensified if they are from a minority faith which may be unfamiliar to other patients and staff. Some wards are wonderful about trying to meet people’s spiritual needs, and hospital chaplains do a fantastic job. But other wards really struggle and support from local congregations is greatly appreciated.
There is understandable concern among potential volunteers about issues like how safe it will be, whether it will be upsetting and what support will be available. Wards themselves are concerned about these – for all staff, visitors and indeed patients. There should be strong support in place for volunteers, and an agreement about the particular role individuals take as well as good information about what the volunteer can expect, limits of their responsibilities and what they should do if they have concerns.
Most ward volunteers find that patients and staff are so appreciative of their involvement, and the activities shared are so enjoyable, that the unavoidable difficulties of the environment tend to melt into the background. But it’s definitely not for everyone!
Diane Bown, the head of volunteering for the Nottinghamshire Healthcare NHS Trust wrote:
“Volunteers are the icing on the cake. The analogy I use is to compare our volunteering programme, where volunteers visit patients and keep them company, to a fairy cake. If it’s just sponge, you can eat it, but put a bit of icing on it and it’s so much more palatable. What the volunteers do is the human, social stuff. They can sit on the wards and play Scrabble from the beginning to the end without getting called away.”
Faith related activities
An A-Z of Volunteer Roles
With thanks to Volunteering England
There are various ways of contacting a ward or hospital to explore volunteering.
Wardipedia has hundreds of examples of group and other activities for mental health inpatients, e.g. gardening, music, art. It also has a feature on spirituality; although it’s written for ward staff, it would be of interest to volunteers and others.
Spirituality and Mental Health from the Royal College of Psychiatrists. This leaflet has lots of useful insights and ideas.
This is a useful list of resources from the Royal College of Psychiatrists’ spirituality and psychiatry special interest group.
Spiritual Care and Psychiatric Treatment: An Introduction by Larry Culliford
This article looks at definitions of terms such as ‘spiritual’ and ‘religious’ and what they may mean to different people. He also lists further resources that you may find useful.
Multi-Faith Group for Healthcare Chaplaincy
Seeks to advance multi-faith chaplaincy in England and Wales. They have a useful list of resources including a comprehensive document on religious and spiritual needs for staff at Derby Hospitals NHS Foundation Trust
Jewish Mental Health
This London-based resource has lots of information and ideas that go beyond both the capital and the Jewish community.
Don’t mention God! by Peter Gilbert and Natalie Watts (2006)
Explores mental health and social inclusion, looking at the NIMHE (National Institute for Mental Health in England) spirituality project.
Taken Seriously: the Somerset Spirituality Project (2002)
This is free to download report from the Mental Health Foundation website, featuring interviews and discussions with mental health service users interested in religious or spiritual beliefs.
The government is in the process of launching a series of consultations and public engagement exercises regarding the healthcare system. I have been in a number of meetings where officials have pointed out that the timing of these programmes, during the summer, is at best incompetent and at worst outright conniving. So many of us with children have work during the summer that does not fall into the usual patterns, and gathering responses from groups to the various consultations is simply unlikely to happen in the summer months.
However, we are where we are, and I was disappointed to see the instant response in one of the papers on the issue of ‘healthcare tourism’. I am not going to make any firm judgement on whether those who visit our shores should get free access to healthcare and the wider welfare state, for that is a topic for a much lengthier piece. However, the outcry seemed to be directed at any kind of change or reform. The point is we can no longer afford the system we have as a nation unless we substantially increase its income. So, the choices are to increase taxes for health and welfare - remember the largest part of welfare is pensions - or decrease costs somehow, which should be done through preventative work or increased efficiency.
This examination of how much overseas visitors should pay and how the system should extract this money led me to ask the team if the whole exercise was worth it. How much do we spend in this area? How much can we get back? Is this merely a tabloid policy - not about real solutions, but about making a noise? As you have guessed, there were no firm answers, there were no figures.
The NHS is in danger of becoming a secular religion. Don’t get me wrong, I think it’s a great achievement. I remember, many years ago, when we had an American youth group visiting us, one of the lads had a fall and broke his arm. Off we went to A&E and he had to sit down and wait for treatment. The group’s leader reached for his credit card and asked me who he could pay to get through the system faster. I felt somewhat proud that there was equality of experience in the A&E, but, of course, very embarrassed that the process took so needlessly long, with staff that had less hustle in them than your average fast-food joint. However, with David Cameron’s stated commitment to the N-H-S - as the three letters which summed up his priorities - we have moved a system that needs to adapt, to move to a ‘beloved aunty’ status. When the NHS played such a key role in the launch of the London 2012 Olympics, the stage was set for unreasonable adoration.
If we are too nostalgic about any institution, we fail to see when it has to change. The welfare state is somewhat a victim of its own success; when old-age pensions at 65 were introduced, the average life expectancy for men was 62. It may have looked very altruistic, but the logic was that most men would not live to enjoy pension, harsh as it may be. The health system was supposed to lead to better health, not this prolonged symptom management. Healthcare costs continue to rise as people live longer, creating more expenses for the public purse through both pensions and health care. We have to consider some changes.
It is great that people are living longer, but we need to find ways that to ensure that, even though people retire, their contribution to society is still appreciated and valued. We need to see multi-generational community re-found; retirement is merely a stage of a new phase of life.
So what about those spiralling costs? There is a mythical thinking that the rich should pay more, pay their ‘fair share’. Firstly, who determines the rich? What is their fair share? Surely by this logic, they should get a tax break for using the private care system and not clogging up the NHS. That’s fair, isn’t it? Technically, it is their money, not the state’s money, just waiting to be taxed.
We do like the idea of people contributing; the original pre-1914 national insurance enshrined this principle. Most continental systems have the same principle. ‘Obamacare’ is on the basis of contributions.
What is clear is that we cannot just say someone else has to do something! I suspect we will need to raise income, make savings by making efficiencies, and reshape healthcare to a more preventative model. But there will not be instant tabloid lead fixes. We will all need to play a part, visitors will need to pay, we will need let go our preoccupation with the local hospital and instead turn to more proactive primary health, where we looks for community based solutions, whether this be in local settings or socialisation opportunities. After all, as it has been said, ‘A problem becomes a crisis when there is no friend to call on…’